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Notice Of Dishonor Of Draft

STATE OF ----------)

) s.s.:

COUNTY OF ---------)

[date]

Please take notice that a draft for ---------- dollars ($----------), drawn by [name] on [institution], in favor of [name], or order of [date], and payable on [date], [acceptance or payment] of the draft was this day demanded, and not having been [accepted or paid] was PROTESTED by the undersigned Notary Public for [nonacceptance or nonpayment].

Holder looks to you for payment as [drawer or indorser].

[signature]

Notary Public

To: [name]