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 ___________, 19__

        _____________ from _________________.

         will be used for:_________________________________________

         and for no other purpose.

                 Subscribed and sworn to this _____ day of ________,

        19__ under pains and penalties of perjury.

                                         _______________________________