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CERTIFICATE OF NAME CHANGE

I,                                                                       of Shaftsbury in the State of Vermont,

state that this is my legal name.

I have an interest in real estate under the name of                                                                          

The property affected by my name change is described in an instrument recorded in the Shaftsbury Lane Records at Volume ________ Page __________.

Signed and dated this ________day of __________________2001.

Witness                                                            Signature

State of Vermont           )

Bennington County, ss  )

At                                             this                                day of                          2001, personally appeared                                                           who acknowledged that signing this certificate to be his/her free act and deed.

Before:

Notary Public

My Commission Expires                        

Vermont Statutes S 350. Change in name or status of owner of real estate

Any person or corporation owning real estate or having an interest in real estate whose name has been changed and any corporation which has been merged into or consolidated with another, may file with the town clerk of the town in which the real estate is located a certificate giving the names before and after the change, merger or consolidation, and the town clerk shall record and index the certificate in the land records.

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