NOTICE FOR TERMINATION OF AGREEMENT FOR DEED UPON

DEFAULT
STATE OF ________________________

COUNTY OF ________________________
Personally appeared before me the undersigned authority, _________________________________________, Affiant, who, being by me, first duly sworn upon oath, deposes and says that:

1. The Affiant is the "First Party" to an Agreement for Deed executed by and between the Affiant and , referred to in such Agreement for Deed as the "Second Party".

2. Said Agreement for Deed was recorded against a parcel of  land situate in the County of ______________, State of ______________, more fully described as: 

3. Said Agreement for Deed was recorded under Paragraph 17  therein, which also provided, in pertinent part, that a termination of said Agreement could also be recorded if the Second Party therein defaulted in the Second Party's obligations. In addition, said paragraph provided that the Notice of Termination would be effective ninety (90) days subsequent to recording hereof; unless a legal proceeding is instituted and lis pendens filed by the Second Party during said ninety (90) day period. 

4. The Second Party has defaulted under Paragraph 9 or 10 of said Agreement and the Affiant is therefore entitled to record this Notice of Termination which shall become effective ninety (90) days subsequent to the date of recording hereof. 

5. The Affiant is the title holder in fee simple of said property and, unless challenged through appropriate proceedings by the Second Party within the time period provided, owns said property free and clear of any encumbrance created by said Agreement for Deed.

____________________________ Affiant Sworn to and subscribed before me this ____ day of   ____________________, 19 _____. 
___________________________
Notary Public 
(SEAL) State of 
My Commission Expires: ______________________