ACKNOWLEDGMENT

REPUBLIC OF THE PHILIPPINES )

PROVINCE OF LA UNION
) S.S.
MUNICIPALITY OF AGOO
)
BEFORE ME, a Notary Public for and in the Province of ___________________,
on this ___ day of ___________________, 20__ personally appeared
______AFFIANT_1_________________
exhibiting
to
me
his/her
______(Competent
Evidence
of
Identity)______
issued
by
the
_________(Government Agency)______ on ________________ and set to
expire on _____________, and ____ AFFIANT_2____ exhibiting to me his/her
_____(Competent
Evidence
of
Identity)______
issued
by
the
_________(Government Agency)______ on ________________ and set to
expire on ________________ as their competent evidence of identity bearing
their photograph and signatures, who are known to me and to me known to be
the same persons who executed the foregoing instrument and acknowledged to
me that the same is their own free act and voluntary act and deed.
This instrument, consisting of _______ (__) pages, including the page on which
this acknowledgment is written, has been signed on the left margin of each and
every page hereof by the concerned parties and their witnesses, and sealed with
my notarial seal.
WITNESS MY HAND AND SEAL, at the place and date above-written.

Doc. No. 123

Page No. 69
Book No. VII
Series of 2007

ATTY _________________________________
COMMISSION NO. _____________________
NOTARY PUBLIC for _____________________
UNTIL DECEMBER 31, 200_
OFFICE: _____________________
ROLL NO. 00001
IBP Lifetime Roll No. 1234567 ; 01/07/07 ; ________
PTR NO 1234567 ; 01/07/07 ; ________
MCLE COMPLIANCE No. __________; July 7, 2007