Affidavit Of Exemption Section 253 (1-a)

Affidavit Of Exemption Section 253 (1-a)

State of )
County of )

, being duly sworn, deposes and says:

The undersigned is the (Attorney for the) owner and holder of the hereinafter described mortgage, and is fully familiar with the facts set forth herein.

That the mortgage offered for recording dated
made by
to

That the mortgagee(s) is(are) a natural person or persons and the mortgaged premises consists of real property improved by a structure containing six residential dwelling units or less, each with separate cooking facilities.

WHEREFORE, your deponent respectfully requests that the mortgage offered for recording herein be exempted from the special additional mortgage recording tax set forth in Section 253 (1-a) of the tax law.

Sworn to before me
This day of ,