Owner Statement Template

OWNER STATEMENT

This Owner Statement is made effective as of (the Effective Date), by and between Owner Name: and Recipient Name: .

WHEREAS

WHEREAS, Owner Name: is the lawful owner of the assets, property, or interests described herein and has authority to make the statements and representations set forth in this Owner Statement;

WHEREAS, Recipient Name: requires a formal written statement from Owner describing ownership, encumbrances, and related transaction terms for the purposes stated below;

WHEREAS, the parties intend that this Owner Statement memorialize factual ownership, representations, permitted uses, payment and other terms relevant to the parties' transaction or evaluation.

OWNER IDENTIFICATION

Individual    Corporation    LLC    Other:

STATEMENT OF OWNERSHIP

Owner hereby states, represents, and warrants that Owner is the sole legal and beneficial owner of the following property, asset(s), or equity interest(s) (each an "Owned Asset") as of the Effective Date. Describe each Owned Asset with sufficient detail, including identifying numbers, physical location, and any distinguishing characteristics.

REPRESENTATIONS AND WARRANTIES

Owner represents and warrants to Recipient that:

1. Ownership and Authority: Owner is the lawful owner of the Owned Asset(s) and has full power and authority to make this statement, and to sell, grant, assign, or otherwise convey any interest in the Owned Asset(s) subject to the terms agreed by the parties.

2. Liens, Encumbrances and Exceptions: Except for the encumbrances listed below, the Owned Asset(s) are free and clear of all liens, security interests, claims, pledges, options, and other encumbrances. Encumbrances (if any) are described here or indicated on an attachment incorporated into this Statement.

3. No Pending Actions: There are no pending or threatened lawsuits, administrative proceedings, or governmental orders that affect Owner's title or right to transfer the Owned Asset(s) except as disclosed in writing to Recipient.

SCOPE OF TRANSFER / PERMITTED USE

Describe the intended transfer, permitted uses, limitations, and any conditions upon which Owner grants rights or transfers interests in the Owned Asset(s). If transaction is for evaluation, collateral, sale, lease, or other purpose, specify here.

PAYMENT TERMS

If consideration is payable to Owner in connection with transfer or licensing of Owned Asset(s), specify amount, schedule, and late payment terms.

Late payments shall accrue interest at or the maximum permitted by law, whichever is less.

TERM AND TERMINATION

This Owner Statement shall commence on Start Date: and, unless earlier terminated in accordance with this paragraph, shall expire on End Date: .

Either party may terminate this Statement for material breach by the other party if the breaching party fails to cure such breach within Notice Period: days after receipt of written notice. Termination shall not affect rights or obligations that accrued prior to termination.

CONFIDENTIALITY

All non-public information provided by Owner to Recipient in connection with this Owner Statement, including business information and descriptions of Owned Asset(s), shall be treated as confidential and shall not be disclosed by Recipient except (a) to its affiliates, agents or advisors on a need-to-know basis who are bound to maintain confidentiality, (b) as required by law, or (c) with Owner's prior written consent. Recipient shall use no less than reasonable care to protect such confidential information.

GOVERNING LAW; DISPUTE RESOLUTION

This Owner Statement shall be governed by and construed in accordance with the laws of the State of without regard to its conflict-of-law principles. The parties agree that any action arising out of or relating to this Statement shall be brought exclusively in the state or federal courts located in that state unless otherwise mutually agreed in writing.

ENTIRE AGREEMENT

This Owner Statement constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior and contemporaneous understandings, agreements, representations and warranties, both written and oral. Any amendment or modification of this Statement must be in writing signed by both parties.

NOTICES

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