Affidavit Of Exemption Under Section 253 (1-a) Of The Tax Law
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Affidavit Of Exemption Under Section 253 (1-a) Of The Tax Law Form. This is a New York form and can be use in Real Estate Statewide.
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AFFIDAVIT OF EXEMPTION
UNDER SECTION 253 (1-a) OF THE TAX LAW
STATE OF NEW YORK
COUNTY OF
)
)ss.:
)
_______________________________________, being duly sworn, deposes and says:
I am the mortgagee, the owner and holder of the hereinafter described mortgage, and as such is
familiar with the facts set forth herein.
That a certain mortgage was made by __________________________(“Mortgagor”) to
______________________(“Mortgagee”) and which mortgage was dated _________________
and which Mortgage is submitted herewith for recording in the Office of the ________ of
_____________________ County in the principal sum of $________________, and upon which
the mortgage tax in the sum of $_____________ is being tendered herewith.
Deponent certifies that the mortgagee is a natural person, and that the mortgaged premises
consists of real property improved by a structure containing six or fewer residential dwelling
units, each with separate cooking facilities.
Wherefore, deponent respectfully requests that, by virtue of the foregoing, such mortgage be
declared exempt from the special additional mortgage tax imposed pursuant to the provisions of
Section 253 (1-a)(a), Article 11 of the Tax Law.
________________________________________
________________________________________
Sworn to before me this
____ day of ___________, 20__
_______________________________
Notary Public
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