[Place and date.] _________ trust company:

Within five days after the title is examined and approved by above attorney, subject only to:

1 Right or claims of parties in possession not shown of record, and questions of survey;

2 Mechanics' lien claims, if any, where no notice appears of record;

3 Special assessment not confirmed, or confirmed after _________[date];

4 Taxes for the year _________;

5 Building line, established by 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 _________;

9 Special assessment, warrant No. _________; and

10 Zoning and building ordinances;

the purchaser agrees to deposit with you the additional $_____, or, if objections to the title are reported, to deposit with you additional sum within five days after objections are cured to the satisfaction of purchaser's attorney. The purchaser also agrees to deposit with you within five days: _________.

Upon deposit of the additional sums required to be made by the purchaser, and upon being advised by purchaser's attorney that the title is approved you are directed to file for record the warranty deed and _________ and to continue the abstract to cover the same, and if the continuation shows only the instruments deposited and recorded under this agreement, and acts done or suffered by or judgments against the grantee or grantees, and special assessments or special taxes, if any, levied or confirmed since the continuation, then you are authorized and directed: (a) To disburse money as follows: _________. (b) To _________.

In the event that the purchaser's attorney reports objections to the title, the seller shall have 60 days from date of receipt of the objections by you and by the seller to cure same, and if cured to the satisfaction of purchaser's attorney, you are directed upon being advised by purchaser's that objections have been cured and upon deposit being made with you of the additional sums called for, to file for record the instruments directed to be recorded and continue the abstract to cover the same and pay out as above directed. If the objections are not cured, then you are directed, upon the demand of either the seller or the purchaser, to return the deposits to the respective parties who made them.

If purchaser's attorney shall fail to report to you in writing any objections to the title within _________ days from the date of delivery of the abstract to the attorney, the attorney shall be conclusively deemed to have approved the title, and you are directed to proceed as though the title was approved.

If the title is approved by the attorney and the purchaser fails to deposit with you, within the time required, the additional sum and purchase money notes and trust deed, if any, required, then you are directed, upon demand of the seller, to return the deed and all other deposits, if any, made by seller, and pay out earnest money as follows: to _________ a broker's commission amounting to $_____ and the balance to the seller.

If objections to the title are reported and are not cured to the satisfaction of the attorney within the time allowed, or if the continuation of the abstract to cover deed shows matters, other than the instruments deposited and directed to be recorded under this agreement, and acts done or suffered by or judgments against the grantee or grantees and special assessments or special taxes, if any, levied or confirmed since the first continuation, then you are directed, upon the demand of either the seller or the purchaser, to return the deposits to the respective parties. However, if the deed was recorded, no return of deposits shall be made to the purchaser until the title is reconveyed to the seller free and clear of encumbrances or liens due to acts done or suffered by or judgments against the grantee or grantees. Any return of deposits under this escrow shall not prejudice the rights of either party under any contract for the sale of the premises.

You are authorized to comply with these instructions and are relieved from all liability for so doing, notwithstanding any demand or notice to the contrary by any party, and you shall not be required to take notice of the terms of any contract for the sale of the premises that may be deposited nor shall you be personally liable for any act you may do or omit to do as escrowee while acting in good faith and in the exercise of your own best judgment, and any act done or omitted by you pursuant to the advice of your own attorneys shall be conclusive evidence of good faith.

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

Are any prorations to be 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 to _________.

Your charges are to be paid as follows _________.