ACKNOWLEDGEMENT FORM A_1

AC KN OWLED GEMENT
REPUBLIC OF THE PHILIPPINES )
PROVINCE OF LA UNION
) S.S.
MUNICIPALITY OF AGOO
)
BEFORE ME, a Notary Public in and for the Province of La Union, Municipality
of Agoo on this day personally appeared:
Name

Com. Tax Cert. No.

Date & Place of Issue

PEPE X. RIZAL

1234567

01/07/2007 ; Agoo, La Union

BONIFACIO X. ANDRES

7654321

01/07/2007 ; Sto Tomas, La Union

______________________

________________

_____________________________

______________________

________________

_____________________________

______________________

________________

_____________________________

known to me and to me known to be the same person who executed the foregoing
instrument and who acknowledged to me that the same is their own free and voluntary act
and deed and that of the corporation they represent.
WITNESS MY HAND AND SEAL this 7th day of July, 2007 at Agoo La Union.

Doc. No. 123

Page No. 69
Book No. VII
Series of 2007

ATTY _________________________________
COMMISSION NO. __________________
NOTARY PUBLIC for AGOO, LA UNION
UNTIL DECEMBER 31, 2007
OFFICE: _______________________________________
ROLL NO. 00001 ADMMITTED AT BAR: Dec. 20, 1958
IBP NO. 1234567 ; 01/07/07 ; LA UNION
PTR NO 1234567 ; 01/07/07 ; LA UNION
MCLE COMPLIANCE No. __________; July 7, 2007