Know all men by these presents: That A. B., of the --------- of ----------.,

County of --------- and State of ---------, in consideration of the sum of --------dollars, to him paid by C. D., of the --------- of ---------, County of --------- and

State of ---------, the receipt whereof is hereby acknowledged, do - hereby Grant,

Bargain, Sell and Convey to the said C. D., his heirs and assigns forever, the following Real Estate, situated in the County of --------- in the State of --------and in the --------- of --------- and bounded and described as follows: ---------

[insert description].

To have and to hold said premises, with all the privileges and appurtenances thereunto belonging, to the said C. D., his heirs and assigns forever.

And the said A. B., for himself and his heirs, does hereby covenant with the said C. D., his heirs and assigns, that he will forever Warrant and Defend the said premises, with the appurtenances, against the lawful claims of all persons whomsoever.

Provided always, and these presents are upon this condition, that if the said A. B. shall pay or cause to be paid unto the said C. D. or to his executors, administrators and assigns --------- [insert note, debt or other obligation], and shall also, at all times, until said notes and every one of them shall be fully paid, keep the interest of the said mortgagee - in the buildings and improvements which now are, or may hereafter be upon said mortgaged premises, insured against loss by five ---------in and by some good and solvent Insurance Company, to be approved by said mortgagee - or hie assigns, in a sum not less than

--------- dollars, the policy for such insurance to be issued in the name of said

A. B., the loss, if any, made payable to said mortgagee - and his assigns as his interest may appear, the policy to be held by the said mortgagee -, and shall also punctually pay, within the time which is or may be limited by law in that behalf, all taxes, levies, charges and assessments which may at any time (while said notes or either of them, shall be either wholly or in part unpaid) be levied, assessed or charged, or become payable on or against said mortgaged premises or any part thereof; and shall, on demand of said mortgagee - or his assigns, pay and refund to said mortgagee - or his assigns, with interest at

--------- per cent. per annum, any sum or sums which said mortgagee - or his assigns may at any time pay, as premium or premiums, for such insurance as is hereinabove stipulated for, or in discharge of any tax, levy, charge or assessment upon or against said mortgaged premises, or any part thereof, after default of ---------, to pay the same or either of them; all of which the said A. B. has covenanted and agreed, and does hereby covenant and agree unto and with said mortgagee - and his assigns to do.

Then these presents shall be void, otherwise to be and remain in full force and virtue in law forever.

.In witness whereof, the said A. B. (and E. B., his wife, who hereby releases her right of dower in the premises), has hereunto set his hand, this ---------day of---------,in the year of our Lord one thousand nine hundred and ---------.

Signed and acknowledged in presence of:

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[Certificate of acknowledgement if necessary] For specific performance of contract to execute mortgage, see 9 3341.