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,ocal Agent:
<br />C;6 Investors'He M COMPMY P.O. Drawer 2687 2 U `� 1 U 6 6
<br />Chapel Hill, North Carolina 27515 -2687
<br />(919) 968 -2200 (800) 326 -4842 Fax: (919) 968 -2235
<br />Return to: Bankers Title Agency, Inc.
<br />1227 Golden Gate Dr.
<br />State of Nebraska, County of Papillion, NE 68046
<br />OWNER(S)' AFFIDAVIT
<br />(Seller to execute if sale / Borrower to execute if refinance, construction or other)
<br />Commitment Number: 200303069NE
<br />To induce the above - referenced agent to issue a policy in accordance with the above commitment, insuring an interest in or
<br />title to the real estate described as follows:
<br />SEE ATTACHED EXHIBIT "A"
<br />The undersigned Seller and/or Mortgagor being first duly sworn, depose and say as follows:
<br />1. The Seller/Mortgagor is the owner of the real estate referred to in the above - referenced commitment.
<br />2. The Seller/Mortgagor is a citizen of the United States, is of legal age, has not been divorced since purchasing the real
<br />estate and has never been known by any other name (except name change due to marriage).
<br />3. That no proceedings in bankruptcy or receivership have been instituted by or against the undersigned within the last 12
<br />months, and that the undersigned has not made an assignment for the benefit of creditors within the last 12 months, except
<br />as follows:
<br />4. That there is not any State or Federal Court judgment, State or Federal tax lien, or any other State or Federal lien of any
<br />kind or nature against the undersigned, which could constitute a lien or charge upon the real estate, except as follows:
<br />5. That there are not any delinquent real estate taxes or unpaid current real estate taxes; nor any pending or levied
<br />assessments on the real estate, including but not limited to those for sidewalks, streets, sewers and water lines, except as
<br />follows:
<br />6. That there are not any unrecorded easements, party wall agreements, or right -of -ways, which encumber the real estate,
<br />except as follows:
<br />7. That in the event it is determined that any unpaid charges or liens which were due and payable prior to and including the
<br />date of recording the deed or mortgage to be insured by the referenced commitment, and which are the responsibility and
<br />obligation of the deponent, the deponent shall pay any and all amounts so charged and shall provide proof of payment of
<br />same to the Issuing Agent for Investors Title Insurance Company.
<br />8. That no dispute exists between deponent(s) and others concerning the title to said real estate, the boundary lines of same,
<br />nor the location of the improvements upon this real estate or the adjoining real estate.
<br />9. The Seller/Mortgagor knows of no other real estate mortgages on the property other than the mortgage(s) disclosed on the
<br />title insurance commitment.
<br />10. That the undersigned hereby indemnify and agree to save harmless the Issuing Agent and/or Investors Title Insurance
<br />Company, from any loss or damage they may suffer, including, but not limited to legal fees, court costs, expenses closing
<br />costs, and losses suffered as a result of Investors Title Insurance Company insuring the Mortgagee, if any, against any loss
<br />or damage resulting from Mechanic or Construction Liens filed upon the above - described property.
<br />Deponent does hereby indemnify the Issuing Agent and/or Investors Title Insurance Company against any and all matters,
<br />including but not limited to omissions, misstatements contained herein, and/or claims filed or recorded prior to and including
<br />the date of recording the deed or mortgage to be insured by the referenced commitment, and which are the responsibility of the
<br />deponent and whi h may cause title to be construed to be unmarketable.
<br />Seller we Seller/Borrower
<br />State of
<br />County of
<br />P INDIVIDUAL: The foregoing instrument was acknowledged before me this 1-50 20 0 3
<br />by
<br />p CORPORATION: The foregoing instrument was acknowledged before me this 7` -3b _,200-5
<br />by , of
<br />1 ra Ve 1 J.At_ , a Nei . corporation, on behalf of the corporation.
<br />person taking acknowledgment) (T$e or rank) (Serial Number, if any)
<br />My commission expires: 1 , 2b)
<br />Form No. NF.-1 (10/2001)
<br />(SEAL)
<br />E�l — GENERAL NO]AHKState of Nebraska
<br />omm, xp.
<br />
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