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Notice Of Non Payment
To: [Party Liable on Instrument]
Please take notice that presentment of a [Draft], for [$------] drawn by [Drawer], of [Address], on [Drawee], of [Address], endorsed by [Name], of [Address], and payable on [Date] to [Payee], of [Address], was made on [Date].
[Name], the undersigned of [Address], who is the present holder of the [Draft] presented the [Draft] to [drawee] for payment. The [Draft] was dishonored when [Drawee] refused to make payment. The undersigned looks to you for payment, including all interest, costs, and charges that have already accrued or that may accrue in the future by reason of nonpayment of this [Draft].
Undersigned (the present holder of the draft)
*** 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]