REOCCURING GIFT AFFIDAVIT - hmspring.net

1 REOCCURING gift AFFIDAVIT I, _____, hereby attest to the following gift given to: (Print name of person giving gift ) _____. (Print name of person receiving gift ) The gift given is in the amount of $_____per_____. I will continue to give this gift until_____/_____/_____. By setting my hand here on the _____day of _____, 20_____, I hereby attest that the statements made herein are accurate and true. _____ gift Giver s Signature WARNING: Section 1001 of Title 18 of the Code makes it a criminal offense to make willful false statements of misrepresentations to any department or agency of The United States as to any matter within its jurisdiction.

2 STATE OF_____ COUNTY OF_____ I, the undersigned Notary Public in and for the aforesaid County and State, do hereby certify that on this day the foregoing instrument was produced and acknowledged before me in the aforesaid County and State. Given under my hand and seal this_____day of _____,20_____. _____ Notary Public My commission expires on: _____