1. That _________ is the borrower in the within building loan agreement [if borrower is a corporation, substitute "_________ is the president of the corporation described as borrower"].

2. That the consideration for the loan described there is the sum of $_____ which includes the cost of examination of title, inspections and appraisal fees, conveyancing, recording fees, recording tax, federal tax and brokerage; that no other expenses have been or will be incurred in connection with the loan except premiums for fire insurance policies and surveys; that after the payment of existing liens, taxes, assessments and water rates against the premises aggregating $_____ and the payment of the consideration for the loan as set forth above, the net sum available to the borrower for the improvement will be $_____, less the amount of fire insurance premiums, interest on existing liens, cost of surveys, interest on the amounts advanced and taxes, assessment and water rates which may hereafter become liens against the premises.