PROPERTY OWNER AFFIDAVIT

STATE OF ___________________	)

)	SS:	_______________________________

COUNTY OF __________________	)	(Town)

As of _________________, ____, 20____, the undersigned, being the owner(s) of property located in the City/Town of _______________, County of _________________ and State of Connecticut located at _______________________________ (the “Property”), being duly sworn, hereby depose(s) and says:

MECHANICS LIENS. Within the last ninety (90) days, no person has performed work or furnished any labor, service or materials in connection with the construction or repair of any buildings or improvements on the Property for which a mechanic’s or materialmans’ lien could be filed. (If work has been performed or materials furnished by any person within the last ninety (90) days, attach a mechanic’s lien waiver for such party.).

TENANTS. There are no tenants or parties in possession of the property except: Enter None or List Tenants.

SURVEY UPDATE.

I/We have examined a certain survey of the Property made by Enter Surveyor Name/Company dated Enter Date of Survey including Revision Date and entitled, "Enter Title of Exhibit C” (the “Survey”).

There have been no additional improvements constructed or exterior alterations made since the date of the Survey and the Survey reflects the current status of the Property.

The undersigned makes this affidavit for the purpose of inducing the State of Connecticut Department of Energy and Environmental Protection to accept the Declaration of Environmental Land Use Restriction and Grant of Easement being granted by Enter Property Owner Name. The undersigned is the Enter Property Owner or Duly Designated Agent of the Property Owner and makes this affidavit knowing that reliance is placed on the above statements.

___________________________________________________

Enter Property Owner/Duly Designated Agent of the Property Owner Name

Subscribed and sworn to before me this ______ day of _________________, 20____.

_________________________________________

Commissioner of the Superior Court

Notary Public

My Commission expires______________