(To be filled up by the BIR)

DLN:

Taxpayer PSOC:

PSIC:

Spouse PSOC:

PSIC:

Republika ng Pilipinas Kagawaran ng Pananalapi

Kawanihan ng Rentas Internas For Self-Employed Individuals, Estates, and Trusts (Including those w/ both Business & Compensation Income)
Fill in all applicable spaces. Mark all appropriate boxes with an X.

Quarterly Income Tax Return

Yes Spouse No

1701Q
July 2008 (ENCS) 4 No. of sheet/s attached 8 RDO Code

BIR Form No.

For the Year (YYYY) Part I 5 9 TIN

2011
Taxpayer/Filer

2 Quarter

X 1st
6 RDO Code

3 Amended 2nd 3rd Return Background Information 7 10 12 TIN

215

125

654

Taxpayer's Name(Last Name, First Name, Middle Name)(Estates & Trusts)

Spouse's Name (Last Name, First Name, Middle Name)(If applicable) Registered Address 17 Zip Code 22 I I 0 1 1
ATC I I 0 1 2

VASQUEZ, EMMANUEL UMAIL

11 Registered Address

50A MOLAVE ST., BGY DUYAN DUYAN, PROJ. 3, .

13 Date of Birth (MM/DD/YYYY) Q.C. 19 Line of Business/Occupation 14 Zip Code 15 Telephone Number 16 Date of Birth (MM/DD/YYYY) 20 II 011 II 013 23 Method of Deduction Itemized Deduction Compensation Business Mixed Income 21 Line of Business/Occupation

18 Telephone Number Compensation Business Mixed Income

ATC I I 0 1 2

II 013 24 Method of Deduction Itemized Deduction

40% Optional Standard Deduction

40% Optional Standard Deduction

25 Are you availing of tax relief under Special Law or International Tax Treaty? Yes No If yes, specify Part II Computation of Tax Declaration This Quarter Taxpayer/Filer 26 Sales/Revenues/Receipts/Fees 26A 26B 170,178.00 27 Add: Amount Received by a Partner from General 27A 27B
Professional Partnership (except loans)

Spouse

28 Total 29 Less: Cost of Sales/Services 30 Gross Income from Operation 31 33 35 Add: Other Income Less: Deductions Add: Taxable Income Previous Quarter/s 32 Total Gross Income 34 Taxable Income This Quarter 36 Taxable Income to Date 37 Tax Due 38 Less: Tax Credits/Payments 38A/B Prior Years' Excess Credits 38C/D Tax Payment/s for the Previous Quarter/s
38E/F Creditable Tax Withheld for the Previous Quarter/s 38G/H Creditable Tax Withheld Per BIR Form No. 2307 38I/J Tax Paid in Return Previously Filed,

28A 29A 30A 31A 32A 33A 34A 35A 36A 37A 38A 38C 38E 38G 38I 38K 38M 39A 40A 40C 40E 40G 41A 41C

170,178.00 0.00 170,178.00 170,178.00 147,126.71 23,051.29 23,051.29 1,805.13

28B 29B 30B 31B 32B 33B 34B 35B 36B 37B 38B 38D 38F 38H 38J 38L

3,403.56

for this Quarter

if this is an Amended Return 38K/L Other Payment/s Made (please attach proof of payment-BIR Form No. 0605)
38M/N Total Tax Credits/Payments (Sum of 38A,C,E,

G,I & K/ 38B,D,F,H,J,& L)

39 Tax Payable/(Overpayment) (37A less 38M & 37B less 38N) 40 Add: Penalties Surcharge Interest Compromise Total Penalties (Sum of Items 40A,C,E/40B,D,F) 41 Total Amount Payable/ (Overpayment)(39A+40G/39B+40H)

3,403.56 (1,598.43)

38N 39B 40B 40D 40F 40H

Aggregate Amount Payable/(Overpayment) ( Sum of Items 41A & 41B)

(1,598.43) 41B (1,598.43)

I declare under penalties of perjury, that this return has been made in good faith, verified by me, and to the best of my knowledge and belief, is true and correct, pursuant to the provisions of the National Internal Revenue Code, as amended, and the regulations issued under authority thereof. 42 EMMANUEL U. VASQUEZ Taxpayer/Authorized Representative/Accredited Tax Agent Signature Over Printed Name Tax Agent Acc. No./Atty's Roll No. (if applicable) Part III Particulars 43 Cash/Bank Debit Memo 44 Check 45 Tax Debit Memo 46 Others Drawee Bank/ Agency
43A 44A 43B 44B 45A 46A 46B

Title/Position of Signatory

TIN of Signatory

Date of Issuance

Date of Expiry Stamp of Receiving Office/

D e t a i l s of P a y m e n t Date Number MM DD
43C 44C 45B 46C

YYYY
43D 44D 45C 46D

Amount

AAB and Date of Receipt (RO's Signature/ Bank Teller's Initial

Machine Validation/Revenue Official Receipt Details (If not filed with the bank)

\mariam

BIR FORM 1701Q (ENCS)-PAGE 2 TAX TABLE If TAXABLE INCOME is: Not over P 10,000 Over P 10,000 but not over Over P 30,000 but not over Over P 70,000 but not over Over P 140,000 but not over Over P 250,000 but not over Over P 500,000 TAX DUE is: P 30,000 P 70,000 P 140,000 P 250,000 P 500,000 5% P 500 + 10% P 2,500 + 15% P 8,500 + 20% P 22,500 + 25% P 50,000 + 30% P 125,000 + 32% of the excess over of the excess over of the excess over of the excess over of the excess over of the excess over P 10,000 P 30,000 P 70,000 P 140,000 P 250,000 P 500,000

BIR Form 1701Q - Quarterly Income Tax Return

GUIDELINES AND INSTRUCTIONS

Republika ng Pilipinas Kagawaran ng Pananalapi

Kawanihan ng Rentas Internas

Quarterly Tax Re

For Self-Employed, Professionals, Estates, and Trusts (Including those w/ both Business & Compensation Income)

Quarterly Income Tax Return

usts Income)

1701Q
July 1999 (ENCS)

BIR Form No.