Debt Settlement Policies and Procedures.

Par. 263

263 Promissory Notes (Continued)

H Completing CCC-279

Complete CCC-279 according to this table.

Circle

Number Instructions

1 Enter the principal amount of the note. This is the claim amount plus interest to

the day the note is drafted.

2 Enter the date of the note. This is the date the note is drafted by the County

Office.

3 Enter the State in which the note is signed by the obligor.

4 Enter the County in which the note is signed by the obligor.

5 Enter the name of the debtor or debtors.

6 Spell out the principal amount of the note from circle number 1.

7 Enter the principal amount of the note, in numerals.

8 Enter the note interest start date. This is the date the note is drafted by the

County Office.

9 Enter the current late payment interest rate.

10 Enter the address and location where payment is to be sent or made.

11 Enter the installment interval, such as monthly, quarterly, semiannual, or annual.

12 Enter the amount due per installment.

13 Enter the day payment is due, such as the 9th.

14 Enter the month the first payment is due.

15 Enter the year the first payment is due.

16 Enter how often the payment is due, such as every month, 3 months, 6 months,

or 12 months.

17 Enter the current penalty interest rate.

18 Enter a description of the collateral. If none, write “N/A”.

19 Each debtor shall sign and date.

20 CED shall sign, unless note originates in State Office, in which case SED or

claims officer shall sign.

21 Enter the county, book number, and page number where lien on collateral is

recorded. Enter “N/A” if no collateral.

22 Enter claim number or numbers settled by CCC-279.

7-8-02 58-FI (Rev. 7) Amend. 1 Page 9-27

Par. 263

263 Promissory Notes (Continued)

I Example of CCC-279

The following is an example of a completed CCC-279.

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