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[[preprinted]] [[double line]] Chattel Mortgage [[double line]] [[single dotted line]] To [[single dotted line]] [[double line]] [[bracketed SS.]] STATE OF ............... County of............. [[/bracketed SS.]] I ...................... a Notary Public within and for said county, herebY certify that the forgoing is a true copy of a note and chattel mortgage executed between the within named parties. Witness my hand and Notarial seal this ................... day of ......188........ [[dotted line]] Notary Public [[double line]] [[bracketed SS.]] STATE OF ............... County of............. [[/bracketed SS.]] Filed in the ........... office of said county the.....day of 188..., at......o'clock....M........ [[dotted line]] County Clerk. [[dotted line]] Deputy. [[double line]] [[/preprinted]]