The undersigned being first duly sworn on oath deposes and states:

That the proceeds of the loan of $______ (________________ &___/100 dollars), 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.

_______________________________
Notary
My Commission Expires on:

Loan Purpose, Affidavit
Review List

This review list is provided to inform you about this document in question and assist you in its preparation. Loan purpose affidavits are required for certain loans. The purpose relates to the rates provided for certain activities, governmental and banking regulations, and similar such things.

1. Make multiple copies. Give one to the lending institution; keep one in the transaction file. Be sure to get the document notarized as provided for in the paperwork above.

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