EFTA01279984

Uniform Residential Loan Application Thus application is designed to be completed by the applicant(s) with the Lender's essistance. Applicants should compel • Ihrs form as -goteower" or •Col3orrow ie.' as applicable. Co-Bonow et information must also be provided (and the appropriate box checked) when th• income or assets of a person other then the Borrower (including the Borrower's spouse) veil be used as a basis for loan qualification or El the income o assets of the borrower's spouse or ()thee parson who hes community properly eights pursuant to State law rill not be used as a bests for loan qualification, but his or her liatelmes must be considered because the spouse or tither person has community property rights pursuant to applicable law and Borrower resides in a community property stele. the security property is located in a community property state. or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan. If this is en applicelion for joint credit. Borrower end Co-Borrower *itch agree that w • intend to apply for joint credit (sign below): Borrower I. TYPE OF MORTGAGE AND TERMS OF LOAN Mortgage ri VA I X I Conventional I i Other (explain). I Agency Case Number Applied for: r FHA IE USDA/Rural Housing Service Amount Interest Rat• !No of Months 1 Amortization $ 325.000.00 3 000-ili 180 Typo: Lender One Number 420361321 X Fixed Rate i MIN (eleglai0 Zih.r ARM (type): Salta PIOpOtly Address MKS. cily. nee ZP) Ii. PROPERTY INFORMATION AND PURPOSE OF Lege ()escalation or ecl Properly (Math desonfeon mow's. Purpose Loan UAa relate Construction W Refinance El Construction-Permanent Complete We One V construction a construction-pommnent loan Year Lot Acquired I Original Cost $ Amount Existing liens $ le) Reseal Value of Lot I $ I (b) Cost of Improvements I $ I Tat/ (e + b) $ Complete this fine it this is a refinance loan. Year Acquired Onginal Cost I 2004 $810,000.00 Amount Existing Liens Rapine of Refinance $321,360.00 Rate and Term Describe Improvements Cost: $ =. made .M. to be made Title will be held in what hierilegd Mannar in which Title wiN be held Title held jointly. Estate III I I veil be holder Fee Simile LeasHord omen Source of Down Payment. Settlement Charges. and/or Subordinate Fnancong (explain) formation0*e) Borrower M. BORROWER INFORMATION Co-Bonower Borrower's Name (include Jr. or Sr. if applicable) Co.Borrower's Name (nclude Jr. or Sr. if appicable) Social Security Number Moms Phone gnel. erne cods 000(menrellwerY) 10/24/1983 Yrs school 0 Social Security Number Home Phone (incl. ewe code) 000(eamildWrinerl Yrs sinnol m mats° Serrated mg unmarried ondussmcde Pvercef. widowed} Deemtun no It Oat agonyCoen/owl 0 j f- 1 ( , maenad C uninamid wow nia Overced widowed) Eccovine nCerneerts Mot listed by Bormwer) leper Present Address (street. [Ay. dote ZPI I X I Own Rent 3/0 No. Yrs. Present Address (street. My Pate. ZiP1 1_1 Own U Rent No. Yrs. 329 Seabreeze Ave Paler Beach, FL 33480 Meiling Address, if different from Resent Address Mating Address. if different from Resent Address If residing at present address for less than two years, complete the following: Former Address (Wed. coy. tae. ZPI COwn Q Rem Other (explan). NO or Units 1 Yeargue 2002 Rowdy we W. W PiRetce I I aRiaranere I I Thestramt Former Address !Strad, city side. ZIP) El Own El No Yrs 420361321 untonn Rinioentier Loon Apotcation Fans. MeerFredhe Mac Vein w Woken Wove Finerod Swore; Application Date 10/2/2014 42036132, ran-weLtd.corm 1003 7105 Moe 0/09) Form OS ?JOS CAW 6/00) vMP22IN (0907)03 Noel PS CON F I DENT In1119470104ZONM EFTA_00141549 EFTA01279984 Borrower IV. EMPLOYMENT INFORMATION Co-Borrower Nerve 6 slims s' Ernimn Sc o Verum Corporation 329 Sea Breeze Ave Palm Beach, FL 33480 Potal/Onentleang of Sunless Rua Car Driver Mooed If employed In =rent position for Nene it AdcanS 0 Employer CI sa Entannod 11/9 Yt inioyed in this one Of weekrixolession 1300ess Phone (nil tea 00) Position/Tann we of Winne Yn On INS job Yrc employed m Nis line 0 Yrkilif•SNOSI Stamen Rions lord roe cote) Mss then two years or If curly employed In more than one melon, complete the following. Pesten/Tale/Type of Business Dan (from Mooney Income Buttes, Pitt* (Ind area code) Name 8 Mena Of EN Nets n SW Employed I:bat:an/Title/Type of Business Dan tam rat Moseley Income OlieleSS Rine (MN tea 0:401 Name 8 Anton of Emirs' El Sin En /0y.] Position/The/type of Business Wes (from - to) Malny Income &wen Phone Ord nos code) Name 8 AGS'ess or &Want CI SW &WOW PostleniTtIOTypo of Business Dies (from - to) Monthly Income Soonest Mane Imd sea Side) IL V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION Ones Nene Incorm &mew. $ Cop,..