This contract entered into on the --------- day of ---------, between A. B., of the City of---------, State of ---------, and C. D., of the City of ---------, State of

--------, Witnesses:

That whereas the said C. D. has conveyed to the said A. B. certain property, described as follows [insert description], at the request of said A. B. and as consideration for the covenants of the said A. B. herein contained; and whereas the said A. B. hereby acknowledges the receipt of said property; now, said A. B. for himself, his heirs, executors and assigns does hereby covenant and agree to pay to the said C. D., for the life of said C. D., the sum of --------dollars per annum, to be paid at the rate of---------dollars per month, beginning with the first day of ---------, at ------.

The said A. B. does furthermore covenant to execute and deliver to the said C. D. within---------days from the date of this contract, his mortgage upon the following described property [insert description], conditioned upon the performance by the said A. B. of the covenants of this contract on his part to be performed.

In witness whereof, etc.

It is safer to execute and deliver the deed, mortgage and contract at the same time as a part of the same transaction. In such case the covenant for the mortgage may be omitted.

Express provisions as to the effect of the death of A. B. before that of C. D. may be inserted.