AKNOWLEDGEMENT RECEIPT

This is to certify that I ________________________________________ of legal

age, resident of Mangga, Peñablanca, Cagayan is indebted to JACINTO G. MEMAN in
the amount of ________________________________________ (₱________). That I
agreed to give an interest at the rate of ___% per month and payable every harvest
season.

Done this _________ day of _____________, 2022 in the presence of my

witness.

_____________________________ __________________________
Debtor Witness
 Republic of the Philippines

Province of Cagayan
Municipality of Peñablanca
Barangay Mangga

OFFICE OF THE BARANGAY CAPTAIN

CERTIFICATION

This is to certify that the Lot surveyed by Geofetic Engineer Charles T. Calimag
located in this barangay for