AFFIDAVIT

State of XXXXX )
) SSS
XXXXXX County )

1 I, _________________ (printed name) hereby certify that I am an officer of ABC

Bank and I have personal, executive, and documented knowledge of loan 123456 which
was taken out by Glenn Winningham; Fearn on 10 July, 2004.

2 I hereby certify under penalty of perjury that the funds provided for loan 123456
were a depositors money.

I hereby Certify under penalty of perjury that the foregoing is true and correct to the best
of my firsthand knowledge and belief.

_________________________________________ ___________
Signature Date

ACKNOWLEDGEMENT

As a Notary Public for the State of ____________, I hereby Certify that

_________________________, who is known to me, or who provided suitable proof of
identity, and executed the forgoing Affidavit of their own free will and choice.

_________________________________________ ____________
Notary Public Date