The Owner Has Reviewed the Foregoing Information Contained in This Data Entry Form And

My Florida Regional Multiple Listing Service RESIDENTIAL DATA ENTRY FORM Shaded Areas are Required

Listing Date: / / Expiration Date: / / Entered Where: Office Association Listing Type: Exclusive Right to Sell Exclusive Agency Limited Service Sold Data / Entry Only

MLS # : List Price: $ Range Price: Yes No (If yes): VRangeListLowPrice: $ , , House #: Street Name: Street Type: Str. Dir.Pre /Post

City: State: FL County: Zip: Zip + 4: Unit #: Condo Floor # : Building # Floors : Building Name / Number : Floors in Unit : Days Lease: MH Width: Single Double Triple Total Units: Model / Make: Millage Rate: Tampa Area: Year Built: Hills. Munic. Code: Tax ID: Taxes: Tax Year: Alt/ Key/ Folio #: Section: Township: Range: Subdivision #: SW Subv Condo #: Block/Parcel: Lot #: Subdivision Section Number: Legal Description (255 characters)

Subdivision / Community Name: SW Subdv / Community Name: Zoning: Plat Book/Page: Future Land Use: Complex/Community Name/NCCB:

Property Style ½ Duplex Manufactured / Mobile Home Single Family Home Co-op Modular Townhouse Condo Planned Unit Development Villa Mobile Home Style Pre-Fabrication Mobile Home Office Primary Board ID (A)Sarasota (G)Lake / Sumter (P)East Polk Bedrooms: (B)Bartow (K)Lake Wales (R)Other Full Baths : (C)Port Charlotte (L)Lakeland (S)Osceola Half Baths: (D)Englewood (M)Manatee (T)Tampa Sq Ft Heated: (E)East Pasco (N)Venice (V)West Volusia Total Building Sq Ft: (F)DeSoto (O)Orlando Regional Square Foot Source Ownership (4 Max) CDD Y/N Annual CDD Fee Measured Appraisal Fee Simple Co-op Yes Owner Provided Builder Condominium Land-Lease No Public Records

Additional Parcel Y/N Zoning Compatible Y/N Homestead Y/N Yes Yes Yes No No No

Other Exemptions Y/N Special Tax District Y/N (Tampa) Auction Y/N Yes Yes Yes No No No

Fannie Mae Secured Home Features (4 Max) FGBC Green Certified home Yes LEED Certified Building No Florida Certified Yard Green Features—Contact Realtor

Owner Name: Owner Phone: ( ) - Tenant Name: Tenant Phone: ( ) - Management Company Information: Land Information

Lot Dimensions: Lot Size (Sq. Ft.): Lot Size (Acre.):

Total Acreage Location (10 Max) Front Exp Utilities Data (10 Max) Close to Bus Line In County N BB/HS Internet Avail Private Utilities Zero Lot Line Coastal Constr Ctrl Lnn Key Lot S Cable Available Public Municipal Wtr Up to 10,889 Sq. Ft. Conservation Area Level E Cable Connected Public Sewer 1/4 Acre to 1/2 Acre Corner Lot Oversize Lot W Canal/Lake For Irrigtn Public Water Avail 1/2 acre to 1acre Corner Unit Pasture/Agriculture NE City Water Public Utilities One+ to Two acres Cul de Sac Park View NW County Water Septic Two + to Five acres End Unit Pool View SE Electric Sprinkler Meter Five+ acres Flood Zone Sidewalk SW Fire Hydrant Sprinkler Recycled 10+ acres Golf Course Frontage Street Brick Gas Sprinkler Well 20+ acres Golf Course View Street Dead-End Mini Sewer Street Lights 50+ acres Greenbelt Street One Way None Underground 100+ acres Greenbelt View Street Paved Other Well 200+ acres Highway Frontage Street Private Private Municipal Water 500+ acres Hilly Street Unpaved Private Sewer Non-Applicable Historic District Tennis Court View In City Limits Tip Lot

