Author: Dan

AFFIDAVIT

Affidavit of Good Faith and Full Disclosure
of the Terms and Execution of the Account Agreement

Broker or Securities Intermediary hereinafter CREDITOR NAME HERE

Account number: 123456789.

Alleged Borrower: Controlling Creditor or Entitlement Holder, hereinafter “
John Henry Doe”

The undersigned Affiant, duly sworn by oath or asseveration, with first hand knowledge, aver, depose, and swear:  

1.	That I am an officer of CREDITOR NAME HERE, and have full authority and first hand knowledge for executing this affidavit on behalf of CREDITOR NAME HERE, and that I am giving adequate assurance of good faith and full disclosure on behalf of CREDITOR NAME HERE concerning the terms and execution of the agreement by the statements in this affidavit, as requested by John Henry Doe.

2.	That CREDITOR NAME HERE is complying with all applicable Federal Reserve Policies and Procedures, Federal laws, and State laws requiring the use of Generally Accepted Accounting Principles and Generally Accepted Auditing Standards for all bookkeeping entries associated with performing the Agreement.

3.	That CREDITOR NAME HERE is attaching all security interests and rights as lawfully required by the Securities Act of 1933 or the Securities Exchange Act of 1934 and has all the rights of the alleged claim and is attaching all of the certified or registered evidence that is lawfully required by the regulatory United States governmental agencies, along with any or all filing numbers for the evidence.  

4.	That the policy of CREDITOR NAME HERE is the repayment of customers whose Retail Installment Sale Contract is used for funding the debt incurred by the execution of the contract by John Henry Doe, in accord with the Agreement with CREDITOR NAME HERE;

5.	That all material facts regarding the alleged Agreement terms and execution are fully disclosed and contained in the written Agreement;

6.	That all CREDITOR NAME HERE’s bookkeeping entries associated with the execution of the alleged Agreement, to wit, materially match the terms and form of the Agreement.

7.	That the value given out of CREDITOR NAME HERE’s own assets or Net Worth for purchasing John Henry Doe’s Retail Installment Sale Contract is NOT any different or less than the face value of John Henry Doe’s Retail Installment Sale Contract.

8.	That CREDITOR NAME HERE did not accept money, money-equivalent, capital, funds, or anything else of value of John Henry Doe in the approximate amounts of the value of the Agreement that were used for funding checks or other negotiable instruments in the approximate amounts of the Agreement’s value that were given or extended to John Henry Doe as the Agreement’s loan or credit, making the economics of the Agreement similar to stealing, counterfeiting or swindling against John Henry Doe, causing John Henry Doe to be damaged.

9.	That John Henry Doe’s original Agreement has not been destroyed, altered or forged, and will be returned to John Henry Doe or if lost or archived, CREDITOR NAME HERE will provide security indemnifying John Henry Doe against loss or archival, upon discharge and termination of the Agreement.

10.	That there is no “adverse claim or wrongful transfer” of John Henry Doe’s Agreement that damages John Henry Doe.

11.	That John Henry Doe has the right of demanding full and immediate payment of any and all deposits of funds by John Henry Doe in connection with CREDITOR NAME HERE’s extending credit or loaning money or money-equivalent under the Agreement with John Henry Doe in conformity with Federal Reserve Policies and Procedures concerning the granting of Federally insured loans, to wit, “A deposit created through lending is a debt that has to be paid on demand of the depositor, just the same as a debt arising from a deposit of checks or currency in the bank.” (Federal Reserve publication “Two Faces of Debt”, page 19).

12.	That CREDITOR NAME HERE accepts all specie of money mandated by the Federal Reserve Bank.

13.	That John Henry Doe has the right of repaying any outstanding loan or money equivalent extended or loaned by CREDITOR NAME HERE in the same specie of money, or money equivalent, that funded such extension or loan, thus ending all claims and interest.

14.	That CREDITOR NAME HERE made loan # 123456789 using shares of capital stock in CREDITOR NAME HERE.

I, the Chief Financial Officer of CREDITOR NAME HERE, in a clear, conscious and competent mind, understand that I am signing my name under the penalty of perjury and under oath or asseveration administered by the Notary Public named below, and I am accepting full liability, both private and for CREDITOR NAME HERE, both civil and criminal, and that I accept all penalties of perjury if and when it is found that my statements in this Admissions document are false in any way.

CREDITOR NAME HERE’s Chief Financial Office

Printed Full Name of Chief Financial Officer

____________________________________ 
Chief Financial Officer Employee ID Number

NOTORIAL CERTIFICATE

STATE OF TEXAS	)
	) 	ss.
COUNTY OF RAPDIES PARISH	)

On the ____ day of ________, 2002 C.E., before me appeared _________________________ personally known by me, or proven on the basis of satisfactory evidence as being the person whose name is subscribed on the within instrument and acknowledged that he or she executed the same in his or her authorized capacity and that by his or her signature on the instrument, the person or the entity upon behalf of which the person acted, signed under oath or asseveration, and accepts the truth thereof.

________________________                               My commission expires: _______ 
Notary Public Signature 
                                                                               Seal: