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AFFIDAVIT AND MEMORANDUM OF

AGREEMENT FOR PURCHASE AND SALE

STATE OF

COUNTY OF

BEFORE ME, the undersigned authority, on this day personally appeared , who, being first duly sworn, deposes and says that:

1. An Agreement for the Purchase and Sale of the real property described in the attached Exhibit "A" was entered into by and between the Affiant, as (Buyer/Seller), and , as (Buyer/Seller), on the day of , 20 .

2. The closing of the purchase and sale of said real property, per the terms of the Agreement, is to take place on or before the day of , 20 .

3. A copy of the Agreement for Purchase and Sale of said property may be obtained by contacting , whose address is , and whose telephone number is .

Dated this day of , 20 .

FURTHER AFFIANT SAYETH NOT.

Signed, sealed and delivered in the presence of:

Witness Affiant

Witness

Sworn to and subscribed before me this day of , 20 .

Notary Public

(SEAL) State of My Commission Expires:

_

This instrument was prepared by:

EXHIBIT "A"

Description of Real Property