STATE OF NEW YORK              )
                                                   ) SS:
COUNTY OF ___________          )

_______________________, AN ASSOCIATE WITH THE FIRM OF _________________________, BEING DULY SWORN, DESPOSES AND SAYS:

1. THAT ___________________ ARE THE ATTORNEYS FOR ___________________________________, THE OWNER AND HOLDER OF THE HEREINAFTER DESCRIBED MORTGAGES, AND HE IS FAMILIAR WITH THE FACTS AND CIRCUMSTANCES SET FORTH HEREIN.

2. THAT A CERTAIN MORTGAGE WAS MADE BY ___________________________ AND ________________________ TO ____________________________, IN THE PRINCIPAL AMOUNT OF __________________ ON _____________________________ AND RECORDED IN THE OFFICE OF THE CLERK OF THE COUNTY OF ROCKLAND ON ___________________________, IN LIBER ________ AT PAGE __________________, OR INSTRUMENT ID#________________________________, UPON WHICH A MORTGAGE TAX WAS PAID. PRINCIPAL BALANCE REMAINING ___________________________.

3. THAT SAID MORTGAGE WAS ASSIGNED BY AN ASSIGNMENT OF MORTGAGE FROM _______________________________________ TO _________________________________, DATED ________________________, AND RECORDED ___________________________, IN LIBER ____________ PAGE _____________, UPON WHICH NO MORTGAGE TAX WAS DUE.

4. THAT A CERTAIN MORTGAGE WAS MADE BY ____________________ AND __________________, TO _________________________, IN THE PRINCIPAL AMOUNT OF ________________, DATED _________________, AND WILL BE RECORDED SIMULTANEOUSLY HEREWITH, UPON WHICH A MORTGAGE TAX WILL BE PAID.

5. THAT _________________________ AND ________________________ HAVE ENTERED INTO A CONSOLIDATION, EXTENSION AND MODIFICATION AGREEMENT WITH _________________, DATED ______________________, WHICH CONSOLIDATED, MODIFIES AND EXTENDS THE LIEN OF THE AFOREMENTIONED MORTGAGES TO FORM A SINGLE LIEN OF __________________, WHICH AGREEMENT WILL BE RECORDED SIMULTANEOUSLY HEREWITH IN THE OFFICE OF THE CLERK OF THE COUNTY OF ROCKLAND.

WHEREFORE, YOUR DEPONENT RESPECTIVELY REQUESTS THAT THE MODIFICATION, CONSOLIDATION AND EXTENSION AGREEMENT HEREWITH TENDERED FOR RECORDING BE DECLARED EXEMPT FROM TAXATION PURSUANT TO THE PROVISIONS OF SECTION 255 OF ARTICLE 11 OF THE TAX LAW OF THE STATE OF NEW YORK.


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SWORN TO ME BEFORE THIS

________ DAY OF _________, 19 .

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NOTARY PUBLIC