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EXHIBIT 4
FORM OF
NOTE
$ MINNEAPOLIS, MINNESOTA
, 2000
FOR VALUE RECEIVED, the undersigned ("Borrower") promises to pay Midwest
Medical Insurance Company, or order, the principal sum of ($ ), with no
interest, payable on demand.
Presentment, notice of dishonor, and protest are hereby waived by all
makers, sureties, guarantors and endorsers hereof. This Note shall be the joint
and several obligation of all makers, sureties, guarantors and endorsers, and
shall be binding upon them and their successors and assigns.
Any notice to Borrower provided for in this Note shall be given by mailing
such notice by certified mail addressed to Borrower at the Property Address
stated below, or to such other address as Borrower may designated by Notice to
the Noteholder. Any notice to the Noteholder shall be given by mailing such
notice by certified mail, return receipt requested, to the Noteholder at the
address stated in the first paragraph of this Note, or at such other address as
may have been designated by notice to Xxxxxxxx.
MIDWEST MEDICAL INSURANCE HOLDING
COMPANY
By:
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Its: President
Property Address:
