__________________ (amount) Mortgage on Property situated at: _________________________________ (address)

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 _________ (no. of days) 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. You 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)