MA Survey Coverage Affidavit 1

Issued by

STEWART TITLE GUARANTY COMPANY

STATE OF MASSACHUSETTS§

COUNTY OF _______________§

I/We ________________________________________________________________

being first sworn, depose and say as follows:

1. That I am/we are the Owner(s) of certain premises in the Town (City) of ____________________ County of _______________________ and State of Massachusetts known as ___________________________________________.

2. I/We have owned the property now being sold or mortgaged by me/us continuously for __________ years last past, and my/our enjoyment thereof has been peaceable and undisturbed and the title to said property has never been disputed or questioned to my/our knowledge, nor do I/we know of any facts by reason of which the title to, or possession of, said property might be disputed or questioned, or by reason of which any claim to any of said property might be asserted adversely against me/us.

3. That within the last ninety (90) days, including the date thereof, no person, firm or corporation has furnished any labor, services or materials in connection with the construction or repair of any buildings or improvements on the herein described premises. (complete lien waiver)

4. That there are no present tenants, lessees or other parties in possession of said premises, except (if none, state "none"). _________________________________

5. That during the time of ownership of the premises above described, I/we have conveyed no portion of the premises nor done any act or allowed any act to be done which has changed or could change the boundaries of the premises.

6. That I/we have allowed no encroachments on the premises above described by any adjoining land owners nor have encroached upon any property of adjoining land owners.

7. That I/we have allowed no easements, rights-of-way, continuous driveway usage, drain, sewer, water, gas or oil pipeline or other rights of passage to others over the premises above described and have no knowledge of such adverse rights.

8. That I/we have no knowledge of any old highways, abandoned roads, lanes, cemetery or family burial grounds, springs, streams, rivers, ponds, or lakes bordering or running through said premises.

9. That I/we have no knowledge of any taxes or special assessments which are not shown as existing liens by the public records other than as shown in the binder or commitment.

10. That I/we have no knowledge of any violation of any covenants, restrictions, agreements, conditions or zoning ordinances affecting said premises.

11. That I/we make this Affidavit for the purpose of inducing a purchase or lease 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 (policies) of title insurance.

Signature

Signature

Subscribed and sworn to before me, this _____ day of __________, 20_____.

Notary Public

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