Reserved

9-11-103. Form of complaint on a promissory note. IN THE COURT OF COUNTY STATE OF GEORGIA A.B., ) Plaintiff ) ) v. C.D., Defendant ) ) Civil action File no. ) ) (Clerk will insert number.) COMPLAINT The defendant C.D., herein named, is a resident of (street), (city), County, Georgia, and is subject to the jurisdiction of this court. 1. Defendant on or about June 1, 1965, 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, 1966, the sum of $10,000.00 with interest thereon at the rate of 6 percent per annum. 2. Defendant owes to plaintiff the amount of said note and interest. Wherefore, plaintiff demands judgment against defendant for the sum of $10,000.00, interest, costs, and attorney fees (where applicable). 1055 9-11-103 Attorney for plaintiff Address (Ga. L. 1966, p. 609, § 103; Ga. L. 1980, p. 649, § 1.)