PERSONAL INTEREST DISCLOSURE= AND CONSENT

FROM LICENSEE SELLING PROPERTY

[ As Req= uired by Tennessee License Law ]

On occasion, a real estate licensee may become invol= ved in a real estate transaction both as a licensed real estate professional and a= s a party - directly or indirectly - to the transaction. Tennessee License Law [ Section 62-13-403 7(A) ] requires that a licensee's personal interes= t 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 “Seller̶= 1; shall mean Seller of Landlord. ]

DISCLOSURE AND CONSENT AS TO LICNSEE’S PERSONAL INTERES= T

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

In Selling Proper= ty:

[ ] the seller/owner of this prop= erty is the licensee;

[ ] the seller of the property is= an immediate family member of the licensee;

[ ] the seller of the property is= an individual, organization or business entity in which the licensee

has a personal interes= t.

&nb= sp;

The BUYE= R of the property located at ______________________________________________=

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

&nb= sp;

Buyer's Signature: = &nb= sp; = &nb= sp; = &nb= sp; Date:___= ________________ = &nb= sp; =

Buyer's Signature: = &nb= sp; = &nb= sp; = = Date:___= ________________ = &nb= sp; = &nb= sp; = &nb= sp; <= span style=3D'mso-spacerun:yes'> = &nb= sp;

&nb= sp;

= ;

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

Licensee's Signature:_____________________________________Date:&sh= y;&sh= y;____________________ = &nb= sp; =

Licensee's Printed Name: _____________________________= ________________ = &nb= sp;