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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