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Quit Claim Form

MORTGAGE DEED

This Mortgage is given by ,
hereinafter called Borrower,
of to ,
hereinafter called Lender, which term includes any holder of this Mortgage,
to secure the payment of the PRINCIPAL SUM of $
together with interest thereon computed on the outstanding balance,
all as provided in a Note having the same date as this Mortgage,
and also to secure the performance of all the terms, covenants, agreements,
conditions and extensions of the Note and this Mortgage.

In consideration of the loan made by Lender to Borrower and for the purpose
expressed above, the Borrower does hereby grant and convey to Lender, with
MORTGAGE COVENANTS, the land with the buildings situated thereon
and all the improvements and fixtures now and hereafter a part thereof,
being more particularly described in Exhibit A attached hereto and made
a part hereof and having a street address of:


(Attach Property Description)


Borrower further covenants and agrees that:

1. No superior mortgage or the note secured by it will be modified without the
consent of Lender hereunder.

2. Borrower will make with each periodic payment due under the Note secured by
this Mortgage a payment sufficient to provide a fund from which the real estate
taxes, betterment assessments and other municipal charges which can become a lien
against the mortgaged premises can be paid by Lender when due. This provision
shall be effective only in the event that a fund for the same purpose is not
required to be established by the holder of a senior mortgage.

3. In the event that Borrower fails to carry out the covenants and agreements
set forth herein, the Lender may do and pay for whatever is necessary to protect
the value of and the Lender's rights in the mortgaged property and any amounts so
paid shall be added to the Principal Sum due the Lender hereunder.

4. As additional security hereunder, Borrower hereby assigns to Lender,
Borrower's rents of the mortgaged property, and upon default the same may be
collected without the necessity of making entry upon the mortgaged premises.

5. In the event that any condition of this Mortgage or any senior mortgage shall
be in default for fifteen (15) days, the entire debt shall become immediately due
and payable at the option of the Lender. Lender shall be entitled to collect all
costs and expenses, including reasonable attorney's fees incurred.

6. In the event that the Borrower transfers ownership (either legal or
equitable) or any security interest in the mortgaged property, whether
voluntarily or involuntarily, the Lender may at its option declare the entire
debt due and payable.

7. This Mortgage is also security for all other direct and contingent
liabilities of the Borrower to Lender which are due or become due and whether now
existing or hereafter contracted.

8. Borrower shall maintain adequate insurance on the property in amounts and
form of coverage acceptable to Lender and the Lender shall be a named insured as
its interest may appear.

9. Borrower shall not commit waste or permit others to commit actual, permissive
or constructive waste on the property.

10. Borrower further covenants and warrants to Lender that Borrower is \
indefeasibly seized of said land in fee simple; that Borrower has lawful
authority to mortgage said land and that said land is free and clear of all
encumbrances except as may be expressly contained herein.

This Mortgage is upon the STATUTORY CONDITION and the other conditions set forth
herein, for breach of which Lender shall have the STATUTORY POWER OF SALE to the
extent existing under State law.

Executed under seal this day of , 19 .


Borrower Borrower


STATE OF
COUNTY OF

On before me, ,
personally appeared ,
personally known to me (or proved to me on the basis of satisfactory evidence)
to be the person(s) whose name(s) is/are subscribed to the within instrument and
acknowledged to me that he/she/they executed the same in his/her/their
authorized capacity(ies), and that by his/her/their signature(s) on the
instrument the person(s), or the entity upon behalf of which the person(s) acted,
executed the instrument.
WITNESS my hand and official seal.


Signature
Affiant Known Unknown
ID Produced
(Seal)

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