HomeMy WebLinkAbout02-12-07
" NOTICE OF CLAIM
(Filed Pursuant to 20 Pa.C.S. ~ 3532)
!'.)
=
=
-..
....,.,
rr1
co
o
~~~'2
---- ~;~ g
(j) /~,
--""1
N
COURT OF COMMON PLEAS OF
t IJIYlAf/tJ.A ,J/) COUNTY, PENNSYLVANIA
ORPHANS' COURT DIVISION
o
--n
-0
--
-
-
..
Ul
W
r!fltsl"/f1L .J. J/J5.eK.
Nod I~OlP -()4Lf<g'
,DECEASED
ESTATE OF
To the Clerk of the Orphans' Court Division:
Enter the claim of H 5 13 c.., 134 .J ,;c:: (/.5 /J
. I (Claimant)
amount of $ .$ 2) 6' 9 '1 / 2- C(. against the above entitled Estate.
in the
The Decedent, who resided at i./ 1.,0 l3/Gt AJ1 tV II l' ~It- fZ-/)
(Street Address)
LAm,o JlIi..L / ;:A l7()/1 . died on ~ - 30 - ~od ~
~ p~reif~~
said claim was gi~en to Ie (/ jJ fJ +- /?1 e I KLC ~
. ) (personal Representative or hislher counsel)
at 3ss IV. =</ 51' S1/(,cf-J' SIC. ala/ CA/V1~ HILL h
/ (Address) / /
~- y- (J1
. Written notice of
/7011
/Z~fJ~
(Clairllant) JlS~ e. /O/9~K P'J//
d r 02 5 tJ.4L-..lJE~ A V/;V'i/L:"
(Street Address)
on
(Date)
All
/
/V(/Y3
j) ,e/;:: w
(City. State. Zip) /
(Supreme Court l.D. No.)
(Claimant's Counsel)
(Address)
(Telephone)
Form OC-07 rev. 10.13.06
0'
2/8/2007
Printed By: mmpj1
Loan Number: 4272183
PAY4 4272183
NAME CJ JASEK
3270 Explorer Page 1 of 1
HSBC MORTGAGE CORPORATION (USA) -- 547
Borrower Name: JASEK, CHESTER J
AS-OF 02/08/07 PAYOFF CALCULATION TOTALS 02/07/07 10:51:31
CONTACT NAME CHESTER J JASEK
-------------------------------------------------------------------------------
-------------------------------------------------------------------------------
PRINCIPAL BALANCE
INTEREST 02/08/07
PRO RATA MIP/PMI
ESCROW ADVANCE
ESCROW BALANCE
SUSPENSE BALANCE
HUD BALANCE
REPLACEMENT RESERVE
RESTRICTED ESCROW
TOTAL-FEES
ACCUM LATE CHARGES
ACCUM NSF CHARGES
OTHER FEES DUE
PENALTY INTEREST
FLAT/OTHER PENALTY FEE
CR LIFE/ORIG FEE RBATE
RECOVERABLE BALANCE
54,152.98
4,131.45
.00
.00
.00
.00
.00
.00
.00
27.00
82.82
.00
.00
.00
.00
.00
200.00
___________ RATE CHANGES
INT FROM RATE
04/04/06 7.00000
01/10/07 10.25000
02/08/07
AMOUNT
3,705.64
425.81
----------
W 2
TOTAL INTEREST
TOTAL TO PAYOFF
NUMBER OF COPIES: 1
4,131.45
58,594.25
PRESS PF1 TO PRINT
-------------------------------------------------------------------------------
HOME EQUITY LINE AGREEMENT
1, DEFINITIONS. In this Agreement. "I", "me", and "my" refer to
each cus~omer ,,:hw signs below. "You" and "your" refer to HSBC Banl<
USA. 'Account means the Home Equity Line Account established in my
name:,
2. CREDIT LINE. I understand that my Credit Line will be
$ 55,000.00 . My Credit Line is the maxuTJ.um I may owe
on the Account at any time, If I exceed my Credit Line, I wIll pay you the
excess immediately if you ask me to do so.
3. LOANS. I understand that you will make loans to me 011 the
Account by paying Home Equity Line Checks (Chec~s) !hat you will issue
to me for my use only or by any other availa,ble electronic/telephonic
method, I will use only Ch~cks tl,lat you issue to me. A Loan i~ consid'ered
made on the date you post It to the Account. I agreeno(to'wnte a Cfleck:
(a) for less than S250; (b) which will cause the amount I owe to exceed my
Credit Line; or (c) as a payment on what I owe you on;the'Aecount.
You agree, subject to Section 8 below, that unless 111111 in Default (as
defined below), you are required to honor Checks (hat I' issue 'and make
Loans to me on the ACCount in their amounts, subject only to the following
restrictions: (a) you are not obligated to pay a Check which is dated more
than six months before the date on which it its presented to you or that is
postdated, provided that you may pay any such Check and if you do, it will
be subject to the terms, of this Agreement; (b) you need not certify any
Check or retul'll canceled Checks to me; (c) you may refuse to pay Checks if
my Checks have been reported lost or stolen.
I agree that I won't use a Check to make a payment on the Account. In
addition, I agree that the pUrpose of the Credit Line is not to finance the
purchase of a one-to four-family dwelling which secures this Account.
