Legal Statement of Ownership

LEGAL STATEMENT OF OWNERSHIP

This Legal Statement of Ownership is made and entered into on this day of , , by and between Owner Name: , Entity Type: Individual Corporation Other with principal address (hereinafter "Owner"), and Recipient Name: , Entity Type: Individual Corporation Other with principal address (hereinafter "Recipient"). Owner and Recipient may be referred to individually as a "Party" and collectively as the "Parties."

RECITALS

WHEREAS, Owner is the lawful holder of certain property described herein and asserts full legal title to such property;

WHEREAS, Recipient requires a written statement of ownership for the purpose of recordation, transfer, insurance, financing, or other lawful uses permitted under applicable law; and

WHEREAS, Owner desires to declare and certify the nature and extent of Owner's title and to provide assurances and representations to Recipient regarding the Property.

NOW, THEREFORE, in consideration of the mutual covenants contained herein and other good and valuable consideration, the Parties agree as follows:

1. DEFINITIONS

For purposes of this Statement, the following terms shall have the meanings set forth: "Property" means the item(s) or right(s) described in Section 2 below; "Encumbrance" means any lien, mortgage, pledge, security interest, claim, easement, lease, option, or other restriction affecting title or use.

2. STATEMENT OF OWNERSHIP

Owner hereby declares and affirms that Owner is the sole legal and beneficial owner of the Property described as follows. Owner acquired the Property by the method and on the date set forth below and holds title free from transfer except as disclosed in this Statement.

Serial number, registration, title number, or other identifying marks (if applicable):

Date of acquisition: . Method of acquisition (purchase, gift, inheritance, other):

3. REPRESENTATIONS AND WARRANTIES

Owner represents and warrants to Recipient as of the date of this Statement that:

(a) Owner is the lawful owner of the Property and has full right, title and authority to make the declarations contained in this Statement;

(b) Except as disclosed in writing in this Statement, the Property is not subject to any Encumbrance, lien, security interest, lease, or adverse claim that would materially impair Owner's ability to convey, transfer or grant rights in the Property;

4. TITLE SEARCH AND RECORDS

Owner agrees that upon reasonable request Recipient may review documents evidencing Owner's title to the Property, including purchase documents, bills of sale, registration certificates, or other records. Owner shall produce reasonable documentation within a commercially reasonable time.

5. COVENANTS

Owner covenants that Owner will not sell, pledge, encumber or otherwise transfer legal or equitable title to the Property without first notifying Recipient if such transfer would materially affect Recipient's reliance on this Statement.

6. INDEMNIFICATION

Owner shall indemnify, defend and hold harmless Recipient and its agents from and against any and all claims, losses, damages, liabilities, costs and expenses (including reasonable attorneys' fees) arising out of any breach of the representations, warranties or covenants contained in this Statement.

7. NOTICES

All notices required or permitted hereunder shall be in writing and delivered to the addresses set forth below or to such other address as a Party may designate by written notice in accordance with this Section.

8. AMENDMENTS; WAIVER

No amendment, modification or waiver of any provision of this Statement will be effective unless in writing and signed by both Parties. No waiver of any breach shall be deemed a waiver of any other or subsequent breach.

9. GOVERNING LAW

This Statement shall be governed by and construed in accordance with the laws of the State of , without regard to conflict of laws principles.

10. ENTIRE AGREEMENT

This Statement constitutes the entire agreement between the Parties with respect to the subject matter hereof and supersedes all prior and contemporaneous agreements, understandings, negotiations and discussions, whether oral or written.

11. SEVERABILITY

If any provision of this Statement is held to be invalid, illegal or unenforceable, the remaining provisions shall remain in full force and effect and the invalid provision shall be reformed to the minimum extent necessary to make it enforceable.

12. COUNTERPARTS

This Statement may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one and the same instrument. Facsimile or electronic signatures shall be effective as originals to the extent permitted by law.

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