Appendix 35 - LR

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Appendix 35

LIQUIDATION REPORT Serial No.: ___________


Period Covered ________________ Date: _______________

LGU : ________________________________________ Function/Program/Project


Fund : _______________________________________ _______________________

PARTICULARS Amount

TOTAL AMOUNT SPENT


AMOUNT OF CASH ADVANCE PER DV NO. ___________ DTD.
_____________
AMOUNT REFUNDED PER OR NO.__________ DTD. _________

AMOUNT TO BE REIMBURSED
A Certified: Correctness of the B Certified: Purpose of C Certified: Supporting documents
above data travel/cash advance duly complete and proper
accomplished

Signature over Printed Name Signature over Printed Name Signature over Printed Name
Claimant Immediate Supervisor Head, Accounting Division Unit
Date:_______________ Date:__________________ Date:__________________

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