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Notice By Adverse Claimant--Stop Payment To Holder
NOTICE BY ADVERSE CLAIMANT--STOP PAYMENT TO HOLDER
To: [name of maker or as the case may be]
[address of maker]
[Name of adverse claimant], of [address of adverse claimant], [city of adverse claimant], [state of adverse claimant], the undersigned, objects to your making payment to [name of present holder of instrument], of [address of present holder], [city of present holder], [state of present holder], on an instrument dated [Date of instrument], and by which you are to pay $[Amount to pay] Dollars to the holder of the instrument on [date to pay]. [name of present holder of instrument] is not the rightful holder of the instrument because [reason, such as: he or she acquired the instrument by theft]; the undersigned is the rightful holder of the instrument and is entitled to receive payment from you.
The undersigned demands that you make payment to [him or her]. The undersigned has enclosed an indemnity bond. This bond was issued by [name of surety company], of [address of surety company], [city of surety company], [state of surety company], for $[amount of issue] Dollars. This bond is payable to you on the condition that after you make payment to the undersigned on the instrument described above, a court of competent jurisdiction may hold that [name of present holder of the instrument] was the rightful holder and force you to make payment to [name of present holder of instrument] on the same instrument. The condition of this bond also provides for payment to you of any costs that may be incurred by you in any litigation that may arise from making payment to the undersigned.
Payment of the instrument may be made by mail to the undersigned at [payment address], [payment city], [payment state].
Dated: [Date of agreement]
signature