Real Estate Certification and Authorization

REAL ESTATE CERTIFICATION AND AUTHORIZATION

Parties

Certifying Party (Owner):

Property Identification

Certifications by Owner

The undersigned Owner certifies, represents and warrants to the Representative and to any third party reasonably relying upon this document that the following statements are true and complete as of the date signed below:

1. Ownership and Authority. Owner is the sole legal owner of the Property and has full right, power and authority to execute this Certification and Authorization. Owner is not a minor, incompetent, or subject to any guardianship or conservatorship. Owner Name:

2. Liens and Encumbrances. Except for the items disclosed below, there are no outstanding mortgages, liens, judgments, assessments, easements, recorded leases, or other encumbrances against the Property. Owner discloses exceptions (if any):

3. Legal Actions. There are no pending or threatened lawsuits, claims or administrative proceedings affecting title to or use of the Property except as disclosed below:

4. Environmental and Hazardous Conditions. Please indicate whether any of the following conditions are known to exist on, beneath, or adjacent to the Property:

Lead-based paint present? Yes No

Mold or water intrusion known? Yes No

Underground tanks, spills, chemical storage, or other contamination? Yes No

Authorizations and Scope

Owner hereby authorizes the Representative to act on Owner's behalf, as described below, solely for the purpose of evaluating, marketing, contracting for sale, closing, or otherwise managing disposition of the Property, subject to the limitations stated in this document.

The Representative is authorized to:

Order and receive title reports, payoff statements and related escrow/title documents

Obtain building permits, zoning records, tax records, utility records, and other public documents

Execute documents on behalf of Owner by limited power of attorney specifically authorizing closings, escrow instructions, and lien releases related to the sale or transfer of the Property

Disclose and deliver ownership, title and property condition information to prospective purchasers, lenders, insurers, and governmental agencies as necessary to consummate a transaction

Term; Revocation; Notices

This Certification and Authorization is effective as of the Effective Date below and remains in effect until revoked in a written instrument delivered to the Representative at the Representative Contact Address above. Owner may revoke this authorization; revocation shall be effective only upon receipt by Representative.

Effective Date:

Indemnification and Reliance

Owner agrees to indemnify, defend and hold harmless the Representative and its affiliates, agents and assigns from and against any and all claims, liabilities, losses, costs and expenses (including reasonable attorneys' fees) arising out of or relating to any false statement, omission, or breach of representation contained in this Certification and Authorization, except to the extent caused by the gross negligence or willful misconduct of the Representative.

Any person, title company, lender, broker, escrow agent or other third party may rely upon this Certification and Authorization until written notice of revocation has been received by the Representative at the address provided above.

Compliance; Representations

Owner represents that to the best of Owner's knowledge the Property, improvements and current uses are in compliance with applicable building codes, zoning, and land-use restrictions except as disclosed in writing below:

Entire Agreement; Governing Law

This Certification and Authorization constitutes the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior agreements and understandings, oral or written. This document may be amended only in writing signed by both parties.

Governing Law State:

Certification and Signature

By signing below, Owner certifies under penalty of perjury under the laws of the Governing Law State that the information provided in this Certification and Authorization is true, correct and complete to the best of Owner's knowledge and authorizes the Representative to undertake the actions described above.

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