ACKNOWLEDGMENT RECEIPT

TO WHOM IT MAY CONCERN:

That I, ___________________________________, of legal age,

Filipino citizen, with residence at ________________________________________, hereby

acknowledge the amount of ______________________________________

(Php___________________) Philippine Currency, from

__________________________________, of legal age, Filipino citizen with

residence at ______________________________________, as payment of

______________________________________________________________________.

IN WITNESS HERETO, we hereunto set our hands this at Bangued, Abra,

Philippines.

______________________ ______________________

SIGNED IN THE PRESENCE OF:

__________________ ____________________

SUBSCRIBED AND SWORN TO BEFORE ME this

___________________________ at Bangued, Abra, Philippines.

Doc. No. _____

Page No. _____
Book No. ____
Series of 2023