Annex A

Revenue Region No. 4

Revenue District Office No. 17A - Tarlac City

Routing Slip No.:

Date: -

Name of Taxpayer: ROSARIO BRIONES TIN: -

Address: TARLAC CITY Contact No.:

TAX TYPE: CGT/DST

One Time Transactions (ONETT) Assignment/Routing Slip

Revenue Officer Activity Date Time Signature

Name of Officer of the
Day (OD)
RO: N. VASQUEZ • Checks and accomplishes the Checklist of
or Documentary Requirements
• Computes the tax due using Computation
GS: Sheet
• Verifies TIN of TP
• Assists TP in filling up the tax returns and
instructs TP to pay to AAB

CSS Staff Issues TIN in case the transacting parties

have no TINs
Name of Officer of the
Day (OD) • Checks completeness of documents and
RO:
RO: stamps “Received Complete Documents” on
or
or the OCS
GS:
GS: • Issues claim slip
• Records in logbook after payment of
applicable taxes

RDO:
or Reviews and signs OCS and CDR (based on
threshold under RMO No. 55-2016)
ARDO:
Chief, Collection Section · Verifies correctness of payment
• Signs OCS

ONETT Encoder Prepares eCAR

RDO:
or Signs eCAR (based on threshold under RMO
No. 55-2016)
ARDO:
ONETT Staff
Records to logbook and releases to TP
 ONETT COMPUTATION SHEET
CAPITAL GAINS TAX (CGT) and DOCUMENTARY STAMP TAX (DST)
FOR ONEROUS TRANSFER OF REAL PROPERTY CLASSIFIED AS CAPITAL ASSET (BOTH TAXABLE AND EXEMPT)
Revenue Region No. 4 , Revenue District Office No. 17A, Tarlac City

NAME OF SELLER/S: ROSARIO BRIONES ADDRESS: TARLAC CITY TIN

IRENEO BRIONES TARLAC CITY
ELMA BRIONES TARLAC CITY
DIOSDADO BRIONES TARLAC CITY
CARLOS BRIONES TARLAC CITY
ALICIA ALARILLA TARLAC CITY
SOLEDAD DIZON TARLAC CITY
NAME OF BUYER/S: ARACELI LAMPA ADDRESS: TARLAC CITY TIN
PHILAMAEL LAMPA TARLAC CITY
FELICISIMA GUIWA TARLAC CITY
SET MAXIMO CASTRO TARLAC CITY
NOELITO PANGAN TARLAC CITY
ROBERTO PANGAN TARLAC CITY
Date of Transaction: DUE DATE (CGT) 29-Jan-00 DUE DATE (DST)

Fair Market Tax Base

Tax declaration ZV/ Zonal Value
OCT/TCT/CCT No. LOCATION CLASS. AREA Value (FMV) Selling Price (ZV/FMV/SP
No.(TD) sq. m. (ZV)
per TD whichever is higher)

126179 07011-00985 LAUNGCUPANG, LA A2 73,384.00 52.00 3,815,968.00 2,948,569.12

3,815,968.00
PAZ, TARLAC 500,000.00
*WITH CNI

TOTAL 3,815,968.00 2,948,569.12 500,000.00 3,815,968.00

COMPUTATION DETAILS: PER AUDIT PER REVIEWER

1. CAPITAL GAINS TAX
TAX DUE
Legal Basis: Section 24(D)1),25(A)(3) & 27(D)(5)
3,815,968.00 x 6.0% 228,958.08
Tax base

LESS: Tax Paid per Return, if a return was filed

CGT STILL DUE / (OVERPAYMENT) 228,958.08
Add: 25% Surcharge P -
Interest until -
Compromise Penalty - -
TOTAL AMOUNT STILL DUE ON CGT 228,958.08

DOCUMENTARY STAMP TAX

Tax Due
Legal Basis: Section 196 (CTRP) NIRC
3,816.00 x P 15.00 for every P 1,000.00 or a fraction thereof 57,240.00

LESS: Tax Paid per Return, if a return was filed

DST STILL DUE / (OVERPAYMENT) 57,240.00
Add: 25% Surcharge -
Interest until -
Compromise Penalty - -
TOTAL AMOUNT STILL DUE ON DST 57,240.00
TOTAL AMOUNT PAYABLE 286,198.08

