EFTA01279984.pdf

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 Lender One Number
Applied for: r
FHA IE USDA/Rural Housing Service 420361321
Amount Interest Rat• !No of Months 1 Amortization X Fixed Rate i MIN (eleglai0
Typo:
$ 325.000.00 3 000-ili 180 Zih.r ARM (type):
Ii. PROPERTY INFORMATION AND PURPOSE OF
Salta PIOpOtly Address MKS. cily. nee ZP)
NO or Units 1
Lege ()escalation or ecl Properly (Math desonfeon mow's. Yeargue 2002
Purpose Loan UAa relate Construction Other (explan). Rowdy we W.
W El
Refinance Construction-Permanent W RPietce I I aRiaranere I I Thestramt
Complete We One V construction a construction-pommnent loan
Year Lot Acquired I Original Cost Amount Existing liens Reseal Value of Lot I (b) Cost of Improvements I Tat/ (e + b)
$ $
$ le) I $ I $
Complete this fine it this is a refinance loan. Describe Improvements =. made .M. to be made
Year Acquired Onginal Cost I Amount Existing Liens Rapine of Refinance
2004 $810,000.00 $321,360.00 Rate and Term Cost: $
Title will be held in what hierilegd Mannar in which Title wiN be held Estate veil be holder
III
Fee Simile
Title held jointly. I I LeasHord omen
formation0*e)
Source of Down Payment. Settlement Charges. and/or Subordinate Fnancong (explain)
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) Yrs school Social Security Number Home Phone (incl. ewe code) 000(eamildWrinerl Yrs sinnol
10/24/1983 0
m mats° mg unmarried ondussmcde Dnoe emtunIt Oat agonyCoen/owl ( f- 1 , m aenad C uninamid wow nia nCerneer le ts p M er o t listed by Bormwer)
Pvercef. widowed} Overced widowed)
Serrated 0 j Eccovine
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:
El El
Former Address (Wed. coy. tae. ZPI COwn Q Rem Former Address !Strad, city side. ZIP) Own No Yrs
420361321 42036132,
untonn Rinioentier Loon Apotcation Application Date 10/2/2014 ran-weLtd.corm 1003 7105 Moe 0/09)
Fans. MeerFredhe Mac Form OS ?JOS CAW 6/00)
Vein w vMP22IN (0907)03
Woken Wove Finerod Swore; Noel PS
CON F I DENT In1119470104ZONM
EFTA_00141549
EFTA01279984

Borrower IV. EMPLOYMENT INFORMATION Co-Borrower
Nerve 6 slims s' Ernimn Mooed Yn On INS job
Sc o Verum Corporation 11/9
329 Sea Breeze Ave
Yt inioyed in this one Of Yrc employed m Nis line 0
Palm Beach, FL 33480 weekrixolession Yrkilif•SNOSI
Potal/Onentleang of Sunless 1300ess Phone (nil tea 00) Position/Tann we of Winne Stamen Rions lord roe cote)
Rua Car Driver
If employed In =rent position for Mss then two years or If curly employed In more than one melon, complete the following.
