Marketing Agency Income Statement

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					AGENT'S EXPERIENCE REPORT
PART 1 - INCOME STATEMENT
FOR THE YEAR ENDING DECEMBER 31, 2005


AGENCY NAME:     Name of Agency
LICENSE NUMBER: __________
FEDERAL EMPL ID: __________
ADDRESS:         __________
CITY:            __________                                                                                                                       RTS       RTS
ZIP CODE:        __________                                                                                                                    PROVIDED PROVIDED
CONTACT PERSON:__________                                                                                                         REGULAR       TO TITLE TO TITLE      RTS
COUNTY NAME:     __________                                                                                                         TITLE       CLIENTS  CLIENTS   PROVIDED
                                                                                                         MARKETING              INSURANCE (CLOSING &       (ALL   TO NON-TITLE ALL OTHER
YEAR ENDING:             2005                                                                      PTS   ACTIVITIES             (EXCL. RTS) ESCROW)       OTHER)    CLIENTS    ACTIVITIES       TOTAL
                                                                                                    (1)     (2)                  (3) = (1)+(2)     (4)       (5)        (6)        (7)    (8) = SUM 3,4,5,6,7
           REVENUE 1.          TOTAL TITLE INSURANCE PREMIUMS                                     XXXXXX   XXXXXX                            0   XXXXXX    XXXXXX     XXXXXX     XXXXXX                  0
                   2.          PREMIUM REMITTED TO INSURER                                        XXXXXX   XXXXXX                            0   XXXXXX    XXXXXX     XXXXXX     XXXXXX                  0
                   3.          PREMIUM RETAINED BY AGENT (1 MINUS 2)                              XXXXXX   XXXXXX                            0   XXXXXX    XXXXXX     XXXXXX     XXXXXX                  0
                   4.          PRODUCTION REVENUES
                                 A. SEARCH                                                        XXXXXX           XXXXXX           XXXXXX           XXXXXX               0                     0      XXXXXX       0
                                 B. EXAMINATION                                                   XXXXXX           XXXXXX           XXXXXX           XXXXXX               0                     0      XXXXXX       0
                                 C. CLOSING & ESCROW                                              XXXXXX           XXXXXX           XXXXXX                0          XXXXXX                     0      XXXXXX       0
                         5.    OTHER REVENUE                                                      XXXXXX           XXXXXX                0                0               0                     0           0       0
                         6.    TOTAL REVENUE (SUM 3 THROUGH 5)                                    XXXXXX           XXXXXX                0                0               0                     0           0       0

