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ACKNOWLEDGMENT
REPUBLIC OF THE PHILIPPINES)
CITY OF _________ )SS.
X - -- - - - - - - - - - - - - - - - - - - - - -X
BEFORE ME, a Notary Public for and in the City of _________, Philippines
this _______________ personally appeared (name of assignor) and (name
of assignee) with their Community Tax Certificate Nos. as follows:
Name CTC No. Date Issued Place Issued
___________ ________ ________ ________
___________ ________ ________ ________