Example TX Policy Form - Insuring One Fee Parcel, One Leasehold Estate, and One Easement Estate 1

SCHEDULE A

GF NO.:

Owner Policy No.: O-5841-

Date of Policy:

Amount of Insurance: $

1. Name of Insured:

2. The estate or interest in the land which is covered by this policy is:

Fee Simple as to Parcel I;

Leasehold Estate as to Parcel II

Easement Estate as to Parcel III

3. Title to the estate or interest in the land is vested in:

4. The land referred to in this policy is described as follows:

PARCEL I:

LOT 21, BLOCK 1, ROYAL ACRES, a subdivision of land in Peanutsville City, Schultz County, State of Comics, according to the recorded plat thereof.

PARCEL II:

Leasehold estate created by a certain indenture of lease dated ______, made by ________, a lessor, to ___________, as lessee, and recorded ___________ in Book _________, Page ________, demising and leasing for a primary term of ____ years, beginnning __________ and ending _________, the following described premises, to-wit:

LOT 20, BLOCK 1, ROYAL ACRES, a subdivision of land in Peanutsville City, Schultz County, State of Comics, according to the recorded plat thereof.

PARCEL III:

A non-exclusive easement for ______________ purposes, appurtenant to Parcel II, as established by the instrument recorded in Book _______, Page _______, over the following described area: _____________________________________________________________________________________________________________________________________.