Receiver's Certificate of Indebtedness

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									This document sets forth a receiver's obligation to pay a certain amount(s) to the holder
of this certificate or to any party that will hold the legal right to this certificate. This
document may be used by a receiver when a court of law has authorized the receiver to
distribute certain funds. This template document is intended to supply language and
terms common to other certificates of indebtedness, but it can be customized to fit the
needs of the drafting parties.
             RECEIVER’S CERTIFICATE OF INDEBTEDNESS
AMOUNT: $___________ [Instruction: Insert amount.]

RECEIVER CERTIFICATE NO: __________ [Instruction: Insert receiver certificate
number.]

    THE UNDERSIGNED, AS RECEIVER (“Receiver”) and not individually in his or her own
right, hereby acknowledges and promises to pay to the holder of this receiver’s certificate
(“Receiver’s Certificate), namely, ___________________ [Instruction: Insert holder’s name.]
or to such person’s heirs, successors or assigns, as the case may be, at ________________
[Instruction: Insert address.] or at such other address as it/he/she may direct, the sum of
_____________ ($_________) [Instruction: Insert written dollar amount to be paid,
followed by numerical representation of same.]Dollars (the “Principal”) with interest thereon
at the rate of __________ (____%) [Instruction: Insert written interest percentage, followed
by numerical representation of same.] percent compounded monthly/annually [Instruction:
Choose whether interest is compounded monthly or annually, delete inapplicable.].

   THE PRINCIPAL together with interest accrued thereon, and any additional fees for late fees,
penalties or returned check fees, or otherwise, shall be paid in full to the holder or to such
person’s heirs, successors or assigns, as the case may be on or before the _____ day of
____________, 2______. [Instruction: Insert date by which all amounts due must be paid.]

   THIS RECEIVER’S CERTIFICATE is being delivered pursuant to an Order made by the
honorable Court of ________________, in the County of ____________ on the ____ day of
_____________, 2_____ bearing Court File Number _____________ in the legal proceedings
between _________________ being the Plaintiff and _____________ being the Defendant,
equity number ____________. [Instruction: Insert applicable information.]

   THIS RECEIVER’S CERTIFICATE shall form a lien on any and all of the Defendant’s
property, real and moveable and the assets and undertaking of the Defendant which are currently
held or in the future may be held by the Receiver, and upon the proceeds which might later come
into the hands of the Receiver, and upon all earnings and income which are now or might later
come into the hands of the Receiver, held by the undersigned as Receiver. The lien formed
herein shall be in first priority to the rights and interests of any other third party which are a party
to the legal proceedings and shall be in first position over any and all claims of any shareholders
or creditors of the Defendant subject to ______. [Instruction: Insert any items which will have
first priority. If none, delete.] The lien formed herein shall not have priority over any other
Receiver’s Certificate issued.

   THIS RECEIVER’S CERTIFICATE IS EXECUTED by the undersigned in its/his/her
capacity as Receiver only and any and all sums due herein shall only be payable out of the
property, real and moveable and the assets and undertaking and earnings and income and
proceeds now held or future held by the undersigned as Receiver and shall be paid pursuant to
the terms and provisions of the Court Order referenced above. The Receiver shall assume no
personal liability for any of the obligations contained herein.

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  IN WITNESS WHEREOF, the Receiver has executed this Receiver’s Certificate on the ____
day of ______________, 2______. [Instruction: Insert date.]




                                                        RECEIVER




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