1234, Main Street
Boston, MA 02123
05 April, 2005
<Recipient Address Goes Here>
We hold your promissory note dated <date of note> in the amount of <original amount>. We hereby give you notice that you are in default on said note for failure to pay the following <amounts/installments>:
– <list of overdue payments>
Accordingly, we hereby demand payment of <total amount of demand>.
If we have not received payment as specified above <payment address> by <payment deadline>, we shall turn this matter over to collection at your expense, as provided for in said note.
encl: <List of enclosed items goes here>