Cash Disbursements Record: Appendix 40

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Appendix 40

CASH DISBURSEMENTS RECORD

Entity Name : SIRUMA NATIONAL HIGH SCHOOL


Fund Cluster : __________________________ Sheet No. : 2017-12-001

LEO B. BOLALIN SCHOOL PRINCIPAL I SIRUMA NHS


Accountable Officer Official Designation Station

Cash Advance Cash


UACS Object
Date Payee Nature of Payment Received/ Disbursements Advance
ADA/Check/ Code
(Refunded) Balance
DV/Payroll/R
eference No.
12/20/2017 691610 LEO BOLALIN 5029999099 ADDITIONAL MOOE FOR JHS 9,000.00 9,000.00
12/29/2017 2017-12-001 LUCIO, RIZEL E. 5020101000 TEV DECEMBER 1-3, 2017 1,468.00 7,532.00
12/29/2017 2017-12-002 HABABAG, SHARON M. 5020101000 TEV DECEMBER 1-3, 2017 1,468.00 6,064.00
12/29/2017 2017-12-003 DAIT, ROMEO III M. 5020101000 TEV DECEMBER 1-3, 2017 1,468.00 4,596.00
12/29/2017 2017-12-004 PRADES, KEVIN PATRICK S. 5020101000 TEV DECEMBER 2017 4,596.00 -
-

CERTIFICATION

I hereby certify on my official oath that the foregoing is a correct and complete record of all cash disbursements had by me in my capacity as SCHOOL PRINCIPAL I of
SIRUMA NATIONAL HIGH SCHOOL during the period from December 20, 2017 to December 29, 2017, inclusive, as indicated in the corresponding columns.

KEVIN PATRICK S. PRADES


Name and Signature of Accountable Officer
________________
Date

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