Appendix __

Fund :
LGU
Date :
DISBURSEMENT VOUCHER DV No. :

Classification of Disbursement
Cash Advance Reimbursement Other Payments

TIN/Employee No. CAFOA No.

Payee

Address

Responsibility
Particulars MFO/PAP Amount
Center

Amount Due:
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

Printed Name, Designation and Signature

Head of the Department or Office

B. Accounting Entry:
Account Title Account Code Debit Credit

C. Certified: D. Approved for Payment

Cash available

Subject to Authority to Debit Account (when applicable)

Su
proper

Signature Signature

Printed
Printed Name
Name

Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative

Date Date

E. Receipt of Payment
Check/ Date : Bank Name & Account Number:
ADA No. :
Date : Printed Name: Date
Signature :
Official Receipt No. & Date/Other Documents

90
 Fund:
DISBURSEMENT VOUCHER
General Fund Proper
Municipal Government of Barobo DV No.:
LGU Date:

ID No./
Payee:
KAREN JOY R. MORENO TIN/740-793-374-000
Responsibility Center:
Address:
POBLACION, BAROBO, SDS Mayor's Office
Particulars Amount

Travelling expenses while on official business(under 4P's) 2,850.00

Amount Due 2,850.00

A Certified:
Expenses/Cash Advances necessary,
valid, proper, lawful and incurred
under my direct supervision.
B Certified: C Certified:
Completeness and propriety of supporting Funds available for the purpose.
documents/previous cash advance
liquidated/existence of funds held in
trust.

JOEY S. PAMA DOREFEL A. BARIT MA.TWINKLE G. VILLAREAL

Signature Over Printed Name/Position Signature Over Printed Name/Position Signature Over Printed Name/Position
Head of the Department or Office Municipal Accountant Municipal Treasurer

D Approved For Payment: P_________ E Received Payment:

D Payment:
D Check No. _______________
Bank Name: _____________
JOEY S. PAMA Date: ___________________ KAREN JOY R. MORENO
Signature Over Printed Name/Position Signature Over Printed Name/Position
Municipal Mayor Date:

F Accounting Entries
Particulars Account Code Debit Credit

Prepared by: Certified Correct:

ELIZABETH R. MAYO JOEMAR M. ALONSAGAY
Administrative Assistant II Administrative Officer III (Fiscal Examiner II)
 Fund:
DISBURSEMENT VOUCHER
General Fund Proper
Municipal Government of Barobo DV No.:
LGU Date:

ID No./TIN:
Payee:
CAFOA No.:
Responsibility Center:
Address:
DILG
Particulars Amount

Amount Due -
A Certified: B Certified: C Certified:
Expenses/Cash Advances necessary, Completeness and propriety of supporting Funds available for the purpose.
valid, proper, lawful and incurred documents/previous cash advance
under my direct supervision. liquidated/existence of funds held in
trust.

DOREFEL A. BARIT ROSALINDA C. VILLAMOR

Signature Over Printed Name/Position Signature Over Printed Name/Position Signature Over Printed Name/Position
Head of the Department or Office Municipal Accountant Municipal Treasurer

D Approved For Payment: P_________ E Received Payment:

D Payment:
D Check No. _______________
Bank Name: _____________
ALLAN C. BERNAL Date: ___________________
Signature Over Printed Name/Position Signature Over Printed Name/Position
Municipal Vice-Mayor Date:

F Accounting Entries
Particulars Account Code Debit Credit

Prepared by: Certified Correct:

ELIZABETH R. MAYO JOEMAR M. ALONSAGAY
Administrative Assistant II Administrative Officer III (Fiscal Examiner II)
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