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Form 3. Complaint on a Promissory Note

1. Allegation of jurisdiction. 2. Defendant on or about June 1, 1935, executed and delivered to plaintiff a promissory note [in the following words and figures: (here set out the note verbatim)]; [a copy of which is hereto annexed as Exhibit A]; [whereby defendant promised to pay to plaintiff or order on June 1, 1936 the sum of XXX dollars with interest thereon at the rate of six percent. per annum]. 3. Defendant owes to plaintiff the amount of said note and interest. Wherefore plaintiff demands judgment against defendant for the sum of XXX dollars, interest, and costs. Signed: XXXXXXXXXXXXXX, Attorney for Plaintiff. Address: XXXXXXXXXXXXX

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