“Help us to stay online by your kind donation.
Every penny will help.”
Acknowledgment of Receipt of Collateral
1. Acknowledgment of Receipt of Collateral. I, [name]
(Creditor), acknowledge receipt of [number] shares of the common
stock of [name] from [name] (Debtor), in accordance with the
terms of a note executed by Debtor to my order on [date] in the
sum of ---------- dollars ($----------). I also acknowledge receipt
of [number] stock powers signed in blank by Debtor.
2. Creditor to Safeguard Collateral. While the
collateral is in my possession, I will keep it in a secure place,
reasonably protected from loss by casualty or theft.
3. Return of Collateral to Debtor. Upon payment by
Debtor of all sums due on the note, I will promptly return all
collateral and all stock powers signed in blank by Debtor held by
me, unless the collateral has been sold in accordance with the
STATE OF ----------)
COUNTY OF ---------)
On this [date] before me came [name], to me known and known to me to
be the individual described in and who executed the foregoing
instrument, and he acknowledged that he executed the same.
Witness my hand and official seal.
My commission expires: _____