staple check here and staple this form to the cd or

RECEIPT OF CHECK
STAPLE CHECK HERE AND STAPLE THIS
FORM TO THE CD OR ESTIMATE.
Borrower and Notary- Please sign below to confirm that
the Notary has received your check and that it was
stapled to this form, and this form was stapled to the CD
or Estimate.
_____________________
_____________________
Borrower
Notary
_____________________
_____________________
Borrower