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7. That there has not been any change in the title, use, occupation, location, possession or exposures of said property since the issuing of said policy, except as follows,

8. That the building or buildings described in the policy and the several parts thereof were at the time of the fire occupied by.. for the following purposes, and no other:

9. That the said fire was not caused by and did not originate by any act, design or procurement, or with any previous knowledge on the part of the insured, or prohibited by said policy and that nothing has been done by said insured before or since said fire to violate any of the conditions of said policy.

10. This statement and claim is subscribed and sworn to by the insured pursuant to the provisions of said policy and the sum claimed from the

Insurance Company as its share of said loss as above specified is

Dollars. Subscribed and sworn to before me this day of .

A.D. 190.....

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(Seal.)

Notary Public,

County, Wisconsin.

No. 79.

CERTIFICATE OF MAGISTRATE OR NOTARY PUBLIC ON FIRE

LOSS. STATE OF WISCONSIN,

SS. COUNTY. I, ...... of. ......... County, and state of Wisconsin, being a Notary Public (or magistrate) residing in the county where the insured property mentioned in the foregoing statement and claim is located, hereby certify that I am not interested in said claim, as creditor or otherwise, nor related to the insured; that I have examined the circumstances attending said fire, and damage and loss, and believe the insured has honestly sustained loss and damage on the property described in said policy of insurance to the amount of

Dollars. In Testimony Whereof, I have hereunto set my hand and official seal this day of

190.... (Official Seal.)

NOTE. – This certificate need only be furnished after it is called for by the insurance company, but it is best to append it to every proof of loss in the first instance. When a loss has occurred under the standard fire insurance policy of this state, immediate notice IN WRITING, of loss should be given the company. The property should be protected from further damage, the damaged and undamaged personal property separated, and an inventory of same made, stating quantity, cost of each article, and the amount claimed thereon. Proof of loss must be furnished with in sixty days from time of fire. Blanks for this purpose are usually furnished by insurance companies on request, and should be asked for when sending 'notice of loss. One form of proof is prescribed for both personalty and realty. The above forms statisfy the requirements under the standard fire insurance policy of Wisconsin. Care should be exercised in furnishing all the proof required by the policy and the chapter on Insurance should be consulted.

No. 80.

LAND CONTRACT. This Article of Agreement, Made and concluded this.. day of

one thousand nine hundred and by and between

part of the first part, and

part of the second part,

Witnesseth, FIRST, That the said part ............ of the second part hereby agree

and bind

legal representatives, to pay or cause to be paid, to the said part....... of the first part, heir or assigns, the sum of

Dollars, in the manner following:

Dollars, at the ensealing and delivery hereof; The said payments to be made to the part

of the first part, in person,

and the same being intended to apply, when fully completed, as the purchase money of the following tract, piece or parcel of land, situate in

County, and state of Wisconsin;

The said part of the second part FURTHER AGREE... AND CONVENANT. that

will pay all taxes, special or general, which have been assessed on the above described premises since the first of January....

and also all such as may be hereafter assessed thereon, whenever such taxes shall become due and payable by law, until the aforesaid purchase money shall be fully paid, in the manner above stated: and also to hold the said premises, from the date hereof, as the tenant of sufferance of the said part

of the first part, subject to be removed as.

tenant. holding over, by process under the statute in such case made and provided," whenever default shall be made in the payment of any of the installments of purchase money above specified, and also to keep the buildings, fences and improvements on said premises in as good repair and condition as they now are, except ordinary wear and decay, and damage by the elements. SECOND. That the said part

of the first part, hereby agree and bind

heirs, executors and administrators, that in case the aforesaid sum of

Dollars, with the interest, shall be fully paid, at the times an manner above specified, will, on demand, thereafter cause to be executed and delivered to the said part ........ of the second part, or

...... heirs or legal representatives, a good and sufficient Deed, in fee simple, of the premises above described, free and clear of all legal liens and incumbrances, except the taxes herein agreed to be paid by the part....... of the second part. And it is distinctly agreed and understood by and between the parties hereto, that if the said part ....... of the second part shall fail to make any of the payments of purchase money above specified, at the time and in the manner above specified, in such case this agreement shall be henceforth utterly void, and all payments thereon forfeited, subject to be revived and renewed only by the act of the part.....of the first part, or the mutual agreement of both parties.

