Bill of Sale Form

Warranty Deed (Husband and Wife to an Individual with reserved Life Estate)

--------Above This Line Reserved For Official Use Only-------------

WARRANTY DEED

(Husband and Wife to an Individual with reserved Life Estate)

KNOW ALL MEN BY THESE PRESENTS THAT:

FOR VALUABLE CONSIDERATION OF TEN DOLLARS ($10.00), and other good and valuable consideration, cash in hand paid, the receipt and sufficiency of which is hereby acknowledged, and , Husband and Wife, hereinafter referred to as “Grantors”, do hereby grant, convey and warrant unto , hereinafter “Grantee”, the following lands and property, together with all improvements located thereon, lying in the County of , State of West Virginia, to-wit:

Describe Property of State "SEE DESCRIPTION ATTACHED"

Prior instrument reference: Book , Page , Document No. , of the Recorder of County, West Virginia.

LESS AND EXCEPT all oil, gas and minerals, on and under the above described property owned by Grantors, if any, which are reserved by Grantors.

SUBJECT to all easements, rights-of-way, protective covenants and mineral reservations of record, if any.

SUBJECT to Life Estates retained by and , Grantors, to run consecutively. It being the intention of the Grantors that the ending of one Life Estate shall in no way affect the remaining Life Estate.

TO HAVE AND TO HOLD same unto Grantee, and unto Grantee’s assigns forever, with all appurtenances thereunto belonging.

GRANTORS do for Grantors and Grantors’ heirs, personal representatives, executors and assigns forever hereby covenant with GRANTEE that Grantors are lawfully seized in fee simple of said premises; that the premises are free from all encumbrances, unless otherwise noted above; that Grantors have a good right to sell and convey the same as aforesaid; and to forever warrant and defend the title to the said lands against all claims whatever.

COMPLETE ALL APPLICABLE STATEMENTS:

The grantor(s) herein does/do hereby declare that this is a transfer exempt from the excise tax; Under the penalties of fine and imprisonment as provided by law, the grantor(s) does/do hereby declare(s) that the total consideration for the real estate transferred by this document is Dollars ($ ).

WITNESS Grantor(s) hand(s) this the day of , 20 .

STATE OF

COUNTY OF

This instrument was acknowledged before me on (date) by (name or names of person or persons acknowledging).

Notary Public

Printed Name:

My Commission Expires:

DECLARATION OF CONSIDERATION OR VALUE

I hereby declare:

(a) The total consideration paid for the property conveyed by the document to which this declaration is appended is $ ; or

(b) The true and actual value of the property transferred by the document to which this declaration is appended is, to the best of my knowledge and belief $ ; or

(c) The proportion of all the property included in the document to which this declaration is appended which is real property located in West Virginia is %; the value of all the property $ ; the value of real estate in West Virginia is $ ; or

(d) This deed conveys real estate located in more than one county in West Virginia; the total consideration paid for, or actual cash value of, all the real estate located in West Virginia conveyed by this document is $ ; and documentary stamps showing payment of all of the excise tax on all of said real estate are attached to an executed counterpart of this deed recorded in County.

Given under my hand this day of , 20 .

Nature of Interest in Conveyance:

Grantor

Grantee

Other

Specify:

Prepared by and after Recording Return to:

Name:

Firm/Company:

Address:

Address 2:

City, State, Zip:

Phone:

Preparer’s signature:

SEND TAX STATEMENTS TO GRANTEE