State of___________________ }
City/County of )
1. The Affiants are the owners of the following described property ("Property"):
______________ _________ _____ __________ __ in the
City/County of______________ , Virginia.
2. The Affiants have this day executed and delivered a certain Deed of Trust dated
______ , 20___________ , encumbering the Property.
3. Since the date Affiant has owned the Property:
a. No improvements (e.g. additions to the house, swimming pools, hot tubs, decks, fences added by either the Affiants or adjoining landowner) have been made to the Property;
b. No alterations of the boundaries or fences of the Property have occurred; and
c. No other changes to the Property have occurred which would be reflected by a current, accurate Survey.
1. Affiants herein realize that it is in reliance upon the statements herein made as well as upon the acknowledgements to said instrument that Title Company as issuing agent for Stewart Title Guaranty Company ("Underwriter") has agreed to insure the lien created by said Deed of Trust and provide Survey coverage.
My Commission Expires:
Sworn to and subscribed before me by and
on this day of 20
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