## GIFT AFFIDAVIT

I,: , attest:

That I reside at: ,
my telephone number is:  and I am:  (relationship) of:  who is purchasing the premises known as: .

That the amount of $50,000 is a bona fide gift and no repayment, in any form, is expected.

That the funds were given on April 20, 2010
That my gift funds were deposited in:
Citibank
974 Third Avenue
NY NY 10022
Account Name: ██████████
Account Type: Checking
Account Number: ████████

That your deponent makes this affirmation knowing that you will rely on this affidavit.

Date: <empty>
<empty>
Notarized By: