ACKNOWLEDGMENT RECEIPT

WE, the __________________________ and the SELLER/VENDOR of a parcel of

land situated in Brgy. Cutay, Sta. Fe, Leyte subject of Tax Declaration No. 08-3500900279
issued by the Municipal Assessor of Sta. Fe, Leyte, hereby ACKNOWLEDGE to have
RECEIVED on _________________ the total amount of
_____________________________ ___________________________________ PESOS
(P_______________) from ____________________________, Filipino, of legal age,
married, and who was then a resident of Lot 29 Block II Buena Park Subdivision, Villa
Monte, Bacolod City, BUYER/VENDEE of the said parcel of land, in payment of the full
purchase price of the same parcel of land with all the existing improvements thereon, free
from all liens and encumbrances of whatever nature per Extrajudicial Settlement of Estate
of ________________________ executed by us on March 3, 2012 and duly notarized by
Notary Public Atty. Edwin B. Tabaranza under Doc. No. 16, Page No. 05, Book No. XI,
Series of 2012 in his Notarial Register.

IN WITNESS WHEREOF, I hereunto affixed my signature this _______________ in

_______________, Philippines.

Co-Heir/Vendor Co-Heir/Vendor
ID Type/No. _____________________ ID Type/No. _____________________

Co-Heir/Vendor Co-Heir/Vendor
ID Type/No. _____________________ ID Type/No. _____________________

Co-Heir/Vendor
ID Type/No. _____________________

Signed in the presence of: ________________________ ________________________

SUBSCRIBED AND SWORN to before me, this ____________________ in

__________________________, Philippines, by the above-named heirs/vendors who
presented competent proof of identity as stated above.

WITNESS MY HAND AND SEAL, on the date and place first above written.

Doc. No. _____;

Page No._____;
Book No._____;
Series of 2022.