I, ____________________________, do hereby certify the following:
(1) I have made a gift of $_____________ to ___________________
(Amount) (Recipient)
Whose relationship is: ______________________________________
(State Relationship to Donor)
(2) This gift is to be applied toward the purchase of the property located at:
(Property Address)
(3) No repayment of the gift is expected or implied in the form of cash or by
future services of the recipient.
(4) The funds given to the homebuyer were not made available to the
donor from any person or entity with an interest in the sale of the
property including the seller, real estate agent or broker, builder, loan
officer, or any entity associated with them.
(5) The Source of this gift is: ____________________________________
(State source funds are to be provided from)
___________________________________________ ______________________________________________________
Donor Signature Date Borrower Signature Date
___________________________________________ ______________________________________________________
Donor Name Borrower Signature Date
Donor Address
Donor Phone Number