CI sa El
Nene it AdcanS 0 Employer Entannod Dan (from Name 8 Anton of Emirs' Sin En /0y.] Wes (from - to)
Mooney Income Malny Income
Pesten/Tale/Type of Business Buttes, Pitt* (Ind area code) Position/The/type of Business &wen Phone Ord nos code)
CI
Name 8 Mena Of EN Nets n SW Employed Dan tam rat Name 8 AGS'ess or &Want SW &WOW Dies (from - to)
Moseley Income Monthly Income
I:bat:an/Title/Type of Business OlieleSS Rine (MN tea 0:401 PostleniTtIOTypo of Business Soonest Mane Imd sea Side)
IL V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION
Ones Nene Incorm &mew. Cop,..„,„ Tea 2=1;1.17:=4 N....t. rt prepmae
27
A
Bag Empl Income' 55,916.66 $ 3 55 916.66 Rent 5
Oyertme First Mortgage (PILI) 3.163.00 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. Homeowner Assn. Dun 350.00
see lb 'clesnite
OINK MOM.? bolos ) 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 Describe Other Income Notice: Alimony, child support, or separate maintenance Income need not be revealed It the Monthly
Borrower (B) or Co-Borrower (C) don not 1:1100111 to have It considered for repaying this loan. Amount
B
420361521 420361321
Union Ralaelie Loan Apirdco Application Date 10/2/2014 FameMoe Forte 1003 7/05 (Rey 8/09)
Fame Mita/Froddmir Mx Freda. Mac Form 7/05(Aw 15/09)
VNP le vm6$P22I NI09 07 )05
inciters rover Faunae Services 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
Monthly payment & Unpaid
UABILITIB3 Months Lett to Pay Ekdonce
List checking and savings accounts below Name and address of Company 5 Payment/Months
Name and address of Sank, S&L. or Ceedt Union CHASE 25.00 104.00
Fifth Third 5
0 Aso no 43885400
imr-ry Nome and address of Company PaymenuMontss
TBD 1 1 000.000. 00 CCO MORT CRP 3,163.00 321,360.00
Name and Stress of Bank. S&L. or Credit Union •
I
AOC a02930022453112
ACC CIO --iname and address or Company Payment/Month $
Nana end address of Bask. S&L. or Credit Union
Name and address of Company 5 Payment/Month $
S
Name and address of Bank, S&L, or Credit Union
Name and address of Company S Payment/Month
v
rotasr; tBiorna)d t(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 1.615 000 Name and address of Company 5 Payment/Months S
from schedule of real estate owned)
Vested Interest in retirement fund
Net worth of businesses) owned
(attach toencial statement)
Automobiles owned (make and year) nod no
O Al w im e o d n t y o / Cord Smoulder:wee mantounce Pawn as 5
...A,Folded E.ranw (chid far* cn duos. etc )
Other Assets (nelon) $
Total Month merits 25 00
Total Assets a. IS 2,675,000.00 aertnrucslcI ► 5 2,353,536.00 Total Liabilities b. $ 321,469.00
Schedule of Real Estate Owned (If addthOlkal properties aro owned, use coat inualtOn sheet.) n
Roperty Address (enter S if sold, PS a pentane sate y ,r,ryoppeivet; mortgage lArrinten•nci Net
or R if rental being held for income) Malr% Value MortAgaggt&Ctiens Rentlfratits ts Taxes & Nisi. Rental Moms
N SFD S 1,125,000 S S S $ 2,300 $
Cond 500,000 321,360 2,225 850
Totals $ 1,675,000 S 321,360 5 $ 2,225 $ 3,150 $
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
420361321 420351321
U.-00m RaciOsetid Lao nprocaticn Fern. oe Form 1003 7/05 (Rev 0/09)
Fame MaerFraciad Mac Application Date• 1012/201 PredGe Mac Fan, 7/05 raw 6/09)
var.* v6M$P22 I N (0907)03
Wtdors lOasv et Finarcid Sorwce; Prue 3 of 5
CONFIDENTIAL
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EFTA01279986

VIII. DECLARATIONS
If you answer "Yes" to any questions a through I, please not w Ciorionvever
s. Finches* mice S use continuation sheet for explanation. Yes rowelo 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 = =
c Hare you hied prOpnly foreclowit upon or anon tale or died in ow/ 1 'roan
d. Refinance Ond. dates to be paid off) 321,360.00 me last 7 yeeir59 IMI al C C
0 CiEl 0 0
O. Eit knitted prepaid MOMS 379.17 d Ant you a Wyk. a law OAF
f. Estimated closing costs 3,004.46 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
g. Mat, MD, FundingFee inekide SuCh ben OS none mOn(pk* loan. SBA ken. rams initicrovernelt
loan. obxatimal loans. meruftclued Onottrel Mane Wow any moneys.
h. Discount Of SWIM for sail pay) Muncie/ collogitel. Ocna or low guaarCee If 'Yes; prawn odes.