„,„ Tea 2=1;11.7:=4 Rent 5 N....t. rt prepmae Bag Empl Income' 55,916.66 3 55 916.66 3.163.00 27 A Oyertme First Mortgage (PILI) s 2,244.39 bonne Other Finetung Wee CemintsUom Heard Insurance Dividends/Interest Real Estate Taxes 500.00 Nat Rental Inman* Mortgage Insurance Mier (bera• COrttOatme. see lb 'clesnite OINK MOM.? bolos ) Homeowner Assn. Dun 350.00 Other: 3,321.00 Total 1 55. 916.66 S 5 SS 916 66 Total a 6,484.00 3 3,094.39 • Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statemerts. B/C B Describe Other Income Notice: Alimony, child support, or separate maintenance Income need not be revealed It the Borrower (B) or Co-Borrower (C) don not 1:1100111 to have It considered for repaying this loan. Monthly Amount 420361521 Union Ralaelie Loan Apirdco Fame Mita/Froddmir Mx VNP le inciters rover Faunae Services Application Date 10/2/2014 420361321 FameMoe Forte 1003 7/05 (Rey 8/09) Freda. Mac Form 6$ 7/05(Aw 07 15/09) vmP22I NI09 )05 Pen 2 of 5 CONFIDENTIAL SDNY_GM_00030937 EF'FA_00141550 EFTA01279985 VI. ASSETS AND UABILMES This Statement and any applicable supportmg schedules may be completed Jointly by both marned and unmarried Co Borrowers if the assets and liabilities we sufficiently joined so the/ the Statement can be meaningfully and fairly presented on • combined basis: Wiens's* separate Statements and Schedules are required. If the Co-Borrower section was completed about a non-applicant spouse or other person. this Statement and supporting schedules must be completed about that spouse or ether peruse also. Completed __, Jointly il Not Joiner ASSETS Call Of Illallot wake Llablatlia and /ladled Asset. -/ the CleOICCS nom. &Wien d4 a., .ur! run tr.c 14 a <.a-Jading OeCtS. Description .nciusing artormotior loan rwrorirno chirroO isCountS ma *deft ic,als aim cry/ <NO support stock 0100001 *lc LIS* COrfinuatiOn SOUL if neCiSSEry Notate by (' ) th0101.11)ilian cinch will 00 Saidt44 upon sale Of real .$280 Cash deposit toward purchase held by: 5 owned or ulttia refelanOin) 01 the SlOyeCI OrOpody List checking and savings accounts below Name and address of Sank, S&L. or Ceedt Union Fifth Third UABILITIB3 Name and address of Company CHASE 0 Aso no 43885400 imr-ry Nome and address of Company TBD 1 1 000.000. 00 CCO MORT CRP Name and Stress of Bank. S&L. or Credit Union ACC CIO Nana end address of Bask. S&L. or Credit Union IAOC a02930022453112 Monthly payment & Months Lett to Pay 5 Payment/Months 25.00 5 PaymenuMontss 3,163.00 • --iname and address or Company Payment/Month S Name and address of Bank, S&L, or Credit Union Unpaid Ekdonce 104.00 321,360.00 $ Name and address of Company 5 Payment/Month $ Name and address of Company S Payment/Month v r otas; Bradt r tion) (Company name/number deso Name end oddness of Company Payment/Months Life insurance net cash value Face amount: $ $ &Motel Liquid Assets 1 000 000 00 rw Real restate owned (enter market value from schedule of real estate owned) 1.615 000 Name and address of Company 5 Payment/Months Vested Interest in retirement fund Net worth of businesses) owned (attach toencial statement) Automobiles owned (make and year) nod no Alimony/Cord Smoulder:wee mantounce Pawn as 5 Owed to ...A,Folded E.ranw (chid far* cn duos. etc ) $ Other Assets (nelon) Total Month merits Total Assets a. IS 2,675,000.00 aertnrucslcI ► 5 2,353,536.00 Schedule of Real Estate Owned (If addthOlkal properties aro owned, use coat inualtOn sheet.) Roperty Address (enter S if sold, PS a pentane sate y or R if rental being held for income) ,,rryoppeivet; Marl% Value MortAgaggt&Ctiens Rentlfratits mortgage ts lArrinten•nci Taxes & Nisi. Net Rental Moms N SFD S 1,125,000 S S S $ 2,300 $ Cond 321,360 2,225 850 500,000 Totals S 321,360 5 $ 2,225 $ 3,150 $ $ 1,675,000 List any additional names tilde( which credit has previously been received and mica app agnate creditor 'lanais) and aeon* number(s): Alternate Name Oedit or Name Account Number S 25 00 Total Liabilities b. $ 321,469.00 n 420361321 U.