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Get PH Tieza 353 1987

_________________________ Route: ____________________________________ Date Issued ____________________________ Travel Tax Collected : P_______________________ Refundable ____________________________ Sales Report No. ____________________________ Date _________________________________ Remittance PTA O.R. No. _____________________ Date _________________________________ Reasons for Refund: ( ) Exemption ( ) Unused Ticket ( ) Reduced ( ) Others ( ) Non-Coverage _______ Non-Revenue Ticket _______ P.

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