Mortgage Note with Uniform Acknowledgment
CONSULT YOUR LAWYER BEFORE SIGNING THIS INSTRUMENT-THIS INSTRUMENT SHOULD BE USED BY LAWYERS ONLY

MORTGAGE NOTE WITH UNIFORM ACKNOWLEDGEMENT

$								New York,

FOR VALUE RECEIVED,

promise to pay to

or order, at

or at such other place as may be designated in writing by the holder of this note, the principal sum of

dollars

with interest thereon to be computed from the date hereof, at the rate of			               per centum

per annum and to be paid on the		day of				,	          , next  ensuing

and 						thereafter

IT IS HEREBY EXPRESSLY AGREED, that the said principal sum secured by this note shall become due at the option of the holder thereof on the happening of any default or event by which, under the terms of the mortgage securing this note, said principal sum may or shall become due and payable; also, that all of the covenants, conditions and agreements contained in said mortgage are hereby made part of this instrument.

Presentment for payment, notice of dishonor, protest and notice of protest are hereby waived.

This note is secured by a mortgage made by the maker to the payee of even date herewith, on property situate in the

This note may not be changed or terminated orally.

							_______________________________________

TO BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE IN NEW YORK STATE	
		
State of New York, County of		               ss:

On the           day of                                in the year
before me, the undersigned, personally appeared

personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument.

___________________________________________________
(signature and office of individual taking acknowledgment)	State of New York, County of		               ss:

On the           day of                                 in the year
before me, the undersigned, personally appeared

personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s) is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument.

__________________________________________________
(signature and office of individual taking acknowledgment)	

	
TO BE USED ONLY WHEN THE ACKNOWLEDGMENT IS MADE OUTSIDE NEW YORK STATE	

State (or District of Columbia, Territory, or Foreign Country) of 								ss:

On the                       day of                                             in the year                        before me, the undersigned, personally appeared

personally known to me or proved to me on the basis of satisfactory evidence to be the individual(s) whose name(s)  is (are) subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their capacity(ies), and that by his/her/their signature(s) on the instrument, the individual(s), or the person upon behalf of which the individual(s) acted, executed the instrument, and that such individual made such appearance before the undersigned in the

_________________________________________ in ____________________________________________________________.
       (insert the City or other political subdivision)	  (and insert the State or Country or other place the acknowledgment was taken)

_______________________________________________________
(signature and office of individual taking acknowledgment)	
	
STANDARD FORM OF NEW YORK BOARD OF TITLE UNDERWRITERS
Distributed by

New York Title Research Corp
www.nytitle.com

Title No.
Loan No.

TO

Mortgage Note
Dated				, 		.