That he/she resides at , and that
he/she is an officer of having its principal office at
.
That said is the owner and holder of a mortgage made
by
to
to secure the payment of the principal sum of $ dated
and recorded
on in the Office of the Register/Clerk of the county of
in control number
covering premises , which mortgage there is now unpaid the
sum of $, the mortgage tax thereon having been paid.
That as further and additional security for the payment of the said indebtedness mentioned in
and secured by the above mentioned mortgage, executed and
delivered to a certain indenture of mortgage, dated
, covering premises known as ,
which said mortgage is herewith offered for record in the Office of the Register/Clerk of the County of.
That the said additional indenture is given for the purpose of further securing the same principal
indebtedness which is or under any contingency may be secured by the above mentioned primary
mortgage and that such additional and collateral mortgage does not create or secure any new or further
indebtedness or obligation other than the principal indebtedness or obligation secured by or which under
any contingency may be secured by the said primary mortgage.
Wherefore, deponent respectfully requests that such additional mortgage may be declared exempt from
taxation pursuant to Section 255 of Article XI of the Tax Law of the State of New York.
Sworn to before me this
day of ,20
Notary Public
AFFIDAVIT NY05: SECTION 255 AFFIDAVIT – COLLATERAL MORTGAGE UNDER SECTION 255 TAX LAW