LOAN PURPOSE AFFIDAVIT

Date:

The undersigned ______________________ being first

duly sworn on oath deposes and states:

That the proceeds of the loan of $___________ being

furnished us this _________________ day of ___________, 20__

_____________ from _________________. 

will be used for:

and for no other purpose.

Subscribed and sworn to this _____ day of ________,

20__ under pains and penalties of perjury.

____________________________________

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