Old Republic National Title Insurance Company

Buyer's Affidavit

Fax To (610) 687-6056

File Number:
Premises:
Address:
City:
State:
Zip Code:

COMMONWEALTH OF PENNSYLVANIA

COUNTY OF

ON THE OF , A.D., before me, the undersigned Officer, personally appeared the undersigned, who being duly sworn according to law and intending to be legally bound, depose(s) and say(s):
That (I)(We) have not borrowed any money for the purposes of buying the premises, excepting only the mortgage being created in this settlement.
That (I am) (We are) eighteen years of age or over and under no legal disability which would impair or void any act on my/our part.
That no Notice has been received of a claim from any real estate broker claiming a right to a lien pursuant to Act 34 of 1998..
As to each Grantor/Mortgagor who is a natural person:
A. If presently married, that he/she is not a party to any pending divorce proceeding in any jurisdiction.
B. If presently married, that he/she is not presently separated.
C. There are no arrearages for child support due in this, or any other, jurisdiction against me/us.


Receipt of HUD Settlement Statement, Title Commitment, and Old Republic National Title Insurance Company's and its Agent's Privacy Policy are hereby acknowledged.

 

 

If this conveyance or refinance occurs within ten years of the issuance of a previous title policy for the same property, you may be entitled to the "reissue" rate. If this is a refinance an occurs within four years of the issuance of a previous title insurance policy for the same property, you may be entitled to the "mortgage loans" rate.

This affidavit is made for the purpose of inducing Old Republic National Title Insurance Company and/or its authorized agent to hold settlement on the above premises, and to issue its title insurance policy, insuring the title thereto, and undersigned confirm(s) that the foregoing statements are true and correct to the best of my/our knowledge and belief.

SWORN TO AND SUBSCRIBED before

me, the day and year aforesaid

Signed:

My Commission Expires