I signed. Furthermore, I hereby attest that the following was fulfilled:
- The notary has provided me with copies of the entire loan package.
- Specifically, the notary has provided me with a copy of the Truth in Lending Disclosure as well as three copies of the Notice of Right to Cancel/Rescission Notice.
- The transaction date on all copies of the Notice of Right to Cancel/Rescission Notice is complete with today’s date of ___________ and the final day to cancel is complete with the date of _____________.
- The notary did not express personal opinions about my loan nor did he or she attempt to sway or discourage me from this loan in any way.
I chose not to sign. Furthermore, I hereby attest that the following was fulfilled:
- The notary did not express personal opinions about my loan nor did he or she attempt to sway or discourage me from this loan in any way.
- The notary did not use the rescission period as a tool to convince me to sign. If I have signed this loan with the intent to use this period to make a final decision, I did so under my own volition and without council from the notary.
| _______________________ | ________________ | _______________________ | ________________ | |
| Borrower’s Signature | Date | Borrower’s Signature | Date |
| State of | ______________________________________ |
| County of | ______________________________________ |
| Subscribed and sworn to (or affirmed) before me on |
| this __________ day of ___________________________, 20__________, |
| by ______________________________________________ personally known to me or proved to me on the basis of satisfactory evidence to be the person(s) who appeared before me. |
| (Seal) | Signature _______________________________ | |
| Notary Public |
To protect yourself, please keep the original copy for your records.
DO NOT RETURN THIS FORM WITH THE LOAN DOCUMENTS.