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Certificate of Value

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Grantor/Assignor: _______________

_________________________________

_________________________________

Grantee/Assignee: ______________

_________________________________

_________________________________

Legal Description:

__________________________________________________________

Date of instrument: _______________

Relationship of grantor/assignor and grantee/assignee:

___________________________________________________________

Total purchase price: $_____ (________________ &___/100 dollars)

Other consideration exchanged for the property: ________________

Terms of payment if other than payment in full at the time of the sale:

__________________________________________________________

______________________________ _________________________________

Assignor/Seller Assignee/Buyer

Certificate of Value

Review List

This review list is provided to inform you about this document in question and assist you in its preparation. To the extent you require a Certificate of Value, this document should serve your purposes.

1. Make multiple copies. Give one to each signatory. Keep a copy with the file in question. This document does not need to be filed with the registry of deeds or any other such agency.

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