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JUDGMENT NOTE
II
r~,lPV1.,iJ' ,,\'Ik,( '~ ,Pennsylvania, VlI".,(1. I., ,
(plaoe) (dale)
FOR VALUE RECEIVED, IIwe promise 10 pay to the order of
Ir"IuI, $ I,l/L, q , ~II
(amount)
(.:,Ii.,,r: .j.'~\... (,\J,.)CI (::),trJI.J/O
the sum Ol'~ I, ~Il, ~ . i-/ /
dollars.
wmHntetnt-et thlttllteol 18% per annum Irommaturlly. laid sum to be payable as
lollows:-r \A.lf.ITt 'i . i-'X\JC -" dollars, ($,;,15'''0)
on the I ',t, day 01 Pfl~'( 19G,.l, and
<. (c.)/':::..JTY, '(-1. \1(: dollars, ($,;>5.,,.,)
on the
\ ~A,
day 01 each and every V,I ",,),(t.-,
t. I 5~_f)(" d i,.., reI II
("..... o v,.) ~ot-_"_.__..__
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therealler until the t, u ~,,,, ,
on whloh date the entire balance 01 the principal then unpaid shall beoome due and payable.
UPON FAILURE to make any payments as herein agreed, this note shall, at the option 01
Its holder, become Immediately due and payable, without demand or nolloe.
AND FURTHER, IIwe do hereby authorize and empower the Prothonotary or allY attorney
01 any Court 01 Reoord 01 Pennsylvania or elsewhere, to appear for and Confess judgment
lor the sum due and payable hereon, with or without declaration, with costs of suit, relea$e
01 errors, without stay 01 execution; and also waive Ihe rlghl 01 Inquisition on any real
estate that may be levied upon to oollect Ihls note; and do hereby voluntarily condemn
the same and authorize the Prothonotary to enter said voluntary condemnallon upon any
Fieri Facias that may be Issued to oollect said judgmenti and lurther agree that said estate
may be sold on a Fieri Facias, and do hereby waive and release all relief from any and
all appraisement, stay 01 execullon, exemption or bankruptcy laws 01 this or any other
state now In loroe or hereafter to be passed.
~~~--_. (L.S.)
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-~.?'"';;:.9 ;,.-:.,-,-~- (L.S.)
This note Is given and exeouled without duress or coercion and with lull and complete
understanding that upon lallure 10 make payment as agreed, that my operating privileges
may be suspended.
F'Irlhar, I do hereby acknowledge that the damages Incurred In the accident 01
Av~..... ~ ~l . 19 q I lor which this note Is given resulted Irom my negllgenoe
and fault, and I do hereby aoknowledge and waive my right to any hearing or trial on that
Issue.
DRIVER DATE OF BIRTH lC"..} 'l C.!
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DRIVER \l1ll~).TI'JR NUMBEfI 10 (),l' Y f' j'
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'(L.S.)
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OWNER DATE OF BIRTH
OWNER OPERATOR NUMBER
9'1 " ',0" pu,d",), >.I
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