Cognovit Promissory Note

$____________________                             _______________19____

For value received the undersigned, ___________________________________

_______________________________________ promises to pay to the order of

______________________________________________________________ Dollars,

with interest at the rate of _________ per cent per annum, payable 

_______________________________________________________________________

the principal to be due and payable ___________________________________

and both principal and interest to be payable at:  ____________________

_______________________________________________   or at any other place

hereafter designated by the holder.

Said interest rate shall be reduced to ______ per cent per annum so long
as each and every installment of interest andprincipal is paid as the 
same falls due or within ten days thereafter. 

Any holder hereof without notice to anyone may declare the entire debt 
due after ten days continuous default in the payment of any installment
of principal or interest or in the performance or observance of any
covenant or condition contained in the mortgage securing this note. 
Upon such declaration the entire debt shall be immediately due and 
payable.

Overdue installments of interest and principal shall bear interest at 
the rate of ________ per cent per annum, payable quarterly.

Any attorney-at-law may appear in any court of record situated in the
County where _______________________________ then reside or in the 
County where ________________________ signed this warranty and being 
in the Unites States at any time after the debt hereby evidenced shall
become due, either at its stated maturity or by declaration, and waive 
the issuing and service of process and confess judgment against the 
maker or makers, jointly and severally, in favor of the holder, for 
the amount then owing hereon, together with the costs of suit, and
thereupon, release all errors and waive all right of appeal.

This note is secured by a mortgage from the maker or makers to the 
payee upon premises known or designated as 

_____________________________________________________________________.

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