Waterfront Information Water Access Y/N: Water View Y/N: Water Frontage Y/N: Water Extras Y/N: Yes Yes Yes Yes No No No No Water Access: Water View: Water Frontage: Water Extras: Bay/Harbor Bay/Harbor – Full Bay/Harbor Boat Ramp – Private Beach – Private Bay/Harbor – Partial Beach - Private Boathouse Beach – Public Beach Beach – Public Boats – None Allowed Beach – Access Deeded Canal Canal – Freshwater Bridges – No Fixed Bridges Canal – Freshwater Creek Canal – Saltwater Dock – Slip 1st Come Canal – Saltwater Gulf/Ocean – Full Creek Dock – Slip Deeded Off-Site Creek Gulf/Ocean – Partial Gulf/Ocean Dock – Slip Deeded On-Site Gulf/Ocean Gulf/Ocean to Bay Gulf/Ocean to Bay Fishing Pier Gulf/Ocean to Bay Intracoastal Waterway Intracoastal Waterway Lift – Davits Intracoastal Waterway Lagoon Lagoon Lock Lagoon Lake Lake Private Lake Dues Required Lake Lake – Chain of Lakes Lake – Chain of Lakes Sailboat Water Lake – Chain of Lakes Marina Marina Seawall – Concrete Limited Access Pond Pond Seawall – Other Marina River River Skiing Allowed Pond Riprap River Water Name Waterfront Feet

- 2 - New Construction Construction Status Projected Completion Date Completed Yes Pre-Construction / / No Under Construction

Exterior Information Private Pool Y/N Exterior Construction (5 Max) Exterior Features (12 Max) Garage Features (10 Max) Yes Asbestos Balcony/Sun Deck Assigned Parking No Block Barn Attached Pool Type (8 Max) Brick Detached In-Law Apt Bath In Garage Log Detached Workshop Circular Drive Metal Frame Fenced Detached Above Ground On Piling French Doors Door Opener Auto Cleaner Other Fruit Trees Drive Space Child Safety Fence Siding Greenhouse Garage Conversion Diving Board Stem Wall Gutters / Downspouts Golf Cart Parking Fiberglass Stone Handicap Modified Guest Parking Gunite/Concrete Stucco Hot Tub/Spa No Street Parking Heated Pool Wood Frame Hurricane Shutters None Heated Spa Maintenance Includes (19 Max) Irrigation System Open Parking In Ground Mature Landscaping Oversized Infinity Edge Building Exterior Oak Trees Parking Pad Other Water Feature Cable Other Portico Other Electric Outdoor Grill Secured Parking Pool Sweep Escrow Reserves Fund Outdoor Kitchen Side Rear Entry Salt Water Fidelity Bond Outdoor Lights Street Parking Screen Enclosure Flood Insurance Outdoor Shower Washer/Dryer Hookup Solar Heated Pool Gas Parking - RV/Boat Workshop Spa Ground Maintenance Patio/Porch Covered Garage Dimensions Tile Maintenance/Repairs Patio/Porch Open x Vinyl Manager Patio/Porch Screened Architectural Style (6 Max) Not Applicable Rental Apartment Bungalow Other Satellite Dish Property Description Cape Cod Private Road Sauna 1st Floor Multi-Story Colonial Public Insurance Sliding Doors 2nd Floor / Multi Story Contemporary Recreational Facilities Stables 3rd Floor + above Multi-Story Courtyard Roof Storage Dock/Rack-ominium Custom Security Trees/Landscaped Efficiency Dutch Provincial Trash Removal Utility Shed Elevated Elevated Water/Sewer Wheelchair Accessible End Unit Florida Xeriscape Ground Floor Unit French Provincial Roof (3 Max) Garage / Carport (3 Max) High-Rise Historical In M / H Community Built up 1 Car Carport Key West Mid-Rise Membrane 1 Car Garage Patio One Story Metal 2 Car Carport Ranch Out of M / H Community Roof Over 2 Car Garage Spanish / Mediterranean Penthouse Shake 3 Car Carport Townhouse Split Level Shingle 3 Car Garage Traditional Stilt Home Slate 4 Car Carport Tudor Three Story Tile 4 Car Garage Victorian Townhouse 2-3 Floors Other 5+ Car Carport Villa Tri-Level 5+ Car Garage Other Two Story None Foundation (3 Max) RV Carport Basement RV Garage Crawlspace Slab Community Features (25 Max)

