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[date]
[city], [state]
In consideration of ---------- dollars ($----------), it is agreed that the promissory note of [date], due [date], for the face amount of ---------- dollars ($----------), signed by [name], is extended to become payable on [date]. The extension shall be at an annual interest rate of ---------- percent (----------%) for the period from [date] to [date], and is subject to all the terms and conditions named in the promissory note, which shall, until payment in full, remain and be in full force and effect.
[signature] [signature]
Holder of Note Borrower