On the _______day of ______ in the year_____, before me, the undersigned notary public, personally appeared. Acknowledgment receipt examples.Use this sample as a guide to help you create your own acknowledgment receipt: Sample 1. After filing online, you will receive an email filing acknowledgement with your filing receipt attached in PDF format. Next, provide the name and signature of the person acknowledging receipt. This is only a sample of the form for an answer. Print or type, double spaced, using black ink only. An acknowledgment is one of the most common types of notarial acts, but it often confuses Notaries. Here are 5 steps to performing an acknowledgment. (a) The standard application form has been filled out in its entirety with all requested information presented in clear language.