PERSONAL INTEREST DISCLOSURE AND CONSENT

FROM LICENSEE BUYING PROPERTY

[ As Required by Tennessee License Law ]

On occasion, a real estate licensee may become involved in a real estate transaction both as a licensed real estate professional and as a party - directly or indirectly - to the transaction. Tennessee License Law [ Section 62-13-403 7(A) ] requires that a licensee's personal interest in any real estate transaction be disclosed in writing to all parties to the transaction.

[ As used in this Disclosure Form: “Buyer” shall mean Buyer or Tenant and “Seller” shall mean Seller of Landlord. ]

DISCLOSURE AND CONSENT AS TO LICENSEE’S PERSONAL INTEREST

THE LICENSEE SHALL DISCLOSE THE NATURE OF HIS/HER PERSONAL INTEREST IN THIS REAL ESTATE TRANSACTION BY CHECKING THE APPROPRIATE STATEMENT BELOW.

In Buying Property:

[ ] the prospective buyer of the property is the licensee;

[ ] the prospective buyer of the property is an immediate family member of the licensee;

[ ] the prospective buyer of the property is an individual, organization or business entity in which

the licensee has a personal interest.

The SELLER of the property located at ____________________________________________

Consents to the continued involvement of the Licensee in this transaction.

Seller's Signature: Date:_________________

Seller's Signature: Date:_________________

THIS PERSONAL INTEREST DISCLOSURE MUST BE SIGNED PRIOR TO THE EXECUTION OF A REAL ESTATE SALES CONTRACT

Licensee's Signature:______________________________________ Date:_________________

Licensee's Printed Name: _______________________________________