In Testimony whereof, the said parties have hereunto set their hands and seals the day and year first above written. In Presence of

.rSeal.] .Seal.

(Add Acknowledgment.)

No. 81.

CLAUSE IN LAND CONTRACT RESTRICTING THE CUTTING OF

TIMBER. It is further expressly stipulated and agreed between the parties hereto that until the sum of

Dollars shall have been paid on this contract, no timber of any kind shall be cut from said land without the consent in writing of the party of the first part, and whenever any timber is cut while this contract is in force, upon said premises, the underbush and waste shall be carefully piled as the cutting progresses. No timber or logs shall be removed from said premises until Dollars shall have been paid on this contract. Any violation of this clause shall make said contract void, at the option of the party of the first part.

No. 82.

LEASE.
This Indenture, Made this

day of A. D. 190...., by and between

of the and county of

in the state of Wisconsin, part of the first part, and

part of the second part, Witnesseth, That the said part of the first part do hereby lease, demise and let unto the said part of the second part the following described premises:

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To Hold for the term of

from for the rent of

Dollars, to be paid in even and equal portions on the

days of the first payment to be made on the

day of

190 And the said lessee do promise and agree to pay said rent at the times and in the manner aforesaid, during the continuance of said term, and not to underlease or sublet said premises or any part thereof, or assign this lease, without the consent of the lessor and to quit and deliver up the same to the lessor peaceably and quietly, at the end of said term; and also to keep the same in as good repair as the same are in at the commencement of said term (reasonable use and wear thereof, and damage by fire or other unavoidable accidents, not happening through the neglect of the lessee only excepted;) and the lessor may enter to view the premises at all reasonable times. If the lessee shall fail to pay the rent aforesaid, at the times expressed in this lease, or shall underlease or sublet the said premises or assign this lease without the consent of the lessor then the lessor may enter on, and expel the lessee from said premises forthwith; and it is stipulated that in case the premises should be sold during the said term, then and in that case the lessor

option, terminate and cancel this lease, by giving months' notice to the lessee who shall thereupon vacate the premises according to such notice, and the lessee , may retain and reserve for damage and compensation therefor the rent accruing after said notice.

And the covenants herein contained shall bind the parties mutually, and their respective heirs, executors, administrators and assigns.

In Witness Whereof, the said parties have hereunto set their hands and seals the day and year above written. Signed, Sealed and Delivered

(Seal) in Presence of

--(Seal)

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No. 83.

LEASE OF CITY PROPERTY WITH WATER RENT CLAUSE. This Indenture, Made this

day of A. D. 190...., by and between

of the

of and county of

in the state of Wisconsin, lessor and

lessee, Witnesseth, That the said lessor do hereby lease, demise and let unto the said lessee the following described premises, lying and being in the of county of

and State of Wisconsin, to-wit:

or

To Hold, for the term of

the said lessee yielding and paying therefor rent in the sum of Dollars, to be paid as follows, to-wit:..

And the lessee promise to pay the said rent at the times and in the manner aforesaid, during the continuance of said term, and not to underlease the said premises, nor assign this lease, without the consent of the lessor in writing, and to quit and deliver up the same to the lessor

attorney, peaceably and quietly at the end of said term, and also to keep the same in as good repair as the same are in at the commencement of said term, reasonable use and wear thereof, and damage by accidental fire, or other accidents not happening through the neglect of the lessee

agents or servants only excepted. And the lessee

further convenant and agreed that will, during the term of this lease pay all water rates levied and assessed against the premises hereby leased, for water used or to be used therein, at the time they become due and payable; and will also pay for the sprinkling of the streets in front of or around said premises, and all assessments and taxes levied therefor, by virtue of any charter provision or ordinance of the city aforesaid. The lessee

further agree to obey all ordinances of the city, in regard to cleaning of streets, alleys and sidewalks, in front of the premises hereby leased, any and all lawful orders, rules and regulations of the proper health officers of said city.

