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Notice By Adverse Claimant Stop Payment To Holder
To: [Maker or as the case may be]
[Adverse Claimant], of [Address], the undersigned, objects to your making payment to [Present Holder of Instrument], of [Address], on an instrument dated [Date], and by which you are to pay [$------] to the holder of the instrument on [date].
[Present holder of instrument] is not the rightful holder of the instrument because [Designate reason, such as: [Name] acquired the instrument by theft]; the undersigned is the rightful holder of the instrument and is entitled to receive payment from you.
Pursuant to [Cite Local Enactment of UCC $ 3-602], the undersigned demands that you make payment to [Name]. The undersigned has enclosed an indemnity bond. This bond was issued by [Surety Company], of [Address], for [$------].
This bond is payable to you on the condition that after you make payment to the undersigned on the instrument described above, a court of competent jurisdiction may hold that [Present holder of Instrument] was the rightful holder and force you to make payment to Present holder of Instrument] on the same instrument.
The condition of this bond also provides for payment to you of any costs that may be incurred by you in any litigation that may arise from making payment to the undersigned.
Payment of the instrument may be made by mail to the undersigned at [Address].
*** 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]