Date
HONGKONG.
Head of Estimates: Miscellaneous Services.
Rent Allowances for the period
Office.
Name.
!
Period.
From
F
Place of residence.
To
191
Amount of rent
and taxes
payable during period. *
X
Amount Payable by officer.
Amount due.
C.
*
c.
Voucher No.....
I hereby certify that the above is a correct statement of the amounts payable to the persons named, in respect of the period stated.
191...
(Signature)..
(Title)....
* If the officer is the owner of the house occupied assessed value and taxes for the period should be given.
I hereby acknowledge the receipt of the total amount payable opposite my name.
434
Head of Department.