$--------. -------,--------, 19-.

--------- after date, for value received, --------- promise to pay to --------- or order,---------dollars, with interest from date, until paid, at ---------per cent. per annum, payable ---------annually, at ---------.

And ---------do hereby authorize ---------, attorney at law, to appear for --------in an action on the above note, at any time after said note becomes due, in any court of record, in or of the State of Ohio, to waive the issuing and service of process against ---------and confess a judgment in favor of the legal holder of the above against --------- for the amount that may then be due thereon, with interest at the rate therein mentioned, and costs of suit; and to waive and release all errors in said proceedings, petitions in error, and the right of appeal from the judgment rendered. ---------,

------------.

-------------,

See references under Sec. 3900.