- 3 - Airport/Runway Fees Required None Storage Association Recreation - Lease Fishing Pier Optional Additional Fees Tenants No Pets Association Recreation - Owned Fitness Park Tennis Courts Boat Slip Gated Community Playground Water Access Buyer Approval Required Golf Community Public Boat Ramp Waterfront Complex Community Boat Ramp Handicap Modified PUD Community Heated Pool Horse Stables Racquet Ball Housing For Older Persons Community Pool Laundry Facility Recreation Building Deed Restrictions Maintenance Free Security 55+ 62 + Dock No Deed Restriction Shuffleboard Elevators No Truck/RV/Motorcycle Special Comm. Restrictions HOA / Comm. Association HOA Fee: HOA Payment Schedule Monthly Maint. (Addition to HOA) Annually None Semi Annually Optional Quarterly Required Monthly Pets Allowed Y / N Pet Restrictions Y/N # of Pets Max Pet Weight Pet Restrictions Yes Yes

No No Elementary School Middle or Junior School High School

Interior Information Approximate Dimensions Living Room x Master Bedroom x Study / Den Dimensions x Dining Room x 2nd Bedroom x Balcony / Porch/Lanai x Family Room x 3rd Bedroom x Dinette x Great Room x 4th Bedroom x Bonus Room x Kitchen x 5th Bedroom x Studio Dimensions x

Additional Rooms (9 Max) Appliances Included (13 Max) Interior Features (14 Max) Floor Covering (6 Max) Bonus Room Built In Oven Attic Breezeway Compactor Attic Ventilator Den / Library / Office Convection Oven Blinds/Shades Brick/Stone Family Room Dishwasher Cathedral/Vaulted Ceiling Carpet Florida Room Disposal Ceiling Fan(s) Ceramic Tile Foyer Dryer Central Vacuum Laminate Game Room Exhaust Fan Corridor Access Marble Inlaw / Rental Apt Freezer Crown Molding Parquet Inside Utility Gas Appliances Dry Bar Quarry Tile Loft Hot Water Electric Dumb Waiter Slate Media Room Hot Water Gas Elevator Terrazzo Kitchen Reverse Osmosis Sys Furnished Vinyl Air Conditioning (2 Max) Microwave Handicapped Modified Wood Central Microwave Hood Hot Tub/Spa Other Humidistat Other In Wall Pest System No Air Oven Intercom System Wall Units/Window Range Medical Alarm Kitchen Features (5 Max) Zoned/Multiple Range Hood Other Heating and Fuel (6 Max) Refrigerator Radiant Barrier Central Solar Hot Water Owned Rods Breakfast Bar Fuel - Electric Solar Hot Water Rented Sauna Closet Pantry Fuel - Gas Bottled Washer Skylights Desk Built In Fuel - Gas Natural Water Aerator Owned Smoke Alarm(s) Island Fuel - Oil Water Aerator Rented Solid Surface Counters Pantry Heat Pump Water Filter Owned Solid Wood Cabinets Walk In Pantry Heat Recovery Unit Water Filter Rented Stone Counters No Heat Water Softener Owned Storage Room Other Water Softener Rented Thermal Windows Partial Wine Refrigeration Thermostat Attic Fan Radiant / Baseboards Tray Ceiling Radiant / Ceiling TV Antenna Solar Unfurnished

- 4 - Interior Layout (7 Max) Fireplace Y/N Walk In Closet Washer/Dryer Hookup Wet Bar Breakfast Room Separate Master Bath Features (4 Max) Yes Eating Space In Kitchen Bath with Spa/Hydro No Formal Dining Room Separate Bidet Fireplace Description (5 Max) Formal Living Room Separate Dual Sinks Great Room Garden Bath Electric Fireplace Kitchen/Family Room Combo Family Room Space Heater Handicapped Accessible 'L' Dining Gas Fireplace Wall Furnace Shower No Tub Living Room/Great Room Living Room Wall Units / Window Units Tub With Separate Shower Stall Living/Dining Room Combo Master Bedroom Zoned / Multiple Tub With Shower Master Bedroom Downstairs Other Specify in Remarks Wood Burning FP Open Plan Security System Other Room Split Bedroom Volume Ceilings Leased Owned

