Affidavit And Waiver Of Right Of Rescission

We, __________________, ___________________, and _____________________ as Tenants in _____________ (the "Customer"), being first duly sworn, hereby depose and say that:

We have entered into a $________ loan transaction with ________ Bank and Trust Company, ___________, _______________ (the "Creditor") on ________, 20__ which may result in a lien, mortgage, or other security interest on our home.

We hereby waive our right to rescind the transaction for the following reasons:

The extension of credit is vitally necessary to meet a bonafide personal financial emergency, whereby a delay of three (3) business days in performance of Creditor's obligation under this transaction will jeopardize our financial welfare and endanger us and our family.

Therefore, We hereby waive our right of rescission and do so under the pains and penalties of perjury this _______day of _______, 20__.

_____________________________

Signatures witnessed by:

____________________________

*** 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)