Appendix 40 - CDRec
Uploaded by
Mark Joseph BajaAppendix 40 - CDRec
Uploaded by
Mark Joseph BajaAppendix 40
CASH DISBURSEMENTS RECORD
Entity Name : __________________________
Fund Cluster : __________________________ Sheet No. : _________________
___________________ ________________________________ ________________
Accountable Officer Official Designation Station
Cash
Cash
UACS Object Advance
Date Payee Nature of Payment Disbursements Advance
ADA/Check/ Code Received/
Balance
DV/Payroll/R (Refunded)
eference No.
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 ______(Designation)____ of (Name of Agency) during
the period from _______________ to _______________,inclusive, as indicated in the corresponding columns.
_______________________________
Name and Signature of Disbursing Officer
________________
Date
110