Financing Available (10 Max) Assumable - Must Qualify Exchange/Trade Lease Option Seller Financing Assumable - Non Qualify FHA Lease Purchase Special Funding Cash Flood Insurance Required Other USDA Conventional VA Realtor Information (25 Max) Agent / Owner HOA Disclosure Available Pet on Premises Assumable Mortgage Home Warranty Scrub Jay-check with county Brochure Available In-Law Quarters Seller Related To Agent CDD Addendum required Lead Paint Disclosure Seller Property Disclosure Condominium Disclosure Avail Lease Restrictions Septic Sewer Addendum Required Condominium Documents Avail Leasing Not Allowed Short Term Rental Allowed Corporate Owned Relo No Sign Sold As-Is Environmental Report Available Not Applicable Special Assessments Fixer-Upper Other Disclosures-Contact Agent Subdivision Restrictions Floor Plan Available Owner Will Assist w/ Closing Costs Survey Available Foreign Seller Owner Will Consider Financing Termite Bond / Warranty

Realtor Information (Confidential) 7 Max Bonus to Selling office Owner Occupied Vacant Go To Site Tenant Approval Variable Rate Commission Tenant Occupied Special Sale Provision Bank Owned / REO Short Sale None

Showing Instructions (16 Max) 24 Hour Notice Contact Call Center Lock Box Coded Appointment Only Gate Code Required No Call Box Call Before Showing Key-Listing Broker Office Other Call Listing Agent Listing Agent Must Accompany Pet on Premises Call Listing Office Lock Box - Combination Under Construction (Go to site) Call Owner Lock Box - Electronic Use Request Showing Button Call Tenant Call Center Phone Number: ( ) -

ShowingTime Secure Remarks (500 Characters):

Special Listing Type Exclusion Other Exclusion / Variable Variable Commission Not Applicable

- 5 - Virtual Tour:

Internet Y/N: Display Property Address on Internet Y/N:

IDX Y/N: Realtor.com Y/N:

VOW AVM Y/N: VOW Display Comments Y/N:

Agent Information

Agent ID: Agent E-mail: Agent Home Page:

Agent Name: Direct Phone: ( ) -

Pager / Cell: ( ) - Agent Fax: ( ) -

List Agent 2 ID: List Agent 2 Name:

List Agent 2 Email: List Agent 2 Phone: ( ) - Sales Team Name:

Office #: Office Phone: ( ) - Agent Extension: Office Fax: ( ) - Office Name: List Office 2 ID: List Office 2 Name: Buyer Agent Comp: Non-Rep Comp: Trans Broker Comp:

Interoffice Info (255 Characters)

Driving Directions (255 Characters)

Realtor Only Remarks 1 and 2 (455 Characters)

Public Remarks (255 Characters) – This is the field that transfers to the public websites

Additional Public Remarks (1275 Characters)

# of Times Per Year Minimum Lease

- 6 - 1-7Days 2 Months 4Months No Rent 1Month 2 Weeks 6Months 1Week 1Year 3 Months No Min The Owner has reviewed the foregoing information contained in this Data Entry Form and acknowledges the information to be true and correct to the best knowledge of the owner.

The Owner agrees to indemnify and hold harmless the My Florida Regional Multiple Listing Service (MFRMLS), the Originating Board, and their employees, the Listing Broker and licensees, the Selling Broker and licensees, and all other cooperating Brokers and licensees against any and all claims or liability (including attorney’s fees) arising from any breach of warranty by Owner or from any incorrect information supplied by Owner or from any facts concerning the Property which was known or reasonably should have been known to Owner but not disclosed by Owner.

At the request of the Listing Broker, unless otherwise properly indicated on this Data Entry form, MFRMLS will electronically transmit information about Owner’s property to Internet web sites to aid in the marketing of the Property for sale.

MFRMLS shall retain and make available all such data and photographs to all its participants for an indefinite period.

MFRMLS assumes no responsibility or liability to Owner for errors or omissions on this Data Entry Form or in the MFRMLS computer system.

The Owner hereby authorizes Listing Broker to file this Data Entry form with the MFRMLS and the Owner will provide timely notice of all status changes.

______DATE OWNER SIGNATURE OWNER SIGNATURE

______DATE BROKER SIGNATURE Revised 11/2/2010