Republic of the Philippines
Province of Pangasinan
Municipality of Manaoag
Barangay Pugaro
Office of the Punong Barangay
Acknowledgment Receipt
TO WHOM IT MAY CONCERN:
This is to acknowledge that I, ________________________________________ of legal
age, Filipino citizen and a resident of _______________________________________, Philippines
received the amount __________________________________________________________________
(P _______________), Philippine currency, from ___________________________________________,
of legal age, Filipino citizen and a resident of ____________________________________________, as
payment for the _____________________________________________________________________.
Done and Issued this _____ day of _________________________ at Barangay Pugaro
Manaoag Pangasinan.
Received By: ________________________________ Received from: ________________________________
Witness by:
_______________________
_______________________
Kagawad On Duty Barangay
Official
Not Valid Without Barangay Dry Seal