Total costs (add Items a through h) $324, 743.63 M an a d u r d ea e s ° o d n a s l f e o . r n th a e l a * d a iO d n 8 / 3 2/455 Or Leares FHA or Me Men leer. /1 ay. — WV — —
I l. t S B u o b rr o o r w d e is r a 's te c k ? i M si a n s g c a a ra n ts paid by Stie f l d A o a r s e i m L y s O in a u e S p r S t r g e C e S g e IO t r tl l y N ir ld d i M n er 0 t in 1 h c 0 e s ° 4 s r 0 o e 4 l c 0 a e 1 d 1 r 0 e i 0 ° . O C b w k e a e n g J d i t C . 0 o o n r l a e n a y n fpeudrterndt edaera la o • r Yin. grocmCC
I. Other Croats (eaplabl) 9 AreY0400100tedlo pay *many. Chid SUMO& or Ware. mareenalcet =MOO
0 M 0 0
h IS ay part or ire down paymont Mercy/ 035
. ...you fl 0 m
• co-maier or endorser on a WO CI
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 C C
A. NAL MP Funding Fee financed L c cr o o m y m ou a s W m N e W w t « O ) m ew w e ow / t he InceaW FF dm Mawr neftnin If *Yes: ra C = =
o. Loan amount (add m 6 n) 325,000.00 m Hate you MO alo cO=ew nicShjtPa nri ece° m a PrOtoeftY in Or lag tine f/off0 M M C Ini
p. Cash from/to Borrower -$256.37 0 / ggif tL i. orTmavtint ‘r; 000C1031 M1060C4) CPR), second pR
(subtract j. Is 16 o nom I) (3 ,Eth!Ier l.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 bees 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 Date I C-oBorrowers Signature Date
X 10/8/2014 X
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: EthnIdly:
Ss is or Limo not HI MC or Leer* Wm or L•ince 14,1 Rs <or Loom
Ram crn ian Race:
AIncenArbeltan — AlaskaNen Avon AMioan AmenCan
(=I &ahtier fur OcliliT Or r--1
El MirP ratacvifriecilt° or W WM* t__, ymt.
fl
Sex: n Endo Ma $ex: n Female - Mote
To be Compieted by Loan OrIgInMor:
This information was provided: ('Ti In a facelofecie interview By the applicant and sebrnated by fax or rasa
In a telephone interview = By the applicant and submitted via email or the Internet
Loan Onginat or s Signatito Date
X
Loan Originators Name (print a type) Loan Originator Identifier Tow Originators Phone Number (includkig area code)
Joann Brown 414603
Limn Origination Company's Name Loan Origination Company Identifier .any's Address
Fifth Third Mortgage Company 5001 Kingsley DR, SD: I MOCK.
134100 Cincinnati, Dl 45227
420361321 Appacabon Date:1072/2014 420361321
Uniform Rsoidonties LOW hersamen Fame Moe Form t003 7/05 (Rev 0109)
Form mearFredde Mae Fredas Mae Form 65 7/05 dev 6.09)
mete v iall22 I N (0907)03
Wolters Kluwer Financid Services Pagel of 5
CONFIDENTIAL
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EFTA 00141552
EFTA01279987

CONTINUATION SHEET/RESIDENTIAL LOAN APPUCA11ON
Agency Case Number.
Use this continuation sheet rl
you need more space to
complete the Ftesidentiel Loan
Application. Mark B for Lender Cos. Number:
Borro era C for C0• 01TOWM
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: Date C-oBorrower's Signature: Date
X 10/6/2014 X
420361321 420311321
union+ Riniagete/ Loco Aporicaticn Fern, MN Fon 10037/05 caw 6,091
Ferns. meerFreate Mac Freckle Mee Form 65 7.75 (Red 6109)
Veep se VMP22 IN (0901) 03
Wdt$n 10vw et nnorod Sorv,co; hen 5 of 5
CONFIDENTIAL
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EFTA_00141553
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