          EXPENSES 7.          LOSS & LOSS ADJUSTMENT EXPENSE INCURRED
                                  A. POLICYHOLDER CLAIMS - LOSSES & ALAE      XXXXXX                               XXXXXX           XXXXXX           XXXXXX          XXXXXX           XXXXXX           XXXXXX   XXXXXX
                                  B. POLICYHOLDER CLAIMS - ULAE               XXXXXX                               XXXXXX           XXXXXX           XXXXXX          XXXXXX           XXXXXX           XXXXXX   XXXXXX
                                  C. NON-POLICYHOLDER CLAIMS - LOSSES & LAE XXXXXX                                 XXXXXX                0                0               0                0                0        0
                         8.    INCREASE IN STATUTORY PREMIUM RESERVE          XXXXXX                               XXXXXX           XXXXXX           XXXXXX          XXXXXX           XXXXXX           XXXXXX   XXXXXX
                         9.    PERSONNEL COSTS
                                  A. SALARIES - EMPLOYEES                          0                                        0                0                0                0                0           0       0
                                  B. SALARIES - OWNERS/PARTNERS                    0                                        0                0                0                0                0           0       0
                                  C. EMPLOYEE BENEFITS - EMPLOYEES                 0                                        0                0                0                0                0           0       0
                                  D. EMPLOYEE BENEFITS - OWNERS/PARTNERS           0                                        0                0                0                0                0           0       0
                                  E. PAYROLL TAXES                                 0                                        0                0                0                0                0           0       0
                                  F. EDUCATION EXPENSE                             0                                        0                0                0                0                0           0       0
                                  G. OTHER PERSONNEL COSTS                         0                                        0                0                0                0                0           0       0
                                  H. SUBTOTAL (SUM A THROUGH G)                    0                                        0                0                0                0                0           0       0
                         10.   PRODUCTION SERVICES (EXTERNAL)                      0                                        0                0                0                0                0           0       0
                         11.   ADVERTISING                                         0                                        0                0                0                0                0           0       0
                         12.   BOARDS, BUREAUS AND ASSOCIATIONS                    0                                        0                0                0                0                0           0       0
                         13.   TITLE PLANT RENT AND MAINTENANCE                    0                                        0                0                0                0                0           0       0
                         14.   CLAIM ADJUSTMENT SERVICES                           0                                        0                0                0                0                0           0       0
                         15.   AMOUNTS CHARGED OFF, NET OF RECOVERIES              0                                        0                0                0                0                0           0       0
                         16.   MARKETING AND PROMOTIONAL EXPENSES (EXTERNAL)       0                                        0                0                0                0                0           0       0
                         17.   INSURANCE
                                  A. E&O AND BONDING                               0                                        0                0                0                0                0           0       0
                                  B. OTHER                                         0                                        0                0                0                0                0           0       0
                         18.   DIRECTORS' FEES                                     0                                        0                0                0                0                0           0       0
                         19.   TRAVEL AND TRAVEL ITEMS
                                  A. AUTOMOBILE                                    0                                        0                0                0                0                0           0       0
                                  B. OTHER                                         0                                        0                0                0                0                0           0       0
                         20.   RENT AND RENT ITEMS
                                  A. UTILITIES                                     0                                        0                0                0                0                0           0       0
                                  B. OTHER                                         0                                        0                0                0                0                0           0       0
                         21.   EQUIPMENT                                           0                                        0                0                0                0                0           0       0
                         22.   COST OR DEPRECIATION OF EDP EQUIP. & SOFTWARE       0                                        0                0                0                0                0           0       0
                         23.   PRINTING, STATIONERY, BOOKS & PERIODICALS           0                                        0                0                0                0                0           0       0
                         24.   POSTAGE, TELEPHONE, MESSENGER & EXPRESS             0                                        0                0                0                0                0           0       0
                         25.   LEGAL & AUDITING
                                  A. LEGAL (NON-POLICYHOLDER)                      0                                        0                0                0                0                0           0       0
                                  B. AUDITING (INCL. ACCOUNTING)                   0                                        0                0                0                0                0           0       0
                         26.   TAXES, LICENSES & FEES
                                  A. NON-POLICYHOLDER                              0                                        0                0                0                0                0           0       0
                                  B. RECORDING, TAX CERTIFICATE, & INSPECTION FEES 0                                        0                0                0                0                0           0       0
                         27.   REAL ESTATE EXPENSES                                0                                        0                0                0                0                0           0       0
                         28.   REAL ESTATE TAXES                                   0                                        0                0                0                0                0           0       0
                         29.   INTEREST EXPENSE                                    0                                        0                0                0                0                0           0       0
                         30.   BUSINESS START-UP EXPENSE                           0                                        0                0                0                0                0           0       0
                         31.   BUSINESS FAILURE EXPENSE                            0                                        0                0                0                0                0           0       0
                         32.   SEARCH FEES (EXTERNAL)
                                  A. PAID TO TITLE AGENTS                          0                                        0                0                0                0                0           0       0
                                  B. PAID TO INSURERS                              0                                        0                0                0                0                0           0       0
                                  C. PAID TO OTHERS                                0                                        0                0                0                0                0           0       0
                         33.   EXAM FEES (EXTERNAL)
                                  A. PAID TO TITLE AGENTS                          0                                        0                0                0                0                0           0       0
                                  B. PAID TO INSURERS                              0                                        0                0                0                0                0           0       0
                                  C. PAID TO OTHERS                                0                                        0                0                0                0                0           0       0
                         34.   CLOSING & ESCROW FEES (EXTERNAL)
                                  A. PAID TO TITLE AGENTS                          0                                        0                0                0                0                0           0       0
                                  B. PAID TO INSURERS                              0                                        0                0                0                0                0           0       0
                                  C. PAID TO OTHERS                                0                                        0                0                0                0                0           0       0
                         35.   AGGREGATE WRITE-INS FOR MISC. EXPENSES              0                                        0                0                0                0                0           0       0
                         36.   TOTAL EXPENSES INCURRED (SUM 7 THROUGH 35)          0                                        0                0                0                0                0           0       0

