Receipt.

Receipt or acknowledgment to be endorsed upon Mortgages by virtue of an Act of the General Assembly of New Zealand, intituled "The Building and Land Societies' Act, 1866"

We, the undersigned, being the Trustees of the within-mentioned Society, do hereby acknowledge to have received of and from the within-named Mortgagor, his or her heirs, executors, administrators, or assigns, all moneys intended to be secured by the within-written deed.

As witness our hands.

Dated the________day of________18