To be accomplished by ONETT Team Payment Verified by: To be accomplished upon review

NINA NICOLI C. VASQUEZ

Revenue Officer ONETT Member/Collection Section Reviewed by: DIOGENES C. VILLARUBIA
Chief, Assessment Division

CATHELEYA C. AQUINO OR No. Tax Type Date of Payment

Assistant Revenue District Officer

Approved by:
Regional Director
THELMA D. MANGIO Reference:
Revenue District Officer
The BIR is not precluded from assessing and collecting any deficiency internal revenue tax(es) that maybe found from the taxpayer after examination.

CP NO. _________________________ DATE:

TAXPAYER/AUTHORIZED REPRESENTATIVE
Signature Over Printed Name
Instruction: Prepare in duplicate and ascertain that ONETT Computation Sheet is signed by Head Onett Team before release to taxpayer. Please attach additional sheet, if necessary.
(To be filled up by the BIR)
DLN: DUE: 29-Jan-00

Capital Gains
BIR Form No.

1706
Republika ng Pilipinas
Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas
Tax Return Jul y, 1999 (ENCS)
For Onerous Transfer of Real Property Classified as
Capital Asset (both Taxable and Exempt)
Fill in all applicable spaces. Mark all appropriate boxes with an “X”.
1 Date of Transaction 2 Amended Return? 3 No. of Sheets Attached 4 ATC II 420 Individual
(MM/DD/YYYY) 12/30/1899 Yes X No IC420 Corporation
Part I Background Information
5 TIN
-
6 RDO 17 7 TIN -
8 RDO
Seller Code
A 10 Buyer Code 17A
9 Seller's Name (et al) Buyer's Name (et al)
ROSARIO BRIONES ARACELI LAMPA
11 Seller's Registered Address 12 Buyer's Registered Address
TARLAC CITY TARLAC CITY
13 Seller's Residence Address (For Individual) 14 Location of Property
TARLAC CITY LAUNGCUPANG, LA PAZ, TARLAC
15 Classification of Property
Residential Commercial Condominium Residential
Agricultural Industrial Condominium Commercial Others (specify)
16 Brief Description of the Property Area sold (sq.m.) 73,384.00 Tax Declaration No. 07011-00985
TCT/OCT/CCT No. 126179 Others
17 Is the property being sold your principal residence? (For Individual sellers only) Yes X No
18 Do you intend to construct or acquire a new principal residence within 18 months from the date of disposition/sale? (For Individuals) Yes X No
19 Does the selling price cover more than one property? 20 Are you availing of tax relief under an International Tax Treaty or Special Law ?
Yes XNo Yes X No If yes, specify
21 Description of Transaction (Mark one box only) For Installment Sale:
Cash Sale Installment Sale 22 Selling Price
Exempt Foreclosure Sale 23 Cost and Expenses
Others 24 Mortgage Assumed
25 Total Payments (Collection) During the Initial Year
If Exempt, or others, specify 26 Amount of Periodic Payment (Collection)
27 No. of Installments 28Date
28 DateofofInstallment
Installment
in the Contract (MM/DD/YYYY)
29 Fair Market Value (FMV) - Valuation at the time of Contract
29A FMV of Land per latest Tax Declaration 2,948,569.12 29C FMV of Land as determined by 3,815,968.00
BIR Commissioner (zonal value)
29B FMV of Improvements per latest - 29D FMV of Improvements as -
Tax Declaration determined by BIR Commissioner (BIR Rules)
30 Determination of Taxable Base
30A Gross Selling Price 500,000.00 30B Bid Price (For Foreclosure Sale)
30C Fair Market Value of Land and 3,815,968.00 30D Taxable Installment Collected
Improvement (Sum of 29A & 29B/29C & 29D/29A & 29D/29B & 29C, whichever is higher) (For Installment Sale Excluding Interest)
30E On the Unutilized Portion of Sales Proceeds 30F Others (specify)
(in case nos. 17 & 18 are applicable)
(see Schedule 1 at the back)
Part II C o m p u t a t i o n o f T a x
31
3,815,968.00
31 Taxable Base (Item 30A or 30C, whichever is higher, for cash sale, or item 30B, or item 30D,
or Item 30E, or Item 30F, whichever is applicable) 32
32 6% Tax Due
228,958.08
33
33 Less: Tax Paid in Return Previously Filed, if this is an Amended Return
-

34 Tax Payable/(Overpayment) 34 228,958.08

35 Add: Penalties
Surcharge Interest Compromise
35A 35B 35C 35D
- - - -
36
36 Total Amount Payable/(Overpayment)(Sum of Items 34 & 35D)
228,958.08
If Overpayment , mark one box only: To be Refunded To be Issued a Tax Credit Certificate
I declare, under the penalties of perjury, that this return has been made in good faith, verified by me, and to the best of my knowledge and belief,
is true and correct, pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof.
37 38
Taxpayer/Authorized Agent Signature over Printed Name Title/Position of Signatory
Part III D e t a i l s of P a y m e n t Stamp of Receiving
Drawee Bank/ Date Office and Date of
Particulars Agency Number MM DD YYYY Amount Receipt
39 Cash/Bank 39
Debit Memo
40 Check 40A 40B 40C 40D
41 Tax Debit 41A 41B 41C
Memo
42 Others 42A 42B 42C 42D

Machine Validation/Revenue Official Receipt Details (If not filed with the bank)

GRP 3.
 DUE:

(To be filled up by the BIR)

DLN: PSOC: PSIC:

Republika ng Pilipinas Documentary Stamp BIR Form No.

Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas Tax Declaration/Return 2000-OT
June 2006 (ENCS)
(ONE- TIME TRANSACTIONS)
Fill in all applicable spaces. Mark all appropriate boxes with an “X”.
1 Date of Transaction/ 2 Amended Return? 3 No. of Sheets Attached 4 ATC
12/30/1899 X DS122
Purchase (MM/DD/YYYY) Yes No
Part I Background Information
5 TIN
- 6 RDO 1 7 A 7 Telephone No.
Code
8 Taxpayer's Name (For Individual) Last Name, First Name, Middle Name/(For Non-individuals) Registered Name

ROSARIO BRIONES
9 Registered Address 10 Zip Code

TARLAC CITY
Part II Details of Transactions
11 Nature of transaction
11A X Transfer of Real Property classified as capital asset Transfer of shares of stock not traded through the local stock
Transfer of Real Property classified as ordinary asset exchange (Does not include original issue of shares of stock
Parties to the transaction by the issuing corporation)
11B 11C
(Seller/Transferor) (Buyer/Transferee)

11D 11E
Taxpayer Identification Number Taxpayer Identification Number
12 Brief Description of Property Sold (attach additional sheet/s if necessary)
Real Property RDO Code of Location
Location of Real Property LAUNGCUPANG, LA PAZ, TARLAC of Property 1 7 A
12A Classification of Real Property
Residential Commercial Condominium Residential
Agricultural Industrial Condominium Commercial Others (specify)
12B Area of Property Sold (sq. m.) 12C TCT/OCT/CCT No. 12D Tax Declaration No.
73,384.00 126179 07011-00985
12E Selling Price 12F Fair Market Value of Property Sold (Schedule 1)
500,000.00 3,815,968.00
Shares of Stocks not Traded in the Local Stock Exchange

12G Name of Corporate Stock

12H Taxpayer Identification Number

12I No. of Shares Sold 12J Stock Certificate No. (attach additional
sheet/s, if necessary)
12K Par Value of Shares 12L DST paid upon original issue of Shares
(for shares of stock of Stock sold (for shares of stock
with par value) without par value)
Part III 18C & 18D/18B & 18C/18A & C o m p u t a t i o n o f T a x(For Installment Sale

13 Taxable Base - Real Property (Item 12E or 12F, whichever is applicable) 13 3,815,968.00
14 Taxable Base - Shares of Stock ( Item 12K or 12L, whichever is applicable) 14
15 Tax Rate 15 P15.00/1,000.00
16 Tax Due
16 57,240.00
17 Less : Tax Paid in Return previously filed, if this is an amended return -
17

