Annex D

RMox2-2013
R.venu€ Rsgion No.S, caloocaocity
REVENUE DISTRTCT OFFICE T'IO. 25A.TA'[ T BULACAN

Inventory Ust of Unused/Expired Principaland Supplementary Receipts & lnvoices

As o{

Name of Taxpayer
Busirre:;s/Trade I'lame
{l'rN} Branch Code
Business Address
ATP OCN Date lssued

No. of Booklets No. of Serial Nas.

sets No. of
Loose Bound Per Copies From To
DESCRTpTtON TYPT Eooklet D^. C^i

I
i

iSignature over Printed Name of Taxpayer)

Received by:

iTSS Chief/Registration Sectioi-r Chiei')

Verified correci by:

{Officer of the Day - Assessment Section)