ACKNOWLEDGEMENT RECEIPT

Date: _______________

TO WHOM IT MAY CONCERN:

This is to acknowledged receipt of cash in the amount of (in words) _____________________

____________________________________________________________________________
(Php_______________) representing _____________________________________________.

PARTICULARS AMOUNT

TOTAL

Received by: __________________________ Witness: _______________________

Barangay Captain
Address: _____________________________
(Signature over printed name)
Name of Payor: _______________________