Legal Financial Assistance Affidavit

LEGAL FINANCIAL ASSISTANCE AFFIDAVIT

Affiant Name:    Affiant Address:

Recipient Name:    Recipient Address:

Effective Date of Assistance:    Amount Provided (USD): $    Form of Assistance: Gift Loan Other

RECITALS

WHEREAS, Affiant affirms that Affiant has delivered to Recipient the monetary assistance described above and further identified in this affidavit; and

WHEREAS, the parties desire to set forth the material terms, classification and agreed treatment of such assistance and to confirm certain representations and obligations of the parties with respect to that assistance; and

WHEREAS, Affiant acknowledges that this affidavit is provided to memorialize the assistance and may be relied upon by the Recipient and third parties for legal, administrative and tax purposes.

NOW, THEREFORE, in consideration of the mutual covenants set forth herein and other good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the parties agree as follows:

1. DEFINITIONS

For purposes of this affidavit, the following terms shall have the meanings set forth below: "Assistance" means the monetary sum described in this affidavit; "Affiant" means the person or entity providing Assistance; and "Recipient" means the person or entity receiving Assistance. Capitalized terms not defined herein shall have the meanings ascribed in the context in which they are used.

2. AFFIDAVIT OF FINANCIAL ASSISTANCE

Affiant affirms under penalty of perjury that Affiant provided Assistance to Recipient in the amount of $ on or about by the following means: .

Source of funds: . Affiant represents that the funds were lawfully obtained and are not proceeds of illegal activity.

3. CLASSIFICATION OF ASSISTANCE

The parties agree that the Assistance is designated as: Gift Loan Other (specify):

4. SECURITY AND COLLATERAL

If the Assistance is secured, describe security and collateral:

Personal guarantee provided: Yes No

5. REPRESENTATIONS AND WARRANTIES

Affiant represents and warrants to Recipient that: (a) Affiant has the full power and authority to execute and deliver this affidavit and to perform its obligations hereunder; (b) the Assistance was not provided under duress or undue influence; and (c) to Affiant's knowledge, the making of this Assistance does not violate any applicable law or material agreement to which Affiant is subject.

Recipient represents and warrants to Affiant that: (a) Recipient has the power and authority to accept the Assistance; (b) the funds will be used for the purpose described in this affidavit; and (c) Recipient will promptly notify Affiant if any material fact or circumstance related to the use or security of the Assistance changes.

6. TAX TREATMENT

The parties acknowledge that the tax treatment of the Assistance depends upon classification and applicable law. Each party shall be responsible for its own tax reporting and liabilities arising from the Assistance. Neither party provides tax advice by virtue of this affidavit. The parties covenant to cooperate in furnishing documentation reasonably necessary for tax reporting.

7. RECORDS AND ACCESS

Recipient shall maintain accurate books and records relating to the receipt and use of the Assistance for a period of not less than five (5) years following receipt. Affiant, or Affiant's authorized representative, may upon reasonable prior written notice inspect such records during normal business hours to verify compliance with this affidavit.

8. RELEASE; INDEMNITY

If the Assistance is a gift, Recipient hereby releases Affiant from any claim for repayment, except as otherwise expressly provided in writing. If the Assistance is a loan, Recipient agrees to indemnify and hold harmless Affiant from any loss arising from Recipient's breach of the repayment terms, except to the extent caused by Affiant's gross negligence or willful misconduct.

9. NO DURESS; VOLUNTARY EXECUTION

Each party acknowledges that it has read and understands the terms of this affidavit, has had the opportunity to seek independent legal counsel, and executes this affidavit voluntarily and without duress or undue influence.

10. NOTICES

All notices required or permitted under this affidavit shall be in writing and delivered to the addresses set forth below or to such other address as a party may designate by written notice.

11. AMENDMENTS; WAIVER

This affidavit may be amended or modified only by a written instrument signed by both parties. No waiver of any provision of this affidavit shall be effective unless in writing signed by the party against whom enforcement is sought.

12. COUNTERPARTS; ELECTRONIC SIGNATURES

This affidavit may be executed in counterparts, each of which shall be deemed an original and all of which together shall constitute one instrument. Signatures delivered by electronic means shall be valid and binding for all purposes to the same extent as original signatures.

13. GOVERNING LAW; SEVERABILITY; ENTIRE AGREEMENT

This affidavit shall be governed by and construed in accordance with the laws of the state of without regard to conflict of laws principles. If any provision of this affidavit is held invalid or unenforceable, the remaining provisions shall remain in full force and effect. This affidavit contains the entire agreement between the parties with respect to the subject matter hereof and supersedes all prior agreements and understandings, whether written or oral.

14. ADDITIONAL PROVISIONS

Additional terms, special conditions, or exhibits describing the assistance, payment schedule, or security may be attached and incorporated by reference as Exhibit A. Describe attachments below.

Affiant certifies under penalty of perjury that the information contained in this affidavit is true and correct to the best of Affiant's knowledge and belief.

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