IN SETTLEMENT OF THE FOLLOWING

SUNRISE INN AND SPACE RENTAL

INVOICE No. AMOUNT Corner Orillaneda – Arizobal Sts., Lininti-an, Cantilan, Surigao del Sur
JOSEFINA PIEDAD AMBRAY – Prop.
TIN: 168-417-326-000NV
Total Sales
OFFICIAL RECEIPT
Less:
SC/PWD Disc. Received from: _____________________________________________
2101
Total Due Address: _______________________________ Date: ________________
TIN:________________
Less: The sum of PESOS:___________________________________________
Withholding Tax __________________________________________________________
Payment Due As partial/full payment of_____________________________________
__________________________________________________________
Sr. Citizen TIN:
Total
OSCA/PWD ID No. SIGNATURE
D/Payment By:__________________
Balance Authorized Signature
25 BKLTS (20X2) 2000-2250
BIR ATP/OCN 2AU0001529291 Date Issued: ***03-02-2016*** Valid Until: 03-02-2021
FORM OF PAYMENT Printed by: J&P Printhaus & Supply – Tandag City TIN: 133-893-494-000NV
Printer Accreditation No. 106MP201400000000002 Date Issued: Jan. 2, 2014
Cash ( ) Check ( )
“THIS DOCUMENT IS NOT VALID FOR CLAIMING INPUT TAXES”
THIS OFFICIAL RECEIPT SHALL BE VALID FOR (5) YEARS FROM THE DATE OF ATP