Street No. of Property ....................................

Location of Property ......................................

Between .................................................

Size of

Lot.............

Valuation of Land..........

Total.................

House..........

Valuation of Building.........

Number of Stories.....Extension.....Number of Rooms .... Material.....

Decorated ...... Price ...... Terms .......... Mortgage:

1st........at...... %, due........Held by ..........

2d ........ at ......%, due ........ Held by..........

Rents:

Store..........Leased to........ 3d Floor....... leased to.........

1st Floor......Leased to........4th Floor......leased to.........

2d Floor...... Leased to ........ Total ...........

Improvements ..........................Heated by ..............

Hot Water Supply? No......Yes.............Remarks .........................

Possession ........................ Keys at........................

Owner's Name .......................................

Residence Address ....................................