Fill and Sign the Agreement Original Contract Form

Supplemental Agreement to Strike Part of Original Contract Supplemental Agreement between John Doe of       , referred to herein as Doe, and (Street Address, City, County, State, Zip Code) Mary Roe , of       , (Street Address, City, County, State, Zip Code) referred to herein as Roe. Whereas, on       , Doe and Roe entered into a contract, a true and (Date) correct copy of which is attached hereto as Exhibit A, initialed by both Parties, and made a part hereof by reference thereto; Whereas, the Parties wish to modify the provisions of the said contract (the Agreement) by this Supplemental Agreement; Now, therefore, for and in consideration of the mutual covenants contained in this Supplemental Agreement, and other good and valuable consideration, the Parties hereby agree the Agreement is hereby changed by eliminating from the said Agreement of       , (Date) all of       , commencing with (specify paragraphs in original contract to be removed) Line       on Page       , and ending with Line       on Page       , and inserting in its place the following paragraph:                               . (set forth text of replacement paragraph) The Agreement of the parties is changed only as above set forth. WITNESS our signatures on this the       day of       , 20       . By: By: (Signature of John Doe) (Signature of Mary Roe)             (P rinted Name of John Doe ) (P rinted Name of Mary Roe ) Supplemental Agreement Page 1 of 1