Date
(Name of bank)
(City or town)
(State)
Gentlemen: Attached is Draft No. ______, for $______, issued by the ____________ Insurance Company in payment of ______ loss which damage the buildings on the farm of __________________, of ______________ County, State of ______________.
This draft has been endorsed by the undersigned payees who request that you collect these funds and issue cashier's checks to the following payees for the following amounts:
________________, First Mortgage $______
________________, Second Mortgage $______
________________, Third Mortgage $______
The balance only, if any, will be paid to ________________, the owner of the property.
First Mortgagee
Second Mortgagee
Third Mortgagee
Owner