Affidavit in Lieu of Registration Statement

(Rev. 7/94)

THE CITY OF NEW YORK

DEPARTMENT OF HOUSING PRESERVATION AND DEVELOPMENT

Division of Code Enforcement

AFFIDAVIT IN LIEU OF

REGISTRATION STATEMENT

County of ) SS.:

State of New York )

, being duly sworn, deposes and says:

(1) I am personally familiar with the real property known by the street address of (insert street address):

Block , Lot , and make this Affidavit as (describe capacity in which affidavit is made)

in connection with a deed/lease/memorandum of lease (cross out inapplicable description) which transfers an interest

in the above real property, that is dated , and is between

and .

(2) The statements made in this Affidavit are true of my own knowledge, and I submit this Affidavit in order that this

Instrument be accepted for recording without being accompanied by a registration statement, as such is defined by

Subchapter IV, Article 2 of Title 27 of the Administrative Code of the City of New York.

(3) Exemption from registration is claimed because the Instrument does not affect an entire multiple dwelling as such term

is defined by Section 27-2004 (a)(7) of Subchapter I, Article I of Title 27 of the Administrative Code of the City of

New York and Section 4(7) of the New York State Multiple Dwelling Law. The Instrument does not affect a multiple

dwelling, because it affects the following (check applicable term):

 a commercial building

 a one or two-family dwelling whose owner resides in the City of New York

 a condominium unit in a multiple dwelling

 cooperative corporation shares relating to a single residential unit in a multiple dwelling

 mineral, gas, water, air or other similar rights not affecting a multiple dwelling

 lease of commercial space in a multiple dwelling

 vacant land

(4) I am aware that this Affidavit is required by law to be submitted in order that the Instrument be recorded or accepted

for recording without begin accompanied by a registration statement. I am aware that any false statements made in

this Affidavit may be punishable as a felony or misdemeanor under Article 210 of the Penal Law or as an offense

under Section 10-154 of the Administrative Code of the City of New York.

Signature

Address

Telephone #

Sworn To Before Me This

day of , 200

Notary Public

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