GIFT AFFIDAVIT
State: ________
County: ________
BEFORE ME, the undersigned authority, a Notary Public duly commissioned and qualified in and for the State and County set forth above, personally appeared the undersigned affiant (the “Donor”), who, being first duly sworn, deposes and states upon oath as follows:
§ 1. Affiant Identification.
1.1. My full legal name is ________.
1.2. My date of birth is ________.
1.3. My current residential address is ________, and my telephone number is ________.
1.4. I am over the age of eighteen (18) years, am of sound mind, am under no legal disability, and am competent to make this Affidavit and the gift described herein.
§ 2. Purpose of Affidavit. This Gift Affidavit is executed to evidence and confirm that I have voluntarily made an absolute and unconditional gift of the property described in § 4 below (the “Gift”) to the following individual or entity (the “Donee”):
Name: ________
Address: ________
Relationship of Donee to Donor: ________
§ 3. Date of Transfer. The Gift was delivered to, and accepted by, the Donee on ________.
§ 4. Description and Value of Gift.
4.1. The Gift consists of the following property:
________
4.2. The fair market value of the Gift as of the date of transfer is ________.
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§ 6. No Consideration; No Repayment. The Gift is given gratuitously, without any consideration of any kind and without any expectation, demand, or requirement of repayment, reimbursement, or return, whether in money, property, services, or otherwise.
§ 7. No Other Agreements. There are no other agreements, terms, conditions, understandings, obligations, or promises, whether express or implied, written or oral, between the Donor and the Donee concerning the Gift. The Gift is absolute, irrevocable, and unconditional.
§ 8. Tax Acknowledgment. I understand that this Gift may have federal and state gift, estate, or income tax consequences, and that I am responsible for the filing of any gift tax return required under Section 6019 of the Internal Revenue Code, 26 U.S.C. § 6019, and any applicable state law. I acknowledge that no tax advice has been provided in connection with this Affidavit.
§ 9. Identification. I have provided the following form of identification to the Notary Public to establish my identity:
________
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§ 11. Signatures. The signatures below are the true and correct signatures of the parties.
DONOR: ________
Signature: _____________________________
Date: _________________________________
DONEE: ________
Signature: _____________________________
Date: _________________________________
ACKNOWLEDGMENT AND JURAT
State of ________
County of ________
Subscribed and sworn to (or affirmed) before me on this ________ day of ________, ________, by ________, who personally appeared before me.
The said signatory is personally known to me or proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to the within instrument, and acknowledged to me that he or she executed the same in his or her authorized capacity, and that by his or her signature on the instrument the person, or the entity upon behalf of which the person acted, executed the instrument.
I certify under penalty of perjury under the laws of the State of ________ that the foregoing is true and correct.
WITNESS my hand and official seal.
Seal:
Notary Public Name: __________________________________
Notary Signature: _____________________________________
Commission Number: ________
My commission expires: ____________________