Loan Purpose Affidavit

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									An affidavit is a written statement made under oath. This Loan Purpose Affidavit is
made by a borrower stating that the proceeds of the loan will only be applied and used
for a particular purpose. The borrower then states the purpose that the loan will be
used for. This template document is intended to provide standard language and should
be modified and customized to fit the needs of a party seeking to provide an affidavit as
to the purpose of a loan. The signatory, the borrower stating the loan purpose, signs
this document under the penalty of perjury.
                     LOAN PURPOSE AFFIDAVIT

STATE OF ____________)

                         ) S.S.:

COUNTY OF __________)
[Instruction: Insert applicable state and county where affidavit being made.]

I, ____________________ [Instruction: Insert name of person making affidavit.] the
undersigned residing at _________________________, [Instruction: Insert address of person
making affidavit.] being first duly sworn on oath depose and declare that:

The proceeds of the loan amount of $ ___________________ [Instruction: Insert principal
loan amount.] made on this _______day of __________, 20______, [Instruction: Insert loan
date.] by _________________, [Instruction: Insert Lender name.] shall be used by me for the
following purpose:

______________________________. [Instruction: Insert purpose for loan.] The loan will not
be used for any other purpose. [Option: State if this affidavit is being made pursuant to
Borrower’s obligations under any other written agreement. If so, describe the agreement
by providing the date of any such agreement, the parties to it and whether or not this
affidavit fulfills the obligations as set forth in such agreement.]

Under penalty of perjury, I affix my signature to the foregoing this _____________ day of
____________, 20 __. [Instruction: Insert date affidavit signed.]


Subscribed and sworn to this _____ day of ________, 20__.


My Commission Expires on: _________

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