TITLE TO PREMISES NO.......closed ... (date)... at......(place)....

present ....(name persons attending closing)..... Title closed by delivery of following instruments:

DEED

....................... to

..........................

MORTGAGE to

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

Recorded .......... by ............

To be returned to ..................

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

Recorded .......... by ............

To be returned to ..................

Terms of mortgage .......................................................

INSURANCE (insert memo. of names and details of policies, changes to be made and by whom).

STATEMENT OF ADJUSTMENTS

Cr.

Dr.

Purchase price................................................................................

.....................

$..........

Paid on signing contract.............................................................

$..........

Mortgage held by.......................................................................

$..........

Interest from........................to ..................... at .....................%

$..........

Purchase money mortgage...............................................................

$..........

Insurance.......................................................................................

.......................

$..........

Rent.....................................................................................

$..........

(or)

$..........

Other items.........................................................................

$..........

(or)

$..........

Total credits...........................................................................

$..........

$..........

Total debits.........................................................................

...................

Total credits brought over....................................................

.....................

$..........

Balance paid........................................................

.....................

$..........

EXPENSES (insert memo. of fees and expenses for drawing and recording papers and by whom paid.