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

             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 © 1994 - 2014 by LAWCHEK, LTD.

MORTGAGE 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 $500,000¹²                    
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
_________________________________________________________________________
________________________________________________________________________,
including any and all future advances made by Mortgagee(s) to Mortgagor(s).

             Mortgagor(s) represents, covenants, warrants, and agrees as follows:

             1.         To timely pay the above-described indebtedness and to timely perform all
 other obligations contained within this Mortgage.

             2.         Mortgagor(s) is lawfully seized of the real estate; holds clear title to it in fee
 simple; and, has a right and authority to execute and convey the mortgaged property.

            3.         The mortgaged property is free and clear of all liens and encumbrances
 except for nondelinquent real estate taxes and special assessments and as otherwise stated in
 this Mortgage.

            4.         Mortgagor(s) will warrant and defend title to the real estate and the lien and
 priority of this Mortgage against claims and demands of all persons now existing or arising
 during the term of this Mortgage and the underlying indebtedness and obligations secured
 by the Mortgage.

             5.         All buildings, structures, improvements, and fixtures described above are and
 will be located on the real estate.

             6.         To maintain fire and casualty insurance in the amount of             $500,000¹³        
 dollars on the mortgaged property, and Mortgagor(s) shall provide proof of such insurance
 to Mortgagee(s).

            7.         To pay all real estate taxes and special assessments upon the Mortgage
 property as they become due.

            8.         To not otherwise encumber or create a lien upon the mortgaged property
 without obtaining prior written approval from the Mortgagee(s).

This is not a substitute for legal advice.  An attorney must be consulted.
Copyright © 1994 - 2014 by LAWCHEK, LTD.

MORTGAGE FORM cont'd.

             9.         To comply with any and all federal, state, municipal or other local laws and
 regulations regarding the mortgaged property and its use.

            10.       To maintain the mortgaged property in good and reasonable condition and to
 make no material alteration of it without receiving prior written approval from the
 Mortgagee(s).

            11.       To allow Mortgagee(s) and/or his/her agents to enter upon the mortgaged
 property, at reasonable times, to inspect it.  Mortgagee(s) has no duty to inspect the
 mortgaged property, but may do so for his/her own benefit.

            12.       To timely notify Mortgagee(s) of any legal suits or proceedings affecting the
 mortgaged property including but not limited to quiet title proceedings, tax sales, and
 condemnation proceedings.  Mortgagee(s) has a right to intervene in such proceedings to
 defend his/her interest in the mortgaged property including the priority of his/her lien.

            In the event that Mortgagor(s) fails to perform any of the covenants and obligations
 contained in this Mortgage, the Mortgagee(s) may perform such covenants and obligations
 and take other action as is necessary to protect Mortgagee(s) interest in the mortgaged
 property.  Any cost incurred by the Mortgagee(s) in making such performance shall be paid
 by the Mortgagor(s) and shall become  immediately due and payable together with interest
 on any unpaid amount at the rate of         10%¹⁴          per annum, unless otherwise agreed
 upon in writing by the parties.

            In the event Mortgagor(s) defaults in performance of any covenant or agreement
 imposed by this Mortgage or the underlying indebtedness or obligations secured by it, the
 Mortgagee(s) may declare the Mortgagor(s) to be in default by the Mortgage and seek such
 remedies as allowed by the laws of the State of               Ohio¹⁵                     including but
 not limiting to acceleration of the indebtedness due, cost, interest and reasonable attorney
 fees (if allowed by state law) subject to the statutory rights afforded to the Mortgagor(s).
 Forbearance by the Mortgagee(s) in exercise of such rights and remedies shall not be
 deemed as a waiver of them and shall not preclude Mortgagee(s) from exercising such
 rights and remedies at a later date.

            All notices required to be given, whether by law or this Mortgage, shall be delivered
 to the parties at the addresses shown above in this Mortgage.

            This Mortgage is affected as a financing statement filed as a fixture filing for
 personal property described in this Mortgage from the date of recording of this Mortgage.

            The laws of the State of                 Ohio¹⁶                   shall govern the construction,
 interpretation and enforcement of this Mortgage.  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.  If any

This is not a substitute for legal advice.  An attorney must be consulted.
Copyright © 1994 - 2014 by LAWCHEK, LTD.

MORTGAGE FORM cont'd.

 provision of this Mortgage is declared to be invalid, illegal or unenforceable, in whole or in
 part, the remaining provisions of this Mortgage shall remain in full force and effect.  If a
 court holds that any provision of this Mortgage is invalid, illegal or unenforceable as
 written, but is valid, legal and enforceable by limiting such provision consistent with state
 law, the provision shall be deemed to have been so written, construed and enforced as
 limited.

            Mortgagor(s) shall, upon the request of the Mortgagee(s), sign additional
 instruments in the event that such additional instruments are reasonably required to evidence
 or prove the lien of this Mortgage and/or to protect the security interest of the
 Mortgagee(s) in the mortgaged property.  Mortgagor(s) shall immediately pay the cost and
 expenses of filing and recording such additional instruments.

            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.

            Mortgagor(s) acknowledges receipt of copies of this Mortgage and the promissory
 notes or other written obligations secured by this Mortgage.

            Additional provisions:                             None¹⁷                                     
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

Date:                 04/01/01¹⁸                          

_______________________________¹⁹         _______________________________²⁰
Mortgagor                                                           Mortgagor

_______________________________²¹         _______________________________²²
Witness (If required by law)                               Witness (If required by law)

            The Mortgagor(s) relinquishes and waives his/her rights of dower, homestead, and
 distributive share in and to the mortgaged property and waives all rights of exemption as to
 any of the mortgaged property.  I/we understand that any homestead property included in
 the mortgaged property is often protected from the claims of creditors and exempted from
 judicial sale.  I/We voluntarily waive and relinquish such protection for the homestead
 property covered by this Mortgage with respect to claims based upon this Mortgage.

This is not a substitute for legal advice.  An attorney must be consulted.
Copyright © 1994 - 2014 by LAWCHEK, LTD.

MORTGAGE FORM cont'd.

_______________________________²³         _______________________________²⁴
Mortgagor                                                           Mortgagor

_______________________________²⁵         _______________________________²⁶
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 © 1994 - 2014 by LAWCHEK, LTD.

1. This space is reserved for the county and/or state officials' use.
2. The full 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 located.
9. The state in which the property is located.
10. A legal description of the property.
11. The full address of the mortgaged property.
12. Indebtedness secured by the mortgage.
13. The amount of the insurance on the property.
14. The rat of interest to be assessed on the unpaid amount.
15. The state in which the property is located.
16. The state in which the property is located.
17. Additional agreements to secure obligations.
18. The date on which the agreement is signed.
19. The signature of the mortgagor.
20. The signature of the second mortgagor.
21. The signature of the first witness.
22. The signature of the second witness.
23. The signature of the mortgagor.
24. The signature of the second mortgagor.
25. The signature of the first witness.
26. The signature of the second witness.