WI Owner's Affidavit and Indemnification Agreement 1995

STEWART TITLE GUARANTY COMPANY

Owner's Affidavit and Indemnification Agreement

The undersigned being first duly sworn on oath deposes and says:

That affiant is _________________________________________________________

(joint, sole, former, officer of, authorized representative of, personal representative of)

NOTE: FILL IN APPLICABLE DESCRIPTION AND PROVIDE PROOF OF OFFICE OR AUTHORIZATION.

owner of certain property located at _________________________ County, Wisconsin, described in Commitment No.: ____________________.

1. That there have been no improvements constructed or repairs of existing improvements on said property within the last six months, (or)

2. That all improvements upon said property, including the construction or repair thereof made within the last six months have been made under owner's own supervision, no contractor having been employed.

3. That all improvements upon said property, including the construction or repair thereof made within the last six months have been made under the supervision of ____________

__________ as contractor employed by owner(s) to make said improvements and that same were accepted as fully completed.

NOTE: FILL IN ONLY APPLICABLE PARAGRAPHS ABOVE AND STRIKE OUT OTHERS.

4. That all bills or obligations incurred in connection with said improvements including the construction or repair thereof, have been paid in full, and that there are no claims for labor, services or materials furnished in connection with said improvements which remain unpaid, except:

NOTE: SET OUT NAMES AND INTEREST CLAIMED; IF NONE, WORD ?NONE? MUST BE ADDED.

5. That there is no person in actual possession or having a right to possession of said property or any part thereof, other than the owner(s), except:

6. That there are no easements, encroachments, walkways or driveways affecting said property except those specifically referred to in the commitment and that no claims of easements, encroachments, walkways or driveways other than those specifically referred to in the commitment have been made against said property during the period said property was owned by the current owner(s).

7. That no bankruptcy (Chapters 7, 11 or 13) or guardianship currently exists on the owner(s) or the spouse(s) of the owner(s) except as cited in the commitment, nor do(es) owner(s) intend to file for bankruptcy or a guardianship.

8. That no construction lien, nor any state or federal tax lien, remains unsatisfied against the owner(s) or the spouse(s) of the owner(s) except as cited in the commitment.

9. That the owner(s) has (have) not been a named defendant in any action in which a judgment was rendered against the owner's spouse(s) except as cited in the commitment and that there are no unsatisfied judgments against the owner(s) except as cited in the commitment.

10. That no mortgage, security interest, or financing statement is filed on said property except as cited in the commitment.

11. That the owner(s) has (have) not received notice of any pending cause of action nor has (have) made any conveyance of the said property since the effective date of the commitment.

12. If a sale - The Seller is not a non-resident alien, foreign corporation, foreign trust, foreign estate or other foreign entity (as defined in the Internal Revenue Code and Income Tax Regulations). Seller's U.S. employer identification number (or Social Security Number) is: ____________________. Seller's address (office address if Seller is an entity; home address if seller is an individual) is: ______________________________.

That this affidavit is made for the purpose of inducing Stewart Title Guaranty Company to insure the title to said property without exception to possible claims of mechanics, materialmen and laborers and to rights of any person or entity which might have a claim adverse to the rights of said owner(s) and that the undersigned on the undersigned's own behalf and on behalf of any person or entity represented by the undersigned hereby expressly agrees to indemnify and save harmless Stewart Title Guaranty Company and agent from any and all loss and attorney's fees arising from claims from the inaccuracy of the above.

_______________________________

Subscribed and sworn to before me this _____ day of _______________, 20____.

____________________________________

Notary Public _______________ County, WI

My commission expires _________________