Date: ____________________________________
 

To: ____________________________________
             Name of Defendant

____________________________________
              Address of Defendant
____________________________________
 

You have not paid a debt owed to _______________________________________________
                                                                                      Name and address of plaintiff
________________________________________________________________________ which you

incurred on ____________________________________. Our records show that you have made
                                   date(s) debt was incurred
the following payment in partial satisfaction of this debt __________________________________
                                                                                                                                             Date(s) and amount(s) paid
_________________________________________________. The amount remaining unpaid on the

debt is $ ______________. Demand is hereby made that this money be paid. Unless payment

of this amount if received by the undersigned no later than ______________________________,
                                                                                                                                                     Date payment expected
a lawsuit will be brought against you in the Commercial Claims part of the Court.

If a lawsuit is commenced, you will be notified of the hearing date and you will be entitled

to appear at the hearing and present any defense you may have to this claim.

______________________________________
Claimant's Name
______________________________________
Claimant's Address
______________________________________