COMPLAINT ON A PROMISSORY NOTE

　　1. Allegation of jurisdiction.

　　2. Defendant on or about June 1,1935,executed and delivered to plaintiff a promissory note[in the following words and figures（here set out the note verbatim）];[a copy of which is hereto annexed as Exhibit A]; [whereby defendant promised to pay to plaintiff or order on June 1,1936 the sum of __________dollars with interest thereon at the rate of six percent per annum].

　　3. Defendant owes to plaintiff the amount of said note and interest.

　　Wherefore plaintiff demands judgment against defendant for the sum of _________ dollars, interest, and costs.

　　Signed: ___________

　　Attorney for Plaintiff

　　Address: __________