BLACKACRE TITLE AGENCY CORP. 2900 Westchester Avenue, Suite 405
Purchase, N.Y. 10577-2551 (914) 481-5000 | (914) 481-5005
www.batitle.com | info@batitle.com

BUYER AFFIDAVIT

STATE OF ________________________________) COUNTY OF
_______________________________)

1.  I am/we are the grantee/mortgagor in the deed/mortgage
    conveying/mortgaging title to the property described in the above
    numbered report.

2.  I/we have not been known by any other name for the past ten (10)
    years except ________________________________, and there are no
    judgments, environmental control board judgments, parking violations
    bureau judgments, any other special municipal judgments, Federal or
    State liens or warrants against me, and any and/or all of the
    foregoing appearing in the above captioned report of title are not
    against your deponent, but against a party of the same or similar
    name.

[ ] The judgments and/or liens returned herein are not against the
deponent but someone of a similar name.

3.  That no work has been done upon the premises that may result or has
    resulted in the filing of a mechanics lien within the permissible
    period for filing.

4.  No proceedings in bankruptcy have ever been instituted by or against
    me nor have ever made an assignment of rents of said premises or an
    assignment for the benefit of creditors. That I/we make this
    affidavit to induce the above noted title/abstract company to insure
    title to the above captioned property, knowing they will rely upon
    the foregoing statements and that this affidavit is made under
    penalties for perjury.

5.  No other valid Contract of Sale for the within described premises
    other than the one executed between the sellers and buyers herein.

6.  I/We hereby agree to indemnify Blackacre Title Agency Corp. and Old
    Republic National Title Insurance Company harmless from any loss or
    damage that may arise by insuring against the enforced removal of
    any projections or encroachments.

7.  I/We make this Affidavit to induce Blackacre Title Agency Corp. and
    Old Republic National Title Insurance Company to issue its policy of
    Title Insurance.

8.  I/We hereby agree to indemnify Blackacre Title Agency Corp. and Old
    Republic National Title Insurance Company for all loss, cost or
    damage which it may sustain as a result of any statements in this
    affidavit being false or fraudulent.

9.  SECTION 6409, SUBDIVISION “C” OF THE INSURANCE LAW REQUIRES THAT
    TITLE COMPANIES OFFER AT OR PRIOR TO CLOSING AN OPTIONAL POLICY
    RIDER TO COVER THE HOMEOWNER FOR THE FUTURE MARKET VALUE OF HIS OR
    HER HOME.

PLEASE CIRCLE AND INITIAL ONE

A. I choose to accept the Market Value Policy Rider.

OR

B. I do not wish to accept the Market Value Policy Rider for future
increase market value and elect to waive the offer for such additional
coverage.

x ______________________________________ Print Name:
_____________________________

x ______________________________________ Print Name:
_____________________________

Subscribed and Sworn before me this ____ day of ____________, 20____.

x ______________________________________ Notary Public:

Stamp of Notary Public or other authorized officer