State of New York
County of ________
I/We, _________________________, being duly sworn, depose and state the following to be true under the penalty of perjury:
1. I/We am/are the owner(s) of _______ shares of _______________________ (insert name of cooperative corporation), and the holder of the proprietary lease appurtenant to _______ (insert unit #) of _______________________ (insert address), which said shares and proprietary lease appurtenant thereto are being conveyed to __________________________.
2. I/We have not resided either permanently or temporarily, in any other county or any other state other thank the address listed above for the past 10 years. (If you have resided elsewhere in the past 10 years, searches must be conducted in that jurisdiction)
3. I/We am/are the sole proprietary tenant(s) of Unit _____; and that there are not statutory rights of possession in and to said Unit ____ in any “non-purchasing tenant”, “eligible senior citizen” or “eligible disabled persons” as defined in sections 352(e)(e)(e) and 352(e)(e)(e)(e) of the New York General Business Law and that there are no rights of possession in any other person by lease or otherwise.
4. There are no bankruptcies, judgments, federal tax liens, state and city tax warrants and other liens against myself, and in the event there are, they are not against me, but rather against others of a same or similar name.
5. There is no loan, security interest, pledge, disposition, assignment or lien upon the shares of stock or proprietary lease other than those set for h in Schedule B, paragraph A-3 of the aforementioned title report.
6. There are no lawsuits, administrative hearings or court proceedings involving Unit _____.
7. No person or entity can claim any right or interest in said shares owned and the proprietary lease appurtenant thereto.
It is understood that this affidavit is being given to induce ___________________, as agents for Stewart Title Insurance Company to issue a policy or policies of title insurance and I/we understand that it is relying on the truth of the statements made by me/us in this affidavit.
Sworn to before me this _____
day of ___________, 20_____.
No guidelines are available for this form at this time.