18 Tax Still Due/(Overpayment) 18 57,240.00

19 Add: Penalties
Surcharge Interest Compromise
19A - 19B - 19C - 19D -
20 Total Amount Payable/(overpayment)(Sum of Items 18 and 19D) 20 57,240.00
In case of Overpayment, mark one box only: To be refunded To be Issued a Tax Credit Certificate
(Note: The herein computation is still subject to review by the appropriate BIR Employee/Official)
I declare, under the penalties of perjury, that this declaration has been made in good faith, verified by me, and to the best of my Stamp of Receiving
knowledge and belief, is true and correct, pursuant to the provisions of the National Internal Revenue Code, as amended, and the Office/AAB and
regulations issued under authority thereof. Date of Receipt
(RO's Signature/
21 President/Vice President/Principal Officer/Accredited Tax Agent/ 22 Treasurer/Assistant Treasurer Bank Teller's Initial)
Authorized Representative/Taxpayer (Signature Over Printed Name)
(Signature Over Printed Name)

Title/Position of Signatory TIN of Signatory Title/Position of Signatory

Tax Agent Acc. No./Atty's Roll No. (if applicable) Date of Issuance Date of Expiry TIN of Signatory
Part IV D e t a i l s of P a y m e n t
Drawee Bank/ Date
Particulars Agency Number MM DD YYYY Amount
23 Cash/Bank 23A 23B 23C 23D
Debit Memo
24 Check 24A 24B 24C 24D

25 Tax Debit 25A 25B 25C 25D

Memo
26 Others 26A 26B 26C 26D

Machine Validation/Revenue Official Receipt Details (If not filed with the bank)
GRP 3.
(To be filled up the BIR)

DLN: PSIC: PSOC:

BIR Form No.

Payment Form 0605

Republika ng Pilipinas
Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas
July 1999 (ENCS)

Fill in all applicable spaces. Mark all appropriate boxes with an "X"

1 For the Calendar Fiscal 3 Quarter 4 Due Date ( MM / DD / YYYY) 5 No. of Sheets 6 ATC
2 Year Ended Attached
( MM / YYYY )
12 2018 1st 2nd 3rd 4th
MC200
7 Return Period ( MM / DD / YYYY ) 8 Tax Type Code BCS No./Item No. (To be filled up by the BIR)

12 31 2018 MC

Part I Background Information

9 Taxpayer Identification No. 10 RDO Code 11 Taxpayer Classification 12 Line of Business/Occupation

0 17A I
X N
13 Taxpayer's 14 Telephone Number
Name ROSARIO BRIONES
(Last Name, First Name, Middle Name for Individuals) / (Registered Name for Non-Individuals)
15 Registered 16 Zip Code
Address TARLAC CITY
17 Manner of Payment 18 Type of Payment

Voluntary Payment Per Audit/Delinquent Account Installment

Self-Assessment Penalties Preliminary/Final Assessment/Deficiency Tax No. of Installment
Tax Deposit/Advance Payment Accounts Receivable/Delinquent Account Partial
Income Tax Second Installment Payment
(Individual) Full
XOthers (Specify) CERTIFICATION FEE Payment

Part II Computation of Tax

19 Basic Tax / Deposit / Advance Payment

19 100.00
20 Add: Penalties Surcharge Interest Compromise
20A 20B 20C 20D

21 Total Amount Payable (Sum of Items 19 & 20D) 21 100.00

For Voluntary Payment For Payment of Deficiency Taxes Stamp of Receiving
From Audit/Investigation/ Office
I declare, under the penalties of perjury, that this document has been Delinquent Accounts and Date of Receipt
made in good faith, verified by me, and to the best of my knowledge and APPROVED BY:
belief, is true and correct, pursuant to the provisions of the National
Internal Revenue Code, as amended, and the regulations issued under
authority thereof.

22A 22B
Signature over Printed Name of Taxpayer /Authorized Representative Title/Position of Signatory Signature over Printed Name of Head of Office

Part III D e t a i l s of P a y m e n t

Particulars Drawee Bank/Agency Number MM DD YYYY Amount

23 Cash/Bank 23
Debit Memo
24A 24B 24C 24D
24 Check
25 Tax Debit 25A 25B 25C
Memo
26A 26B 26C 26D
26 Others
Machine Validation/Revenue Official Receipt Details (If not filed with the bank)

Taxpayer Classification: I - Individual N - Non-Individual