Town of Lady Lake                                                           ATTN: Kris Kollgaard

State of Florida                                                                  Fax: (352) 751-1510

                                                                                         Phone: (352) 751-1571

                                                                                         E-mail:  kkollgaard@ladylake.org

                                                        TOWN CERTIFICATE

            I, ________________________________, Town Clerk for the Town of Lady Lake,
                  Florida, hereby certify that there are:

1.      Unpaid utility bills due to the Town up to and including the date of this certificate
 that may create a lien against the property described herein of: _______________________________________________________________
_______________________________________________________________

2.      Municipal improvement liens levied or assessed by the Town up to and including
 the date of this certificate against the property described herein of: ________________________________________________________________
________________________________________________________________
________________________________________________________________

3.      Other items of:

_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________

LEGAL DESCRIPTION:

WITNESS my hand and seal this _____________day of __________________,
20____

{SEAL}

                                                                        _________________________________

                                                                        Town Clerk for the

                                                                        Town of Lady Lake, Florida

Owner:

Physical Address: