We, __________________, ___________________, and
______________________________ as Tenants in _____________ (the
"Customer"), being first duly sworn, hereby depose and say that:
We have entered into a $_______________ loan transaction
with _______________ Bank and Trust Company, ______________,
____________________ (the "Creditor") on ______________, 19__
which may result in a lien, mortgage, or other security interest
on our home.
We hereby waive our right to rescind the transaction for
the following reasons:
The extension of credit is vitally necessary to meet a
bonafide personal financial emergency, whereby a delay of three
(3) business days in performance of Creditor's obligation under
this transaction will jeopardize our financial welfare and
endanger us and our family.
Therefore, We hereby waive our right of rescission and do
so under the pains and penalties of perjury this _______day of
___________, 19__.
_____________________________
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