AFFIDAVIT OF SUCCESSFUL BIDDER

UPSET TAX SALE/JUDICIAL SALE/PRIVATE SALE/REPOSITORY SALE

SALE NO:_______________________________ PARCEL NO._________________________

COMMONWEALTH OF PENNSYLVANIA

COUNTY OF Lycoming County

I, __________________________ of ____________________________________________,

Having been duly sworn according to law depose and say as follows:

1. I am an adult citizen of the United States of America and am the successful bidder at the sale of the above-referenced property conducted by the Lycoming County Tax Claim Bureau on _______________.

2. Pursuant to Section 619.1 of the Real Estate Sale Law, 72 P.S. Section 5860.619.1, I hereby certify to the Lycoming County Tax Claim Bureau that I am not delinquent in paying real estate taxes to any of the taxing districts in Lycoming County, and that I have no outstanding municipal utility bills within any municipal jurisdiction in Lycoming County.

3. Pursuant to Section 618 of the Real Estate Tax Sale Law, 72 P.S. Section 5860.618, I hereby certify that I was not the owner of the above-referenced property immediately prior to any judicial, private, or repository sale thereof by the Lycoming County Tax Claim Bureau. I further certify that I am not a partner or a shareholder of the owner of the above-referenced property, nor am I in any of the following legal relationships with the owner: trust, partnership, corporation or any other business association.

4. Pursuant to Section 601(d) of the Real Estate Tax Sale Law, 72 P.S. Section 5860.601(d), I hereby certify that I have not had a landlord license revoked in any municipality within the County of Lycoming, and I further certify that I am not bidding for, or acting as an agent for a person whose landlord license has been so revoked.

5. Pursuant to 16 P.S. 1806 of the County Code, I further certify that I am not a Lycoming County elected official or appointed officer.

__________________________________________ ________________________________

(Print Name) (Signature)

Sworn to and subscribed before me,

This _______________day

Of_________________, 200__.

_________________________________________

NOTARY PUBLIC (Raised Seal)