STATE OF NEW YORK County of................

SS.:

............ being duly sworn, says, that he resides at .......... and is by occupation ............; that he is a citizen of the United States, twenty-one years of age and upwards; and that he is now in possession, and the owner in fee simple, of the premises known as .......... in .......... this day to be

..........by him to..........

Deponent further says that the said premises have been held by him for upwards of..........years last past, and that his possession thereof has been peaceable and undisturbed, and that the title thereto has never been disputed, questioned or rejected, to his knowledge, nor does deponent know of any facts by reason of which said possession or title might be disturbed, or questioned, or by reason of which any claim to said premises, or any part thereof, or any interest therein adverse to him, might arise, or be set up adverse to this deponent; and that he is informed and believes that his grantors held the said premises for more than twenty years prior to the transfer to him; and that no person has any contract for the purchase of, or claim to or against said premises, except as hereinafter stated; and that the same are now free and clear of all taxes, incumbrances or liens by mortgage, decree, judgment or by statute, or by virtue of any proceedings by or against him in any court or before any officer of any State or of the United States, or filed in the office of the clerk of any county or court in this State, or in any State or the United States and of all other liens of every nature and description, save and except

.............................................................................................................................................

.............................................................................................................................................

or have any proceedings in bankruptcy ever been instituted by or against the deponent in any court or before any officer of any State, or of the United States, or has deponent at any time made an assignment for the benefit of creditors.

Deponent further says that he is married to*.................. and who is the same person who executed, with deponent, the......to the said premises; and that there are no judgments, or decrees, or attachments, or orders of any court or officer for the payment of money against him, or to which he is a party, unsatisfied or not canceled of record in any of the courts, or before any officer of the United States, or this State, or any suit or proceedings pending anywhere affecting said premises, to his knowledge, information or belief and that any judgments found of record against any person under the name........

are not against deponent.

Deponent makes this affidavit to induce..........above named, to accept a

.........said premises, and pay the consideration therefor, knowing that said

..........relies upon the truth of the statements herein contained.

.........................................................

Sworn to before me, this ..........

day of......................

* In case deponent is a single man, a widower, or if he has been divorced for his fault or not, such facts should be substituted.