ACKNOWLEDGMENT RECEIPT

I hereby acknowledge the receipt of __________________________PESOS

ONLY (₱ _______.00) from the HEIRS OF ______________________, through
its representative, __________________________, as full payment and in
consideration of my adverse claim over a certain parcel of land
covered by ________________ CERTIFICATE OF TITLE No. ________________,
located in ___________________________________________________.

Received on the ___ day of ______ 20__, in ________________________,

Philippines.

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