Legal & declarations
Acknowledgment of receipt 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
I, Recipient Name, Recipient Title or Capacity, if any, of Recipient Organization or Address, acknowledge that on Receipt Date I received from Sender Name, of Sender Organization or Address, the following:
| Item | Description | Quantity | Condition |
| --- | --- | --- | --- |
| First Item | First Item Description | First Item Quantity | First Item Condition |
| Second Item | Second Item Description | Second Item Quantity | Second Item Condition |
| Third Item | Third Item Description | Third Item Quantity | Third Item Condition |
Purpose: Purpose, such as return of company property, delivery of documents or goods on loan
Notes: Notes or Exceptions, such as missing or damaged items
This acknowledgment confirms only receipt of the items listed, in the condition noted. It is not an acceptance of their quality or an admission about any related claim, unless stated here: Other Statement or None.
| Received by | Delivered by |
| --- | --- |
| Signature: Recipient Signature | Signature: Sender Signature |
| Name: Recipient Printed Name | Name: Sender Printed Name |
| Date: Recipient Signing Date | Date: Sender Signing Date |