MORTGAGE DEED of Name(s) of Mortgagor(s) Address of Mortgagor(s) to secure payment of dollars ($ ) as provided in a certain surety bond in the criminal prosecution of UNITED STATES OF AMERICA v. , Docket No. now pending in the United States District Court for the District of Connecticut do hereby grant to the UNITED STATES OF AMERICA, acting by and though the United States Attorney for the District of Connecticut, with mortgage covenants a piece, parcel or tract of land and premises, more particularly described on the attached Exhibit A , which piece, parcel or tract of land and premises is subject to the following encumbrances: Reference is hereby made to a certain Escrow Agreement between the Grantors and the Grantee, which agreement is being held in escrow with the Clerk of the United States District Court for the District of Connecticut, in the criminal proceeding entitled UNITED STATES OF AMERICA v. , Docket No: American LegalNet, Inc. www.FormsWorkFlow.com IN WITNESS WHEREOF, we have hereunto set our hand and seal this , 20 Signed, Sealed and Delivered in the presence of . day of WITNESSES: Signed: Print: Grantor Signed: Print: Grantor State of : : ss. County of Before me personally appeared : (City) , Signer and Sealer of the foregoing Instrument and acknowledged the same to be their free act and deed. Commissioner of the Superior Court Notary Public My Commission Expires on: American LegalNet, Inc. www.FormsWorkFlow.com