COMMUNITY TAX CERTIFICATE INDIVIDUAL CCI201717956825

YE AR P LACE OF I S S UE ( CI T Y / M UN. / P ROV. ) DAT E I S S UE D

TAXP AYER' S COP Y

NAM E ( S URNAM E ) ( FI RS T ) ( M I DDLE ) T I N ( I f An y) :

ADDRE S S
S E X: M ALE FE M ALE

CI T I Z E NS HI P I CR NO. ( if an Alie n ) P LACE OF BI RT H HE I GHT

CI VI L S in gle Widow/ Widower / Legally S epar at ed DAT E OF BI RT H WE I GHT

S T AT US Mar r ie d Divor ced

T AXABLE COM M UNI T Y

AMOUNT T AX DUE

A. BASIC COMMUNITY TAX (₱5.00) Voluntry or Exempted (₱ 1.00) ₱

B. ADDITIONAL COMMUNITY TAX (tax not to exceed ₱5,000.00)

GROS S RE CI E P T S OR E ARNI NGS DE RI VE D FROM BUS I NE S S DURI NG
1 T HE P RE CE DI NG YE AR ( ₱1. 0 0 FOR E VE RY ₱ 1, 0 0 0 )
₱
S ALARI E S OR GROS S RE CI E P T OR E ARNI NGS DE RI VE D FROM E XE RCI S E OF
2 P ROFE S S I ON OR P URS UI T OF ANY OCCUP AT I ON ( ₱1. 0 0 FOR E VE RY ₱ 1, 0 0 0 )

3 I NCOM E FROM RE AL P ROP E RT Y ( ₱1. 0 0 0 f or ever y ₱ 1, 0 0 0 )

R IGHT THUM B T AXP AYE R'S S I GNAT URE

T OT AL ₱
P rint
INT E R E ST

T OT AL
AM OUNT P AID
₱
( In wo r d s ):
M UNI CI P AL/ CI T Y T RE AS URE R