No.................. First registered...........

CERTIFICATE OF TITLE (First Certificate) or (Transfer from No......) ...........................

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State of New York County.........ss.:

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of (residence, and if a minor give his age; if under other disability, state the nature of the disability); married to (name of husband or wife, or if not married, say not married); is the owner of an estate in fee simple (or as the case may be) in the following land (here describe the premises) subject to the estates, easements, incumbrances and charges hereunder noted. (In case of trust, condition or limitation, say "in trust" or "upon condition" or "with limitation," as the case may be.)

WITNESS my hand and seal this (date)

(Seal) ..................................

Registrar. MEMORIALS of estates, easements and charges on the land described in the above certificate of title.