DISTRICT OF COLUMBIA, CITY/COUNTY OF _____________________, to wit:
BEFORE ME, the undersigned authority, personally appeared _____________________
____________________________ ("Affiant(s)"), who, being by me duly sworn, depose and say:
1. That Affiant(s) is/are over 18 years of age and is/are the sole owner(s) of certain real property located in _________________ City/County, District of Columbia, and known as _______________________________________ ("Property");
2. That the Property is improved by a 1-4 family residential dwelling;
3. That Affiant(s) has/have this day executed, acknowledged and delivered a certain Deed of Trust or Mortgage securing _____________________________________ in the amount of $____________________ ; (refinances only)
4. That Affiant(s) has/have this day executed, acknowledged and delivered a Deed for the Property to ______________________________ ; (transfers only)
5. That to the best of Affiant(s) information, knowledge and belief, the following is true with regard to the Property:
a. the dwelling, outbuildings and all driveways and fences are located entirely within the lines of the legal description of the Property;
b. the location of the dwelling is not in violation of any building restriction lines established by plat or other recorded instrument;
c. no permanent structures encroach upon any drainage and utility or other easements of record located over, under or across the Property; and
d. no structure, driveway or fence belonging to others encroaches onto the Property.
6. That Affiant(s) make this affidavit to induce the Stewart Title Guaranty Company to issue its Lenders Title Insurance Policy to ____________________________________ with survey coverage but without the benefit of a location survey of the Property and understand that Stewart will act in reliance on the statements made herein.
SWORN TO AND SUBSCRIBED before me this _____ day of ____________, 20_____.
My Commission Expires: ___________________
No guidelines are available for this form at this time.