= fofafa - - BR For @ Bees Gertificate-of Compensation 53 (S) fasnihan dyer htomas Payment/Tax Withheld Fetes Faeroe Total vy) Som uno) own) Par Enpiows Biommetion Pe frre By atte aaa Wontfeaton No A. Non-Taxablorexemot Compencation Income floors Namo (Lat Nar Fra Rare WAG Rona) ——@ FOOBIS [28 “sh Non Pa ene 2 Giro borfia as Sos coe MCR Peatby 28 leroqaimernmes ‘RDC | conrbutone, A union cues CoRR RO 2S ROY SOUTH BOVE LAO 1100 TY 7 Sears 8 GherFomech 27 Corpereston eo Local Home Adress 6c 2ecode fos TouinonTorabloccemet 28 Conversation neome leo Forcion Adress cezpcoie |p. Taxable Compensation income Pao TB RTO YT VT 7 Taare Rarer ee base Salary 2 erin Sate so. Representation x0 EST'Sroe Head of tre Fariy —— (—] Mares loathe we cling the addtonal exeroton for quafied dependent chiro? Yes es Transporation " Ho tare of Guafied DopondertOhtaron 11 basoTannimniBOnY fs2 Costof Living Alowance 32 ||... fos. Fresousing Alowance a3 34. Others (Specty) }12 Other Dependent (tobe accompsshed if taxpayer is head of the fami) P40] Other Eamings fea ‘Name of Dependent Relatonship Pateot#n ‘SUPPLEMENTARY [13 Taxoavor “3 Iss Gonmssion as entiation No a6. Profit Sharing 6 . 137 Foes Inckiing rectors 37 Fees [15 Reaistored Adress TEA Zipcode |38 Taxable 13th Month Pay 38 Tieton e.o0 m0 TR UN ot PLAN ST CORNER GAA and Other Benatts FERN SNRs ANE Js9 Faeard Pay 39 rain emplover Secondary enplover J40. ters (Speci) Pare [Employer Information (Previous)-+ [16 Taxpayer 6 aon hoa Lentficaton No [F7 eroiyers Nar 408] foe Jat. Total Taxable Conpensaton 44 [78 Rogictorea Adress TEA Zp ease |_income. jaz Taxabie Conparsatonheore 42 Employer information (Provious)-2 trom Present Eployer [ie Taxnaver ® J43. Add: Taxable Compensation 43 lentficaton No_ from Previous Enpoyer (s) [20 Erpioyer's Nar Jes Gross Taxable “4 ton neome Jas. Lose: Total Erorretions 45 [at Registered Adarose BIA Zipcode [46 Less: Premum Pais on Heath andlor Hoeoval 46 FReurance (f appiesbl) Employer Information (Previous) 3 Jar Taxabie a [az Tawoaver__" 22 sontistion No Jas Tax Due cs fas Eroivers Name 49A Present Emolover 498, [ae Roaisored Adress TR Tp eae | 488, revows srpojers) 498 50 Total Armunt of Taxes witha Toad unde the ponies of pry. ats cecattas bee ace gooaTath, vetiedbys, onto thebestof ourkno wedge ond bae is wus apsconecE a ‘ANNA MARIE G. DAVE. orsign’ | ‘CONFORNE i 22, FLORENCIO M. DAISOG JR. (osesigred Tobe accomplished bettutea i _ " rom ony one ersioyer ina Ps or tec yen a nes vere 53 ANNA MARIE G. DAVE ho. 204CF ted my enpyerto the BR shal conete income oer 54 FLORENCIO M. DAISOG JR. Finns tau Ove seca= rT - BR ami GB) | Sansrantgtatenaept Certificate of Compensation 93 EO) caisninan eg Ronos nternas Paymeni/Tax Withheld fee ay =m Enpiowe Hiormalion Fptaxoayer a aot Wenticaton No A. Non-taxablerExempt Compensation income fr rpovees Name Cast Rime, Frat ame, WE are) 6 ROOORGE 26 1th Month Pav and 38 ire Bont le S55 G56 PCa Forbin 28 ls ranma naarose ‘GATZw Cais | Conirbutons, & Union dues SODPAPAARAN ST BARANGKA DRIVE MANDALUYONG CITY 7 SaaresS ome Fomsot 27 Compensation Je .cal ae Adcress 207 code 20 ToraNon-TorobieExemt 28 Conpanaaton heame lo rorcion adress c2zp cote |e. Texable Compensation Income Pate oT RTOS) 7 Talshone aber 0 Basic Salary 2 fF Bzeapton Sas 0. Repcesentaton 2 ‘Single [_] Head of the Famity = [_] Married JoA i the wife clams the adcional exemption for quaified dependent chikren? Yes No [31 Transportation Pa lio Name of Quatfied Dependent Ghisren 17 baeoraimnm@™n/ooNW Is2 costot Living Alowance 32 L 1 |__| eae 34 thers (Specty) ee Name of Dependent Relationship Pateor Sam er — = Ca : ero ese oe - aia ee ~ Fees rae aes Teteae | Reina [gene eas Pavements Deen = Serer aren Sees ie bn aos pete Fe = ) oT TER ae =a a aa cae as er oe pene z —— . SIE eae soa eet ee ‘eure ae EE a ea 2 aa ‘dentificstion No. 48 Tax Due 48 — Pr as ee eee oi ae au 51 ANNA MARIE G. DAVE oxesioed [4 Fraser poy Aahorned AGE Sgratas Ove P RGSS CONFORME ROWENA G. MENDIOLA (os Sarea f ste op sve “To be accomplished under substituted Ming rom ony ove crgoyer nt Pie for ta caenaae yt tases have bn conecy nite bymyemeloye taxauc eats taxoehed): Wate SIR FO, 53 ANNA MARIE. DAVE uo 208CF fed my emeoyerto he OR shal conse a myincome axel: 54 ROWENA G. MENDIOLA Fines Sina Ove mea