$_ Mortgage on Property situated at:

_
(Identification of Transaction)

Notice to Customer Required by Federal Law:
You have entered into a transaction on _, 19_ which may
result in a lien, mortgage or other security interest on your
home. You have a legal right under federal law to cancel this
transaction, if you desire to do so, without any penalty or
obligation, within three business days from the above date or
any later date on which all material disclosures required
under the Truth in Lending Act have been given to you. If you
so cancel the transaction, any lien, mortgage or other
security interest on your home arising from this transaction
is automatically void. Your are also entitled to receive a
refund of any down payment or other consideration if you
cancel. If you decide to cancel this transaction, you may do
so by notifying

_
(Name of Creditor)

at: _
(Address of Creditor’s Place of Business)

by mail or telegram sent not later than midnight of _,
19_. You may also use any other form of written notice
identifying the transaction if it is delivered to the above
address not later than that time. This notice may be used for
that purpose by dating and signing below.

I hereby cancel this transaction.

________________________________ _____________________________
(Date) (Customer’s Signature)

See Next Page for Important Information
About Your Right of Rescission

Receipt is herewith acknowledged of the foregoing NOTICE,
EACH of the undersigned CUSTOMERS having received two copies
thereof, and one copy of the Disclosure Statements concerning
the above identified transaction this _ day of _, 19_.

_________________________&&&__________________________________

EFFECT OF RESCISSION. When a customer exercised his
right to rescind under paragraph (a) of this section, he is
not liable for any finance or other charge, and any security
interest becomes void upon such a rescission. Within ten days
after receipt of a notice of rescission, the creditor shall
return to the customer any money or property given as earnest
money, down payment or otherwise, and shall take any action
necessary or appropriate to reflect the termination of any
security interest created under the transaction. If the
creditor has delivered any property to the customer, the
customer may retain possession of it. Upon the performance of
the creditor’s obligations under this section, the customer
shall tender the property to the creditor, except that if
return of the property in kind would be impracticable or
inequitable, the customer shall tender its reasonable
value. Tender shall be made at the location of the property
or at the residence of the customer, at the option of the
customer. If the creditor does not take possession of the
property within ten days after tender by the customer,
ownership of the property vests in the customer without
obligation on his part to pay for it.

Issue two copies to customer.