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                                HOME TRUST COMPANY MORTGAGE OF LAND
                                                    ALBERTA LAND TITLES ACT

 (1)    Mortgagor(s):

 (2)    Address of Mortgagor(s):

 (3)    How Property Held – Tenancy:
        (if more than one mortgagor)
 (4)    Mortgagee:                                 HOME TRUST COMPANY

 (5)    Address and Postal Code of Mortgagee:

 (6)    Legal Description of Property:

 (7)    Principal Amount:


 (8)    Interest/Estate Charged:                              fee simple                               leasehold


 (9)   Payment Provisions:
       (a) Principal                               (b)   Interest                                      (c)   Calculation
       Amount: $                                         Rate:                         % per annum           Period:

                            M       D       Y                                                                                   M        D          Y
       (d) Interest                                      Payment                                             First
       Adjustment                                  (e)   Date and                                      (f)   Payment
       Date:                                             Period:                                             Date :

        (g) Last                                         Amount
        Payment                                    (h)   of Each
        Date:                                            Payment:

        (i) Balance
        Due Date:                                  (j)   Term:

 (10) Standard Form Mortgage Terms

 The Mortgagor(s) acknowledge(s) that the Mortgage consists of those terms contained herein and also that the Mortgage consists of those terms
 and is subject to the terms contained in the Standard Form Mortgage that was filed with the Registrar in the Alberta North District Land
 Registration District as #                            and in the Alberta South District Land Registration District as #                         as
 varied by any deletions from, or amendments or additions to, the terms of the Standard Form Mortgage. The following are such deletions, or
 amendments or additions (attach additional page(s) if space insufficient) (state “none” if there are no deletions, or amendments or additions).



 (11) Acknowledgments of the Mortgagor(s)

 The Mortgagor(s) acknowledge(s)

       (a) that the Mortgagor(s) understand(s) the nature of the statement referred to in box 10 hereof,
       (b) that the Mortgagor(s) has (have) been given a copy of those terms contained in the Standard Form Mortgage referred to in box 10
           hereof,
       (c) that the Mortgagor(s) is (are) the registered owner(s) of the land being mortgaged, and
       (d) that the Mortgagor(s) mortgage(s) all of the Mortgagor(s) estate and interest in the land described in box 6 hereof for the purpose of
            securing the payment of the Principal Amount, interest and all other amounts secured by the Mortgage.

 (12) Execution

       Dated at the                                           of                            , in the                       of                 , this
                 , day of                                              ,         .



       Witness




       Witness

 (13) DOWER - CONSENT OF SPOUSE

 I,                                                 being married to the within named                                                do hereby give
 my consent to the disposition of our homestead, made in this instrument, and I have executed this document for the purpose of giving up my life
 estate and other dower rights in the property given to me by The Dower Act, to the extent necessary to give effect to the disposition.


 Witness                                                                             Spouse of Mortgagor


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 (14) DOWER CERTIFICATE OF ACKNOWLEDGEMENT


                       1.      This document was acknowledged before me by _____________________________ apart from her husband (or his wife).

                       2.      _______________________________ acknowledged to me that she (or he):

                               (a) Is aware of the nature of the disposition;
                               (b) Is aware that The Dower Act gives her (or him) a life estate in the homestead and the right to prevent disposition of the
                                   homestead by withholding consent;
                               (c) Consents to the disposition for the purpose of giving up the life estate and other dower rights in the homestead given to her
                                   (or him) by The Dower Act, to the extent necessary to give effect to the said disposition;
                               (d) is executing the document freely and voluntarily without any compulsion on the part of her husband (or his wife).

 DATED at _______________________ in the Province of ____________________, this ___________ day of _______________, ______.



                                                                                                          _________________________________
                                                                                                          A Commissioner for Oaths/A Notary Public in and
                                                                                                          for



 (15) DOWER AFFIDAVIT

 I, _____________________________________, of____________________________________, ________________________ (occupation)
 make oath and say:

                       1.      I am the mortgagor (or the agent acting under power of attorney in my favour registered in the Land Titles Office on
                               ______________________ , __________ as instrument number _________________ granted by the mortgagor) named in the
                               within (or annexed) instrument.

                       2.      I am (or My principal is) not married.

                               OR

                               Neither myself nor my spouse (or my principal nor my principal’s spouse) have resided on the within mentioned land at any
                               time since our (or their) marriage.

                               OR

                               I am (or My principal is) married to __________________________ being the person who executed the release of dower rights
                               registered in the Land Titles Office on _____________________ , ______ as instrument number ____________________.

                               OR

                               A judgment for damages was obtained against me by my spouse (or my principal by my principal’s spouse) and registered in
                               the Land Titles Office on __________________ , _______ as instrument number _____________________.

 Sworn before me at _____________________                                                  )
 in the Province of _______________________                                                )               ____________________________________
 this ____ day of __________________, _____                                                )
 A Commissioner for Oaths In and For the Province of Alberta
 A Notary Public In and For the _____________ of _____________




         (16) AFFIDAVIT OF EXECUTION

                       I,                                                , of                                     , in the                               of
                                                                         ,                                 , (occupation) MAKE OATH AND SAY:

                       (1) I was personally present and did see                                                        , who is (are) known to me to be the
                           person(s) named in the within (or annexed) instrument, duly sign the instrument; OR THAT I was personally present and did
                           see                                          who, on the basis of the identification provided to me, I believe to be the person(s)
                           named in the within (or annexed) instrument, duly sign the instrument.

                       (2) the instrument was signed at                                    in the                          of                        and I am a
                           subscribing witness thereto.

                       (3) I believe the person(s) whose signature(s) I witnessed is (are) at least of eighteen (18) years of age.

 Sworn before me at the                                          of        )
 in the        of                                                          )                               ____________________________________
 this _____ day of                                                ,        )
 A Commissioner for Oaths In and For the Province of Alberta
 A Notary Public In and For the ____________ of ______________




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