Affidavit of Mortgage Declaration

SALE WITH ASSUMPTION OF MORTGAGE

UNITED STATES OF AMERICA

PARISH OF

STATE OF LOUISIANA

BE IT KNOWN, That on the date indicated below, before the undersigned Notary Public, duly commissioned and qualified and in the presence of the witnesses hereinafter named and undersigned:

PERSONALLY CAME AND APPEARED:

, Tax Identification Number , an unmarried man of full age of majority domiciled in , whose present mailing address is , referred to herein as "SELLER";

who declared and said that, for the price and consideration, and on the terms and conditions hereinafter expressed SELLER did and does by these presents, grant, bargain, sell, convey, transfer, assign, set over and deliver, unto:

, whose Tax Identification Number is , and , whose Tax Identification Number is , husband and wife domiciled in , whose present mailing address is , referred to herein jointly as "PURCHASER";

here present, accepting and purchasing for PURCHASER and PURCHASER's heirs, and acknowledging delivery and possession thereof, the following described property, to-wit:

The property conveyed herein has as its address .

The consideration for this sale is () DOLLARS which the SELLER acknowledges receiving in the form of: () DOLLARS, cash, and assumption of the balance due on that mortgage loan obligation assumed and described as follows: PURCHASER assumes and agrees to hold the SELLER, free and harmless from the payment of the balance due on that certain conventional mortgage note made and executed by to the order of , payable , dated in the principal sum of , with interest at the rate of per cent per annum, which note was paraphed "Ne Varietur" by Notary Public, for identification with an Act of Mortgage, passed before on the same date, which mortgage rests upon the property herein conveyed and recorded in the office of the Recorder of Mortgages of at , the PURCHASER herein assuming all the obligations imposed on in the said note and the said mortgage. The parties hereto acknowledge that the principal balance due by SELLER on the note secured by the aforedescribed Mortgage as of this date, is the sum of .

SELLER transfers to PURCHASER all SELLER's right, title and interest in and to any escrow account maintained in connection with the loan assumed and in and to any insurance policies affecting the property conveyed. Ad valorem property taxes for the current year shall be .

And to these presents there personally appeared , the holder of the hereinabove described note, represented herein by its duly authorized officer, , who appears herein to acknowledge the transfer made hereby, to confirm that the balance due on the aforedescribed mortgage is as of this date, and to consent to the assumption of the hereinabove described obligation by the PURCHASER herein. does hereby SELLER as an obligor on the promissory note referred to above. then delivered to the undersigned Notary the said promissory note, and after having paraphed the same "Ne Varietur" for identification with this act, the said Notary returned the same to .

All parties signing this instrument have declared themselves to be of full legal capacity. All agreements and stipulations herein, and all the obligations herein assumed shall insure to the benefit of and be binding upon the heirs, successors, and assigns of the respective parties, and the PURCHASER, their heirs and assigns, shall have and hold the described property in full ownership forever.

SELLER warrants the title to the herein described property but excepts from said warranty all matters of public record creating (1) mineral leases or reservations, (2) land use restrictions or (3) servitudes. SELLER transfers to PURCHASER and subrogates PURCHASER to all rights and actions of warranty which SELLER has against all prior owners.

Tax Receipts

Tax receipts and/or certificates are annexed hereto showing payment of all state, parish, municipal and levee district taxes and past due charges for local improvement assessments assessed against the property.

Conveyance Cert.

By reference to the certificate of the Register of Conveyances for the Parish of Orleans it does not appear that said property has been alienated by the vendor. The parties are aware that the certificate attached hereto is open, being not yet dated and signed, and relieve and release the undersigned notary from all responsibility and liability in connection therewith.

The parties acknowledge that the acts of any such Notary in the preparation and execution hereof do not constitute the expression of any opinion as to the validity of the title to the property herein described, and unless otherwise separately certified in writing, no title examination of said property has been performed by any undersigned Notary.

Thus signed on , at , Louisiana, in the presence of the undersigned Notary Public and witnesses, who have signed with the parties after due reading of the whole.

WITNESSES: