Legal & declarations
Acknowledgement of receipt of money template (US)
A general template under US law. Laws differ from state to state, so check it against your state's law or with a lawyer licensed there. We are not a law firm and do not give legal advice.
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Preview — US standard
Acknowledgment of Receipt of Money
I, Recipient Full Name, of Recipient Address, acknowledge that on Payment Date I received from Payer Full Name, of Payer Address, the sum of:
$Amount (Amount in Words dollars)
Payment method: Cash, Check Number, Bank Transfer or Other
Purpose of the payment: Purpose, such as loan, deposit, payment toward an invoice or purchase price
This payment is: Full Payment, Partial Payment, or Loan to Be Repaid Under a Separate Note
Balance still owed after this payment: $Remaining Balance or None
A check or transfer is received subject to its clearing.
Recipient signature: Recipient Signature
Printed name: Recipient Printed Name
Date: Signing Date
Witness (optional): Witness Signature and Printed Name