On the ____ day of ____ in the year ____ before me, the undersigned, personally appeared. , personally known to me or proved to me on the basis of satisfactory.Learn what an acknowledgement receipt is and how to create one for your business (with a template and two examples). After filing online, you will receive an email filing acknowledgement with your filing receipt attached in PDF format. The Notice explains how we fulfill our commitment to respect the privacy and confidentiality of your protected health information. Next, provide the name and signature of the person acknowledging receipt. Note: All persons involved in a lawsuit should consult an attorney. This office gives you information, forms and instructions on court procedures. Fill in the blanks on the form to show that more than one person acknowledged a signature. Check with the County Clerk regarding acceptable forms of payment.