_______________, Connecticut

____________________, 20________



            FOR VALUE RECEIVED, I, ________________________, of ________________________________, Connecticut (Social Security No. ___-__-_____) hereby unconditionally promise to pay the sum of ________________________ Dollars and __/100 (_______) to _________________________, a Connecticut corporation (“NOTE HOLDER”), or to its order, together with __% interest per year as follows:Beginning on _____________________ I will make one (1) payment of __.00 and will continue to make payments of ___.00 on the __ of each and every month thereafter up to and including __________________________ and on ________________________ I will pay all outstanding amounts of principal and interest then owing.

I will make these payments payable to Attorney Philip H. Monagan, (the Note Holders Attorney) and I will deliver them to his office, which is located at 61 HOLMES AVENUE, POST OFFICE BOX 2390, WATERBURY, CONNECTICUT 06722-2390.

I have the right to make prepayments of principal at any time before they are due without charge. When I make a prepayment, I will tell Attorney Philip H. Monagan in writing that I am doing so. Any such prepayment shall be credited to the unpaid principal balance, but shall not affect the obligation to pay the regular installments as required under this note until the entire debt has been paid.

If I do not pay the full amount of each monthly payment on the date it is due or if said payments are not received by Attorney Philip H. Monagan on the __ of each month, or if my monthly payments are sent by MAIL and they are not POSTMARKED on or before the __ of each month, then I will be in DEFAULT.

If I am in DEFAULT, I will be required to pay immediately the full amount of principal and interest which has not been paid, without notice of any kind. The Note Holder may bring a lawsuit against me to collect on the Note. Even if, at a time when I am in DEFAULT, the Note Holder does not require me to pay immediately in full as described above, the Note Holder will still have the right to do so at a later time.

If the Note Holder has required me to pay immediately in full as described above, the Note Holder will have the right to be paid back by me for all of its costs and expenses in enforcing this Note to the extent not prohibited by applicable law. These expenses may include reasonable attorneys’ fees as limited by law and the court, court filing fees and/or marshal’s fees in any action to collect money due under the Note. In the event of a collection lawsuit you agree that post judgment interest will accrue on any judgment obtained at the interest rate of this Note.

I hereby waive any rights of presentment and notice of dishonor. “Presentment” means the right to require the Note Holder to demand payment of amounts due. “Notice of dishonor” means the right to require the Note Holder to give notice to other persons that amounts due have not been paid.

Social Security No:         –          –
D.O.B.:       /      /
Dated: ____________________, 20__