3

STATE OF NORTH CAROLINA-Guilford County
The execution of the foregoing mortgage was this day duly proven before the undersigned____________________
________________________________________________________________________________of said County, by
________________________________________________________________________the grantor thereto.
Let the said mortgage and this certificate be registered.
Witness my hand and______________this ____________day___________of ____________192___
___________________________________________(Seal)

STATE OF NORTH CAROLINA-Guilford County
The execution of the foregoing mortgage was this day proven before the undersigned__________________________
___________________________________________________________________________of said County, by the oath and
examination of ______________________________________________________________, the subscribing witness.
Let the said mortgage and this certificate be registered.
Witness my hand and__________this_____________day of_____________________192___
____________________________________________(Seal)

STATE OF NORTH CAROLINA-Guilford County
The foregoing certificate of______________________________________________________________________________
a Justice of the Peace of said County, is adjudged to be correct. Let the said mortgage and the certificate be registered.
Witness my hand and______________this___________day of__________________192___
______________________________________C.S.C.