NH Survey Affidavit 1

STEWART TITLE GUARANTY COMPANY

AFFIDAVIT I/We, ___________________________________________________________________

(hereafter called the Deponents) being first duly sworn severally depose(s) and say(s):

1. That I/We are the true and lawful owners in the fee of the premises situated in the City/Town of ____________________, County of ____________________, State of ____________________, known as:

PROPERTY ADDRESS:

2. That within the last 120 days, no person, firm or corporation has furnished any labor, services or material in connection with the construction or repair of any buildings or improvements on the herein described premises. (If work has been performed or materials supplied by any person, please list on reverse side and AGENT please list in TITLE POLICY).

3. That the Deponent(s) have allowed no encroachments on the premises described above nor have encroached on any adjoining property. There have been no changes to the boundaries during my/our period of ownership.

4. That said premises are in the possession of the Deponent(s). (STATE ANY OTHERS On REVERSE) and that, to the knowledge of the Deponent(s), no claims have been asserted by other parties as to said premises. The Deponent(s) represent that no dispute exists between Deponent(s) and others concerning the title to said premises or the boundary lines of the same nor as to the location of the improvements upon the said premises or the adjoining premises. The Deponent(s) represent that the applicable building codes, restrictions, conditions and agreements are not being violated.

5. That the Deponent(s) is/are over the age of 18 years.

6. That no proceedings in bankruptcy or receivership have been instituted by or against Deponent(s) which are now pending, nor has/have Deponent(s) made any assignment for the benefit of creditors which is in effect as to the said premises.

7. That Deponent(s) know of no assessment or lien for taxes, federal or state, or any special assessments which are not shown as existing liens by the public records other than as shown in the commitment or binder.

8. The Deponent(s) are not aware of any easement, right-of-way, road, lane, cemetery, pipeline, lake, pond, river or any of the like that could have an effect on the property boundary or the rights of others, other than listed in the commitment or binder.

9. That this affidavit is made for the purpose of inducing a purchase of said premises, and/or for the purpose of inducing the granting of a mortgage on said premises and for the purpose of inducing Stewart Title Guaranty Company to issue a policy(s) of title insurance.

EXECUTED ON _______________

STATE of ___________________ §

COUNTY of _________________ §

The foregoing instrument was acknowledged before me this _____________________ by _______________________________________________________________________

Notary Public/Justice of the Peace

Commission Expires:

No guidelines are available for this form at this time.