2

UNITED STATES OF AMERICA
STATE OF NORTH CAROLINA
No. [blank]
$5,000.00

Real Estate Loan
FIRST MORTGAGE
INTEREST PAYABLE SEMI-ANNUALLY

On the FIRST day of NOVEMBER, 1916, for value received,
WE promise to pay to the order of JEFFERSON STANDARD LIFE
INSURANCE COMPANY, its successors or assigns, at its office in Greensboror N. C., the principal
sum of FIVE THOUSAND AND NO/100 Dollars,
with interest thereon from the date hereof until paid at the rate of 6 per centum per annum, payable
semi-annually, said interest being represented by SIX notes of even date
herewith, payable at the office of the said Jefferson Standard Life Insurance Company, in Greens-
boro, N. C., each of said interest notes and said principal sum to bear 6 per cent. interest per annum,
payable semi-annually after maturity until paid, both principal and interest payable in lawful gold-coined
money of the United States of America, of the standard of weight and fineness established by the
laws of the United States now in force, and if default be made in the payment of any of said
interest notes, or any portion thereof, for the space of thirty days after the same becomes due and
payable, or if the insurance required by the provisions of the mortgage or deed of trust of even date
herewith, given by US to secure this note be not
kept in full force and operation according to the provisions of said mortgage or deed of trust, or if failure
occurs to pay or cause to be paid all taxes or liens of any kind attached or hereafter attaching to the
premises so mortgaged or conveyed, as required by the provisions of said mortgage or deed of trust, then
said principal sum with all arrearages of interest thereon shall, at the option of the said Jefferson Stand-
ard Life Insurance Company, its successors or assigns, become at once due and payable without further
notice, and may be sued upon and collected in like manner as if the full time provided in this note had
expired. It is expressly agreed and declared that this note and the said interest notes are given for an
actual loan of
FIVE THOUSAND AND NO/100 Dollars.

Witness OUR hands and seals this FIRST day of
NOVEMBER, 1913.
W. G. Shipman (SEAL)
Hazel Fisher Shipman (SEAL)

[stamped: PAID
JUL 30 1921
Jefferson Standard Life Ins.
L. W. Johnson?]

JOS. J. STONE & CO., PRINTERS, GREENSBORO, N. C.