SURVEYOR’S INSPECTION REPORT

INSTRUCTIONS – Civil Engineer or Registered Land Surveyor Will complete this report and attach copy of Survey or Plat. The Plat must show the boundary lines and all distances; the location of improvements on the land and distances from lot lines; a description of the property, and encroachments, party walls or easements. The plat must be dated, sealed and signed by Civil Engineer or Registered Surveyor.

To: STEWART TITLE GUARANTY COMPANY

THIS IS TO CERTIFY, that I have made and accurate survey of the premises standing in the name of

situated at

City County State

known as Street Numbers

and shown on the accompanying survey entitled:

I made careful personal inspection of said premises and of the building located thereon at the time of making such survey, and from such inspection I found

to be in possession of said premises as ¨ tenant ¨ owner.

AND CERTIFY THAT SAME HAS ACCESS TO A PUBLIC ROAD AS SHOWN ON THE ATTACHED PLAT.

I further certify as to the existence or non-existence of the following: (If none, state “None”)

1. Rights of way, old highways or abandoned roads, lanes or driveways, drains, sewer or water pipes over and across said premises:

2. Telephone, telegraph or electric power poles, wires or lines locates on or crossing said premises:

3. Springs, streams, rivers, ponds or lakes located, bordering on or running through said premises:

4. Disputed boundaries or encroachments. (Specify definitely whether buildings on surveyed premises encroach on adjoining properties and whether buildings on adjoining properties encroach upon surveyed premises):

5. Cemeteries or family burying grounds located on said premises:

6. Building or possession lines. (In case of city or town properly specify definitely as to whether or not walls are independent walls or party walls and as to all easements of support or “beam rights.”

In case of county property report as to all fence lines.)

7. Are there any indications of building construction, alterations or repairs within recent months?

8. Description of present improvements

9. If any zoning or other municipal regulations affect the use of survey premises, do the improvements on the premises and the use made of them comply with such?