Owner Policy Rejection Form

OWNER POLICY REJECTION FORM

DATE: , 200_

FILE NO:

The undersigned hereby acknowledges that a Mortgagee Policy of Title Insurance is to be issued to the lender in this transaction for a premium of $___________ and understands that such policy ONLY PROTECTS THE LENDER and does NOT afford title insurance coverage to the undersigned in the event of a defect in the title to the real estate which is being acquired. An Owner Policy of Title Insurance which would provide protection to the undersigned in the face amount of $_____________ would be issued to the undersigned for an additional premium cost of $_____________ but is rejected hereby.

The undersigned(s) hereby REJECT the issuance of said Owner Policy.

_______________________________________

STATE OF MISSISSIPPI

COUNTY OF

Personally appeared before me, the undersigned authority in and for the said county and state, within my jurisdiction, the within named __________________ who acknowledged that he/she/they executed the above and foregoing instrument as his/her/their own act and deed.

Given under my hand and seal on this the day of _____________, 200_.

My commission expires: _______________________________________

Notary Public