CARNEY REALTY CO.

Name...... Address...... Lot......Block...... Tract...... Location of property..... Size of lot...x... To......Alley .........Cement

Walks...... Rooms...... Bath......Toilet...... Sewer......Barn....

Price $......$......Down, Balance $......per month......per cent interest. Mortgaged for $......per cent......Due......Rented for $......

per month. Water...... Will exchange for...... Insured for.......

Owner to furnish unlimited Certificate of Title at......expense.

I hereby constitute the CARNEY REALTY CO. sole agent for the herein described property and agree to pay a regular commission of 5 per cent on first $1,000 and 2 1/2 per cent on balance at whatever price sold.

This price to be good until......190.....

Dated............

(Signed)................