_________ being duly sworn, says that he [she] resides at _________ and is by occupation _________; that he [she] is a citizen of the United States, [age of majority] years of age and upwards; and that he [she] is now in possession, and the owner in fee simple, of the _________ premises in the city, this day to be _________ by him [her] to _________ and more particularly described in the deed of conveyance.

Deponent further says that the premises have been held by him [her] for upwards of _________ last past, and that his [her] possession has been peaceable and undisturbed, and that the title has never been disputed or questioned to his [her] knowledge, nor does deponent know of any facts by reason of which possession or title might be disturbed, or questioned, or by reason of which any claim to the premises, or any part of the premises might arise, or be set up adverse to this deponent; and that he [she] is informed and believes that his [her] grantors held the premises for more than twenty years prior to the transfer to him [her]; and that no person has any contract for the purchase of, or claim to or against the premises, except as later stated; and that the premises are now free and clear of all taxes, incumbrances, or liens by mortgage, decree, judgment, or by statute, or by virtue of any proceedings in any court, or filed in the office of the clerk of any county or court in this state, and of all other liens of every nature or description, save and except _________.

Deponent further says that the premises are now occupied by _________.

Deponent further says that he [she] is married to _________ who is over the age of [age of majority] years, and who is the same person who executed, with deponent, the _________ premises, and that he [she] has never been married to any other person now living; and that there are no judgments, or decrees, or attachments, or orders of any court or officer for the payment of money against him [her] or to which he [she] is a party, unsatisfied or not cancelled of record in any of the courts, or before any officer of the United States, or of this state, or any suit or proceedings pending anywhere affecting the premises, to his [her] knowledge, information or belief, and that any judgments found of record against any person by the name of _________ or any similar name, are not against deponent, and that no proceedings in bankruptcy have ever been instituted by or against deponent.

Deponent makes this affidavit to induce _________ to accept a _________ premises, and pay the consideration therefor, knowing that the _________ relies upon the truth of the statement contained in this affidavit.

Sworn to before me this _________ day of _________ _________[date].

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