LIQUIDATION REPORT L.R. No.

SK of Barangay __, __________, ___________, _________

Date:
(SK of Barangay, City/Municipality, Province)

PARTICULARS AMOUNT

Liquidation of Cash Advance for the . . .

Total Amount Spent ₱ -

Amount of Cash Advance per D.V. No. __________________ dated _____________ -
Amount Refunded per O.R. No. __________________ dated ______________ -
Amount to be Reimbursed ₱ -
A. CERTIFIED: Correctness of the B. CERTIFIED: Purpose of cash C. CERTIFIED: Supporting documents are
above data. advance duly accomplished. complete and proper.

(printed name) (printed name) (printed name)

(Signature over Printed Name) (Signature over Printed Name) (Signature over Printed Name)
Accountable SK Official SK Chairperson SK Treasurer

Date Date Date