              PROFIT 37. NET PROFIT/(LOSS) BEFORE TAX (6 MINUS 36)                                XXXXXX           XXXXXX                    0                0                0                0           0       0


NOTES:

PTS = Primary Title Services; RTS = Related Title Services
Charitable contributions, political contributions, and lobbying costs are not allowable expenses and shall be excluded.
Title insurance operations excludes all underwriting, administration, and claims settlement activities of the insurer, even if they are carried out in the physical facility that also houses the agency.

Row 7C: "Non-Policyholder Claims - Losses and LAE" shall include errors & omissions / malpractice claims and shall be net of recoveries from insurers.
Rows 9A and 9B: "Salaries" shall include salaries, bonuses, draws, and other W-2 compensation (per diem, mileage, vehicle use, education, etc. in excess of IRS allowances).
Rows 9C and 9D: "Employee Benefits" shall include group insurance, profit sharing, pension plans, unemployment taxes, service awards, employee lounge supplies, company parties, etc.
Row 11: "Advertising" shall include advertising, sponsorship, gifts, customer convenience services (complimentary beverages), etc.
Row 19A: "Automobile" shall include lease payments or accrued depreciation, gas, oil, maintenance, repairs, etc. Also, automobile insurance expense shall be included here.
Row 21: "Equipment" shall apply to non-EDP equipment with sales price in excess of $1,000 and shall include rental expenses or depreciation, repair, maintenance, set-up fees, delivery, freight costs, etc.
Row 26A: "Non-Policyholder TL&F" shall include notary bonds, sales tax permit, personal property taxes, franchise taxes, agent, agency nd solicitor license fees.
Row 27: "Real Estate Expenses" shall include rental expense or depreciation or mortgage interest payments, repair, maintenance, improvements, janitorial, building security, etc.
Row 29: "Interest Expense" shall include interest paid on all business loans except building mortgages, and shall also include yearly accrual of amortized loan origination fees as computed under GAAP
AGENT'S EXPERIENCE REPORT
PART 2 - PREMIUM BROKEN DOWN BY INSURER
FOR THE YEAR ENDING DECEMBER 31, 2005


      Name of Agency

                                                                    TITLE PREMIUMS WRITTEN                                                  PREMIUM
      Name of Each Insurer                                                                                                                 B
                                                      -------------------------------------------------------------------------------------- ALANCES
      For Which This Agency                             REMITTED                    RETAINED                      TOTAL                       OWED
      Wrote Premiums                                          (1)                         (2)                        (3)                       (4)
1.                                                                          0%                          0%                    0 0%
2.                                                                          0%                          0%                    0 0%
3.                                                                          0%                          0%                    0 0%
4.                                                                          0%                          0%                    0 0%
5                                                                           0%                          0%                    0 0%
6.                                                                          0%                          0%                    0 0%
7.                                                                          0%                          0%                    0 0%
8.                                                                          0%                          0%                    0 0%
9.                                                                          0%                          0%                    0 0%
10.                                                                         0%                          0%                    0 0%
11.   Total                                                            0 0%                       0 0%                        0 0%                  0

