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Name
ESC Grantees/VPBs/TSS Check No. Issuing Bank
Recipients (Surname, First Name,
MI) Purpose (ESC/SHS/TSS Refund;
ESC/SHS double billed; Monitoring
School ID School Name School Address LRN Grade Level School Year Amount Date of Check Findings; Overpayment) Remarks
Prepared by:
Designation
Contact Information