-00m RaciOsetid Lao nprocaticn Fame MaerFraciad Mac var.* Wtdors lOasv et Finarcid Sorwce; Application Date• 1012/201 420351321 Fern. oe Form 1003 7/05 (Rev 0/09) PredGe Mac Fan, 6$ 2 7/05 raw 07 6/09) vMP2 I N (09 )03 Prue 3 of 5 CONFIDENTIAL SDNY_GM_00030936 EFTA_0014155 I EFTA01279986 VIII. DECLARATIONS s. Finches* mice S If you answer "Yes" to any questions a through I, please rowel not w Ciorionvever use continuation sheet for explanation. Yes o Yes No b. Akintkes. Impromments. repairs a Are there wry carioncong payments runnel your C Fa C = e. Land Of acquired separately) 0 Hee you teen cledwid bridal within lid pint 7 yearso = FM = = d. Refinance Ond. dates to be paid off) 321,360.00 c Hare you hied prOpnly foreclowit upon or anon tale or died in ow/ 1 'roan me last 7 yeeir59 IMI al C C 0 0 O. Eit knitted prepaid MOMS 379.17 d Ant you a Wyk. a law OAF 0 CiEl e Hare you direCtly or Waridly been otter:pled al by loin which *OM° in fanfold:num 9111SIW or lois in lieu of foreclosure, or pcSgmentf (fats woad inekide SuCh ben OS none mOn(pk* loan. SBA ken. rams initicrovernelt loan. obxatimal loans. meruftclued Onottrel Mane Wow any moneys. Muncie/ collogitel. Ocna or low guaarCee If 'Yes; prawn odes. f. Estimated closing costs 3,004. 46 g. Mat, MD, FundingFee h. Discount Of SWIM for sail pay) Total costs (add Items a through h) $324, 743.63 Maude° dale. nal* ad 832/455 Or Leares FHA or Me Men leer. /1 ay. and reasons for the adiOn / — WV — — l. Subordisate ?Mascara f Are yOu preSertly derincssol a ri OkaJt on any fedtrd deal or losiL inertgegt lirldM010 40401100. bend. or lean purentear a •Yin. grocmCC dams aS SCIONin the °recede° CwegiC0 9 AreY0400100tedlo pay *many. Chid SUMO& or Ware. mareenalcet =MOO h IS ay part or ire down paymont Mercy/ 035 0 M 0 0 It Borrower's ckising ants paid by Stie I. Other Croats (eaplabl) . ...you • co-maier or endorser on a WO CI fl 0 m I Are you GU 5 clan? WI = = = IR Loan mount Of Chao FIAL MO Funangfoo emir/WI 325,000. on k Ate you 0 pennenort reeding Mew> 1= MI *Yes: C C A. NAL MP Funding Fee financed L cro you WNW tO ewe/ the InceaW FF dm Mawr neftnin If commas mew«) m wow ra C = = o. Loan amount (add m 6 n) 325,000.00 m Hate you MO al Ow nicShP niece° m a PrOtoeftY in Or lag tine f/off0 M M C Ini p. Cash from/to Borrower (subtract j. Is 16 o nom I) - $256.37 0 / ggif t Li. oce= tjar orT matvi tn‘r; 000C1031 M1060C4) CPR), second pR (3 ,Ethel. !Ir t ^i, - 61. ; , lr , i' . :51. plantlY eras IX. ACKNOWLEDGEMENT AND AGREEMENT Bich of the undersigned specificity represents to Lander and to Lender's actual 0/ pclontial agents. brokers, processors. attorneys, Inform. Slinaterli. SUCCOSSOrs and assigns and agrees and acknowledges that: (1) the information provided in this application is true end correct as of the date sot forth opposite my signature end that any istentional or negligent misrepresentation of this information contained in this application may result in dug liability. inflating monetary damages. to any person who may suffer my loss die to reliance upon any rnisrepresentMion that I have made on this application, and/or n criminal penalties including. but not kneed to. fine or imprisonment or both under the provisions of Title le. United States Code. Sac. 1001. et seq.: (2) the loan requested pursuant to this application (the • Loan') wit be secured by a mortgage or deed of trust on the property described in this application; (3) the property wdl not be used for any liege or prohibited purpose or use; (4) all statements made in this appication we made for the purpose of obtaining a residential mortgage Soo,: (5) the property will be occupied as indicated in this application: (6) the Lender. Its servicers, successors or assigns may retain the original and/or an electronic record of this application. whether or not the Lean Is approved. (7) the Lender and its agents. brokers, Insure's, servIcers. Successors. and assigns may continuously rely on the infOrmallon contained in the application, and I am obligated to amend sndlor supplement the information provided in this application if any of the material facts that I have represented herein should change prior to closing of the Loan; (Thin