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ACKNOWLEGDEMENT RECEIPT

I, ____________________ received ___________________ from


_______________ as full payment of portion parcel of land with an area of
________________, situated in ______________ with Original Certificate of Title No.
__________.

IN WITNESS WHEREOF, I have hereunto set my hand this _____________,


Philippines.

_______________________
Affiant

SUBSCRIBED AND SWORN to before me, this____________ in the Municipality of


_____________.

Doc. No. ______;


Page No. ______;
Book No.______;
Series of 2023.

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