NEW YORK STATE AFFIDAVIT OF TITLE Project Map No. Map No. Parcel No. Parcel No. County Town City or Village STATE OF NEW YORK COUNTY OF , being duly sworn, says: FIRST: I, __________________or We reside at ______________________________, and I was the owner or We were the owners in fee simple of the property shown on the above designated map or maps on 200 , the date of appropriation thereof by the State of New York. That said property was acquired by said owner or owners at the time and in the manner following, to wit: ) ) ss.: ) SECOND: During the entire period of such ownership, the property was in the possession of said owner or owners; that such possession was peaceable and undisturbed, and the title thereto was never disputed, questioned or rejected. I/We know of no facts by reason of which such possession or title might have been called into question or by reason of which any claim to any part of the appropriated property or interest therein adverse to said ownership might have been set up. There are no judgments against such owner or owners unpaid or unsatisfied of record entered in any Court of this State or of the United States. Said property and the claim of said owner or owners by reason of the appropriation thereof are free and clear of all mortgages, attachments, judgments, leases, tenancies, easements, licenses, charges, estates, unpaid taxes and assessments, unredeemed or uncancelled tax sales, contracts of sale, actions or proceedings that may affect the same, and of any and all other rights, liens and encumbrances whatsoever, except (state exceptions, if any.) THIRD: No proceedings in bankruptcy have ever been instituted by or against said owner or owners in any Court or before any officer of any State or of the United States, nor has an assignment for the benefit of creditors been made at any time by said owner or owners. -over- American LegalNet, Inc. www.FormsWorkflow.com FOURTH: I am or We are each over the age of eighteen years. None of the owners has been known by any other name (e.g., maiden name) in the past ten years except as follows: FIFTH: (additional proof, if any) SIXTH: Said owner or owners has not (or have not) transferred, pledged or assigned either all or any part of aforesaid claim herein or of the compensation to be paid therefor by reason of the aforementioned appropriation, except (state exceptions, if any.) SEVENTH: The allegations herein as they relate to any co-owners and to any ownership in corporate, representative or fiduciary capacity are upon information and belief. All statements and representations in this affidavit are made to induce The People of the State of New York to pay to the money in accordance with the Agreement relating to the claim of said owner or owners, or, in the absence of any such agreement, in accordance with Award of the Court of Claims. Sworn to before me this of , 200 day Notary Public, State of New York American LegalNet, Inc. www.FormsWorkflow.com