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.
_______________________________
Form 139
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