Fill and Sign the Affidavit Claiming Senior Citizen Exemption from Transfer Tax Form

NC-6-5EXEMPTION FROM REAL ESTATE TRANSFER TAX AFFIDAVITSTATE OF NEW YORK) )ss.: COUNTY OF) The undersigned being duly sworn depose and say that we submit this Affidavit in support of the exemption from the COUNTY OF NASSAU REAL ESTATE TRANSFER TAX on the grounds that this conveyance was made pursuant to a binding written contract made between Grantor and Grantee prior to August 15, 1999, as follows: (A)A binding contract was entered into between Grantor and Grantee on (date) _____________ , 1999 (must be prior to August 15, 1999); and (B) A downpayment in the sum of (amount) ________ was deposited on (date) _________ in an account maintained at __________ Bank, in the name of (account holder) __________. The undersigned further certify that a complete copy of the fully executed contract of sale and the record of downpayment deposit shall be maintained for a period of three years from the date of this affidavit. Wherefore, we respectfully request that this conveyance be declared exempt from taxation pursuant to Article 31-E of the Tax Law and Title 34 of the Miscellaneous Laws of Nassau County. __________________________________ Grantor(s) SignatureGrantor(s) Name ____________________ Grantor(s) Address _____________________________________ Grantee(s) SignatureGrantee(s) Name ____________________ Grantee(s) Address _______________________________________ Grantor’s Attorney Signature Grantor’s Attorney Name ____________________ Grantor’s Attorney Address _________________________________________ Grantee’s Attorney SignatureGrantee’s Attorney Name ______________________ Grantee’s Attorney Address Sworn to before me this day of ___________________ Notary Public