MACGREGOR ABSTRACT CORPORATION by 8tDh90y

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									                               CJS Land Services, Inc.
                         COMBINED FEDERAL ESTATE TAX AND
                        NEW YORK STATE ESTATE TAX AFFIDAVIT
                            (Decedent’s Death After 2/1/2000)


                                                               Title No. ________________

                                                               Premises: _______________

                                                               _______________________


STATE OF NEW YORK                              )
COUNTY OF _____________                        ) SS.:


       ____________________________________, being duly sworn deposes and says:

       I reside at _____________________________________________________________.

       I am the (Executor-Administrator)* of the Estate of __________________________ who
died a resident of ______________________ County on ____________________, ______.
(* If neither of the above, state relationship to decedent ______________________________)


       I am fully familiar with the assets of which the decedent died seized. The value of the
decedent’s gross Federal estate, as defined by the Internal Revenue Code, is less than
$ _____________, and therefore the decedent’s estate is not subject to Federal Estate Tax or
New York Estate Tax. (Delete reference to New York Estate Tax if amount is greater the exempt
amount set forth on the Notes on reverse side.)


       I make this statement knowing full well that ___________________Title Insurance
Company and its agent CJS Land Services, Inc. are relying on the truth of the statements herein
for the purposes of issuing its policy of title in the captioned matter.




                                                               _____________________________




Sworn to before me this ____________
day of _______________, 20____.

								
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