| Mortgagee: |
(Name of person collecting mortgage) |
| Morgtagee's Gender: | |
| Street Address: |
(Mortgagee's street address) |
| City: | |
| State/Province: |
(Select a U.S. state or Canadian province.) |
| Zip/Postal Code: | |
| Country: |
Select U.S.A. or Canada |
| Mortgagor: |
(Name of person to pay the mortgage) |
| Mortgagor's Gender: |
(Indicate mortgagor's gender) |
| Street Address: |
(Mortgagor's street address) |
| City: | |
| State/Province: |
(Select a U.S. state or Canadian province.) |
| Zip/Postal Code: | |
| Country: |
Select U.S.A. or Canada |
| Spouse: |
(Name of Mortgagor's spouse, if applicable) |
| Street Address: |
(Complete the above field and the following City and State fields if spouse's address is different than mortgagor's) |
| City: | |
| State/Province: |
(Select a U.S. state or Canadian province.) |
| Zip/Postal Code: | |
| Country: |
Select U.S.A. or Canada |
| Property Description: |
(Legal description of property being mortgaged. Press <ENTER> for each new line you want to start.) |
| Principal Sum: |
(principal amount of mortgage, e.g. "$150,000.00") |
| Interest Rate: |
(Annual interest rate of mortgage - e.g., 8.5%) |
| Bond: |
(Indicate how mortgage note is secured - e.g., promissory note, bond, etc.) |
| Date Signed: |
(Date bond securing the mortgage was signed - e.g., December 12, 2001) |
| Encumbrances: |
(List any encumbrances the mortgage will be "subject to," e.g. first mortgage, etc.) |
| Witness: |
(Name of first witness to sign mortgage) |
| Witness: |
(Name of second witness to sign mortgage) |
| Date Signed: |
//
(Select the day, month and year the mortgage is signed by all parties involved.) |
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