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Republic of the Philippines

Province of South Cotabato


Municipality of Tboli
OFFICE OF THE MUNICIPAL VICE MAYOR
ACKNOWLEDGEMENT RECEIPT

To whom it may concern:

I _________________ resident of Sitio _________ Barangay


_______________have received the amount of PHP._______for
hospital______________ assistance/donation from the Vice Mayor’s Office, Tboli
South Cotabato.

Done this _______day of _____________ year ____ at Vice Mayor’s Office

Tboli South Cotabato.

Received by:

_______________________
Authorized Representative

Conformed:

______________________
VICE MAYORS OFFICE

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