Mortgage Statutory Form {LPB 50-05(r)}

LPB 50-05(r) Page 1 of 2 When recorded return to: MORTGAGE (STATUTORY FORM) THE MORTGAGOR mortgages to to secure payment of the sum of Dollars ($ ) according to the terms of promissory note bearing date the following described real estate, situated in the County of , State of Washington: Abbreviated Legal: (Required if full legal not inserted above.) Tax Parcel Number(s): And the mortgagor promise and agree to pay before delinquency all taxes, special assessments and other public charges levied, assessed or charged against said described premises, and to keep all improvements on said described premises insured against loss or damage by fire in the sum of Dollars($ ) for the benefit of the mortgagee and to deliver all policies and renewals to the mortgagee. American LegalNet, Inc. www.FormsWorkFlow.com LPB 50-05(r) Page 2 of 2 In case the mortgagor shall fail to pay any installment of principal or interest secured hereby when due or to keep or perform any covenant or agreement aforesaid, then the whole indebtedness hereby secured shall forthwith become due and payable, at the election of the mortgagee. Dated: STATE OF ss. COUNTY OF I certify that I know or have satisfactory evidence that (is/are) the person(s) who appeared before me, and said person(s) acknowledged that signed this instrument, on oath stated that authorized to execute the instrument and acknowledge it as the of to be the free and voluntary act of such party(ies) for the uses and purposes mentioned in this instrument. Dated: Notary name printed or typed: Notary Public in and for the State of Residing at My appointment expires: American LegalNet, Inc. www.FormsWorkFlow.com