Owner Policy No.: O-5841-
Date of Policy:
Amount of Insurance: $
1. Name of Insured:
2. The estate or interest in the land which is covered by this policy is:
Fee Simple as to Parcel I;
Leasehold Estate as to Parcel II
Easement Estate as to Parcel III
3. Title to the estate or interest in the land is vested in:
4. The land referred to in this policy is described as follows:
LOT 21, BLOCK 1, ROYAL ACRES, a subdivision of land in Peanutsville City, Schultz County, State of Comics, according to the recorded plat thereof.
Leasehold estate created by a certain indenture of lease dated ______, made by ________, a lessor, to ___________, as lessee, and recorded ___________ in Book _________, Page ________, demising and leasing for a primary term of ____ years, beginnning __________ and ending _________, the following described premises, to-wit:
LOT 20, BLOCK 1, ROYAL ACRES, a subdivision of land in Peanutsville City, Schultz County, State of Comics, according to the recorded plat thereof.
A non-exclusive easement for ______________ purposes, appurtenant to Parcel II, as established by the instrument recorded in Book _______, Page _______, over the following described area: _____________________________________________________________________________________________________________________________________.
No guidelines are available for this form at this time.