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Notice Of Rescission--To Present Holder Of Instrument
NOTICE OF RESCISSION--TO PRESENT HOLDER OF INSTRUMENT
To: [present holder of instrument]
[address of present holder]
[Name of Indorser], of [address of Indorser], [city of Indorser], [state of Indorser], the undersigned, negotiated the instrument described below to [Name of transferee], of [address of transferee], [city of transferee], [state of transferee], on [date]. The instrument referred to was made by [Name of maker], of
[address of maker], [city of maker], [state of maker], on [date instrument was made], which instrument is to pay $[Amount to pay] Dollars on [date to pay], to the order of [Name of payee], of [address of payee], [city of payee], [state of payee], or to the rightful holder. The undersigned understands that you are presently holding the instrument. The undersigned rescinds [his or her] negotiation of this instrument because [Facts justifying rescission, such as: the negotiation of the instrument was obtained by fraud]. The undersigned, therefore, requests that you return the instrument promptly to [him or her].
Dated:
signature