And that the lessor may enter to view the premises and may expel the lessee if ........ .... shall fail to pay the rent and assessments, or refuse to obey the said ordinances and rules and regulations as aforesaid, or shall underlease the premises or assign this lease without the consent of the lessor , in writing.

And it is herein stipulated that in case the premises should be sold during the said term, then in that case the lessor may at

own option terminate and cancel this lease by giving.

days notice to the lessee , who shall thereupon vacate the premises according to such notice, and the lessee may reserve to himself for damages the sums of the rent accrued after said notice.

And the covenants herein contained shall bind the parties mutually, and their respective heirs, executors, administrators and assigns.

In Witness Whereof, the said parties have hereunto set their hands and seals the day and year first above written. Signed, Sealed, and Delivered In Presence of

(Seal.) Seal.)

and agree

No. 84.
ČITY HOUŠÉ LÉASE WITH WATER RENT CLAUSE AND AD-

DITIONAL COVENANTS.
This Indenture, Made this

day of A. D. one thousand nine hundred and

by and between of

County, State of Wisconsin, of the first part, lessor and

of the second part, lessee witnesseth that the said

for and in consideration of the moneys and rents to be paid, and the conditions, provisions and reservations hereinafter contained, doth demise, let and lease unto the said part of the second part, the following described premises to-wit:. for the term of

from the

day of A. D. one thousand nine hundred and for the rent of

dollars per annum payable in installments of

dollars, in advance, to be used for the usual purpose of The said

part of the second part, covenant that

will pay said rent in manner aforesaid, and deliver up said premises, together with the appurtenances thereunto belonging, to the said

attorneys, heirs, administrators, or assigns, peaceably and quietly, at the expiration of the said term of time, in good condition and repair, injury or destruction by fire, and natural wear and decay excepted.

And the said lessee further agree that any alteration, improvement or addition that

may be permitted by said to make on said premises, shall be at lessee's own expense, and shall be left by

as attached to said premises, and free of charge, to said.

notwithstanding any apparent benefit said alteration, improvement or addition may be to said. And the lessee

further covenant and agree that..

will, during the term of his lease pay all water rates levied and assessed against the premises hereby leased, for water used or to be used therein, at the time they become due and payable, and will also pay for the sprinkling of the streets in front of or around said premises, and all assessments and taxes levied therefor, by virtue of any charter provision or ordinance of the city aforesaid.

The lessee ...... ...... further agree to obey all ordinances of the city, in regard to cleaning of streets, alleys and sidewalks, in front of the premises hereby leased, and any and all lawful orders, rules and regulations of the proper health officers of said city.

And the lessee further covenant and agree that will not do or suffer any waste in the said leased premises; that will use the same for the above named purposes only; that will not underlet the same, or any part thereof, or assign this lease; that

will not make or suffer to be made, any alteration of the premises without the written consent of the lessor being first had and obtained; and further that the said lessor attorney or agent, may enter the said premises for the purpose of viewing the same, or making improvements and repairs at all reasonable hours.

And the lessee further covenant and agree to observe special care and caution to preserve the above described premises from damage or injury, by fire or otherwise; keep a friction match safe in all rooms where fires are used; keep a plate of zinc or other equivalent safeguard, as stone or brick, under every stove and between the stove and woodwork if less than twenty-four inches distant; deposit ashes outside of buildings and rooms hereby leased, in some place of safety in regard to fires and observe such rules and regulations as may be required by any fire insurance company or companies that may insure the said premises or buildings connected therewith.

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