the event that my payments on the Loan become delinquent, the Lender, its services, successors or assigns may. in addition to any other rights and remedies that it may have relating to such delindnency report my name and account information to one or more consumer records(' agencies. (9) ownership of the Loan modem administration of the Loan account may be transferred with such notice as may be required by law; (10) neither Lender nor its agents, brokers, insurers. services. successors or assigns has made any representation or warranty, express or implied to me regarding the property or the condition or value of the property: and (11) my transmission of this application as an 'electronic record' containing my 'electronic signature.' as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings). or my facsimile transmission ot this application containng a facsimile of my signature. shall be es effective enforceable and valid as il a piper version of this application were delivered containing my original written signature. Acknowledgement. Bich of the undersigned hereby acknowledges that any owner of the Loan. as sonic/es. successors and assigns. may verify or reverify any information contained in this application or obtain any information or data relating to the Loan• for any legitimate business gapese through any source. including a source named in this application or a consumer reporting agency. Borrower's Signature X Date I Co-Borrowers Signature 10/8/2014 X Date X. INFORMATION FOR GOVERNMENT MONITORING PURPOSES The following automation is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the enders compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The taw provides that a lender may not discriminate either on the basis of this information. or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity. race, or sex. under Federal regulations, this lender is regaled to note the ntonnation on the basis of visual observation and surname if you have made this application in person. If you do net wish to furnish the Information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy at requirements to which the lender is subject under applicable state law for the pa/tinnier type of loan applied for.) BORROWER 0 I do Ml sante rurrogothiSinfanntbOn CO-BORROWER NI I CO not wigs tO lanai MS infOnnetiOn Oh city: Ss is or Limo not HI MC or Leer* EthnIdly: Wm or L•ince 14,1 Rs <or Loom Ram crn ian Mir Prtavr acifiecilt° or AIncenArbeltan Race: AlaskaNen &atheir fur cOilliT Or Avon AMioan AmenCan El W WM* — (=I r--1 t__, ymt. Sex: n Endo fl Ma $ex: n Female - Mote To be Compieted by Loan OrIgInMor: This information was provided: ('Ti In a facelofecie interview In a telephone interview Loan Onginat or s Signatito X Loan Originators Name (print a type) Joann Brown Limn Origination Company's Name Fifth Third Mortgage Company By the applicant and sebrnated by fax or rasa = By the applicant and submitted via email or the Internet Date Loan Originator Identifier 414603 Loan Origination Company Identifier 134100 Tow Originators Phone Number (includkig area code) .any's Address 5001 Kingsley DR, SD: I MOCK. Cincinnati, Dl 45227 420361321 Uniform Rsoidonties LOW hersamen Form mearFredde Mae mete Wolters Kluwer Financid Services Appacabon Date:1072/2014 420361321 Fame Moe Form t003 7/05 (Rev 0109) Fredas Mae Form iall 65 22 7/05 07 N dev 6.09) v I (09 )03 Pagel of 5 CONFIDENTIAL SDNY_GM_000347939 EFTA 00141552 EFTA01279987 CONTINUATION SHEET/RESIDENTIAL LOAN APPUCA11ON Use this continuation sheet rl you need more space to complete the Ftesidentiel Loan Application. Mark B for Borro era C for C0• 01TOWM Agency Case Number. Lender Cos. Number: 420361321 VWe fully understand that it is a Federal crime punishable by fine or imprisonment. or both, to knowingly make any false statemeMs concerns° any of the above facts as applicable under the provisions of Title 10. United Steen Code, Section 1001. M seq. Borrowers Signature: X Date 10/6/2014 Co -Borrower's Signature: X Date 420361321 union+ Riniagete/ Loco Aporicaticn Ferns. meerFreate Mac Veep se Wdt$n 10vw et nnorod Sorv,co; 420311321 Fern, MN Fon 10037/05 caw 6,091 Freckle Mee Form 65 7.75 (Red 6109) VMP22 IN (0901) 03 hen 5 of 5 CONFIDENTIAL SONY_GM_00030940 EFTA_00141553 EFTA01279988