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Reference No: 291400009728762

Date Filed: October 07 2014 02:49 PM
Batch Number: 0

PSOC: PSIC: 9199

BIR Form No.

Republika
Kagawaranng
ngPilipinas
Pananalapi
Kawanihan ng Rentas Internas Payment Form 0605
September 2003(ENCS)

1 For the 3 Quarter Clear Quarter 4 Due Date 5 No. of Sheets Attached 6 ATC
Calendar Fiscal (MM/DD/YYYY)

2 Year
Ended 12 - December 2014 0 MC200
(MM/YYYY) 1st 2nd 3rd 4th

7 Return Period (MM/DD/YYYY) 10 07 2014 8 Tax Type Code MC

ParIt B
a
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kg
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ru
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dmo
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rfn
Iia
t

9 Taxpayer Identification No. 10 RDO Code 11 Taxpayer Classification 12 Line of Business/Occupation

266 172 814 000 037 I N ACTIVITIES OF OTHER MEMBERSHIP

13 Taxpayer's Name(Last Name, First Name, Middle Name for Individuals)/(Registered Name for Non-Individuals) 14 Telephone Number
FAMILY ARRANGE THE RESOURCES AND MANAGED MPC 09214086741

15 Registered Address 16 Zip Code

TUBAN OCCIDENTAL MINDORO 5104

17MannerofPayment 18TypeofPayment

VoluntaryPayment PerAudit/DelinquentAccount

Self-Assessment Installment

Penalties Preliminary/Final Assess/Deficiency No. of Installment

Tax Deposit/Advance Payment Tax
Income Tax Second Installment(Individual) Accounts Receivable/Delinquent Partial Payment
Others(Specify) Account Full Payment

CERTIFICATION FEE

PartII ComputationofTax

19 Basic Tax/Deposit/Advance Payment 19 100.00

20 Add Surcharge Interest Compromise

Penalties
20D 0.00
20A 0.00 20B 0.00 20C 0.00

21 Total Amount Payable(Sum of Items 19 & 20D)

21 100.00

Payment of Deficiency Taxes

For Voluntary Payment From Audit/Investigation
Delinquent Accounts
I declare, Under the penalties of perjury, that this document has been
made in good faith, verified by me, and to the best of my knowledge Pre-approved by Investigating Office
and belief, is true and correct, pursuant to the provisions of the Not approved by Investigating Office
National Internal Revenue Code, as amended, and the regulations
issued under authority thereof.

Print Payment Details Proceed to Payment

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