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.8. Employee Acknowledgement: On this day, I received notice of my pay rate, overtime rate (if eligible), allowances, and designated payday. The sample acknowledgement letters for receipt of payment provided below can be used as format templates for official and personal purposes. Thank you for your prompt payment. How do I fill this out? Filling out this document involves providing accurate employer and employee details. How do you fill out an acknowledgment letter? How to fill out the New York State Notice Acknowledgement of Pay Rate? You can also download it, export it or print it out.