Appendix 67

REPORT OF ACCOUNTABILITY FOR ACCOUNTABLE FORMS

For the month of NOVEMBER, 2020

Entity Name : STA MARIA ELEMENTARY SCHOOL Fund Cluster : 01-Regular

Accountable Forms Beginning Balance Receipt Issue Ending Balance

Inclusive Serial Nos. Inclusive Serial Nos. Inclusive Serial Nos. Inclusive Serial Nos.
Name of Form Number Face Value Quantity Quantity Quantity Quantity
From To From To From To From To
A. WITH FACE VALUE
165

B. WITHOUT FACE VALUE

000872-1097-22 88 854013 854100 7 854013 854019 81 854020 854100

CERTIFICATION

I hereby certify that the foregoing is a true statement of all accountable forms received,
issued and transferred by me during the period above-stated and that the beginning and ending balances are correct.

RECY T. DATO,Ph.D.
Disbursing Officer Officer