The sample acknowledgement letters for receipt of payment provided below can be used as format templates for official and personal purposes. This modification allows us to send an acknowledgment receipt and copy of filed image.Since the City of Bristol is exempt from the payment of Federal. Excise Taxes and the Connecticut Sales Tax, do not include such. Complaint sample. PDF. Complaint fill in. PDF. Form 16A — Acknowledgment of Receipt Form. The Dispute Note is a document for the Defendant to fill out if they choose to dispute the Civil Claim. Fill in and return to the address below. For many of the proceedings, a "checklist" is available on the related forms page.