ACKNOWLEDGMENT RECEIPT

That We, ____________________, ____________________,

_____________________, and ___________________, all of legal ages, Filipino citizens, and
residents of __________________________, herein represented by our attorney-in-fact,
RECEIVED the amount of _______________________ (P______________), Philippine
currency, to me in hand paid and acknowledged to have received from
___________________, single, of legal age and a resident of _________________________,
Philippines as full payment for the purchase of those parcels of land, including all the existing
improvements thereon, more particularly described as follows:

TRANSFER CERTIFICATE OF TITLE NO. __________

“A parcel of land __________________.”

IN WITNESS WHEREOF, the parties have hereunto affixed their signatures this
____________________ at Dagupan City, Philippines.

___________________________ __________________________
Vendor Vendor
ID ________________________ ID ________________________

___________________________ __________________________
Vendor Vendor
ID ________________________ ID ________________________

______________________________
Vendee
ID ____________________________

SIGNED IN THE PRESENCE OF:

____________________________ __________________________
Witness Witness

SUBSCRIBED AND SWORN to before me this __________________ at Dagupan

City, affiants having exhibited to me their ID as above indicated.

Doc. No. ______;

Page No. ______;
Book No. _______;
Series of _______.