NEW YORK LIEN LAW STATEMENT

State of New York ]
County of _______ ]ss:

The undersigned, being duly sworn, deposes and says that:

(1) He resides at the address shown at the foot hereof and holds the office in Borrower indicated beneath his signature.

(2) The amount of the Loan is $________________

(3) The consideration for the loan to be paid and the other expenses heretofore incurred or to be incurred in connection with and paid out of the Loan are (or are estimated to be) as follows:

Commitment fee, if any, for the Loan: $_________________

Examination of title and recording fees: $________________

Mortgage recording taxes: $___________________________

Fees of Lender's Construction Consultant: $______________

Fees of Lender's legal counsel: $________________________

Interest on the Building Loan Mortgage $_________________

Total $___________________________

(4) The amount, if any, to be advanced from the Loan to repay amounts previously advanced to the Borrower pursuant to Notices of Lending for costs of the Improvements is: $_________________

(5) The amount, if any, to be advanced from the Loan to reimburse the Borrower for costs of the Improvements expended by the Borrower after the commencement of
the Improvements but prior to the date hereof are itemized as follows:

Description of Cost of Improvement Amount

a) $__________________________________
b) $__________________________________
c) $__________________________________
d) $__________________________________

Total: $______________________________

(6) The estimated amount to be advanced from the Loan for indirect costs of the Improvements which nay become due and payable after the date hereof and during the construction of the Improvements (such as bond and insurance premiums, fees of architects, engineers and surveyors, ground rents, taxes, assessments and water and sewer rent) is: $_____________________ .

(7) The net sum which the Borrower estimates will be available to it from the Loan to pay contractors, subcontractors, laborers and materialmen for the Improvements is: $___________________________ .

(8) This affidavit is made pursuant to and in compliance with Section 22 of the Lien Law of the State of New York.

(9) If the Borrower is a corporation or partnership, this statement is verified by deponent and not by Borrower because the Borrower is a corporation or partnership (of which the deponent is an officer or general partner).

(10) The facts stated above and any costs itemized on this statement are true to the knowledge of the undersigned.

______________________________

Sworn to before me this _________ day
of _________ , 19 ___.

______________________________

Notary Public