MORTGAGE , of. , for mortgage covenants, to dollars paid, grant(s), with , of , the following real property: The last recorded instrument through which the mortgagor claims title: (The omission of the reference shall not affect the validity of the mortgage.) This mortgage is given, upon the statutory condition, to secure the payment of dollars with interest as provided in a note of the same date. "Statutory condition" is defined in section 5302.14 of the Revised Code and provides generally that, if the mortgagor pays the principal and interest secured by this mortgage, performs the other obligations secured by this mortgage and the conditions of any prior mortgage, pays all the taxes and assessments, maintains insurance against fire and other hazards, and does not commit or suffer waste, then this mortgage shall be void. , wife/husband of the mortgagor, releases to the mortgagee all rights of dower in the described real property. Executed this day of , 20 . _____________________________ (Signature of Mortgagor) _____________________________ (Execution in accordance with Chapter 5301 of the Revised Code) American LegalNet, Inc. www.FormsWorkflow.com