Loan #: 1006023256

Republic Mortgage Home Loans, LLC

GIFT LETTER AFFIDAVIT

INSTRUCTIONS:

Donor-Please complete ALL blanks and sign where indicated below.

Donor’s Depository - Please complete Part II and sign where indicated below.

NAME OF DONOR(S): _____________________________________ _____________________________________

ADDRESS: _______________________________________________________________________________

_______________________________________________________________________________

PHONE: _______________________________________________________________________________

I (We), __________________________________________________________________________will give/gave to my (our)

_________________________________________________, ______________________________________________, the

(Relationship) ( Borrower’s Name)
sum of $__________________________________to help with the purchase of the property located at :

Address: ______________________________________________________________________________________

______________________________________________________________________________________

Said funds are a bona fide gift and no repayment is expected or implied.

(If you have already given funds to the Borrower(s), please enclose proof by either attaching a copy of your cancelled check or
copy of the receipt indicating the withdrawal.)

The funds given to the homeowner 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.

_______________________________________________________ _______________________________________________________
Donor Date Donor Date

I hereby certify all of the information stated above is correct.

_______________________________________________________ _______________________________________________________
Borrower William J Fealy Borrower Angella M Fealy

PART II

This is to verify that the above named Donor(s) have sufficient funds on deposit in account #___________________________
which is a (circle one): Checking Savings Money Market Other:______________________, to provide
the gift funds as indicated above.

NAME OF DEPOSITORY: _______________________________________________________________________

ADDRESS OF DEPOSITORY: _______________________________________________________________________

_______________________________________________________________________

PHONE: _______________________________________________________________________

____________________________________________ _________________________________ ___________________

SIGNATURE TITLE DATE

Federal statutes provide severe penalties for any fraud, intentional misrepresentation, or criminal connivance or conspiracy
purposed to influence the issuance of any guaranty or insurance by the VA Secretary, the U.S.D.A., FmHA/FHA Commissioner, or
the HUD/SPD Assistant Secretary.
FHA Gift Letter