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Back to Forms for 'Notices'.





To:  _______________________ (maker or as the case may be)

       _______________________ (address)



__________ (Adverse claimant), of __________ (address), __________ (city), __________ (county), __________ (state), the undersigned, objects to your making payment to __________ (present holder of instrument), of __________ (address), __________ (city), __________ (county), __________ (state), on an instrument dated __________, and by which you are to pay __________ Dollars ($__________) to the holder of the instrument on __________ (date).  ______________ (Present holder of instrument) is not the rightful holder of the instrument because __________ (designate reason, such as: __________ (he or she) acquired the instrument by theft).  The undersigned is the rightful holder of the instrument and is entitled to receive payment from you.


Pursuant to __________ (cite local enactment of UCC § 3-602), the undersigned demands that you make payment to __________ (him or her).  The undersigned has enclosed an indemnity bond.  This bond was issued by __________ (surety company), of __________ (address), __________ (city), __________ (county), __________ (state), for __________ Dollars ($__________).  This bond is payable to you on the condition that after you make payment to the undersigned on the instrument described above, a court of competent jurisdiction may hold that __________ (present holder of the instrument) was the rightful holder and force you to make payment to __________ (present holder of instrument) on the same instrument.  The condition of this bond also provides for payment to you of any costs that may be incurred by you in any litigation that may arise from making payment to the undersigned.


Payment of the instrument may be made by mail to the undersigned at __________ (address), __________ (city), __________ (county), __________ (state).


Dated: _____________________________






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