Property location: ______________________________ Date: ___________________ Seller: _________________________ Address: ______________________________ Buyer: _________________________ Address: ______________________________ Attorneys: ____________________________ Date of Closing: __________________ Date of Sale Contract: __________________ Place of Closing: __________________

Sale Price: $ _____________________ __________

Down Payment: $_________________ __________ __________

Subject to First Mortgage

Subject to Second Mortgage

Principal: $__________ Interest: $_____ __________ __________

Subject to Land Contract

Principal: $ __________ Interest: $ ____ __________ __________

Delinquent Taxes (if assumed)

for Years _______________ __________ __________

Tax Adjustment: ___ (Year),

prorated from ____ to ____

(Last Years Tax: $________) __________ __________

Future Installments of Special

Assessments (if assumed): _____ __________ __________

Insurance Premiums prorated _______ __________ __________

Rent prorated _______________ __________ __________

Coal: _________ tons, $ ______________

Oil: __________ gals. $ ______________

Recording Fees: __________________ __________ __________

Documentary Stamps: ____________ __________ __________

Allowances for: __________________ __________ __________

TOTAL __________ __________

LESS CREDIT TO BUYER ____________________

BALANCE DUE SELLER ____________________

BALANCE OF $ ___________________ DUE SELLER AS FOLLOWS:

Land Contract Mortgage executed this day to

Seller: ___________________________ __________

Check or Cash to balance: __________ __________

TOTAL __________ __________

______________________________________

(Signature of broker)

______________________________________

(Signature of buyer)

______________________________________

(Signature of seller)