Demand for Contribution or Indemnity

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Demand for Contribution and Indemnity TO: Name of Person upon whom Demand for Contribution and Indemnity is being made (the "Indemnifier") Reference is made to the Describe Agreement which Establishes Obligation for Contribution or Indemnity (ie. Indemnity Agreement dated May 14, 1998) (the "Indemnity Agreement") pursuant to which the Indemnifier agreed to indemnify or make contribution to the undersigned in the event that Describe event in Indemnification Agreement which triggers obligation to contribute or indemnify (ie. the undersigned was sued by former creditors of the Indemnifier) (the "Indemnification Event"). You are hereby notified that that the Indemnification Event occurred on or about Date on which Indemnification Event occurred, and as a consequence thereof, you are hereby required to contribute to or indemnify the undersigned in the amount of Amount of Contribution or Indemnification Obligation (ie. $15,000.00). You are hereby required to remit payment of such amount to the undersigned at the following address: Name of Person Requesting Payment for Contribution or Indemnity Address of Person Requesting Payment for Contribution or Indemnity Dated: Date (ie. July 31, 2000) Witness Name of Person Requesting Payment for Contribution or Indemnity

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