KNOW ALL MEN BY THESE PRESENTS, THAT......of the first part, for and in consideration of the sum of........lawful money of the United States, to......in hand paid, at or before the ensealing and delivery of these presents, by ........ of the second part, the receipt whereof is hereby acknowledged, ha.. bargained and sold, and by these presents do. . grant and convey unto the said part.. of the second part, ...... executors, administrators and assigns,

.............................................................................................................................................

.............................................................................................................................................

TO HAVE AND TO HOLD the same unto the said part.. of the second part,

......executors, administrators and assigns forever. And......do. ., for......

heirs, executors and administrators, covenant and agree to and with the said part.. of the second part, to warrant and defend the sale of the said........

hereby sold unto the said part.. of the second part,......executors, administrators and assigns, against all and every person and persons whomsoever.

IN WITNESS whereof, ...... have hereunto set ......hand and seal this

......day of........one thousand nine hundred......

Sealed and delivered in the Presence of

.......................................... ..................[L.S.]

STATE OF.................

CITY OF...................

COUNTY OF...............

SS.: being duly sworn, deposes and says that . .h.. resides at....................

in the Borough of........, in the City of........

That ..h.. is the same person who executed the within bill of sale.

That ..h.. is the sole and absolute owner.. of the property described in said bill of sale, and each and every part thereof, and has full right to sell and transfer the same.

That the said property, and each and every part thereof, is free and clear of any and all liens, mortgages, debts and other incumbrances or claims of whatsoever kind or nature.

That ..h.. is not indebted to anyone and has no creditors.

That there are no judgments existing against ..h.., in any Court, nor are there any replevins, attachments, or executions issued against ..h.. now in force; nor has any petition in bankruptcy been filed by or against ..h..

That this affidavit is made for the purpose and with the intent of inducing to purchase the property described in said bill of sale, knowing that ..h.. will rely thereon and pay a good and valuable consideration therefor.

Sworn to before me this..............

day of ......................192 .................................................

............................................................

(ACKNOWLEDGMENT)