Documente Academic
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1 For the 3 Quarter Clear Quarter 4 Due Date 5 No. of Sheets Attached 6ATC
Calendar Fiscal (MM/DD/YYYY)
2 Year
Ended 12 - December 2019 0 MC200
(MM/YYYY) 1st 2nd 3rd 4th
478 108 258 000 016 I N BUILDING OF CONSTRUCTIONS OR PARTS, CIVIL ENGINEERING
13 Taxpayer's Name(Last Name, First Name, Middle Name for Individuals)/(Registered Name for Non-Individuals) 14 Telephone Number
MEJIA, IRA JANDEL UYAM
Self-Assessment Installment
CERTIFICATION FEE
21 100.00
21 Total Amount Payable(Sum of Items 19 & 20D)
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 and
Pre-approved by Investigating Office
belief, is true and correct, pursuant to the provisions of the National
Internal Revenue Code, as amended, and the regulations issued under Not approved by Investigating Office
authority thereof.
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