REPUBLIC OF THE PHILIPPINES

DEPARTMENT OF FINANCE
BUREAU OF INTERNAL REVENUE
Revenue Region No. 004-SAN FERNANDO, PAMPANGA
Revenue District Office No. 17A-TARLAC CITY, TARLAC
OFFICE
Head Office
Branch X
PERMIT TO USE SALES MACHINE
Permit is hereby granted to ANTONETTE L. MISA with business name KASS & KAYE
CONVENIENCE STORE, of MAC ARTHUR HIGHWAY, SAN SEBASTIAN, TARLAC
CITY, with TIN 214-986-185-003, effective June 29,2021 , to use the sales machine
and/or software with Approved Accreditation No. 0482325800762016110624, pursuant
to the provisions of the National Internal Revenue Code, as implemented by Revenue
Regulations No. 11-2004 and other related issuances.

POS-SERVER
[Machine Details [Brand / Model / Serial Number] Software Details [Name / Version]
Type of Sales Machine

Server Consolidator ADVANCED INTEGRATED POINT-

CLONE / CLONE / 5VVM58SJ
OF-SALE SYSTEM vVERSION 2.0

/ /

POS MACHINE DETAILS

[Machine Details [Brand / Model /
Machine Identification Number Permit Number
Serial Number]

CLONE / CLONE /
FP062021-17A-0294359-
D20030301006010725 21062811121359673
00003

Any revision thereof shall be subject to automatic revocation of the above Pemit to
Use and shall be subject to penalties and sanction pursuant to the Tax Reform Act of
1997.

POS2906202109911
REMEDIOS C. ADVINCULA JR.
Original Copy
NO SIGNATURE REQUIRED LTAD/ ELTRD/ LTDO/ RDO
NOT FOR SALE