2.被告于或大約于1935年6月1日簽署并交付原告本票一張[以下述文字與數(shù)字作成：（在此逐字抄錄）]；[該本票副本見(jiàn)附件證據(jù)A]；[因此被告于1936年6月1日承諾支付或指示支付原告___________美元并附加年利息率為6%].

　　3.被告欠原告該本票所載款項(xiàng)及利息。

　　據(jù)此，原告請(qǐng)求判決被告償付________美元的款項(xiàng)、利息及費(fèi)用。

　　簽名：___________

　　原告律師

　　地址；_____________

　　COMPLAINT ON A PROMISSORY NOTE

　　1.Allegation of jurisdiction.

　　2.Defendant on or about June 1,1935,executed and delivered to plaintiff a promissory note[in the following words and figures（here set out the note verbatim）]；[a copy of which is hereto annexed as Exhibit A]；[whereby defendant promised to pay to plaintiff or order on June 1,1936 the sum of __________dollars with interest thereon at the rate of six percent per annum].

　　3.Defendant owes to plaintiff the amount of said note and interest.

　　Wherefore plaintiff demands judgment against defendant for the sum of _________ dollars , interest ,and costs.

　　Signed： ___________

　　Attorney for Plaintiff

　　Address： __________