Republic of the Philippines

LA UNION SCHOOLS DIVISION OFFICE

Region I
Department of Education

ACKNOWLEDGEMENT RECIEPT

SCHOOL: __TOCOC ELEMENTARY SCHOOL____________________________________________

SCHOOL ADDRESS: _____TOCOC, STO. TOMAS, LA UNION_______________________________
NAME OF SCHOOL HEAD:_____CRISELDA V. PACULAN__________________________________
NO. OF ITEMS:________152_______________________________________________________

I, ______________________________________________________( received ) acknowledge

from the above mentioned items and received complete and in good condition.

__________________________
SIGNATURE OF RECEIVER