Form 1

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Copy as parenthetical citation

“STATE OF ARKAN- SAS COUNTY OF . . . . . . . . . . 其 Be it known that I, . . . . . . . . . . . . . ., (Wife) (Husband) of . . . . . . . . . . . . . . of the County and State aforesaid, own in my own right the property below described, which I hereby schedule as my separate property, to-wit: Witness my hand this . . . . . . . . . . day of . . . . . . . . . ., 20 . . . . . .

(listing of property) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .

SIGNATURE”

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