Affidavit and Waiver of Right of Rescission

							                        Affidavit and Waiver of Right of Rescission


I/We, ____________________________, and ____________________________
as a consumer/consumers in the extension of credit (the "Borrower"), being first
duly sworn, hereby depose and say that:

The Borrower has entered into a $_________________________ loan transaction
with ________________________________________________, (the "Lender")
on ___________________________, 20___ which shall result in a lien, mortgage,
or other security interest on the Borrower’s home.

The Borrower hereby waives the right to rescind the transaction because the
extension of credit is needed to meet a bona fide personal financial emergency as
described below:
 _________________________________________________________________
 _________________________________________________________________
 _________________________________________________________________
 _________________________________________________________________
 _________________________________________________________________
 _________________________________________________________________
 _________________________________________________________________


The Borrower hereby waives the right of rescission this _______day of
________________________________, 20___.




Accommodation Party Signature                      Borrower Signature



Print Name of Accommodation Party                  Print Name of Borrower



Accommodation Party Signature                      Borrower Signature



Print Name of Accommodation Party                  Print Name of Borrower


QS_Affidavit_and_Waiver_of_Rights_of_Rescission   1 of 2                      4/8/2009
State of Minnesota      ⎫
                        ⎪
                        ⎬                    ss.
County of _____________ ⎪
                        ⎭


This instrument was acknowledged before me this                  day of ______________ ,
 ____________ , by _______________________________________________ .



                                                       ________________________________
                                                                    Notary Public



State of Minnesota      ⎫
                        ⎪
                        ⎬                    ss.
County of _____________ ⎪
                        ⎭


This instrument was acknowledged before me this                  day of ______________ ,
 ____________ , by _______________________________________________ .



                                                       ________________________________
                                                                    Notary Public




QS_Affidavit_and_Waiver_of_Rights_of_Rescission    2 of 2                         4/8/2009