1. Allegation of jurisdiction.
2. Defendant on or about ____(month)_____(day)_____(year),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 ____(month)_____(day)_____(year)，the sum of __________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 _________ dollars, interest, and costs.
Signed: ______________
Attorney for Plaintiff
Address: _____________
