.

this document is recorded according to the principles of common law and does not
recognize or grant any special powers to any administrative agency or instrumentality of
the united states

certificate of non-response
for
notary protest

(insert bill or note or copy thereof)

united states of america
state of new mexico
county of bernalillo

be it known that on the 12th day of december, (year), at the request of olga: masten, of roosevelt county,
new mexico, i, edward bashista, a notary public duly commissioned and sworn, residing in roosevelt
county county, new mexico, did present the original instrument dated , 2003, hereto
attached, for acceptance, , and demanded acceptance thereof, which was refused.
whereupon i, at the request of the aforesaid claimant olga: masten, did protest, and by these presents do
protest, as well against the drawer, maker, endorsers, and acceptors of said instruments as against all others
whom it may concern, for exchange, costs, charges, damages, and interest already incurred and hereinafter
to be incurred by reason of non-acceptance thereof.
i further certify that on , 2003, notice
in writing of the foregoing presentment, demand, refusal and protest was served by united states postal
service certified mail no. , return receipt requested,
postage prepaid to: respondent david p. evans at his place of employment at courthouse square, p.o. box
1011, west plains, missouri 65775 i further certify that further notices were served as follows:

notice dated , 2003 served on david p. evans, respondent by certified mail

no. at the below address and place of business of the named
respondent:
courthouse square
p.o. box 1011,
west plains, missouri 65775
second notice dated , 2003 served on jose speedy gonzalez, respondent by certified
mail no. at the below address and place of business of the named
respondent:
courthouse square
p.o. box 1011,
west plains, missouri 65775

in testimony whereof i have hereunto set my hand and affixed my seal of office at pep, new mexico, on
day of , (year).

edward bashista

______________________
notary public's signature
federal witnesss
(personalized seal)

(list fees and expenses to include postage)