AFFIDAVIT GRANTEE/GRANTOR: NO JUDGMENTS STATE OF NEW YORK COUNTY OF [CITY/VILLAGE/TOWN] OF ) ) ) ss.: RE: Premises commonly known as ___________________________________. ___________________________________, being duly sworn, deposes and says: That (s)he resides at ____________________________________________________. Affiant is a grantee in a deed conveying the above-described premises which was recorded in the ______________________ County Clerk’s Office on ______________________________, _______, in Liber _________ of Deeds at page __________. Affiant’s attention has been called to certain judgments, tax liens, warrants or other recorded encumbrances or liens against persons with names similar to affiant’s. That there are no judgments, tax liens, warrants, attachments or other encumbrances or liens of any nature whatsoever against affiant nor has affiant ever been adjudicated incompetent or bankrupt. That affiant has been known by the name in which this affidavit is made (and by no other name) for the last ________ years. For purposes of complying with Real Property Transfer Tax (Article 31 of the Tax Law) the date of conveyance of the above premises is the date of the final closing of conveyance, regardless of the date of the deed, as said deed is being executed in advance of the closing date and being delivered to grantor’s attorney only in escrow pending final closing. That this affidavit is made with the knowledge that __________________________ or any prudent purchaser of the above-described premises will rely upon the veracity of all statements made herein in dealing with the premises and to induce __________________________________ to issue its policy of Title Insurance. Subscribed and sworn to before me this ________ day of _____________, ______. Notary Public RETO37 amended American LegalNet, Inc. www.FormsWorkflow.com