RECEIPT FOR LOAN

Full names:______________(lender)

Address:_______________

Full names:______________(Borrower)

Address:_______________

Re: promissory Note dated___________20___

The Lender hereby acknowledges receipt of the sum of_____________

As payment in respect of the note referenced above.

As per terms of the Note all payments shall first be applied to interest accrued to date and thereafter to the principal amount. The remaining unpaid balance on this date is______

Signed on this ______ day of _____ 20__

Signature of Lender:

Signature of Witness: