Appendix A to Part 1010 — Standard and Model Forms and Clauses

I. Forms for Developer's Affirmation for Land Sale - § 1010.13(a)(9)

Developer's Name__

Developer's Address__

Purchaser's Name(s)__

Purchaser's Address(es) (including county)__

Name of Subdivision__

Legal Description of Lot(s) Purchased__

I hereby affirm that all of the requirements of the MSA exemption as set forth in 15 U.S.C. 1702(b)(8) and 12 CFR 1010.13 have been met in the sale or lease of the lot(s) described above.

I also affirm that I submit to the jurisdiction of the Interstate Land Sales Full Disclosure Act with regard to the sale or lease cited above.

(Date)__

(Signature of Developer or Authorized Agent)__

(Title)__

II. Language Notifying Buyer of Option to Cancel Contract - § 1010.15(b)(5)(i)

You have the option to cancel your contract or agreement of sale by notice to the seller until midnight of the seventh day following the date of signing of the contract or agreement.

If you did not receive a Lot Information Statement prepared pursuant to the rules and regulations of the Bureau of Consumer Financial Protection in advance of your signing the contract or agreement, the contract or agreement of sale may be cancelled at your option for two years from the date of signing.

III. Sample Lot Information Statement and Sample Receipt - § 1010.15(b)(11)

Sample Format

(Use of the following headings and first paragraph are mandatory.)

Lot Information Statement

Important: Read Carefully Before Signing Anything

The developer has obtained a regulatory exemption from registration under the Interstate Land Sales Full Disclosure Act. One requirement of that exemption is that you must receive this Statement prior to the time you sign an agreement (contract) to purchase a lot.

Right To Cancel

(Under this heading the developer is to state the specific rescission rights provided for in the contract pursuant to 1010.15(b)(5)(i)).

Risk of Buying Land

(Under this heading the developer is to list the following information:)

There are certain risks in purchasing real estate that you should be aware of. The following are some of those risks:

The future value of land is uncertain and dependent upon many factors. Do not expect all land to automatically increase in value.

Any value which your lot may have will be affected if roads, utilities and/or amenities cannot be completed or maintained.

Any development will likely have some impact on the surrounding environment. Development which adversely affects the environment may cause governmental agencies to impose restriction on the use of the land.

In the purchase of real estate, many technical requirements must be met to assure that you receive proper title and that you will be able to use the land for its intended purpose. Since this purchase involves a major expenditure of money, it is recommended that you seek professional advice before you obligate yourself.

If adequate provisions have not been made for maintenance of the roads or if the land is not served by publicly maintained roads, you may have to maintain the roads at your expense.

If the land is not served by a central sewage system and/or water system, you should contact the local authorities to determine whether a permit will be given for an on-site sewage disposal system and/or well and whether there is an adequate supply of water. You should also become familiar with the requirements for, and the cost of, obtaining electrical service to the lot.

Developer Information

(Under this heading the developer is to list the following information:)

Developer's Name:__

Address:__

Telephone Number:__

Lot Information

(Under this heading the developer is to list the following information:)

Lot Location:__

(Enter a statement disclosing all liens, reservations, taxes, assessments, easements and restrictions applicable to the lot. A copy of the restrictions may be attached in lieu of recitation.)

Suppliers of Utilities and Issuers of Permits

(Under this heading the developer is to list the name, address and phone number of the appropriate governmental agency or agencies, if any, that will provide information on permits or other requirements for water, sewer and electrical installations. The information will also contain the name, address and telephone number of the suppliers of such utilities which can provide information to the purchaser on costs and availability of such services. A chart similar to the one below may be used to supply this information).

Listed below are contact points for determining permit requirements, if any, and to obtain information on approximate costs and availability for the listed services:

If misrepresentations are made in the sale of this lot to you, you may have rights under the Interstate Land Sales Full Disclosure Act. If you have evidence of any scheme, artifice or device used to defraud you, you may wish to contact: Consumer Financial Protection Bureau, Interstate Land Sales Registration Program, 1700 G Street NW., Washington DC 20552.

(The Receipt is to be in the following form:)

Sample Receipt for Lot Information Statement

Purchaser (print or type):__

Date:__

Signature of purchaser:__

__

Street Address:__

City:__

State:__

Zip:__

Name of salesperson (print or type):__

Signature of salesperson:__

IV. Request for Multiple Site Subdivision Exemption - § 1010.15(c)(1)

Request for Multiple Site Subdivision Exemption

Developer:

Name:__

Address:__

Telephone No.:__

Agent:

Name:__

Address:__

Telephone No.:__

(Insert a general description of the developer's method of operation.)

I affirm that I am, or will be, the developer of the property and/or method of operation described above.

I affirm that the lots in said property will be sold in compliance with all of the requirements of 12 CFR 1010.15.

I further affirm that the statements contained in all documents submitted with this request for an Exemption Order are true and complete.

Date:__

Signature:__

Title:__

WARNING: 18 U.S.C. 1001 provides, among other things, that whoever knowingly and willingly makes or uses a document or writing containing any false, fictitious, or fraudulent statement or entry, in any matter within the jurisdiction of any department or agency of the United States, shall be fined not more than $10,000 or imprisoned for not more than 5 years or both.

V. Request for Regulatory Exemption Order - § 1010.16(c)

REQUEST FOR EXEMPTION ORDER

Subdivision__

Location (including county)__

Developer__

Address__

Authorized Agent or President of Developer__

__

Address__

Number of Lots Subject to Exemption Request__

Description of Lots (list lot and block number or other identifying designation)__

__

I affirm that I am the developer or owner of the property described above or will be the developer or owner at the time the lots are offered for sale to the public, or that I am the agent authorized by the developer or owner to complete this statement. I further affirm that the statements contained in all documents submitted with the request for an exemption order are true and complete.

__

(Date)__

(Signature of Developer, Owner or Authorized Agent)

__

(Title)

WARNING: Section 15 U.S.C. 1717 provides: “Any person who willfully violates any of the provisions of this title or of the rules and regulations or any person who willfully, in a Statement of Record filed under, or in a Property Report issued pursuant to this title, makes any untrue statement of a material fact shall upon conviction be fined not more than $10,000.00 or imprisoned not more than 5 years, or both.”

VI. Developer's Affirmation for Advisory Opinion - § 1010.17(b)(3)

Developer's Affirmation

Name of Subdivision__

Location (Including County and State)__

Name of Developer__

Address of Developer__

Name of Agent__

Address of Agent__

Number of Lots in Subdivision__

Number of Acres in Subdivision__

I affirm that I am the developer or owner of the property described above or will be the developer or owner at the time the lots are offered for sale to the public, or that I am the agent authorized by the developer or owner to complete this statement.I further affirm that the statements contained in all documents submitted with the request for an Advisory Opinion are true and complete.

__

(Date)

__

(Signature)

__

(Title);

WARNING: 15 U.S.C. 1717 provides: “Any person who willfully violates any of the provisions of this title or of the rules and regulations or any person who willfully, in a Statement of Record filed under, or in a Property Report issued pursuant to this title, makes any untrue statement of a material fact shall upon conviction be fined not more than $10,000.00 or imprisoned not more than 5 years, or both.”

VII. Initial and Consolidated Registration Fee Schedule - § 1010.35(b)

VIII. Property Report for Statement of Record - § 1010.100(b)

(a) General Instructions

(b) Method of Sale

(c) Encumbrances, Mortgages and Liens

(d) Recording the Contract and Deed

(e) Payments

(f) Restrictions

(g) Plats, Zoning, Surveying, Permits, Environment

(a) Water

(b) Sewer

(c) Electricity

(d) Telephone

(e) Fuel or other Energy Source

(a) General Topography

(b) Water Coverage

(c) Drainage and Fill

(d) Flood Plain

(e) Flooding and Soil Erosion

(f) Nuisances

(g) Hazards

(h) Climate

(i) Occupancy

(a) Property Owners' Association

(b) Taxes

(c) Violations and Litigation

(d) Resale or Exchange Program

(e) Unusual Situations

1. Leases

2. Foreign Subdivision

3. Time Sharing

4. Membership

(f) Equal Opportunity in Lot Sales

(g) Listing of lots

The Bureau's OMB control number for this information collection is: 3170-0012.

IX. Sample Page for Statement of Record - 1010.102(e)

SAMPLE PAGE

ROADS

Here we discuss the roads that lead to the subdivision, those within the subdivision and the location of nearby communities.

ACCESS TO THE SUBDIVISION.

County road #43 leads to the subdivision. It has two lanes and the width of the wearing surface is 22 feet. It's paved with a macadam surface.

This road is maintained by Bottineau County with County funds. No improvements are planned at this time.

ACCESS WITHIN THE SUBDIVISION.

The roads within the subdivision will be located on rights of way dedicated to the public.

We are responsible for constructing the interior roads. There will be no additional cost to you for this construction.

WE HAVE NOT SET ASIDE ANY FUNDS IN AN ESCROW OR TRUST ACCOUNT OR MADE ANY OTHER FINANCIAL ARRANGEMENTS TO ASSURE COMPLETION OF THE ROADS, SO THERE IS NO ASSURANCE WE WILL BE ABLE TO COMPLETE THE ROADS.

At present, the roads are under construction and do not provide access to the lots in Units 2 and 3 during wet weather. The succeeding chart describes their present condition and estimated completion dates.

X. Language for Warning on Cover Page of Property Report - § 1010.105(c)

This Report is prepared and issued by the developer of this subdivision. It is not prepared or issued by the Federal Government.

Federal law requires that you receive this Report prior to your signing a contract or agreement to buy or lease a lot in this subdivision. However, NO FEDERAL AGENCY HAS JUDGED THE MERITS OR VALUE, IF ANY, OF THIS PROPERTY.

If you received this Report prior to signing a contract or agreement, you may cancel your contract or agreement by giving notice to the seller any time before midnight of the seventh day following the signing of the contract or agreement.

If you did not receive this Report before you signed a contract or agreement, you may cancel the contract or agreement any time within two years from the date of signing.

Name of Subdivision__

Name of Developer__

Date of This Report__

XI. Sample Entry in Table of Contents for Statement of Record - § 1010.106(a)

Title and Land Use # Page #

Method of Sale

Encumbrances, Mortgages and Liens

Recording the Contract and Deed

Payments

Restrictions on the Use of Your Lot

Plat Maps, Zoning, Surveying, Permits and Environment

XII. Required Language for Risks of Buying Land - § 1010.107(a)

(1) The future value of any land is uncertain and dependent upon many factors. DO NOT expect all land to increase in value.

(2) Any value which your lot may have will be affected if the roads, utilities and all proposed improvements are not completed. This paragraph may be omitted if all improvements have been completed or if no improvements are proposed.

(3) Resale of your lot may be difficult or impossible, since you may face the competition of our own sales program and local real estate brokers may not be interested in listing your lot.

(4) Any subdivision will have an impact on the surrounding environment. Whether or not the impact is adverse and the degree of impact, will depend on the location, size, planning and extent of development. Subdivisions which adversely affect the environment may cause governmental agencies to impose restrictions on the use of the land. Changes in plant and animal life, air and water quality and noise levels may affect your use and enjoyment of your lot and your ability to sell it.

(5) In the purchase of real estate, many technical requirements must be met to assure that you receive proper title. Since this purchase involves a major expenditure of money, it is recommended that you seek professional advice before you obligate yourself.

XIII. Format for General Information - § 1010.108

“This Report covers __ lots located in ______ County, (State). See Page __ for a listing of these lots. It is estimated that this subdivision will eventually contain __ lots.”

“The developer of this subdivision is:

__

(Developer's Name)

__

(Developer's Address)

__

(Developer's telephone number)

“Answers to questions and information about this subdivision may be obtained by telephoning the developer at the number listed above.”

XIV. Paragraphs to be included in the General Report - Title to the Property and Land Use - § 1010.109(a)(1)

“A person with legal title to property generally has the right to own, use and enjoy the property. A contract to buy a lot may give you possession but doesn't give you legal title. You won't have legal title until you receive a valid deed. A restriction or an encumbrance on your lot, or on the subdivision, could adversely affect your title.”

“Here we will discuss the sales contract you will sign and the deed you will receive. We will also provide you with information about any land use restrictions and encumbrances, mortgages, or liens affecting your lot and some important facts about payments, recording, and title insurance.”

XV. Statement on Release Provisions - § 1010.109(c)(2)(i)(A)

“The release provisions for the (indicate all or particular lots) have not been recorded. Therefore, they may not be honored by subsequent holders of the mortgage. If they are not honored, you may not be able to obtain clear title to a lot covered by this mortgage until we have paid the mortgage in full, even if you have paid the full purchase price of the lot. If we should default on the mortgage prior to obtaining a release of your lot, you may lose your lot and all monies paid.”

XVI. Warning for Release Provisions - § 1010.109(c)(2)(i)(C)(1)

“The (state type of encumbrance) on (indicate all or particular lots) in this subdivision does not contain any provisions for the release of an individual lot when the full purchase price of the lot has been paid. Therefore, if your lot is subject to this (state type of encumbrance), you may not be able to obtain clear title to your lot until we have paid the (state type of encumbrance) in full, even though you may have received a deed and paid the full purchase price of the lot. If we should default on the (state type of encumbrance) prior to obtaining a release, you may lose your lot and all monies paid.”

XVII. Method and Purpose of Recording Warning - § 1010.109(d)(1)(iv)

“Unless your contract or deed is recorded you may lose your lot through the claims of subsequent purchasers or subsequent creditors of anyone having an interest in the land”.

XVIII. Escrow Statement - Disclosure § 1010.109(e)(1)

“You may lose your (indicate deposit, down payment and/or installment payments) on your lot if we fail to deliver legal title to you as called for in the contract, because (they are/it is) not held in an escrow account which fully protects you.”

XIX. Road Chart - § 1010.110(b)(3)

XX. Nearby Communities Chart - § 1010.110(b)(6)

XXI. Water Chart Form - § 1010.111(a)(1)(ii)(B)

Water

XXII. Comfort Station Chart - § 1010.111(b)(1)(ii)

Comfort Stations

Unit__

Estimated Starting Date (month-year)__

Percentage of Construction now complete__

Estimated Service Availability Date (month and year)__

XXIII. Sewer Chart - § 1010.111(b)(1)(iii)(B)

Sewer

Unit Estimated Starting Date (month/year)__

Percentage of Construction now complete__

Estimated Service Availability Date (month/year)__

XXIV. Electric Service Chart - § 1010.111(c)(2)

Electric Service

XXV. Recreational Facility Chart - § 1010.114(b)

XXVI. Cost Sheet Format - § 1010.117(a)

Cost Sheet

In addition to the purchase price of your lot, there are other expenditures which must be made.

Listed below are the major costs. There may be other fees for use of the recreational facilities.

All costs are subject to change.

The information contained in this Property Report is an accurate description of our subdivision and development plans.

__

Signature of Senior Executive Officer

XXVII. Sample Receipt, Agent Certification and Cancellation Page - § 1010.118(a)

Receipt, Agent Certification and Cancellation Page purchaser receipt Important: Read Carefully

Name of subdivision__

ILSRP number__

Date of report__

We must give you a copy of this Property Report and give you an opportunity to read it before you sign any contract or agreement. By signing this receipt, you acknowledge that you have received a copy of our Property Report.

Received by__

Date__

Street address__

City__

State__

Zip__

If any representations are made to you which are contrary to those in this Report, please notify the:

Bureau of Consumer Financial Protection

1700 G Street NW

Washington, DC 20552

Agent Certification

I certify that I have made no representations to the person(s) receiving this Property Report which are contrary to the information contained in this Property Report.

Lot__

Block__

Section__

Name of salesperson__

Signature__

Date__

Purchase Cancellation

If you are entitled to cancel your purchase contract, and wish to do so, you may cancel by personal notice, or in writing. If you cancel in person or by telephone, it is recommended that you immediately confirm the cancellation by certified mail. You may use the form below.

Name of subdivision__

Date of contract__

This will confirm that I/we wish to cancel our purchase contract.

Purchaser(s) signature__

Date__

XXVIII. Affirmation of Senior Executive Officer - § 1010.219

I hereby affirm that I am the Senior Executive Officer of the developer of the lots herein described or will be the Senior Executive Officer of the developer at the time lots are offered for sale or lease to the public, or that I am the agent authorized by the Senior Executive Officer of such developer to complete this statement (if agent, submit written authorization to act as agent); and,

That the statements contained in this Statement of Record and any supplement hereto, together with any documents submitted herein, are full, true, complete, and correct; and,

That the developer is bound to carry out the promises and obligations set forth in this Statement of Record and Property Report or I have clearly stated who is or will be responsible; and

That the fees accompanying this submission are in the amount required by the rules and regulations of the Bureau of Consumer Financial Protection.

__

(Date)

__

(Signature)

__

(Corporate seal if applicable)

__

(Title)

WARNING: 15 U.S.C. 1717 provides: “Any person who willfully violates any of the provisions of this title or of the rules and regulations or any person who willfully, in a Statement of Record filed under, or in a Property Report issued pursuant to this title, makes any untrue statement of a material fact shall upon conviction be fined not more than $10,000.00 or imprisoned not more than 5 years, or both.”

XXIX. Form for Certification for Disclosure Documents - § 1010.504(a)(2)

The (indicate the State Department of Real Estate or other appropriate entity) has reviewed the attached materials and finds they are true copies of (1) the (indicate Property Report or other similar state accepted document or amendment to such document) for (indicate the name of the subdivision), made effective by the state of ______ on ______ (give date) and still in effect; and (2) the supporting documentation upon which such (indicate the document or amendment) is based.

__

Signature

XXX. Language to be Included on Property Report Cover Page - § 1010.558(a)(1)

“If you received this Report prior to signing a contract or agreement, you may cancel your contract or agreement by giving notice to the seller anytime before midnight of the seventh day following the signing of the contract or agreement.

“If you did not receive this Report before you signed a contract or agreement, you may cancel the contract or agreement anytime within two years from the date of signing.”

XXXI. Notice of Revocation Rights - § 1010.559(a)(1)

You have the option to cancel your contract or agreement of sale by notice to the seller until midnight of the seventh day following the signing of the contract or agreement. If you did not receive a Property Report prepared pursuant to the rules and regulations of the Bureau of Consumer Financial Protection, in advance of your signing the contract or agreement, this contract or agreement may be revoked at your option for two years from the date of signing.