REPUBLIC OF THE PHILIPPINES)
CITY/MUNICIPALITY OF ______) SS.
BEFORE ME, a Notary Public for and in the (Province/City/Municipality) of _____________, personally appeared the following persons, with their respective Community Tax Certificates as follows:
Name C.T.C. No. Date / Place Issued
1. ____________ _____________ _____________
2. _____________ _____________ _____________
3. _____________ _____________ _____________
all known to me and to me known to be the same persons who executed the foregoing instrument which they acknowledged to me to be their free and voluntary act and deed, consisting of only ______ (____) page/s, including this page in which this Acknowledgement is written, duly signed by them and their instrumental witnesses on each and every page hereof.
WITNESS MY HAND AND SEAL this _____________ at _____________, Philippines.
Doc. No. ______;
Page No. ______;
Book No. ______;
Series of ______;