In Re: Fiduciary No. RECEIPT. The sample acknowledgement letters for receipt of payment provided below can be used as format templates for official and personal purposes.The Accounting Department of the Fairfax Circuit Court is located on the third floor of the Fairfax County Courthouse at 4110 Chain Bridge Road in Suite 318. Acknowledgment of receipt for payment​​ Use this template to acknowledge the receipt of a payment. Dear (Recipient's name), I hope you are well. Once we receive this completed form, the money will be direct deposited into the account indicated on this form. Learn what an acknowledgement receipt is and how to create one for your business (with a template and two examples). This manual is intended to assist persons who are involved in the administration of a decedent's estate in Virginia. Upon receipt of this Acknowledgement, you will receive a final approval letter that will accompany the signed acknowledgment. Upon request, a tenant is entitled to a written statement of all charges and payments over the past 12 months.