Republic of the Philippines

Province of South Cotabato

Municipality of Tboli
OFFICE OF THE MUNICIPAL VICE MAYOR
ACKNOWLEDGEMENT RECEIPT

To whom it may concern:

I _________________ resident of Sitio ______________ Barangay

_______________have received the following items from the Vice Mayor’s
Office, Tboli South Cotabato.

1. __________________
2. __________________
3. __________________
4. __________________

Done this _______day of _____________ year ____ at Vice Mayor’s Office

Tboli, South Cotabato.

Received by:

_______________________
Authorized Representative

Conformed:

______________________
Vice Mayor’s Office