Single Installment Note

FOR VALUED RECEIVED, the borrower ________ [Name], residing at ________ [Address], who has executed this note below, shall pay to ________ [Name] (the lender or his or her assignee) the principal amount of $------ [Dollars], together with interest calculated at __ percent (---%), per year on the outstanding balance.

The entire amount, principal and interest, shall be due and payable on or before the ________ day of ________ [Month] 20 __, at the following address:

[List Address]

Failure to make payment when due shall be a default of the loan. Should a default exist for more than [---] days, the borrower agrees to pay the holder of this note reasonable costs of collection including attorney fees.

Dated this ________ day of ________, [Month] 20 __.

[Signature]

[Borrower]

ACKNOWLEDGEMENT BY NOTARY PUBLIC

State of ________)

) SS.:

County of________)

On ________, before me, ________, Notary Public, personally appeared ________, who proved to me on the basis of satisfactory evidence to be the person(s) whose names(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 signatures on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

I certify under the PENALTY OF PERJURY under the laws of the State of _________ that the foregoing paragraph is true and correct.

WITNESS my hand and official seal.

[signature]

Name of Notary

Notary Public

My Commission Expires

[Seal]

[Address]