Loan Purpose Affidavit

I, the undersigned, _________, being duly sworn hereby declare that the proceeds of the loan made by _________, in the amount of $____, given me this day, ________________, 20 _, will be used for and only for the following purpose(s): ________________.

Under penalty of perjury, I affix my signature to the foregoing this _____________ day of ____________, 20 __.

Date: ____________.

_______________________________

Signed

*** If Required By FederaL or State Law ***

This Section for Notary:

ACKNOWLEDGMENT

State of _________

County of ________ [COUNTY]

On [DATE] before me, [NAME OF NOTARY], notary, personally appeared [NAME OF PERSON(S) INVOLVED], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.

Witness my hand and official seal.

Signature ________
Notary

My commission expires: _____

(Seal)