LR No :

Date :

Responsibility
Doc. Control No.: Ver. No.: Effective Date: Page 1 of 1 Center:
LIQUIDATION REPORT Code :
DATE OR No. PARTICULARS Amount

TOTAL AMOUNT SPENT

AMOUNT OF CASH ADVANCE PER DV # : ADA#: DATED

AMOUNT REFUNDED PER OR# : DATED

AMOUNT TO BE REIMBURSED

[B] Certified : Purpose of travel/ cash advance [C] Cetified : Supporting documents
[A] Certified : Correctness of the above data:
accomplished complete & proper

MARILOU B. DEDUMO, Ph.D., CESO V BETHANY I. EVILLA, CPA _________

Claimant Schools Division Superintendent Accountant III JEV No.
 Fund Cluster :

Date :
DV
Doc. Control No.: Ver. No.: Effective Date: Page 1 of 1 No. :
DISBURSEMENT VOUCHER
Mode of MDS Check Commercial Check ADA Others (Please specify)
Payment
_________________
TIN/Employee No.: ORS/BURS No.:
Payee

Address

Responsibility
Particulars MFO/PAP Amount
Center

Amount Due
A. Certified: Expenses/Cash Advance necessary, lawful and incurred under my direct supervision.

SHIRLENE E. CRABAJALES
ADMINISTRATIVE OFFICER V

B. Accounting Entry:
Account Title UACS Code Debit Credit

- -
C. Certified: D. Approved for Payment
Cash available
Subject to Authority to Debit Account (when applicable)

Su
proper

Signature Signature

Printed Printed
Name BETHANY I. EVILLA, CPA Name
MARILOU B. DEDUMO, PhD.,CESO V

Accountant III Schools Division Superintendent

Position Position
Head, Accounting Unit/Authorized Representative Agency Head/Authorized Representative

Date Date

E. Receipt of Payment JEV No.

Check/ Date : Bank Name & Account Number:
ADA No. :
Signature Date : Printed Name: Date
:
Official Receipt No. & Date/Other Documents

DepEdSurSur//OSDS/ACC/07-09-2019/006-V1
Control No.: Ver. No. : Effective Date:
CASH DISBURSEMENT REGISTER
(FOR THE PERIOD: -INDICATE THE QUARTER OF LIQUIDATION-e.g. 4th Quarter CY
Entity Name :
Sub-Office/District/Division: _______________ / Division of Surigao del Sur
Municipality/City/Province: _________________, Surigao del Sur
Fund Cluster: 01-Regular

Advance for Operating Expenses (1990101000)

DV/CHK/
O.R./SALES DUE TO BIR
INVOICE/ Travelling Drug and Fuel, Oil and
DATE PAYEE / PARTICULAR Training Office Supplies
RER Percentage Expenses- Medicines Lubricants
Cash Advance PAYMENT VAT / EVAT BALANCE Expenses Expenses
PAYROLL Local Expenses Expenses
1% 2% 3% 5%
NO.
2020101001 2020101002 2020101003 2020101004 5020101000 5020201000 5020301000 5020307000 5020309000

- - -

- -

- -

- -
 - - -

- -

- - -

- -

- - -

SUB TOTAL - - - - - - - - - -

PREPARED BY: CHECKED & VERIFIED:

/ Accountable Officer District Bookkeeper Designate

Date: _________________________ Date: _______________

 Page : 1 of 1

uarter CY 2018 )
Name of Accountable Officer:
Official Designation:
Station:
Register No.:
Sheet No.:
BREAKDOWN OF PAYMENTS
Semi- Repairs and
Semi- Other Supplies Telephone Internet Printing &
Expendable- Water Electricity Janitorial Security Maintenance- Fidelity Bond
Expendable- and Materials Expenses- Subscription Publication
Office Expenses Expenses Services Services School Expenses
ICT Equipment Expenses Mobile Expenses Expenses
Equipment Buildings

5020321002 5020321003 5020399000 5020401000 5020402000 5020502001 5020503000 5021202000 5021203000 5021304002 5021502000 5029902000

-
- - - - - - -

NOTED:

PSDS