This note shall certify that the trust formed under the agreement between ___________ (Trustor) and ___________________ (Trustee) on ___________________________ (Date) owes a debt to _____________________________ for the following amount:


Principal of $ ______________________________

Annual interest rate of ____________________%


This certifies that the trust established under a trust agreement between _____________ (Name Of Trustor) as trustor and __________ (Name of Trustee) as trustee on _________ (Date) is indebted to ____________________ (Name of Payee) for _________ Dollars ($__________), to be paid solely out of the principal of the trust estate on its termination with interest at the rate of __________ percent (__________%) per year, payable in __________ (Quarterly, or as the Case May Be) installments. This certificate is personal to the payee named in this certificate and may not be transferred or assigned without the written consent of the trustee.



______________________________________           ____________________

Signature                                                                         Date


______________________________________           ____________________

Witness                                                                           Date