Government of the

District of Columbia Office of Tax

and Revenue

Recorder of Deeds 1101 4th Street, SW

Washington, DC 20024

Phone (202)727-5374

SECURITY AFFIDAVIT — CLASS 1

Square Suffix Lot

I, (We) the owner(s) of the real property

described within certify, subject to criminal penalties for making false statements pursuant to

section 22-2405 of the District of Columbia Official Code, that the real property described

within is Class 1 Property, as that class of property is established pursuant to section 47-813,with 5 or fewer units:

Signature

Signature

Subscribed to and sworn to before me this day of , 20 . .

Notary Public

My Commission Expires:

mmddyyyy

Form ROD 21 (Rev. 10/2018)