Received from __________, __________ dollars and _________ cents net, in full payment for the grain represented by this warehouse receipt. Gross price per bushel __________, storage per bushel _________, net price per bushel _________. I certify that I am the owner of the grain for which this receipt was issued, and that there are no liens, chattel mortgages, or other claims against the grain represented by this receipt.
Dated _____________, ______. Signed _________________ Owner.
N.D.C.C. § 4.1-58-16