Republic of the Philippines

Province of La Union
Municipality of Bacnotan
Barangay Sipulo

December 2, 2014

ACKNOWLEDGEMENT RECEIPT

This is to certify that I ______________________________________ (land owner

representative-Vendor) has received the amount of One Hundred Thousand
Pesos (Php 100,000.00) as full payment for the sale of my rice land (______ sq. m.)
located at Sipulo, Bacnotan, La Union from Mr. Nelson P. Perez and Rey Badua
of Sipulo, Bacnotan, La Union.
This certification is issued upon the request of Mr. Perez and Mr. Badua for
legal intents and purposes.

___________________________________
Land Owner Representaticve-Vendor

Witness by:

ESTELITA SURIBEN
Barangay Captain

JULITA DELA CRUZ NELSON S. PEREZ

Brgy. Secretary Vendee

ALEJANDRO O. TUVERA REY BADUA

Pagbennecan, Balaoan, L.U. Vendee

YOLANDA T. AGBULOS
Pagbennecan, Balaoan, L.U.