SAMPLE FORM

____________________________________________________________¹
 (SPACE ABOVE RESERVED FOR RECORDING INFORMATION)

               Buck Daniel McSween,  20 F Avenue,  Harper, OH  45011  (999) 774-2233²           
(RESERVED FOR NAME, ADDRESS, AND TELEPHONE NUMBER
OF PERSON PREPARING INSTRUMENT)

MORTGAGE - SHORT FORM

             This Mortgage is made on the   1st of April       (date), in the year of        2001³       ,
 between                   Carol Ann Walker⁴                               (name), as Mortgagor(s), whose
 address is                   77 3rd Street SE,  Harper, OH  45011⁵                                 and 
                       Alice Marie Kone⁶                              (name), as Mortgagee(s), whose
address is                     22 3rd Street SE,  Harper, OH  45011⁷                     . Mortgagor(s)
 conveys, sells and mortgages to Mortgagee(s) real estate located in               Clint⁸               
 County, State of                    Ohio⁹                     , described as follows:  (Legal description)

             The south third quarter of section 10, township 22, range 4.¹⁰

This is not a substitute for legal advice.  An attorney must be consulted.
Copyright © 2003 by LAWCHEK, LTD.

MORTGAGE SHORT FORM cont'd.

 Including all buildings, structures, improvements, and fixtures now or in the future located
 on the real estate during the term of this Mortgage, and together with all appurtenances,
 and all revenue and income arising from such property.  The street address of the Mortgage
 property is                                1414 3rd Street SE,  Harper, OH  45011¹¹                      .

             This Mortgage secures the following obligations or indebtedness of Mortgagor(s) to
 Mortgagee(s):

A promissory note in the amount of $50,000.¹²

           All words and phrases contained in this Mortgage (and the attached
 Acknowledgment, if any) shall be construed in the singular, plural, masculine, feminine or
 neuter according to the context in which they appear.

            The rights and obligations created within this Mortgage are binding upon and to the
 benefit of the parties and their legal representatives, heirs, successors, and assigns.

            Additional provisions:                             None¹³                                 
__________________________________________________________________
__________________________________________________________________

Date:                 04/01/01¹⁴                          

_______________________________¹⁵         _______________________________¹⁶
Mortgagor                                                           Mortgagor

_______________________________¹⁷         _______________________________¹⁸
Witness (If required by law)                                Witness (If required by law)

Attach Acknowledgment If Required By Law.

This is not a substitute for legal advice.  An attorney must be consulted.
Copyright © 2003 by LAWCHEK, LTD.

1. This space is reserved for the county and/or state officials' use.
2. The name, address and telephone number of the lawyer or banker preparing the document.
3. The date on which the agreement is signed.
4. The full name of the mortgagor(s).
5. The full address of the mortgagor(s).
6. The full name of the mortgagee(s).
7. The full address of the mortgagee(s).
8. The county in which the property is held.
9. The state in which the property is held.
10. A legal description of the property.
11. The full address of the mortgaged property.
12. Indebtedness secured by the mortgage.
13. Additional agreements to secure obligations.
14. The date on which the document is signed.
15. The signature of the mortgagor.
16. The signature of the second mortgagor.
17. The signature of the first witness.
18. The signature of the second witness.