To....:

In the matter of the sale of....lot___under " An Act to

Give to Mortgagees Certain Powers, now Commonly Inserted in Mortgages:"

I,...., hereby require you, on or before the.....day of

...., 18., to pay off the principal money and interest secured by a certain indenture of mortgage, dated the....day of...,

18., and expressed to be made between......on all th___, which said mortgage was registered in the registry office for the

....on the...day of...., 18., under the number___, and has since become the property of the undersigned.

And I hereby give you notice that the amount due on the said mortgage for principal, interest and costs respectively, is as follows:

And unless the said principal money and interest and costs are paid on or before the said ...day of...., 18., I shall sell the said property, comprised in the said indenture (and above described), under the authority of the act entitled "An Act to Give to Mortgagees Certain Powers, now Commonly Inserted in Mortgages," at..........

Dated at.....the....day of..., 18.

......., Witness.