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Bill of Exchange Template

This invoice is for $amount regarding case/bill number. It accepts the value for honor, consideration, and in accordance with various Uniform Commercial Code and public law. The invoice directs the treasury to credit the court/business and discharge the public liability for the taxpayer. It is signed by the surety without recourse on behalf of the payor.

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14K views2 pages

Bill of Exchange Template

This invoice is for $amount regarding case/bill number. It accepts the value for honor, consideration, and in accordance with various Uniform Commercial Code and public law. The invoice directs the treasury to credit the court/business and discharge the public liability for the taxpayer. It is signed by the surety without recourse on behalf of the payor.

Uploaded by

Swank
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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Date: Today’s Date, 2021 Invoice # EX98765

**(supply your own invoice number – can be anything)**

Registered / Certified Mail # xxxx xxxx xxxx xxxx xxxx

BILL OF EXCHANGE
NON-NEGOTIABLE
PRIVATE ISSUE

Pass-Through Account # SSN-xx-xxxx

Re: Non-Negotiable Acceptance of Inconsideration and Request Inconsolation in Accord with


U.C.C. § 3-419, HJR-192 of 5 June 1933, Public Law § 73-10, and Registered Adjustment of Account:

Collateral: Case # or Creditor Bill # xxxxxxxxxx

Value of Bill: $ _________________________________.

The Undersigned accepts for value, honor, and consideration all indorsements front and back and includes
those in accord with U.C.C. § 3-419 as evidence with the herein Bill of Exchange to U.C.C. Contract
Account # SSN-xx-xxxx in the amount listed below and is part of the Undersigned’s tax estimate for use by
the Republic, and the account is charged for the fees necessary for securing and registering the priority
exchange for the tax exemption to discharge the public liability in accord with HJR-192 of 5 June 1933 and
Public Law § 73-10. The Undersigned directs commanding the memory of account # SSN-xx-xxxx and
charging the same to the debtor’s order or to the Secretary of the Treasury’s order.
Without Recourse,

By:___________________________________

First Middle Last, as Surety


for FIRST MIDDLE LAST, Payor
c/o 1234 Your Address Street
City / Town, State [12345]

………………………………………………………………………………………………………………………………………
Please detach Please detach

Return to: First Middle Last


Date: Date 1, 2020 c/o 1234 Your Address Street
City / Town, State, nearby [12345]

Invoice # InvoiceNumFromTop
Pass-Through Account #: SSN-xx-xxxx
Collateral: Case # or Bill # xxxxxxxxxx
Pay to: UNITED STATES TREASURY
For Credit to: COURT / BUSINESS NAME GOES HERE Indorsement of Payor:

Value of Bill: $ __________________ ______________________


Authorized Representative
without recourse
Written Amount: _________________________________________ Dollars
STUB STUB

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