Fill and Sign the Mortgage on Real Estate Given as Security for a Loan C an Obligation Owning to a Contractor Subcontractor or Other Form

- 1 - OWNER'S (SELLER'S) AFFIDAVIT NOTE:Complete all provisions which apply.STATE OF UTAH, COUNTY OF ________________________________,SS: (In this Affidavit the pronoun "We" means "I" when there is only one Purchaser.) We, ________________________________________________ (owners) ,being sworn according to law, say under oath that: 1. We are 21 years old or older. We are the sole owners of the real estate and improvements ("Property") located at: We received a deed to the Property dated ______/________/_______. We are now the Sellers of the Property. Marital Status: 2. We have been and are now (being the time and date that we are signing this Affidavit) married to each other. If not married, so state here:_______________. Liens: 3. In this Affidavit, a lien is a legal claim of another against property for (a) the payment of a debt or (b) the performance of an obligation. Examples of liens are (a) a judgment of a court for the payment of money owed, (b) a mortgage on real estate given as security for a loan, (c) an obligation owning to a contractor, subcontractor or other mechanic who has furnished labor or material for the improvement of real estate and for which money is owed, and (d) taxes and assessments assessed against real estate. There are no liens against the Property as a result of (a) debts that we owe or (b) obligations we have undertaken, except: (a) Real estates taxes and assessments for this year. (b) Other __________________________________________ __________________________________________No Mechanic's Liens; Rights to Liens: 4. During the last 60 days prior to the date we have signed this Affidavit, we have made no repairs, additions, or improvements, nor ordered or contracted for any labor or materials to be performed or furnished to the Property, which have not been paid in full. We do not owe any money for improvements, labor or materials performed on or furnished to the Property within 60 days immediately preceding the date of this Affidavit. Nor have we received any notice from anyone claiming to have not been paid in full, and there are no outstanding or disputed claims for any such work or item. No such work is now in progress. Fixtures: 5. We have fully paid for all fixtures, appliances, or other personal property attached to or otherwise used with the improvements on the Property. No Pending Governmental Improvements: 6. There has been no work done, and we have not received any notice that any work is to be done, by the City, Village, County, Township, State of Alabama or any sewer district or other governmental authority, or at its direction, in connection with the installation of sewer, water, curbs, sidewalks, streets or alleys, or repairs or improvements thereto. - 2 - No Nuisance or Condemnation: 7. We have not received any notice from any governmental authority for the removal or abatement of any nuisance or any notice of condemnation or other exercise of the power of eminent domain, or for the violation of any Zoning Regulations concerning the Property. No Hidden Structural Defects: 8. There are no hidden structural defects in the Property. Boundary Lines, etc.: 9. All of the utilities and improvements concerning the Property are located within the boundary lines of the subject real estate or within lands dedicated to public use or within recorded easements for the same. There have been no violations of any restrictions affecting the Property. There are no disputes with any adjoining property owners as to the location of property lines or the encroachment of any improvements. No Lawsuits: 10. The are no pending lawsuits against us in any court. We have not received notice of any lawsuits pending against us. No Bankruptcy or Receivership: 11. We are not a debtor in any proceeding under the bankruptcy laws of the United States, and no bankruptcy or insolvency proceedings have been started by or against us. No receiver or trustee has ever been appointed to take possession of the Property. Our sale of the Property is not made for the purpose of hindering, delaying or defrauding any of our creditors. Easements: 12. In this Affidavit, an easement is a right given to another for a specific and limited use of real estate. An example of an easement is a right given to a utility company to maintain poles on the property. We have not given anyone any unrecorded easements affecting the Property. Nor have we given anyone any other unrecorded rights or interests in the Property, such as land contracts, mortgages, deeds, options, leases or licenses to use any part of the Property. Liens Affecting Similar Names: 13. Our attention has been called to the liens listed below. The liens listed below are for debts or obligations of others with names similar to or the same as ours. We are not the same person as named in the following liens: _________________________________________________________ _________________________________________________________Reliance By & Obligations To Mortgagee & Title Insurance Company: 14. We know that ______________________________________ ("Mortgagee" is making a loan to _______________________________________________________, the "Mortgagor(s)" of the Property, and that without said loan we, the Sellers, would not now be closing the sale of the Property and would not now be receiving the sale proceeds (either directly by payment to us, or indirectly by payment to one or more of our lenders). We know that in deciding whether or not to make the loan to our Purchasers the Mortgagee is relying on the truth of the statements made by us in this Affidavit. We also know that _______________________________________ (the "Title Insurance Company") is insuring the title to the Property for the Mortgagee because the Mortgagee requires that the title be insurable and that it be insured before it makes the loan to the Purchasers of our Property, and before it accepts the Property as security for its loan. We known that the Purchasers may also be insuring their title to the Property. We know that in deciding whether or not to insure the title for the Mortgagee, and for the Purchasers, the Title Insurance Company is relying on the truth of the statements made by us in the Affidavit. It is with knowledge of the reliance by the Mortgagee and by the Title Insurance Company, and it is in consideration of and as an inducement to the making of the loan and of the insuring of the title so that we can benefit by the sale of the Property, that we acknowledge and agree that we are and will continue to also be directly liable to the Mortgagee and to the Title Insurance Company for any loss or damage either or both may suffer should any of the statements made by us in this Affidavit be not true. - 3 - Penalty of Perjury: 15. We know that we shall be bounded by this Affidavit under the penalties of perjury. _______________________________________ Owner Signature Print Name: ______________________ _______________________________________ Owner Signature Print Name: ______________________ SWORN TO and subscribed in my presence this __________ day of _________________,20_____. ___________________________________________ NOTARY PUBLIC My Commission Expires:_________________________