John Doe
c/o w/e
Secretary:
Memorandum and Registration No.
0000000000
The undersigned Registrant hereby notifies you that he/she when redeeming bills or the like for lawful money shall utilize a stamp or the like bearing "Registration No.
0000000000" In connection with said redeeming, a register is to be kept and maintained wherein shall be entered particulars of the bills or the like which are redeemed.
The undersigned Registrant claims the right to redeem bills or the like for lawful money in special pursuance to (bleh USC bleh) and has the right to do so. etc.
{inside of a box}
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In the box above, I have included a specimen of the stamp for your convenience. This memorandum is not intended to have any monetary value.
/s/ Scribble.