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Certificatr Of Protest Of Commercial Paper
STATE OF -------]
] ss: [Date]
COUNTY OF ------]
On [Date], at the request of [Holder of Instrument], of [Address], I, [Name], a duly commissioned and sworn notary public, residing at [Address], did during the business hours of this day present the original instrument that is annexed to this certificate to [Maker Or As Case May Be], of [Address], and demand payment thereof. Payment was refused for the following reason: [Enumerate].
Whereupon, I, at the request of [Holder of Instrument], did protest and do hereby protest against every [Maker Or As Case May Be] and indorser and against all others against whom it is proper to protest, for exchange, re-exchange, and all costs, damages, and interest already incurred and to be incurred on this instrument.
I do hereby certify on the day written above that notice of protest, demand, and nonpayment of the instrument described above was served on the following parties at the following addresses: [Designate Names & Addresses].
The notices were served by [Registered or Certified] mail, with postage prepaid and returned receipt requested. The addresses to which the notices were sent are the addresses given in the instrument or, if no addresses were given in the instrument, the addresses used were the reputed places of residence or business of the parties.
In testimony whereof, I have set my hand and affixed my seal on the day first above written. My commission expires on [Date].
Amount protested is:
Amount due on instrument [$------]
Interest due from [Date] to [Date]
Protest fee [$------]
Notice fee [$------]
Witness my hand and official seal.
[Name of Notary Public]
My commission expires: [date]