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EFTA01279834.pdf

set10 Interestingness: 4/10 Original PDF ↗

AI Summary

This is a blank status certification affidavit template from Fifth Third Mortgage Company for a loan transaction in Palm Beach County, FL, dated December 10, 2014. The document is a standard mortgage form with signature lines left blank. [Rating: 4/10 - Standard mortgage document template with blank fields, though it's from Palm Beach area where Epstein had property]

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Extracted Entities

Name Type Context
Palm Beach location County where the notarization took place
Fifth Third Mortgage Company organization Lender identified in the mortgage status certification affidavit

Full Text

STATUS CERTIFICATION AFFIDAVIT
Borrow er(s): Lender: Fifth Third Mortgage Company
Property Address:
BEFORE ME, the undersigned authority duly authorized to take acknowledgments and administer
oaths, on this day personally appeared the undersigned Borrower(s) who, after being duly sworn on oath
stated the following:
1. I/We the undersigned Borrower(s) understands that Lender is granting a mortgage loan (the "Loan")
based on the representations made in the Loan application given by the Borrower(s) to Lender I/We
hereby certify that all statements related to the Loan application, including but not limited to financial.
marital, and employment status, have not changed and to my/our knowledge, will not change in the
foreseeable future. The statements of fact regarding occupancy of the Property which is being
purchased, improved, refinanced or additionally encumbered with the proceeds of the Loan are the
same as represented at time of Loan application.
2. If the Property is being purchased by Borrower(s). the funds for down payment and closing costs are
being paid from the source stated on the loan application and there is no secondary financing in this
transaction that has not been disclosed to the Lender. I/We certify that if my/our Loan application
states that other real estate was to be sold, this is to certify that such transaction has taken place and
I/we no longer have title to that real estate.
3. If the Property is currently owned by the Borrower(s), I/we certify that there are no delinquent state.
county, city, school, water district, utility district or other governmental taxes or assessments due or
owing against said Property, and that no tax suit has been filed by any state, county, municipality.
water district, utility district or other governmental agency for taxes or assessments levied against
Borrower(s) which have not been disclosed in writing to Lender. I/We also certify that there are no
unpaid paving assessments or delinquent owner association dues.
4. There are no suits filed by or pending against Borrower(s) in any federal or state court which have not
been disclosed in writing to Lender
5. Borrower(s) acknowledges that this Status Certification Affidavit is given as a material inducement to
cause Lender to make the Loan to Borrower(s). Borrower(s) also understands that any false
statements, misrepresentations or material omissions may result in civil and criminal penalties. The
agreements and covenants contained herein shall survive the closing of this Loan transaction.
(Borrower) (Date)
(Borrower) (Date)
(Borrower) (Date)
(Borrower) (Date)
THE STATE OF FL
COUNTY OF PALM BEACH
BEFORE ME, the undersigned authority, on this day appeared
, known to me to be the
person(s) whose name(s) is subscribed to the foregoing instrument, and acknowledged to me that
he executed the same for the purposes and consideration therein expressed.
GIVEN UNDER MY HAND AND SEAL OF OFFICE, this 10th day of December
2014
Notary Public. State of FL
4- 305 19207).01 %%IP IA ORTOACIE FORMS 7192
!1 9047010420361321!
CONFIDENTIAL
SDNY_GM_00030279
EFTA_00I 40897
EFTA01279834