Notice of Right of Rescission


$__________________Mortgage on Property Situated at:


Notice of Customer Required by Federal Law:

You have entered into a transaction on _____________, 2005

which may result in a lien, mortgage or other security
interest on your home. You have a legal right under federal law
to cancel this transaction, if you desire to do so, without any
penalty, or obligation, within three business days from the
above date or any later date on which all material disclosures
required under the Truth in Lending Act have been given to you.
If you so cancel the transaction, any lien, mortgage or other
security interest on your home arising from this transaction is
automatically void. You are also entitled to receive a refund
of any down payment or other consideration if you cancel. If
you decide to cancel this transaction, you may do so by

(Name of Creditor)


by mail or telegram sent not later than midnight of
__________, 2005. You may also use any other form of written
notice identifying the transaction if it is delivered to the
above address not later than that time. This notice may be used
for that purpose by dating and signing below.

I hereby cancel this transaction.

________________________________ _____________________________
(Date) (Customer's Signature)

Receipt is herewith acknowledged of the foregoing NOTICE,
each of the undersigned CUSTOMERS having received two copies
thereof, and one copy of the Disclosure Statements concerning the
above identified transaction this ______day of_________,2005.

______________________________ __________________________

Issue two copies to customer.
Form 128

Bank Fraud Victims



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