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

________________________________ BEING DULY SWORN DESPOSES AND SAYS:

1. THAT HE/SHE IS MANAGER OF THE LOAN DEPT. FOR THE (CREDIT UNION)__________, WITH ITS PRINCIPAL OFFICES LOCATED AT ________________________________________________________________________________.

 2. THAT A CERTAIN MORTGAGE MADE BY _______________________________________(MORTGAGOR) TO THE _____________________________FEDERAL CREDIT UNION, TO SECURE PAYMENT OF THE SUM OF $_______________, AFFECTING REAL PROPERTY LOCATED IN THE COUNTY OF ROCKLAND, STATE OF NEW YORK, IS HEREBY SUBMITTED FOR THE PURPOSE OF HAVING SAME RECORDED BY THE CLERK OF THE COUNTY OF ROCKLAND.

 3. THAT ALL THE MONEY DUE AND OWING PURSUANT TO THE TERMS OF SAID MORTGAGE IS DUE AND OWING TO THE _______________________________FEDERAL CREDIT UNION, AN ORGANIZATION EXEMPT FROM FEDERAL INCOME TAXATION PURSUANT TO 501(A) OF THE INTERNAL REVENUE CODE.

 4. DEPONENT THEREFORE ON BEHALF OF THE ______________________________FEDERAL CREDIT UNION, CLAIMS EXEMPTION FROM THE ADDITIONAL MORTGAGE TAX IMPOSED BY 253 (1-A) OF TAX LAW AND THE PAYMENT OF ADDITIONAL MORTGAGE TAX PURSUANT TO 253 (1A) (B) OF THE TAX LAW OF THE STATE OF NEW YORK.

_________________________________________________________________________________ 

SWORN TO BEFORE ME THIS

________ DAY OF _____________, 19____.

___________________________________
NOTARY