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ACKNOWLEDGEMENT OF DEBIT AND PROMISSORY NOTE

KNOW ALL MEN BY THESE PRESENTS: I, ______________________________ of legal age, Filipino, married and a resident of ______________, WITNESSETH: 1. That I am indebted in the sum of ___________________________________________________ pesos, (P __________) Philippine Currency to JOSEFINA DE VERA DAGDAG, of legal age, Filipino, married and a resident of Cabilaoan, Laoac, Pangasinan. That I bind myself to pay the aforesaid obligation unto the said Josefina De Vera Dagdag, her heirs and assigns, within _____________ months from the date hereof, together with the agreed interest of ___________ percent ( _____ % ) a month. That I should fail to comply herewith; I shall be liable for liquidated damages in the amount of ___________________________. That if this matter is brought to Court for collection because of non-payment, I further to pay attorneys fees of not less than 25% of all amounts due. _______________, ___________________.

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IN WITNESS WHEREOF, I have here unto set my hand this _______ day of ________________________ , 2013, at Cabilaoan, Laoac, Pangasinan. _____________________________ Debtor Signed in the Presence of: _____________________________ _____________________________

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