Date:__________________

ACKNOWLEDGEMENT

This is to acknowledge receipt of the sum of _______________________

_____________________________________________________ from

______________________________________ as a room rental payment

(advance and deposit) at 114 GreenVilleHomes Bayanihan St, Baesa

Caloocan City.

Breakdown of Payment:

Two (2) months deposit - _________________

One (1) month advance - _________________

 Monthly remtal will be starting from _____________________

 Two (2) months deposit will be used for the months of leasing
Premise and to be used likewise for the unsettled (unpaid)
Electric and water bills, and such as amounts of deposit should
not exceed to the total remaining unpaid bills incase of
“Termination of lease”

MICO JOHN J. CEA Receive/acknowledge by:

Lessor ______________________________________
Name and Signature