ACKNOWLEDGMENT. County, North Carolina. Dear CLAIMANT OR EMPLOYER: This is to acknowledge receipt of a copy of a Petition for Judicial Review of Higher Authority.I,. , a Notary Public for said County and. Learn what an acknowledgement receipt is and how to create one for your business (with a template and two examples). Looking for local rules and forms? This is a sample of letter acknowledging receipt of an appeal. EMPLOYER. NOTIFICATION. The Appeals Department received the 's appeal to. IN THE MATTER OF: APPEALS DECISION NO. VII-A-90871. CLAIMANT. Make changes to the sample. Use the upper and left panel tools to modify Receipt acknowledgment.