                                      Part 1 Totals               0                          0                          0
                                                 -------------------------- ------------------- ------ --------------------------
                    Difference Should Equal Zero                  0                          0                          0
AGENT'S EXPERIENCE REPORT
PART 3 - OTHER REVENUE
FOR THE YEAR ENDING DECEMBER 31, 2005


    Name of Agency

                                                                                                                                       RTS                     RTS
                                                                                                                                    PROVIDED               PROVIDED
                                                                                                              REGULAR                TO TITLE               TO TITLE       RTS
                                                                                                                TITLE                CLIENTS                CLIENTS     PROVIDED
                                                                                     MARKETING              INSURANCE              (CLOSING &                 (ALL     TO NON-TITLE                     ALL OTHER
                                                                    PTS              ACTIVITIES             (EXCL. RTS)              ESCROW)                 OTHER)      CLIENTS                        ACTIVITIES        TOTAL
ITEMIZE "OTHER REVENUE"                                              (1)                 (2)                 (3) = (1)+(2)              (4)                     (5)         (6)                             (7)     (8) = SUM 3,4,5,6,7
1. Investment Income (Due to Delayed Premium Remittance)            XXXXXX              XXXXXX                             0                  0                      0            0                               0                0
2. Investment Income (All Other)                                    XXXXXX              XXXXXX                             0                  0                      0            0                               0                0
3. Abstracting                                                      XXXXXX              XXXXXX                   XXXXXX                XXXXXX                   XXXXXX            0                        XXXXXX                  0
4. Underwriting Inspection Fees                                     XXXXXX              XXXXXX                             0           XXXXXX                   XXXXXX            0                        XXXXXX                  0
5. In-house Copy, Express & Other Fees                              XXXXXX              XXXXXX                             0                  0                      0            0                               0                0
6. Recording Fees                                                   XXXXXX              XXXXXX                   XXXXXX                       0                      0     XXXXXX                                 0                0
7. Tax Certificates                                                 XXXXXX              XXXXXX                   XXXXXX                       0                      0     XXXXXX                                 0                0
8. Termite, Building & Other Inspection Fees                        XXXXXX              XXXXXX                   XXXXXX                       0                      0     XXXXXX                                 0                0
9. Other (itemize)                                                  XXXXXX              XXXXXX                             0                  0                      0            0                               0                0
10.                                                                                                                                                                                                                                0
11.                                                                                                                                                                                                                                0
12.                                                                                                                                                                                                                                0
13.                                                                                                                                                                                                                                0
14.                                                                                                                                                                                                                                0
15.                                                                                                                                                                                                                                0
16.                                                                                                                                                                                                                                0
17. TOTAL                                                           XXXXXX                 XXXXXX                            0                      0                      0                      0               0                0

                                            Part 1 Totals            XXXXXX                 XXXXXX                           0                      0                      0                      0                      0                      0
                                                            ---------------------- ---------------------- ---------------------- ---------------------- ---------------------- ---------------------- ---------------------- ----------------------
                           Difference Should Equal Zero              XXXXXX                 XXXXXX                           0                      0                      0                      0                      0                      0


NOTES:

PTS = Primary Title Services; RTS = Related Title Services
Investment Income should be net of bank charges.
AGENT'S EXPERIENCE REPORT
PART 4 - OTHER CONSIDERATION PAID TO OWNERS & PARTNERS
FOR THE YEAR ENDING DECEMBER 31, 2005


    Name of Agency

    OTHER CONSIDERATION PAID
    TO OWNERS & PARTNERS                                  AMOUNT
1.  Directors Fees                                                 0
2.  Exam Fees                                                      0
3.  Search Fees                                                    0
4.  Closing & Escrow Fees                                          0
5.  Management Fees                                                0
6.  Rents                                                          0
7.  Interest                                                       0
8.  Other (itemize)                                                0
9.
10.
11.
12.
13.
14.
15. TOTAL                                                          0


NOTES:

