Legal Affidavit of Value

LEGAL AFFIDAVIT OF VALUE

This Legal Affidavit of Value is made on by Affiant Name: of Affiant Address: (hereinafter "Affiant") in favor of Recipient Name: of Recipient Address: (hereinafter "Recipient").

RECITALS

WHEREAS, Affiant is the purchaser/transferee or other party involved in the conveyance of certain real property described below (the "Property"); and

WHEREAS, the conveyance from Seller Name: to Buyer Name: was effectuated by an instrument recorded or to be recorded in County: on or about Date of Conveyance: ; and

WHEREAS, certain jurisdictions require a sworn statement of the consideration and value of the Property for purposes of recording, transfer tax, assessment or public record, and Affiant is submitting this Affidavit to satisfy such requirements and to declare the true value and consideration of the transaction.

NOW THEREFORE

NOW THEREFORE, for and in consideration of the foregoing recitals and the mutual covenants contained herein, Affiant hereby certifies, affirms, and states under oath as follows:

1. PROPERTY

1.1 Property Address:

1.2 Parcel or Tax ID No.:

2. STATEMENT OF VALUE AND CONSIDERATION

2.1 Purchase Price. Affiant states that the total consideration for the conveyance of the Property was the sum of $ (USD).

2.2 Manner of Payment. The consideration was paid or to be paid as follows:

2.3 Other Consideration. Affiant declares that no other material consideration, whether monetary or otherwise, was paid by or to any party in connection with the conveyance except as disclosed:

3. RELATIONSHIP OF PARTIES; SPECIAL CIRCUMSTANCES

3.1 Affiant is a(n): Individual Corporation Limited Liability Company Other

3.2 Relationship. Affiant declares whether the parties to the transaction are related or had a preexisting commercial relationship:

4. REPRESENTATIONS AND WARRANTIES

4.1 Affiant hereby affirms, under penalty of perjury, that the statements contained in this Affidavit are true, correct and complete to the best of Affiant's knowledge; that the consideration stated is the total amount paid or to be paid and that no material facts have been omitted with intent to mislead any person or entity relying upon this Affidavit.

4.2 Affiant further represents that Affiant has authority to execute this Affidavit on behalf of the party identified herein and that the execution of this Affidavit is not in violation of any contract, law, or court order.

5. USE, RECORDING AND TAX IMPLICATIONS

5.1 Purpose. This Affidavit is prepared for the purpose of informing public records, transfer tax authorities, or taxing jurisdictions of the true consideration and value of the Property, and may be relied upon by recording officers, tax assessors, and other governmental entities for the indicated purposes.

5.2 Transfer Taxes and Fees. Affiant acknowledges that any statements made herein may be used to determine transfer taxes, documentary fees, or other charges. Affiant is responsible for correction of any errors or omissions and for any resulting assessments, penalties or interest.

6. REMEDIES AND PENALTIES

6.1 Affiant acknowledges that willful submission of a materially false statement in this Affidavit may constitute perjury or other criminal offenses under applicable law and may give rise to civil liability, including but not limited to penalties, fines and forfeiture.

6.2 Affiant agrees to indemnify and hold harmless Recipient and any recording authority from and against any claims, losses, liabilities, costs or expenses arising from Affiant's false or incomplete statements contained in this Affidavit.

7. NOTICES

7.1 All notices, demands or communications required or permitted hereunder shall be in writing and shall be deemed delivered when personally delivered, sent by nationally recognized overnight courier, or when deposited with the United States Postal Service as certified mail, return receipt requested, to the addresses provided above or to such other addresses as the parties may designate by notice in accordance with this Section.

8. AMENDMENT, WAIVER, AND COUNTERPARTS

8.1 This Affidavit may not be amended or modified except by a written instrument signed by the parties. No waiver of any provision of this Affidavit shall be effective unless in writing and signed by the party waiving compliance.

8.2 This Affidavit may be executed in counterparts, each of which shall be deemed an original, and all of which together shall constitute one and the same instrument.

9. GOVERNING LAW; ENTIRE AGREEMENT; SEVERABILITY

9.1 Governing Law. This Affidavit shall be governed by and construed in accordance with the laws of the State of , without regard to principles of conflicts of law.

9.2 Entire Agreement. This Affidavit constitutes the entire agreement and understanding between the parties with respect to the subject matter hereof and supersedes all prior or contemporaneous oral or written agreements, representations, and understandings.

9.3 Severability. If any provision of this Affidavit is held to be invalid or unenforceable, the remaining provisions shall remain in full force and effect, and the invalid or unenforceable provision shall be reformed to the minimum extent necessary to make it valid and enforceable.

10. EXECUTION; ACKNOWLEDGMENT

10.1 Affiant acknowledges that this Affidavit may be presented to public officials for recording and that such officials may rely upon Affiant's statements. Affiant understands that a material misstatement may expose Affiant to criminal and civil penalties.

10.2 Affiant certifies under penalty of perjury under the laws of the State of that the foregoing is true and correct.

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