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Counter Demands By Party To Whom Presentment Made
To: [Holder of Instrument]
[Name], the undersigned, of [Address], has received your letter of [Date], in which you state that you are the holder of a negotiable instrument on which the undersigned is liable in the capacity of [Enumerate].
Pursuant to [Cite local enactment of UCC $ 3-501(b)(2)], the undersigned demands, without the intention of dishonoring the instrument, [Describe demands, such as: the exhibition and production of the instrument at (Address)], reasonable proof of your identity, and the surrender of the instrument when the undersigned makes full payment on it).
*** If Required By State Law ***
This Section for Notary:
STATE OF -------)
) ss: [Date]
COUNTY OF ------)
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.
[Name of Notary Public]
My commission expires: [date]