1. Rights or claims of parties in possession, not shown of record, and questions of survey.

2. Mechanic's lien claims, if any, where no notice appears of records.

3. Special assessments not confirmed or confirmed after _________[date].

4. Taxes for the year _________.

5. Building line established in instrument recorded as document _________.

6. Restrictions contained in instrument recorded as document _________.

7. Agreement for party wall, recorded as document _________.

8. Mortgage encumbrance, recorded as document _________. Amount due on the mortgage _________. Interest since _________ to be paid by _________.

9. Special assessment, warrant No. _________.

10. Zoning and building ordinances _________.

11. Acts done or suffered by or judgments against the grantee _________.

You are then authorized and directed to disburse the money as follows _________.

Is there any commission to be adjusted through this escrow? _________.

Have all prorations been made? _________.

Are fire insurance policies to be brought in? _________. Are mortgage clauses to be attached? _________ $_____.

Are leases to be brought in? _________.

Are water taxes paid? _________. Is receipt to be produced? _________.

Objections Nos. _________ erased before signing.

Deliver abstract and policy to _________.

Your charges are to be paid as follows: _________.