Do not include amounts counted as salaries.
Do not include amounts counted as employee benefits.
Do not include stockholders dividends for corporations.
AGENT'S EXPERIENCE REPORT
PART 5 - LOSS & LOSS ADJUSTMENT EXPENSES INCURRED BY AGENT
FOR THE YEAR ENDING DECEMBER 31, 2005


      Name of Agency

                                                                                                  RTS        RTS
                                                                                               PROVIDED PROVIDED
                                                                                  REGULAR       TO TITLE  TO TITLE      RTS
                                                                                    TITLE       CLIENTS   CLIENTS    PROVIDED
      LOSS AND LAE INCURRED BY AGENT                                 MARKETING INSURANCE (CLOSING &         (ALL    TO NON-TITLE ALL OTHER
      (NET OF RECOVERIES FROM INSURERS)                        PTS   ACTIVITIES (EXCL. RTS) ESCROW)        OTHER)     CLIENTS    ACTIVITIES       TOTAL
                                                                (1)     (2)      (3) = (1)+(2)     (4)       (5)         (6)         (7)    (8) = SUM 3,4,5,6,7
1.    CLOSING & ESCROW LOSSES                                 XXXXXX   XXXXXX                0          0   XXXXXX            0    XXXXXX                  0
2.    AGENT SEARCH & EXAM LOSSES                              XXXXXX   XXXXXX                0   XXXXXX           0           0    XXXXXX                  0
3.    ALL OTHER LOSSES                                        XXXXXX   XXXXXX                0          0         0           0           0                0
4.    LOSS ADJUSTMENT EXPENSE                                 XXXXXX   XXXXXX                0          0         0           0           0                0
5.    TOTAL                                                   XXXXXX   XXXXXX                0          0         0           0           0                0

                                          Part 1 Totals  XXXXXX             XXXXXX                        0                  0                  0                  0                  0                   0
                                                    ------------------ ------------------ ------------------ ------------------ ------------------ ------------------ ------------------ --------------------
                       Difference Should Equal Zero      XXXXXX             XXXXXX                        0                  0                  0                  0                  0                   0



                                                          ITEMIZATION OF
                                                          LOSS & LAE PAYMENTS                                       LOSS
                                                                                                                ADJUSTMENT
                                                                               DATE OF           LOSS             EXPENSE
                                                                              PAYMENT           AMOUNT            AMOUNT
                                                               1
                                                               2
                                                               3
                                                               4
                                                               5
                                                               6
                                                               7
                                                               8
                                                               9
                                                              10
                                                              11
                                                            TOTAL                                           0                 0


NOTES:

PTS = Primary Title Services; RTS = Related Title Services
AGENT'S EXPERIENCE REPORT
PART 6 - MISC. EXPENSES
FOR THE YEAR ENDING DECEMBER 31, 2005


      Name of Agency
                                                                                                                                  RTS                  RTS
                                                                                                                               PROVIDED            PROVIDED
                                                                                                             REGULAR            TO TITLE            TO TITLE            RTS
                                                                                                               TITLE            CLIENTS             CLIENTS          PROVIDED
                                                                                       MARKETING           INSURANCE          (CLOSING &              (ALL          TO NON-TITLE ALL OTHER
                                                                          PTS          ACTIVITIES          (EXCL. RTS)          ESCROW)             OTHER)            CLIENTS    ACTIVITIES       TOTAL
ITEMIZE "MISC." EXPENSES                                                  (1)             (2)               (3) = (1)+(2)          (4)                 (5)               (6)         (7)    (8) = SUM 3,4,5,6,7
1.                                                                                                                      0                                                                                  0
2.                                                                                                                      0                                                                                  0
3.                                                                                                                      0                                                                                  0
4.                                                                                                                      0                                                                                  0
5.                                                                                                                      0                                                                                  0
6.                                                                                                                      0                                                                                  0
7.                                                                                                                      0                                                                                  0
8.                                                                                                                      0                                                                                  0
9.                                                                                                                      0                                                                                  0
10.                                                                                                                     0                                                                                  0
11.                                                                                                                     0                                                                                  0
12.                                                                                                                     0                                                                                  0
13.                                                                                                                     0                                                                                  0
14.                                                                                                                     0                                                                                  0
15.                                                                                                                     0                                                                                  0
16. TOTAL                                                                         0                                     0                    0                                0           0                0

