Amount, $........ at........per cent for......years. Bond of..............

secured by.......mortgage covering premises shown on diagram and known as Nos....................................... Street.

Dimensions of Ground ..............Dimensions of Building ..............

Number of Stories........Building Materials........Purposes of Use........

Value of Ground, $........ Value of Building, $........ Total, $..........

Assessed Value: Land, $.......... Building, $.......... Total, $..........

Amount of Present Mortgage, $........., Annual Rent, $..........

REMARKS:

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• • •••••••••••••••••••••••••

The undersigned desiring to obtain the loan described above hereby employs

............ as broker to endeavor to obtain said loan, and said ............

hereby accepts such employment, it being agreed that such employment shall continue from now until the......day of........ at 6 p. m. and that during that time the undersigned will not endeavor to obtain such loan through any other source. If the loan be obtained, the undersigned shall pay said.........

the sum of $......to cover its commission, disbursements for title insurance, survey, drawing bond and mortgage and any other necessary papers, mortgage recording tax, recording fees, except the cost of satisfaction of existing liens. If said.........find a party ready and willing to make such loan but who declines to make the same because the title is defective or because the Title Company examining the title declines to insure the title, the undersigned shall pay said sum. If before the expiration of the period of this employment the undersigned revoke this agreement or through any other source obtain said loan, the same sum shall be paid as if said loan had been obtained through

........... In addition to the above ...... agree to pay any war stamp tax that may be necessary. The loan is to be closed within thirty days after its acceptance.

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Address...........................

No. 77c

New York................19....

LOAN WANTED OF $.......... at.....% Interest per annum for ........

years on First Mortgage secured by the Bond of .............. on the property described below. Location .......... Dimensions of Ground ...........

Dimensions of Building.......... No. of stories ........ Materials.........

Purpose of use.................. Owner's Valuation, $........Rent, $......

Remarks .............,...,,...,,... ,.,, ,.,,,,, ,,,,,,,,,........,,,.,...

Nearest Station:

Subway ......................................

Elevated .....................................

Surface Line ..................................