1010 Table
Content
Date: 10/7/2011
I, Kevin L. Jackson, certify the information contained below to be true and correct to the best of my knowledge. The sources of deposits into my Bank Accts (that are over $200) are as follows: Date of Deposit 10/4/2011 10/5/2011 10/5/2011 Amount $ 274.36 $ 380.00 $2,262.47 Source of Funds $250.00 – My LOVING mother $ 24.36 – Customer appreciation payment from my power company Grey Stone Power Cash deposit love offering from Pastor Dale Brunner Car insurance check deposit from my insurance company Liberty Mutual for body damages caused on my now repossessed car Car insurance supplemental check deposit from my company Liberty Mutual for additional damages found. $345.87 – Final car insurance supplemental check deposit from my insurance company Liberty Mutual for additional damages found $140.60 – The state of Georgia requires all insurance companies to submit a diminished value calculation on for cars involved in an accident. Car insurance deposit from my insurance company Liberty Mutual from the diminished value calculation Home insurance check deposit from my insurance company Cotton States due to minor house damages that occurred
10/12/201 $ 910.55 1 10/19/2011 $ 486.47
10/28/201 1
$2,629.10
Signed:
______________________________________________
(Borrower) WARNING: Section 1010 of Title 0, U.S.C. Department of Housing and Urban
Development Transactions provides that, “Whoever for the purpose…influencing in any way the action of such department…Makes, passes, utters, or publishes any statement knowing the same to be false…shall be fined not more than $5,000.00 or imprisoned not more than two years, or both.”
I, Kevin L. Jackson, certify the information contained below to be true and correct to the best of my knowledge. The sources of deposits into my Bank Accts (that are over $200) are as follows: Date of Deposit 10/4/2011 10/5/2011 10/5/2011 Amount $ 274.36 $ 380.00 $2,262.47 Source of Funds $250.00 – My LOVING mother $ 24.36 – Customer appreciation payment from my power company Grey Stone Power Cash deposit love offering from Pastor Dale Brunner Car insurance check deposit from my insurance company Liberty Mutual for body damages caused on my now repossessed car Car insurance supplemental check deposit from my company Liberty Mutual for additional damages found. $345.87 – Final car insurance supplemental check deposit from my insurance company Liberty Mutual for additional damages found $140.60 – The state of Georgia requires all insurance companies to submit a diminished value calculation on for cars involved in an accident. Car insurance deposit from my insurance company Liberty Mutual from the diminished value calculation Home insurance check deposit from my insurance company Cotton States due to minor house damages that occurred
10/12/201 $ 910.55 1 10/19/2011 $ 486.47
10/28/201 1
$2,629.10
Signed:
______________________________________________
(Borrower) WARNING: Section 1010 of Title 0, U.S.C. Department of Housing and Urban
Development Transactions provides that, “Whoever for the purpose…influencing in any way the action of such department…Makes, passes, utters, or publishes any statement knowing the same to be false…shall be fined not more than $5,000.00 or imprisoned not more than two years, or both.”
