Mortgagees Affidavit

COMMONWEALTH OF MASSACHUSETTS LAND COURT DEPARTMENT OF THE TRIAL COURT MORTGAGEE'S AFFIDAVIT Defendant(s)/Mortgagor(s): FOR LAND COURT USE ONLY PLACE CASE NO. LABEL HERE Property Address: 1. The undersigned makes oath and says that it is (check one): The Mortgagee of the Mortgage which is the subject of this proceeding, in that it is the person or entity currently holding both the subject Mortgage and the note; or The Mortgagee of the Mortgage which is the subject of this proceeding, in that it is the person or entity currently holding the subject Mortgage and is acting on behalf of the current holder of the note; or Acting on behalf of the person(s) or entity(ies) currently holding the subject Mortgage and the note. AND 2. The undersigned further makes oath and says that (check one): Notice(s) to Defendant(s)/Mortgagor(s) has/have been given in compliance with Massachusetts General Laws, Chapter 244, Section 35A, as amended (COPY OF NOTICE ATTACHED); or No notice has been given because no notice is required under Massachusetts General Laws, Chapter 244, Section 35A, as amended. Signed under the pains and penalties of perjury on (Date) , Plaintiff(s): By: Name: Title: Rev. 2/13 www.mass.gov/courts/landcourt American LegalNet, Inc. www.FormsWorkFlow.com