FORM OF EVIDENCE OF INDEBTEDNESSAssuranceamerica Corp • May 3rd, 2005 • Fire, marine & casualty insurance
This agreement has been delivered as evidence of indebtedness of Sercap Holdings, LLC to Guy W. Millner, for accrued and unpaid interest in the amount of $2,965,127 owed by the Borrower to Millner under a promissory note dated January 23, 1998, and a promissory note dated January 1, 1999. This Evidence of Indebtedness is not intended to constitute payment of such accrued and unpaid interest.
