On the _______day of ______ in the year_____, before me, the undersigned notary public, personally appeared. Employee Acknowledgement: On this day, I received notice of my pay rate, overtime rate (if eligible), allowances, and designated payday.Learn what an acknowledgement receipt is and how to create one for your business (with a template and two examples). Forms ; Summons extra caption. PDF ; Complaint sample. This document is a receipt acknowledging payment received from an individual or entity. The PDF version of these forms are FILLABLE. They can be filled out electronically, then printed. Bring the required documents and the Vehicle Release Form with you. Only the original application will be accepted.