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| Issuer | Jørgen Thormøhlen (authorized by Christian V of Denmark-Norway) |
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| Year | 1695 |
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| Currency | Rigsdaler specie (1746-1814) |
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| Obverse description | Handwritten promissory text in the centre, issued under the royal ordinance of 22 June 1695, with the royal cipher CVC (Carolus V Corona) in the upper right of the text block. Four red wax seals authenticate the note: one bearing the arms of Christian V at upper left, and three along the lower edge bearing the seals of Jørgen Thormøhlen, Jacob Sørensen (interest writer), and Lauritz Mauritzen Trap (interest writer) respectively. Manuscript signatures appear below and to the right of the text, with the place and date of issue — Kiøbenhafn, 10 July 1695 — inscribed at the foot. |
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| Reverse description | The reverse bears a handwritten control number (No. 163) and the manuscript denomination notation "Croner = 50 = Rx", repeated twice in different hands, alongside a single red wax seal at lower right. The text block on the right half carries additional handwritten script consistent with administrative endorsements. |
| Reverse lettering | N. 163 Croner = 50 = Rx |
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