CERTIFICATE OF FULL PAYMENT OF LOAN

This Certificate of Full Payment of Loan (the “Certificate”) is being issued this
[INSERT DATE] in consideration of the fully payment by [INSERT FULL NAME OF
BORROWER] (the “Borrower”), residing at [INSERT ADDRESS], of the debt
evidenced by the Loan Agreement dated [INSERT DATE] (the “Agreement”) /
Promissory Note date [INSERT DATE] (the “Promissory Note).

I hereby release and forever discharge the Borrower, his/her successors and
assigns, from any and all manner of actions, cause and causes of action, suits,
debts, sums of money, damages, and demands whatsoever, in law or in equity,
whether known or unknown arising of the Agreement/Promissory Note and all
prior debts, whether known or unknown are considered released, and
discharged as of this date.

[INSERT NAME OF LENDER]

Lender