Affidavit Regarding Release Of Private Transfer Fee {50.3.6}

(Top 3 inches reserved for recording data) AFFIDAVIT REGARDING RELEASE OF PRIVATE TRANSFER FEE Minn. Stat. 513.76 State of Minnesota, County of Minnesota Uniform Conveyancing Blanks Form 50.3.6 (2013) being first duly sworn on oath says that: 1. is the current record owner ("Owner") of real property in follows ("Property"): (insert name of Affiant) ("Affiant"), County, Minnesota, legally described as Check here if all or part of the described real property is Registered (Torrens) 2. A private transfer fee obligation (as defined in Minn. Stat. 513.73) relating to the Property is contained in a document dated and recorded on , as Document Number (or in Book Office of the County Recorder Registrar of Titles of (check the applicable box(es)) (month/day/year) of (month/day/year) , Page County, Minnesota. ), in the 3. A Notice of Private Transfer Fee Obligation relating to the Property was recorded on as Document Number in the Office of the County Recorder Private Transfer Fee Obligation, as amended, is referred to herein as the "Notice." 4. The name and address of the payee shown in the Notice is: (check the applicable box(es)) Registrar of Titles of (or in Book of , Page County, Minnesota. The Notice of (month/day/year) , ), Page 1 of 2 American LegalNet, Inc. www.FormsWorkFlow.com Page 2 of 2 Minnesota Uniform Conveyancing Blanks Form 50.3.6 5. A request for a written statement of the private transfer fee payable upon conveyance of the Property ("Request") was sent to the payee named in the Notice at the address shown therein on . (month/day/year) 6. More than 30 days have elapsed since the date that the Request was sent to the payee and the payee has not provided to the party named in the Request a written statement of the private transfer fee payable upon conveyance of the Property. 7. The undersigned Affiant has actual knowledge of the facts stated in this Affidavit and makes this Affidavit in support of release of the private transfer fee in accordance with Minn. Stat. 513.76. Affiant (signature) Signed and sworn to before me on (month/day/year) , by (insert name of Affiant) . (Stamp) (signature of notarial officer) Title (and Rank): My commission expires: (month/day/year) THIS INSTRUMENT WAS DRAFTED BY: (insert name and address) American LegalNet, Inc. www.FormsWorkFlow.com