Republic of the Philippines

DISBURSEMENT VOUCHER

DV No.
Date:

Barangay: 583_ Zone 57

City/Municipality: ____________________
Province: ___________________________

District IV

NAME AND ADDRESS OF BARANGAY TREASURER:

TIN No.

Fund:
________________

PARTICULARS

AMOUNT

To liquidate the cash advance received for personal services/laborers/nutrition project P

for the period _________Qtr/s CY 20___ in the amount of ..
Add: Redeposit/Refund .
__________________
TOTAL
Recap:
(
)
Page 1
2

(
)
(
)
TOTAL

P ___________________
Personal services
Honoraria
addl honoraria
lupon
Tanod allowances
St. sweeper
Others
laborers for the projects
nutrition project

_______________
_______________
_______________
_______________
_______________
_______________
_______________
_______________

_______________
_______________
_______________
_______________
_______________
_______________
_______________
_______________

List of supporting documents attached:

_____ payrolls _______ sheets
_____ deposit slips
_____ summary of receipts
_____ official receipts/Cash Invoice
_____ _______________________
_____ _______________________
A certified
Appropriation exist and funds available
for the charges/expenses indicated above

____________________________
Signature Over Printed Name
Chairman, Committee On Appropriation
Date ______________

B. Certified
Supporting documents complete
and proper, and funds available.

____________________________
Signature Over Printed Name
Barangay Treasurer
Date ______________

C. Approved
As to validity. Properly, legally and for comment

____________________________
Signature Over Printed Name
Punong Barangay
Date ______________

D.
I hereby certify that this Report Disbursement is a full, true and correct statement of the disbursement made by
me and that this is in liquidation of the cash granted last ____________________ in the amount of P __________
Per check No. _____________________ dated ____________________.
_______________________
Barangay Treasurer