AFFIDAVIT IN CONNECTION WITH A NO OR MARGINAL CONSIDERATION TRANSFER 

STATE OF 						)
COUNTY OF 						)

Grantee (s) being duly sworn deposes and says under the penalties of perjury as follows:
I/we are the Grantee (s) in the deed dated _______________ and delivered to
_________________________________________________________________
conveying title in the property or premises known as: _________________________________________.
	(Section: ___________ 		Block: ___________		Lot(s): ___________)
I/we hereby acknowledge and confirm the execution and delivery of said deed to the grantee(s)
herein named:
___________________________________________________________
___________________________________________________________
___________________________________________________________
The undersigned represents that the grounds upon which the claim of no or marginal consideration is based as follows:
_______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
The aforementioned no or marginal consideration transfer was made solely for the grounds stated herein.
I/we affirmatively represent that said transfer does not leave insolvent, and is not done to hinder, delay or
fraud creditors. Therefore, any returns filed in collection with this no consideration deed shall be free from any transfer taxes. This affidavit is made to induce Blackacre Title to issue its policy covering the above referenced premises, knowing that it relies upon the truth thereof.



x							x						
Print Name:						Print Name:

x							x						
Print Name:						Print Name:



Subscribed and Sworn before me this 	 day of 		 , 20	    .	

x							
Notary Public: