In consideration of $1.00 and other valuable
consideration the undersigned hereby subordinates all of our
claims (secured or unsecured) against _______________
____________ , (Debtor) to a claim owed to _____________
___________ , in an amount not to exceed $ __________.
Signed and sealed this _________day of ________, 19__.
_________________________
Assented to:
______________________________
Debtor
Form 136
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