Promissory Note {CM111}

IN THE COURT OF CHANCERY OF THE STATE OF DELAWARE IN THE MATTER OF: , a minor /a person with a disability : : : : C.M. # PROMISSORY NOTE I, , ( co - ) g uardian ( s ) of the p rope rty of , a minor /a person with a disability , promise to repay to the guardianship account the amount of $ a month beginning , until the $ borrowed is repaid. Proof of deposits mus t be sent to the Register in Chancery office by the 15 th of each month. Failure to show proof of deposits to the guardianship account will require a C ourt appearance. NO FUTURE PETITIONS TO EXPEND WILL BE CONSIDERED UNTIL THE GUARDIANSHIP ACCOUNT HAS BEEN REPAID IN FULL. STATE OF : COUNTY OF : This instrument was acknowledged before me on this day of , 20 by [Name of affiant] . Notary Public/ Chancery Court Clerk Rev. 4/2018 American LegalNet, Inc. www.FormsWorkFlow.com