To: ______________________ (party liable on instrument)

______________________ (address)

______________________

Please take notice that presentment of a promissory note for __________ Dollars ($__________) made by __________ (maker), of __________ (address), __________ (city), __________ County, __________ (state), and payable to __________ (payee), of __________ (address), __________ (city), __________ County, __________ (state), on __________ (date), was made on __________ (date). The undersigned, who is the present holder of the promissory note described above, presented the note to __________ (maker) and payment was demanded. __________ (Maker) refused to make payment. The undersigned, therefore, looks to you for payment, including the payment of all interest, costs, and charges that have already accrued or that may accrue in the future by reason of the nonpayment of this promissory note.

Dated: __________________