AFFIDAVIT UNDER SECTION 255
OF THE TAX LAW
State of _______________ }
County of _____________ }ss:
_______________________ , being duly sworn, deposes and says that he is the owner of the premises encumbered by the mortgage referred to herein:
That _____________________ , ("Lender") is the owner and holder of the mortgages described on the attached Schedule A, inclusive of the mortgage (the "Mortgage",) dated as of the date hereof, intended to secure the Note given Lender under the date hereof evidencing an indebtedness of $_______________.
By reason of the possible addition to the principal indebtedness of accrued interest, the aggregate principal indebtedness specified in the Mortgage includes $___________ of such accrued interest, which, together with the principal advanced of $____________ , for a total of $_________________ is the maximum amount secured at the execution of the Mortgage and which under any contingency may be secured thereby at any time thereafter. The amount tendered with the recordation of the Mortgage includes the sum of $ _____________ constituting a mortgage recording tax on such conditional additional indebtedness.
WHEREOF, deponent respectfully requests that the Mortgage be recorded upon payment of $_____________ mortgage tax thereon.
Sworn to before me this
_____ day of _______, 20___
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