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Disclosure Statement and Note
(Federal Truth-in-Lending Act)
FOR VALUE RECEIVED, the borrower ______________________, residing at _____________________, shall pay to the order of _______________________, the total amount of ________________________ dollars ($------) in consecutive payments payable on the _______ day of the month __________, beginning on _________, 20 ____, until the loan is paid in full.
Failure to make a payment when due shall be a default of the loan. Should a default exist for more than (--) days, the holder of this note may cause the entire loan to be due immediately.
1. Amount of Loan:
3. Total Financed:
4. Interest Charges:
5. Total of Payments:
6. Annual Financed Percentage Rate:
*** If Required By State Law ***
This Section for Notary:
State of _________
County of ________ [COUNTY]
On [DATE] before me, [NAME OF NOTARY], notary, personally appeared [NAME OF PERSON(S) INVOLVED], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
Witness my hand and official seal.
My commission expires: _____