3.被告欠原告该本票所载款项及利息。
据此，原告请求判决被告偿付________美元的款项、利息及费用。签名：___________
原告律师
地址；_____________
Form1
COMPLAINTONAPROMIORYNOTE
1.Allegationofjurisdiction.
2.DefendantonoraboutJune1,1935,executedanddeliveredtoplaintiffapromiorynote[inthefollowingwordsandfigures（heresetoutthenoteverbatim）];[acopyofwhichisheretoaexedasExhibitA];[wherebydefendantpromisedtopaytoplaintiffororderonJune1,1936thesumof__________dollarswithinterestthereonattherateofsixpercentperaum].
3.Defendantowestoplaintifftheamountofsaidnoteandinterest.
Whereforeplaintiffdemandsjudgmentagaitdefendantforthesumof_________dollars,interest,andcosts.
Signed:___________
AttorneyforPlaintiff
Addre:__________