STEWART TITLE

GUARANTY COMPANY

PURCHASER'S AFFIDAVIT 

STATE OF PENNSYLVANIA                                                                                            No.___________________________

COUNTY OF                                                                                                                         Premises:______________________

                                                                                                                                                      ___________________________

                                                                BE IT KNOWN,   That on the              day of                        , 200    , before me, a Notary Public personally appeared ________________________________________

Who, being duly sworn according to law, did depose and say

                THAT deponent (s) have not entered into any unrecorded leases or agreements affecting premises

                THAT the newly erected building (s) on the premise to be insured is/are completed.

                THAT it is the intention of the deponent (s) to take title as follows:

Single ___  Tenants in Common ___   Joint Tenants with Rights of Survivorship ___ Tenants by the Entirety ___

                THAT the deponent (s) is/are of full legal age and has (have) never been declared an incompetent..

                THAT the deponent (s) have not borrowed any money or signed any judgment notes, mortgages, or other obligations excepting such obligation, if any executed herewith.

                THAT deponent(s) is/are not separated and is/are not involved in divorce proceedings.

                THAT there are no support arrearages or support judgments entered against deponent(s) in any jurisdiction.

This affidavit is made for the purpose of inducing Stewart Title Guaranty Company (" Stewart") to hold settlement and insure title to the above premises and I/we realize that the Seller, Lender and Stewart are relying on the representations contained herein.  If the undersigned is an entity, I have authority to sign on its behalf.

Sworn to and subscribed before me

This _________ day of _______________A.D. 20                                    ____________________________________

                                                                                                                                ____________________________________

__________________________________________

                                                                                Notary Public                        Address_____________________________