A Memorial to be registered of an Indenture bearing Date the _____________ Day of _____________18____, made between A.B. of, &c. of the one Part, and CD, of, &c. of the other Part
[In the Case of a Transfer or Devolution of any Gale or Lease by Will or Descent, or in any other Manner than by a Deed requiring Registration under this Act, here recite the Circumstances under which such unregistered Transfer or Devolution took place]. For the Considerations therein mentioned, [transcribe Parcels], with their Rights and Apurtenances, were conveyed [or assigned] unto and to the Use of the said CD., his Heirs and Assigns [or unto the said CD., his Executors, Administrators, and Assigns]. [In case of a Mortgage], "by way of Mortgage." Which said Indenture as to the Execution thereof by the said A.B. and CD. is witnessed by,
_______________________________________ W.Z. of, &c.