NON-NEGOTIABLE CHARGEBACK

OFFICE HOLDER
SECRETARY OF TREASURY

ACCEPTED
VALUE ______________________________
THE UNDERSIGNED ACCEPTS & ASSIGNS
THE ABOVE VALUE IN CREDIT FOR
ALL RELATED ENDORSEMENTS FRONT AND BACK
IN ACCORDANCE WITH UNIFORM COMMERICAL CODE
§§ 1-104, 3-419 AND
HOUSE JOINT RESOLUTION 192 OF JUNE 5TH 1933
CHARGE UCC CONTRACT TRUST ACCOUNT
# ____________________________
FOR THE REGISTRATION FEE AND COMMAND THE
MEMORY OF ACCOUNT # __________________ TO CHARGE THE
SAME TO THE DEBTOR’S ORDER OR THE ORDER OF THE
TREASURY OFFICE HOLDER

DATE: ________________________

/S/: ____________________________

PRE-PAID - - PREFERRED STOCK

PRIORITY - - EXEMPT FROM LEVY