Schedule 5

This Indenture, made ___________ [month, day, year], under the Land Transfer Form Act, Part 3, between [here insert names of parties and recitals, if any], witnesses that, in consideration of $ ________ of the lawful money of Canada, now paid by [mortgagee] to [mortgagor], the receipt of which is acknowledged, [mortgagor] grants and mortgages to [mortgagee] his heirs and assigns, for ever, all [parcels] [here insert provisoes, covenants or other provisions].

In witness of which the parties have set their hands.