Amendment of Mortgage by Individual Borrower(s) {20.4.1}

(Top 3 inches reserved for recording data) AMENDMENT OF MORTGAGE by Individual Borrower(s) Minnesota Uniform Conveyancing Blanks Form 20.4.1 (2012) (You must check one box for this document to be recorded.) This is a mortgage amendment, as defined in Minn. Stat. 287.01 subd. 2, and as such it does not secure a new or an increased amount of debt. This document secures additional debt in the amount of $ Mortgage Registry Tax of $ County, Minnesota on Additional MORTGAGE REGISTRY TAX DUE: $ . was paid on the original debt amount in . (month/day/year) (payable only if Indebtedness is increased in paragraph 3B) This Amendment of Mortgage is made (month/day/year) (insert name and marital status of each Borrower) (insert name of Lender) by and between ("Borrower") ("Lender"). and Borrower and Lender agree as follows: 1. Lender is the owner and holder of indebtedness (as evidenced by a promissory note or other document) in the original principal amount of ($ ) owed by Borrower, dated (the "Indebtedness"), which is secured by a mortgage on real estate owned by Borrower, situated in the County of , Minnesota and recorded on , as Document Number (insert amount of Indebtedness (month/day/year) County Recorder Registrar of Titles of (check the applicable boxes) (or in Book of , Page ), in the Office of the County, Minnesota (the "Mortgage"). (month/day/year) 2. (Complete if applicable) (month/day/year) The document evidencing the Indebtedness (i.e. the promissory note or other document) was amended on by (insert name of document that modified Indebtedness) . Page 1 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 3 Minnesota Uniform Conveyancing Blanks Form 20.4.1 3. The Mortgage is hereby amended by those provisions checked below. (At least one box must be checked. Check all that apply.) A. The maturity date of the Indebtedness has been changed to . B. The original principal amount of Indebtedness has been changed to $ C. The Mortgage is further amended as follows: (month/day/year) . 4. All stipulations, provisions, conditions, and covenants of the Mortgage shall remain in full force and effect except as herein modified. Borrower Lender State of Minnesota, County of This instrument was acknowledged before me on , by , as Borrower. (month/day/year) (insert name and marital status of each Borrower) (Stamp) (signature of notarial officer) Title (and Rank): My commission expires: (month/day/year) Page 2 of 3 American LegalNet, Inc. www.FormsWorkFlow.com Page 3 of 3 Minnesota Uniform Conveyancing Blanks Form 20.4.1 State of Minnesota, County of This instrument was acknowledged before me on , by , as Lender. (month/day/year) (insert name of Lender, if individual, or name and type of authority if business entity) (Stamp) (signature of notarial officer) Title (and Rank): My commission expires: (month/day/year) THIS INSTRUMENT WAS DRAFTED BY: (insert name and address) Note: This document, by itself, does not amend the Indebtedness (i.e. promissory note or other document). American LegalNet, Inc. www.FormsWorkFlow.com