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ACKNOWLEDGEMENTS AND JURAT

Form No. 1-- ACKNOWLEDGMENT (Ordinary Short Form)

REPUBLIC OF THE PHILIPPINES )

CITY/MUNICIPALITY OF ........) SS.

BEFORE ME, a Notary Public for and in the Province /City of....... this... . day
of.... ...19........personally came and appeared....... ............,with Residence Certificates No.
A-.............. issued on ............. at .................. and Tax Account No.3 .......... known to me
and to me known to be the same person who executed the foregoing instrument which he
acknowledged before me as his free and voluntary act and deed.

1. 'SS. (or ss.) means "scilicet" from the latin scire licet, "it is permitted to know" and
is translated to mean "to wit, or namely",and utilized here to particularize the place of the
execution of the instrument. The place, however, is not so material as to in validatethe
instrument by its absence (BABCOCK v. ANUTZCH, 85 Hun.33, 32, N.Y. Suppi. 689
Bouvier's Law Die.). It is material only to indicate the jurisdiction of the notary, which is
co-extensive with the province or city in which he is appointed (SEC. 240, ADM.
CODE).

2. The residence certificate to be exhibited shall be the one issued for the current year,
except during the month of January of each year, where that for the previous year shall
stiff ice (SEC. 6, C.A.465).
The residence certificate is required of everyone above 18 years Of age provided he
has been employed regularly on a wage or salary basis for at least 30 consecutive days; or
who is engaged in business or occupation, or owns real property; or who is required by
law to file an income tax return (SEC. I, Ibid).

The following are exempt from the residence tax-, diplomatic and consular
representatives and officers of foreign powers; commissioned officers, enlisted soldiers
and marines of the U.S. Army and Navy; civilian officers and employees of the U.S.
Government who are not Filipino citizens; temporary visitors in the Philippines for not
exceeding 3 months; barrio lieutenants (now barangay captains under P.D. 657) and their
substitutes, barrio councilors, and policemen while holding office assuch (SEC. 4, Ibid.
as amended).
 The failure of the notary to make the proper notation regarding cedula (residence)
certificates is a ground for the revocation of his commission (SEC. 249 (/) ADM. CODE)

"Sec. 337-A(2) of the Tax Code requires any person who is required under the Code to
make, render, or file a return, statement, or other document with respect to another
person, to request from such other person his taxpayer account number (T.A.N.) for
proper identification.

WITNESS MY HAND AND SEAL* this ....................... day of ............. 19... .

at ............... ...

Notary Public
My Commission Expires on 31 Dec. 19. . .
. PTR No." ............
Issued on...........
At.................

Doc. No. ..;

Page No. . ;
Book No. . . .;
Series of........................