Know all men by these presents: That I, A. B., of ---------, for the consideration of --------- dollars ($---------), received to my full satisfaction of

C. D., do hereby sell, assign, transfer and set over unto the said C. D., his executors, administrators and assigns, a certain mortgage deed bearing date the --------- day of ---------, 19-, executed and delivered to me by E. F. and recorded in volume---------, page---------, of County records on the--------- day of

--------, 19-, at --------- o'clock, --------- M., together with the promissory note

[or bond] secured thereby and referred to therein; and all sums of money due and to become due thereon.

And I do covenant with the said C. D., his executors, administrators and assigns, that the sum of $--------- is owing and unpaid on said note and mortgage, and that I have good right to sell and assign the same.

In witness whereof, etc. A. B.

In presence of---------.

In case it is desired to assign a note and mortgage as collateral security, the following clauses may be added to the foregoing form:*

The condition of this assignment is such. that, whereas, the said A. B. has executed and delivered to the said C. D. his certain promissory note da'ed ---------, 19 -, for the sum of Sec. ---------, with interest at --------- per cent..

per annum and due on the --------- day of ---------, 19-

Now if the said A. B. shall well and truly pay the aforesaid promissory note according to the tenor thereof to the said C. D., or his assigns, then the above assignment shall be void, otherwise to remain in full force and effect.

In witness whereof, etc.

See references under Sec. 3791.