Evidence of Indebtedness Sample Contracts

FORM OF EVIDENCE OF INDEBTEDNESS
Evidence of Indebtedness • May 3rd, 2005 • Assuranceamerica Corp • 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.

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