                                                   Part 1 Totals               0                   0                   0                   0                   0                   0                   0                   0
                                                              ------------------- ------------------- ------------------- ------------------- ------------------- ------------------- ------------------- -------------------
                                 Difference Should Equal Zero                  0                   0                   0                   0                   0                   0                   0                   0


NOTES:

PTS = Primary Title Services; RTS = Related Title Services
Charitable contributions, political contributions, and lobbying costs are not allowable expenses and shall be excluded.
AGENT'S EXPERIENCE REPORT
PART 7 - RESIDENTIAL VS. COMMERCIAL SPLIT
FOR THE YEAR ENDING DECEMBER 31, 2005


      Name of Agency

                                                                          TOTAL TITLE INSURANCE PREMIUMS                                  NUMBER OF TRANSACTIONS OR POLICIES ISSUED
                                                               -------------------------------------------------------------------------- --------------------------------------------------------------------------
      TYPE OF TRANSACTION OR POLICY ISSUED                   RESIDENTIAL COMMERCIAL                                TOTAL               RESIDENTIAL COMMERCIAL                                 TOTAL
1.    Original Owners & Leasehold Policies                                     0                        0                        0                        0                        0                        0
2.    Single Issue Lender's Policies                                           0                        0                        0                        0                        0                        0
3.    Construction Loan Policies                                               0                        0                        0                        0                        0                        0
4.    Search or Abstract Without Policy Issued by Agent                        0                        0                        0                        0                        0                        0
5.    TOTAL                                                                    0                        0                        0                        0                        0                        0


NOTES:

"Residential" means dwellings with 1 to 4 family units; "Commercial" means undeveloped land and all other property.
For purposes of the number of transactions or policies:
   Count simultaneous issue situations as one (1) transaction or policy rather than two (2) (e.g., when mortgagee and mortgagor are both issued a policy).
   Do not count endorsements.
   Include commitments for which no policy was issued in row 4.
AGENT'S EXPERIENCE REPORT
PART 8 - RECONCILIATION OF REPORTED NET INCOME TO BOOK INCOME & TAXABLE INCOME
FOR THE YEAR ENDING DECEMBER 31, 2005


          Name of Agency




1.        Net Income per Part 1                                                  0

2.        Adjustments for book income
     a.   Charitable contributions                                  0
     b.   Political contributions and lobbying                      0
     c.   Penalties                                                 0
     d.   Depreciation                                              0
     e.   Income tax expense                                        0
     f.   Other (attach itemized schedule)                          0
     g.   Total 2a to 2f                                                         0

3.        Total 1 and 2                                                          0

4.        Book Income (should equal 3)                                           0

5.        Book/tax adjustments                                      0
     a.   Depreciation - tax adjustments                            0
     b.   50% of meals & entertainment                              0
     c.   Carryovers/Carrybacks                                     0
     d.   Capital gains or losses                                   0
     e.   Tax exempt income                                         0
     f.   Other (attach itemized schedule)                          0
     g.   Total 5a to 5f                                                         0

6.        Total 4 and 5                                                          0

7.        Taxable Income (should match 6)                                        0




          FISCAL YEAR WORK SHEET:
          Used to convert to a calendar year basis, if necessary.
                                                                                        Less:
                                                                                    Months Included
                                                                         Add:          In Prior
                                                       Most Recent  Months After      Experience
                                                       Fiscal Year Last Fiscal Year     Report        Total
8.        Total revenue                                           0              0               0            0
9.        Total expense                                           0              0               0            0
10.       Net income                                              0              0               0            0

				
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