Fill and Sign the Borrowers Certification Form

CERTIFICATION OF NO MATERIAL CHANGE AND NO DAMAGE RE: Modification of Loan No. ______________ to ________________________________ ("Borrower") secured in part by land and property located at ____________________________________, and being more particularly described in Exhibit "__" hereto and being hereafter referred to as the "Property." The undersigned hereby certifies to _________________________________ as follows: That the building or buildings located on the Property have not been damaged to any material extent; and That as of the date hereof: The Property had not been taken, in whole or in part, in condemnation or in any other similar proceedings, and no such proceedings were pending; and That Borrower and all tenants whose leases have been assigned as security, if there be any, and the leases of all such tenants were not the subject matter of any bankruptcy, reorganization or insolvency proceeding or any other debtor - creditor proceeding. The within certification is being made and given by the undersigned in order to induce _________________________________ to make the above loan modification and with the knowledge of the undersigned that said _________________________________ is relying upon the within certification in making said loan modification. WITNESS our signature this ______ day of _______________, 20___. By: Name: __________________________________ Title: _________________________________ STATE OF ____________ COUNTY OF ____________ Personally appeared before me, the undersigned authority in and for the said County and State, on this _________ day of ____________, _____, within my jurisdiction, the within-named _____________________, who acknowledged that he is a ___________________ of ___________ _____________________, a _____________________________, and that for and on behalf of the said ___________________, and as its act and deed, he executed the above and foregoing instrument, after first having been duly authorized by said ______________________ so to do. _____________________________________________ Notary Public My Commission Expires: _____________________ [affix notarial seal]