To all to Whom These Presents Shall Come - Greeting:

Whereas, ....................................................

of....................in the County of...............State of..........

lately purchased of........................in the County of.............

State of........................a certain piece or parcel of land, with the appurtenances thereunto belonging, known and described as follows, to wit:

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

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

situate, lying and being in the County of................State of........., which said piece or parcel of land was, by the direction and appointment of the said..................................................conveyed to me the said......................................as grantee thereof, as by the said conveyance dated the.....................day of............

A. D. 190.., and recorded in the Recorder's office of................County,

State of......................in Book..................of Records, on page..........will fully appear.

And Whereas, I had no right, title nor interest in or to said place or parcel of land, but the same was conveyed to me as grantee to hold in trust for the benefit of the said..................................and his heirs.

Now Therefore, Know Ye, That I, the said......................

do hereby acknowledge and declare, that I am nominated and named as grantee in said conveyance upon and in hehalf of the said..................

and his heirs, as trustee, solely, and I do not claim to have any right, title or interest in said land or any portion thereof, by virtue of said conveyance, to my own use or benefit, but solely to the use and benefit of the said.........

....................................and his heirs, and I, the said.......

............................................do for myself and my heirs covenant with the said........................................by these presents that I will at any time hereafter upon the proper written request of the said............................................and at his cost and expense, by good assurance and conveyance at law, convey and assure the said piece or parcel of land, and all my interest as such trustee therein, to the said..........................................or to such other person or persons as he shall in writing nominate or appoint.

In Witness Whereof, I have hereunto set my hand and seal this

............................day of......................, A. D. 190 ..

.................................[seal.]

State of .................

County of................

ss.

I,................................

Do Hereby Certify That,..............

personally known to me to be the same person whose name is subscribed to the foregoing instrument, appeared before me this day in person and acknowledged that he signed, sealed and delivered the said instrument as his free and voluntary act, for the purposes therein set forth.

Given under my hand and..........

Seal this...........................day of........................A. D. 190....

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

Notary Public.