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: _______________________________________

 [ 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 LICNSEE'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 Selling Property:

[   ] the seller/owner of this property 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 interest.

The BUYER of the property located at ______________________________________________, consents to the continued involvement of the Licensee in this transaction.

Buyer's Signature: _______________________________   Date:___________________

Buyer'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: _____________________________________________

[ As Required by Tennessee License Law ]

On occasion, when asked by a party to a real estate transaction, a Real Estate Licensee may recommend the services of a service vendor:

· Who may offer the Licensee a referral fee for that recommendation;

· With whom a relative or family member of the Licensee may have personal interest;

· With whom the Licensee has a personal interest ( indirect or direct ).

Tennessee Law requires that a Licensee's personal interest in these situations be disclosed.

[ As used in this Disclosure Form: "Buyer" shall mean Buyer or Tenant ]

DISCLOSURE OF LICENSEE'S PERSONAL INTEREST IN A REFERRAL FOR SERVICES

The Licensee named below has recommended that Buyer use the services of

_________________________________________________________________________________

Buyer has been advised of the Licensee's interest in the Provider of Services as

_________________________________________________________________________________

and /or that Licensee shall receive compensation of for this referral.

TO BE SIGNED PRIOR TO THE USE OF THE RECOMMENDED SERVICE VENDOR

Licensee's Signature_________________________________________ Date:_____________________

Licensee's Printed Name______________________________________ Date:_____________________

Buyer's Signature ___________________________________________ Date:_____________________

Buyer's Signature ___________________________________________ Date:_____________________