CITY TREASURER'S DEPARTMENT

SETS OF DATA BEING COLLECTED FOR TREASURY LICENSE

Information Sheet
1. DATE
2. LAST NAME
3. FIRST NAME
4. MIDDLE NAME
5. SUFFIX
6. BIRTH DATE
7. BIRTH PLACE
8. GENDER
9. CIVIL STATUS
10. CURRENT ADDRESS
11. Block/Bldg./House/Unit No.
12. Street
13. Barangay
14. City/Mun./Prov.
15. GROSS ANNUAL INCOME
16. SIGNATURE