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BIR Form No.

Republika ng Pilipinas Monthly Percentage
Kagawaran ng Pananalapi
Kawanihan ng Rentas Internas
Tax Return 2551M
September 2005 (ENCS)
3 For the month (MM /YYYY) 4 Amended Return? No. of Sheets
1 For the i Calendar
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n j Fiscal
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n 5 Attached
2
Year Ended
12 - December 2016 11 - November 2016
(MM/YYYY) j Yes
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n 0
i No
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Part I Background Information
6 TIN 446 273 816 000 7 RDO 028 Line of Business / Occupation
Code 8
7020-REAL ESTATE ACTIVITIES
9 Taxpayer's Name (For Individual) Last Name, First Name, Middle Name/ (For Non-individual) Registered Name 10 Telephone Number
CARLOS, MARY GRACE, GOYAL 9375780
11 Registered Address 12 Zip Code
608 CARLOS EXTN., SAN BARTOLOME, NOVALICHES, QUEZON CITY 1116
13 Are you availing of tax relief under Special Law / International Tax Treaty? j Yes
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n i No
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n If yes, specify

Part II Computation of Tax ATC

Taxable Transaction / Industry Classification ATC Taxable Amount Tax Rate Tax Due

PERSON EXEMPT FROM VAT UNDER SEC. 109V (SEC. 16) PT010 0.00 3.0 0.00

19 Total Tax Due 19 0.00

20 Less: Tax Credits/Payments
20A Creditable Percentage Tax Withheld Per BIR Form No. 2307 (See Schedule 1) 20A 0.00
20B Tax Paid in Return Previously Filed, if this is an amended return 20B 0.00
21 Total Tax Credit/Payments (Sum of Items 20A & 20B) 21 0.00
22 Tax Payable (Overpayment) (Item 19 less Item 21) 22 0.00
23 Add Penalties Surcharge Interest Compromise

23A 0.00 23B 0.00 23C 0.00 23D 0.00

24 Total Amount Payable (Overpayment) (Sum of Items 22 and 23D) 24 0.00

If Overpayment, mark one box only j
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n j To be issued a Tax Credit Certificate
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To be Refunded
Schedule 1 Tax Withheld Claimed as Tax Credit
Period Covered Name of Withholding Agent Income Payments Tax Withheld Applied

Total Amount(to item 20A)................. 0.00

I declare, under the penalties of perjury, that this return has been made in good faith, verified by me, and to the best of my knowledge, and belief,
is true and correct, pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof.
25___________________________________________________________________________________ 26_____________________________
President/Vice President/Principal Officer/Accredited Tax Agent/ Treasurer/Assistant Treasurer
Authorized Representative/Taxpayer (Signature Over Printed Name)
(Signature Over Printed Name)
___________________________________________ ___________________________________________ ______________________________
Title/Position of Signatory TIN of Signatory Title/Position of Signatory
___________________________________________ _______________ _______________ ______________________________
Tax Agent Acc. No./Atty's Roll No.(if applicable) Date of Issuance Date of Expiry TIN of Signatory

Machine Validation/Revenue Official Receipt Details (If not filed with an Authorized Agent Bank)

file://C:\Users\clarisse\AppData\Local\Temp\{C66626E0-8E02-40EC-8AEB-918FB3C7E91C}\forms\BIR... 12/17/2016