Promissory Note Page 4

CROSS RECEIPT

[CORPORATE NAME], a __________________ corporation (the “Company”),

hereby acknowledges receipt from [NAME OF STOCKHOLDER] (the “Holder”) of the

full principal amount of the Promissory Note of the Company dated the date hereof, a

copy of which is attached hereto, and Holder hereby acknowledges receipt of such Note.

[CORPORATE NAME]

By: _________________________

Authorized Officer

_____________________________

Stockholder

Stockholder’s Promissory Note

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Parent category: Miscellaneous