(Personalized Seal). (Seal). Given under my hand and seal of office this _____ day of ______, 20____.(Notary's Signature). Learn what an acknowledgement receipt is and how to create one for your business (with a template and two examples). Name of Authorized Agent, Fiduciary, or Secured. Each receipt is blank, intended to be filled out with details of the transaction such as names, amounts, reasons for payment, and signature of the receiver. A form for the employee to sign acknowledging receipt of the policies. Following are samples of these provisions. When there are multiple donors or recipients signing, additional copies of this form should be used to document signatures and notary acknowledgements. I have a document that two people are signing.