COMMONWEALTH OF MASSACHUSETTS
_______________________________________________________________________ being first duly sworn, depose and say as follows:
1. That I am/we are the owner(s) of certain premises situated in the Town (City) of ____________________, County of ____________________________ and State of Massachusetts, know as _________________________________________.
2. That within the last ninety (90) days, including the date hereof, no person, firm or corporation has furnished any labor, services or materials in connection with the construction or repair of any buildings, fixtures or improvements on the herein described premises, except (if work has been performed or materials furnished within the last ninety (90) days, please explain fully and state whether payment for same has been made in full):
3. That there are no present tenants, lessees or other parties in possession or who have a right to possession of said premises, except (if none, state "none")
4. That I/we have examined a certain survey entitled " ____________________________ _______________________________________________________________________ ______________________ " made by ____________________________, Surveyor, dated _______________, that no exterior alterations or additions have been made to the buildings shown on said survey; that no additional buildings or other improvements have been constructed on said premises since that date of said survey, and that said survey reflects the current statutes of the premises. A copy of said survey is hereto attached. WHEN CURRENT SURVEY IS PROVIDED OR IF SURVEY COVERAGE IS NOT DESIRED, THIS PARAGRAPH NEED NOT BE COMPLETED.
5. 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 a current Municipal Lien Certificate or as reflected on the HUD-1 Settlement Statement.
6. That I/we have no knowledge of, nor have I/We created, any violations of any covenants, restrictions, agreement, conditions or zoning ordinances affecting said premises.
7. That all bills which could become liens pursuant to M.G.L.A. Chapter 551 of the Acts of 1980 (Municipal Lighting Plants - Real Estate Liens) have been paid.
8. That I/we make this Affidavit for the purpose of inducing a purchase, lease and/or mortgage on said premises, and for the purpose of inducing Stewart Title Guaranty Company to issue a policy (policies) of title insurance insuring same and I/We hereby agree to indemnify and hold harmless the Title Insurance Company from any loss resulting from reliance upon the truth and accuracy of the statements contained herein.
Subscribed and sworn to before me, this _______ day of __________________, 20____
Notary Public/Commissioner of the Superior Court
STEWART TITLE GUARANTY COMPANY
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