Republic of the Philippines

DEPARTMENT OF TRANSPORTATION
LAND TRANSPORTATION OFFICE
BRGY. TIZA ROXAS CITY, CAPIZ

Field Office: ROXAS CITY DISTRICT OFFICE, CAPIZ TIN: 000865491052

Office Code: 0636 Date: 07/21/2021 12:27 PM

OFFICIAL RECEIPT 0636-000000039434

RECEIVED FROM (Last Name, First Name Middle Name)
DENOYA, ARTURO D
ADDRESS (No. Street, Barangay, Municipality, Zip Code, Province)
-, Baybay, Roxas City (Capital), 5800, Capiz
TIN (Tax Identification Number)

PAYMENT DETAILS BREAKDOWN OF PAYMENT

Transaction: TX-MVIRS-20210721- MVUC PHP 300.00
565927
Application: MVIRS-RN-20210721- Delinquent Registration PHP 150.00
858510
Posted: 07/21/2021 Legal Research Fee PHP 10.00

Classification: For Hire

Plate No: 063603
Engine No: KYY10E004168
Chassis No: KYY10004126
Color: BLACK
Year: 2014
Type: Tricycle With Sidecar
Category: Motorcycle / Moped /
Tricycle
Gross Weight: 300
Net Weight: 150
Fuel: Gas
Next Renewal: 03/22/2022 - 03/31/2022

TOTAL AMOUNT PAID: PHP 460.00

AMOUNT IN WORDS: FOUR HUNDRED SIXTY PESOS

MODE OF PAYMENT: Cash

LOCATION: Roxas City District Office, Capiz
CASHIER: Maria Camia Agaton
POS MACHINE: ROXAS DO - CASHIER

This is a system generated Official Receipt. No Signatures needed.

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 Republic of the Philippines
DEPARTMENT OF TRANSPORTATION
LAND TRANSPORTATION OFFICE
BRGY. TIZA ROXAS CITY, CAPIZ

Field Office: ROXAS CITY DISTRICT OFFICE, CAPIZ TIN: 000865491052

Office Code: 0636 Date: 07/21/2021 12:27 PM

OFFICIAL RECEIPT 0636-000000039434

Page 2 of 2