ACKNOWLEDGMENT RECEIPT

DATE: ___________________

I, (VENDOR's NAME), of legal age, Filipinos, single/married ____________, and with residence and
postal address at ________________________________, do hereby acknowledged the receipt of the
sum of ______________________ (P__________) PESOS representing FULL PAYMENT for the purchase
of a portion of land, covered by an OCT/TCT No. _______, (Lot No. ______,(Lot description based on the
title), containing an area of ______________________ (__) SQUARE METERS, more or less, from
(VENDEE's NAME), of legal age, Filipino, single/married, and with residence and postal address at
_________________________________.

Payment received by:

___________________
Vendor

With my marital consent:

__________________
Vendor's Husband/Wife

Signed in the presence of:

1. _______________________ 2. ______________________
ID No. ______________ ID No.______________

SUBSCRIBED AND SWORN TO BEFORE ME, a notary public in and for the City of Dumaguete, this
________________________ Affiant personally came and appeared _________________ with his/her
_________________________________, known to me as the same person who personally signed the
foregoing instrument before me and avowed under penalty of law to the whole truth of the contents
thereof.

NOTARY PUBLIC

Doc No. _____

Page No._____
Book No._____
Series of 2020