Owners Affidavit - Individual

File Number:

Premises:

Address:

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COMMONWEALTH OF PENNSYLVANIA _SS

_{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 the Grantor/Mortgagor herein is/are the owner(s) of the premises being insured hereunder and the same person(s) as the grantee(s) in DEED BOOK , PAGE , Instrument NO. .

That there are no bankruptcies, easements, encumbrances, judgments, mortgages or pending suits adversely affecting the owner(s) and the said premises which are known to the undersigned and are not being properly provided for in this transaction.

That there have been no repairs, additions or improvements made, ordered or contracted to be made on or to the premises, within six (6) months from the date hereof; and that there are no outstanding or disputed claims for any such work, labor or materials for the matters aforementioned.

That there has been no work done, or notice received that work is to be done, by the Municipality (City, Borough or Township), or at its direction, in connection with the installment of sewer or water or for improvements such as paving or repaving of streets or alleys, or the installation of curbs or sidewalks.

That no notice has been served by any governmental authority for the removal or abatement of any nuisance, or concerning the condemnation of any portion of said premises.

That there has been no violation of any restrictions affecting the premises.

That there are no purchase money obligations being created in this transfer.

That the Grantor/Mortgagor is/are in actual possession of the entire premises, and there are no disputes with any adjoining property owners, and there are no leases or agreements affecting the premises or any part thereof outstanding, other than those that are presently being assigned.

That the present transaction is not made for the purpose of hindering, delaying or defrauding the creditors of said owner(s) and does not come within the provisions of any Bankruptcy or Insolvency Acts.

Than the Grantor/Mortgagor(s) in this transaction are of full legal age and in every respect competent to convey or encumber the title to the premises in question.

That all taxes, sewer and water rents assessed against the said premises as of the date of this settlement are fully paid.

As to each Grantor/Mortgagor who is a natural person:

If presently married, that he/she is not a party to any pending divorce proceeding in any jurisdiction.

That any interest in the within described premises has never been awarded or distributed to or liened in favor of any former spouse nor is his/her interest in the within described premises subject to the continuing jurisdiction of any court for possible future award or distribution to any former spouse.

If presently married, that he/she is not presently separated.

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