PERSON COUNTY TAX OFFICE

                                                        CONFIDENTIAL INFORMATION

                                                        FOR TAX OFFICE USE ONLY

                                                        (NOT FOR PUBLIC USE)

          __________                          _________

          TOWNSHIP                           AP# LOT#

GRANTOR ______________________________________________________________________

GRANTEE _______________________________________________________________________

ADDRESS _______________________________________________________________________

________________________________________________________________________________

SALE PRICE $ _____________________________      SALE DATE _________________________

GIFT ____          TRADE ____         INHERITANCE ____        PROPERTY SETTLEMENT ____

PERSONAL PROPERTY INVOLVED:

        NO ____        YES ____

                                                                                   Type ___________________________________

                                                                                   Value $ _________________________________

LOAN ASSUMPTION:                                             TOBACCO LBS. SOLD

        NO ____        YES ____                                    ALL ____     NONE ____   LBS SOLD _______

PRESENTED FOR RECORDATION BY:

SIGNED: _________________________________________________________________________

TITLE: ______________________________________       DATE: ____________________________

N.C.G.S.    §105 - 303        Obtaining information of real property transfers; permanent listing.

(a) (2)          "When any conveyance of real property (other than a deed of trust of mortgage) is

                    submitted for recordation, the Board of County Commissioners may require the

                    Register of Deeds to refuse to record it unless it has been presented to the Tax

                    Supervisor and the Tax Supervisor has noted thereon that he has obtained the

                    information he desires from the conveyance and from the person recording it."

_________________________________________________________________________________

(THE FOLLOWING INFORMATION IS OPTIONAL AND DOES NOT HAVE TO BE

COMPLETED IN ORDER TO HAVE DEED RECORDED).

TYPE FINANCING:                                                            MARKET TIME:

    ____ 1. Conventional                                                           ____ 1. Less than 3 months

    ____ 2. Loan assumption                                                     ____ 2. 3 to 6 months

    ____ 3. FHA                                                                       ____ 3. Over 6 months

    ____ 4. VA

    ____ 5. Other _________________

Are closing costs included in above sale price?                       No ____        Yes ____

Are points included in above sale price?                                 No ____        Yes ____

Are realtor's fee included in above sale price?                         No ____        Yes ____