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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