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To:  _______________________ (person answerable over)

       _______________________ (address)



An action has been brought against the undersigned, __________ (defendant), of __________ (address), __________ (city), __________ County, __________ (state), in the __________ Court of __________ County, Docket No. __________, on a negotiable instrument on which the undersigned may be liable in the capacity of __________. This instrument was executed on __________ (date), by __________. The instrument promises to pay __________ Dollars ($__________) on or before __________ (date), to the order of __________ (payee), of __________ (address), __________ (city), __________ County, __________ (state). You are liable on this instrument in the capacity of __________, and you are also liable over to the undersigned if the undersigned is held liable in this action.


Please take notice that the undersigned demands that you appear and defend this action against __________ (him or her). If you do not do so within __________ days from the receipt of this notice, which notice has been sent to you by __________ (registered or certified mail), with postage prepaid and return receipt requested, you will be bound in any action that the undersigned may hereafter bring against you with regard to any determination of facts common to the two litigations.


Dated: __________





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