The following is prescribed as the form of petition to be used when application is made for the original register of lands:

IN THE SUPERIOR COURT OF ______ COUNTY STATE OF GEORGIA

In re petition ) Civil action of ____ ) File no. ____

ORIGINAL PETITION FOR REGISTRATION OF LANDS The petition of ___________ shows:

The petitioner applies to have the land hereinafter described brought under the provisions of the Land Registration Law, and his title thereto confirmed and registered as provided therein, and under oath shows the following facts:

1.

Full name of each applicant __________________________________ ______________________________________________________________

2.

Residence of each applicant __________________________________ ______________________________________________________________

3.

Post office address of each applicant ________________________ ______________________________________________________________

4.

The name and address of applicant's agent or attorney upon whom process or notices may be served (not required unless applicant is a nonresident) ______________________________________________________________ ______________________________________________________________

5.

Full description of the lands (giving also land district and lot numbers where the land lies in that portion of the state where the lands have been surveyed by districts and numbers; and if more than one parcel is included, describe each parcel separately and distinctly). ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ containing ______________ acres.

6.

What is the value thereof? $ _______ 7.

At what value was it last assessed for taxes? $__________

8.

What interest or estate does the applicant claim therein? ___ ______________________________________________________________

9.

What is the value of the interest or estate claimed by the applicant? $ ______

10.

From whom did the applicant acquire the land? ________________ ______________________________________________________________

11.

Does the applicant claim title by prescription? ______________

(If so, set forth fully the color of title, if any, under which the prescription is claimed, and state the details of the possession by which it is claimed prescription has ripened. If the color of title consists of one or more instruments of record on the public records of the county, such instruments need not be copied or exhibited to the application otherwise than by giving the name of the grantor and the grantee, the date and nature of the instrument, and a reference to the book and page where recorded.) ______________________________________________________________ ______________________________________________________________

12.

Does applicant claim title by a complete chain of title from the state or other original source of title? _________________ ______________________________________________________________

13.

Is there a true and correct abstract of applicant's title papers attached hereto? _____

14.

Do you know, or have information, of any other deed, writing, document, judgment, decree, mortgage, or instrument of any kind not set forth in the abstract which relates to this land or any part thereof, or which might affect the title thereto or some interest therein? If so, state the same. _____________

15.

Has the land, or any part thereof, ever been set apart as a homestead or exemption or as dower? If so, state particulars. _ ______________________________________________________________ 16.

Who is now in possession of the land? ________________________ ______________________________________________________________

17.

Do you know anyone else who claims to be in possession of the land or any part thereof? If so, give name and address. ______ ______________________________________________________________

18.

Give name and address of each person occupying the land or any part thereof, and state by what right or claim of right such occupancy is held. ___________________________________________ ______________________________________________________________

19.

Give the name, residence, and address of each and every person, other than the applicants, who claim any interest, adverse or otherwise, vested or otherwise, in the land or any part thereof, stating the nature of the claim, and if any such persons are under disability of any kind, state the nature of the disability.

Nature Disability of Name Residence Address (if any) Claim ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________

20.

Give the name, residence, and address of the holder of every known lien, whether considered by the applicant to be valid or not.

Nature of Name Residence Address Lien ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________

21.

Give the names and addresses of the owners and occupants of all adjoining lands. _________________________________________ ______________________________________________________________

22.

Is the land subject to any easement, except public highways and railroads in actual operation? If so, state fully. ______________________________________________________________ ______________________________________________________________

23.

Give age of applicant. _____________

24.

Is the applicant male or female? __________; married or single? ______________; widow or widower? __________

25.

If married, give wife's (or husband's) name, and include her or him in the list of defendants. ____________________________ ______________________________________________________________

26.

The applicant names as defendants the following persons whose names have been given above: ______________________________________________________________ ______________________________________________________________ ______________________________________________________________ ______________________________________________________________

and also all other persons "whom it may concern."

Wherefore the applicant prays process and judgment accordingly.

_____________________ Petitioner's attorney

(To be sworn to by each applicant. Verification in case of a corporation may be made by any officer thereof; in case of minor or other persons under disability, by the person filing the petition in his behalf.)

I do swear that I have read the foregoing petition, and have examined the schedules thereto attached, and that the same are true to the best of my knowledge and belief, and that nothing has been withheld in the answers which would in anywise affect the title to the land or any interest therein or which would disclose any person claiming an adverse interest, valid or not. I do further swear that I bona fide believe that the applicant is the true owner of the estate he seeks to have registered.

_______________ Petitioner Sworn to and subscribed before me, this ______ day of ______________, ____.

______________ Notary

(If more than one applicant, they may verify jointly or by separate affidavits.) EXHIBIT A (Attach abstract of title)