AFFIDAVIT OF MARITAL STATUS

FILE NO: __________________________

NOTE:	This Affidavit should be completed and returned to the Title Company
for immediate examination.

STATE OF WISCONSIN	)

) SS

COUNTY OF ________________	)

The undersigned, ____________________________________, being first duly sworn on oath deposes and says:

1.	That I currently reside at ______________________________________________________________.

(address)

Please check item if applicable:

A.	_______ I have never been married.

B.	_______ My spouse died prior to January 1, 1986 and I have not since married.

C.	_______ My divorce from my most recent spouse was finalized prior to January 1, 1986.

If Box A, B or C is checked, DISREGARD Items 2 and 3 below. Merely sign, notarize and return to us. Thank you.

2.	The name of my current spouse, and the name(s) of my former spouse(s), is/are:

NOTE: (Please include aliases or nicknames of spouses, if any).

CURRENT SPOUSE ______________________________________________________________

FORMER SPOUSE _______________________________________________________________

3.	I am not aware of any lawsuit in which the above named spouse(s) have been named a party to the action, except: (NOTE: If none, the word "NONE" must be added).

________________________________________________________________________________

4.	That this affidavit is made for the purpose of inducing Heritage Title Services, Inc., and its underwriters, to insure the title to said property without exception for possible adverse rights, claims, liens, encumbrances of title of or arising from the interest of any spouse, his/her successors or assigns, by reason of Chapter 766, WIS. STAT., and that the Affiant hereby expressly agrees to indemnify and save harmless Heritage Title Services, Inc., and its underwriters, from any and all loss arising from any failure to disclose the name of any spouse.

_________________________________________________

Subscribed and sworn to before me this day of , 20_____.

Notary Public

My Commission Expires