IOU Form
I, the undersigned (Name of Debtor) hereby confirm and
acknowledge to (Name of Creditor), hereinafter called Creditor, that I
am indebted to said Creditor in the amount of
($ ) dollars as of the date set forth below. The amount includes any and all
legally permitted charges, such as accrued interest, up to the dated set forth below. I
acknowledge and agree that I incurred said Debt and I am solely responsible for repayment of it
to Creditor. I also agree and acknowledge that I have no defense should the Creditor use this
document in a court of laws as a confession of judgment on my part (where legally permissible).
I have promised and agreed to pay the entire amount by (date), and I will
pay a least $ of the amount of said Debt on or before the
(date) of each month beginning (date), until it is paid. I have agreed that
the entire amount of said Debt will be paid on or before (date).
below.
I signed this document on the (date) in front of the Witness named
Signature of Debt Holder Name & Signature of Debtor
Debt Holder’s Printed Name Debtor’s Printed Name
Witness Witness
(if applicable)
Notary Public
On this _________________ day of ___________________________, 20______ before me,
__________________________________________ a notary public, personally appeared
__________________________________________, who proved to me on the basis of
satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument
and acknowledged to me that he/she/they executed the same in his/her/their authorized
capacity(ies), and that by his/her/their signatures on the instrument the person(s), or the entity
upon behalf of which the person(s) acted, executed the instrument. I certify under Penalty of
Perjury under the laws of the State of __________________ that the foregoing is true and correct.
Witness my hand and Official Seal
_______________________________________________________________________
(Seal)
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