Date: _____________________
To: _______________________
Street Address: _______________________________________________________________
City: __________________________ State: ________ Pin Code: _______________________
This is to acknowledge that the undersigned has received the sum of Rs. ___________________ from ____________________. This amount constitutes
[full] payment for the period of __________ to _____________ for the above-described premises. [This leaves an outstanding balance of Rs._____________, which must be paid to the undersigned by the tenant no later than _______________________, ___________.]
Received by: _________________________________________
Printed Name: ________________________________________
Title: ________________________________________________….
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