AFFIDAVIT UNDER SECTION 256 OF THE TAX LAW
State of ______________}
County of ____________}ss:
_____________________________ being duly sworn, deposes and says:
That (s)he is the ____________________ of ______________________ , the mortgagee
in a certain mortgage instrument to be recorded herewith, made by
__________________________, Mortgagor to ______________________ , Mortgagee,
dated _____________________ affecting real property known as
_______________________________________ in the County of _________________.
That the aforesaid instrument was given to secure an indebtedness or obligation in the
sum of $__________________; that the maximum amount secured at the execution of the
said instrument or which under any contingency has since been or may be secured
thereby at any time thereafter, including any and all advances, readvances, loans or
reloans that may be made thereunder is $____________________.
Sworn to before me this
_____ day of_____________20___
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