ABCDEFGHIJKLMNOPQRSTUVWXYZ
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LIQUIDATION REPORT
No: _____________
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Date: ___________
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DEPARTMENT OF EDUCATION
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DIVISION OF SOUTHERN LEYTE
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(NAME OF SCHOOL)Responsibility Center Code:
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PARTICULARSAmount
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 To Liquidate Cash Advance of MOOE Funds for the month of ___________________ , as per supporting papers hereto attached in the amount of…P
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Breakdown: (If with cluster school/s and additional fund)
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TOTAL AMOUNT SPENT
P
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AMOUNT OF CASH AVANCE PER DV NO. __________
DTD. _______________P
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AMOUNT REFUNDED PER OR NO. ________________
DTD. ________________P
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AMOUNT TO BE REIMBURSED
P
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A.Certified: Correctness of the above dataB. Certified: Purpose of travel/cash advance duly accomplishedC. Certified: Supporting documents complete and proper
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JEV No. __________
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ULYSSES M. SABANDAL, CPA
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ClaimantCluster Head/School HeadHead Accounting Unit
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