TN Indemnity and Affidavits as to Debts, Liens, and Possession
This form applies to:
- Tennessee
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International
TN Indemnity and Affidavits as to Debts, Liens, and Possession
GF# __________________
Subject Property: _______________________________________________________
______________________________________________________________________
State of _______________
County of _____________
Before me, the undersigned authority, on this day personally appeared:
___________________________________________________________
Seller or Owner-Borrower
___________________________________________________________
Contractor (if new construction)
Personally known to me to be the person whose name is subscribed hereto and upon his/her oath deposes and says that no proceedings in bankruptcy or receivership have been instituted by or against him/her and that the marital status of Affiant has not changed since the day of acquisition of said property and represents to the purchaser and/or Lender in this transaction that there are:
1. No unpaid debts for lighting and plumbing fixtures, water heaters, floor furnaces, heaters, air conditioners, built-in fireplace screens, installed outdoor cooling equipment, swimming pool equipment, built-in cleaning equipment, built-in kitchen equipment, satellite dish, radio or television antennae, garages, carpeting, rugs, lawn sprinkling systems, Venetian blinds, curtains and rods, window shades, draperies and rods, valances, screens, shutters, awnings, mirrors, ceiling fans, attic fans, mail boxes, security and fire alarms detection equipment, water softener, electric appliances, fences, street paving, or any personal property or fixtures that are located on the subject property described above, and that no such items have been purchased on time payment contracts, and there are no security interest on such property secured by financing statements, security agreement or otherwise except the following:
Creditor
______________________________
______________________________
______________________________
(If none, write "none" on blank line)
Approximate Amount
______________________________
______________________________
______________________________
2. No loans, unpaid judgments, or liens (including Federal or State Liens or judgment Liens) and no unpaid association or governmental taxes, charges or assessments of any kind on such property except the following:
Creditor
______________________________
______________________________
______________________________
(If none, write "none" on blank line)
Approximate Amount
______________________________
______________________________
______________________________
3. All labor and materials used in the construction of improvements on the above-described property have been paid for and there are now no unpaid labor or material claims against the improvements or the property upon which same are situated, and I hereby declare that all sums of money due for the construction of improvements have been fully paid and satisfied, except the following:____________________________________________________ (If none, write "none" on blank line)
4. No leases, contracts to sell the land, or parties in possession other than Affiant except as follows: _______________________________________________________ (If none, write "none" on blank line)
*5. *To be filled in if a sale ? The Seller is not a non-resident alien, foreign corporation, 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: _________________________________________
This affidavit may be disclosed to the Internal Revenue Service and is furnished to Buyer to inform Buyer that withholding of tax is not required under Section 1445 on the Internal Revenue Code.
INDEMNITY: I AGREE TO PAY ON DEMAND TO THE PURCHASERS AND/OR LENDER AND/OR TITLE COMPANIES (INCLUDING STEWART TITLE GUARANTY COMPANY) IN THIS TRANSACTION, THEIR SUCCESSORS AND ASSIGNS, ALL AMOUNTS SECURED BY ANY AND ALL LIENS, CLAIMS, OR RIGHTS NOT SHOWN ABOVE, TOGETHER WITH ALL COSTS, LOSS AND ATTORNEY'S FEES THAT SAID PARTIES MAY INCUR IN CONNECTION WITH SUCH UNMENTIONED LIENS, PROVIDED SAID LIENS, CLAIMS OR RIGHTS EITHER CURRENTLY APPLY TO SUCH PROPERTY, OR A PART THEREOF, OR ARE SUBSEQUENTLY ESTABLISHED AGAINST SAID PROPERTY AND ARE CREATED BY ME, KNOWN BY ME, OR HAVE AN INCEPTION OR ATTACHMENT DATE PRIOR TO THE CLOSING OF THIS TRANSACTION AND RECORDING OF THE DEED AND MORTGAGE.
I realize that the Purchaser and Lender and title companies in this transaction are relying on the representations contained herein in purchasing same or lending money thereon and issuing title policies and would not purchase same or lend money or issue a title policy thereon unless said representations were made. If Seller of Borrower is an entity, I have authority to sign on its behalf.
__________________________________
__________________________________
Sworn to and subscribed before me this ________ day of ________________, ______.
_________________________________
Notary Public in and for ________________
My Commission expires: _______________
*NOTE: This form is to be filled in and signed by Seller in case of sale. If no sale, it is to be filled in and signed by the Owner-Borrower. If there is any new construction, the contractor must also join in this form or fill in and sign a separate one.
**If Seller is a non-resident alien, foreign corporation, etc., call your manager or underwriting personnel (1-800-729-1902).
NOTE TO BUYER: Buyer must retain until end of fifth taxable year following taxable year of transfer and must file with the Internal Revenue Service if required by regulation or otherwise.
No guidelines are available for this form at this time.
No guidelines are available for this form at this time.