COMPLAINT ON A PROMISSORY NOTE

1. Allegation of jurisdiction.

2. Defendant on or about June 1，1935，executed and delivered to plaintiff a promissory note[in the following words and figures（here set out the note verbatim）]；[a copy of which is hereto annexed as Exhibit A]； [whereby defendant promised to pay to plaintiff or order on June 1，1936 the sum of __________dollars with interest thereon at the rate of six percent per annum].

3. Defendant owes to plaintiff the amount of said note and interest.

Wherefore plaintiff demands judgment against defendant for the sum of _________ dollars， interest， and costs.

Signed： ___________

Attorney for Plaintiff

Address： __________