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Fillable Printable Affidavit Under Section 255 Tax Law - New York

Fillable Printable Affidavit Under Section 255 Tax Law - New York

Affidavit Under Section 255 Tax Law - New York

Affidavit Under Section 255 Tax Law - New York

AFFIDAVIT UNDER SECTION 255 TAX LAW
STATE OF NEW YORK
COUNTY OF 
 , being duly sworn, deposes and says:
1. That he is  , the owner and holder of the hereinafter described
mortgage, and is familiar with the facts and circumstances set forth herein.
2. That an instrument herewith offered for recording is identified as follows:
a) Type of instrument: 
b) Date of Instrument: 
c) Parties:
Mortgagor: 
Mortgagee: 
d) Amount of Loan: 
e) Mortgage Tax to be Paid: 
3. That the mortgage to which the above instrument is supplemental is identified as follows:
a) Dated: 
b) Parties:
Mortgagor: 
Mortgagee: 
c) County of Recording: 
d) Date of Recording: 
e) Liber and Page: 
f) Mortgage Tax Paid: 
g) Present Mortgage Balance: 
h) Original Mortgage Amount: 
4. That the  contained in this mortgage does not secure a re-loan or
re-advance or new loan except the indebtedness secured by the previously recorded mortgage set out
in paragraph three (3) above.
5. That the exception from further tax is claimed under Section 255 of the Tax Law as to the said
instrument herewith offered for recording.
6. That the maximum amount secured hereunder and in conjunction with the previously recorded
mortgage is:
__________________________________________
Sworn to before me this
 day of  , 20
________________________________
Notary Public
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