FB.

MEMORANDUM OF MORTGAGE.

I, ____, being a shareholder in the Society known as ____, in respect of ____ shares numbered ____, and being registered as proprietor of an estate [Here state nature of the estate or interest], subject, however, to such encumbrances, liens, and interests as are notified by memoranda underwritten or indorsed hereon, in that piece of land situated in the [District, County, Hundred, or Township] of ____, containing [Here state area], be the same a little more or less [If road intersecting, say "exclusive of roads intersecting the same."] [Here state, rights-of-way, privileges, or easements, if any appertaining; and if the land to be dealt with contains all that is included in an existing grant or certificate of title or lease, refer thereto for description of parcels and diagram; otherwise set forth the boundaries in chains, lint's, or feet, and refer to plan thereof on margin of or annexed to the mortgage or deposited in the Segistry Office], in consideration of tbe sum of [amount of money advanced], this day lent to me by the Trustees of the [name of Society], tbe receipt of which sum I hereby acknowledge, do hereby covenaut with the Trustees of the said Society that I will [Here set forth term of payment, special covenant, &c.] And for the better securing to the Trustees of the said Society the payment of tbe said ____, I hereby mortgage to the Trustees of the said Society all my estate and interest in the said land above described.

In witness whereof I have hereto signed my name this day ____ of ____ Mortgagor.

Signed by the above-named ____, this ____ day ____ of ____ 187 ____, in presence of ____