4, MORTGAGE. I acknowledge that I have given you as security
for repayment of all sums that may become due under this Agreement a
Mortgage on my primary or secondary residence. The Mortgage will not
secure the amount of any Check which exceeds my Credit Line. The terms
of the Mortgage are included in and made a part of this Agreement. STATE
OF FLORIDA DOCUMENTARY STAMP AND INTANGIBLES TAXES
IN THE AMOUNT REQUIRED BY LAW HAVE BEEN PAID ON THE
MORTGAGE SECURING THIS AGREEMENT IF THE MORTGAGED
PROPERTY IS LOCATED IN FLORIDA.
5, STATEMENTS. At the end of each monthly period in which
there has been activity in my Account you will send me a statement (the
Statement) showing the activity during the month, the new balance, and the
credit available, II will also show any Minimum Payment I must make and
the date that it is dUe. I have 60 days from the date you mail me a Statement
to notify you of any mistakes in it. If I don't contact you within that 60
days, the Statement will be considered correct and accepted by me.
6, PAYMENTS AND PAYMENT DUE DATE. My obligation will
be to repay you, as billed, all Loans made under this Agreement together
with all Ftnance Charges, group credit life insurance premiums, Other
Charges (including Late Charges), expenses, and cos.ts specified either in
this Agreement or the Mortgage. Each month I recetve a Statement from
you I will pay you by the indicated Payment Due Date at least the Minimum
Payment shown. My Payment Due Date will be the day of the month you
select.
7. MINIMUM PAYMENT.
I will pay each month 1/240 of Principal plus FlnRnce Charges and
Other Charges figured as described below begInning on the Payment
Dlle Date showII 011 lilY first Statement alter I obtain my Initial Loan.
If I have missed any payment I Owe you, its amount will be added to the
payment for the next month and will be showlI on the Statement as the
Amount Pas/Due.
8. ACCOUNT TERM. I may obtain Loans on the Account for one
hundred and twenty ( 120) months from the date of this Agreement or
any addi!ional period to which you agree in writing. Thereafter, no further
Loans2'418 be made to m!, and my monthly principal repayment fraction will
be II -'"' The repayment period will not exceed 20 years.
'~ ,
9, FINANCE CHARGE RA TE. The initial, ANNUAL
PERCENTAGE RATE will be 3.7500 % ( a daily Periodic Rate of
0.010300 %). Those rates and each subsequent rate will change from
time' to time In accordance with Section lOaf this Agreement. The
maximum periodic interest rate (Maximum Rate) charged during the term of
this A.sreement will in no event ,exceed 15.900% per annum. If I delay
obtainll1g my first Loan, my initial rates may be different. The APR includes
only interest and no other costs.
10. ANNUAL PERCENTAGE RATE CHANGES. The initial AP~
is -0.250 % above the initial Index Rate of 4.000% . That
ditterence "etween Ihe figures is the Initial Spreau. The APR will chan~e
monthly to reflect direclfy changes in the Index Rate. Any increase WIll
result in higher payments.
The Index Rate is the Prime Rate published in The Wall Street Jounral on
the first day of publication after the 10th of each calendar month. If The
Wall Street JOIIl'llr.t publishes more than one Prime Rate for that day
(whether as separate rates or a spread of rates), the Index Rate will be the
average of those rates.
The APR will change on the opening day of the next billing cycle to
reflect the change in the Prime Rate.
' If The Wall Street JOIll'llal discontinues publication of the present Prime
Rate, you will choose a replacement Index and Spread which produce an
interest rate substantially similar to the rate in effect at the time llle original
You wHl notify me of each APR adjustment (and of the adjustment to the
daily Periodic Rate) in each Statement affected by the adjustment by
indicating the then current rates and payment amount. The daily Periodic
Rate is determined by dividing the APR by 365. If, as a result of any APR
adjustment, the rates or charges to be made would exceed maximums set by
applicable law, or as provided for above, then such rates or charges payable
shall be reduced by the amount necessary to bring them within permitted
limits. .
In no event will the APR change more than Four (4.000%) percentage
points in any year of this Agreement (the Annual Change Limit), A year for
this purpose is the period frolllthe date the Account is established to the first
anniversary date thereof and each similar annual period that follows, If as a
result of increases or decreases in the Index Rate during a year the APR
would differ from the APR in effect at the beginning of the year by more than
the Annual Change Limit or the Maximum Rate, any APR changes to be
made thereafter during the year will be reduced by t,he amount necessary to
bring the changes for the year within the permitted limits.
The APR for the rest of the year will then remain unchanged unless the
Index Rate thereafter changes to a figure which, when added to the Initial
Spread, results in an APR which is within the permilled Iilllits for the year, in
' Wllich case that APR shall take effect.
Limitations on APR changes resulting from application of the foregoing
provisions shall remain in effect only until the next rate change date. At that
time, the APR for the next rate period shall be detennined by adding the
Initial Spread to the current Index Rate; provided, however, that Ihe Annual
Change Limit for that year shall include any APR adjustments resulting from
reinstatement of the Initial Spread and that the Maximum Rate shall not be .
exceeded.
The provisions of Section 9 and this Section '10 apply to both the draw
period and the repayment period. ,
It. ITEMIZATION OF, CLOSING COSTS.
Item To Be Paid To Be Charged
My m,"lhly P,inci~1 paymon' , is ,fign"d hy ,.pplying Ih. .hn" In C"h To My Aceonnl
principal repayment frachon to the Prmclpal outstandmg as of the date of
my latest Loan. Each time I obtain a new Loan its amount is added to the (a) Appraisal Fee $ 15.00 $ 0.00
outstanding Principal which is then refinanced over the agreed upon number (b) Credit Report $ 12.50 $ 0.00
of months. For purpose ~f this computation, the wor~ ~o~n does not (c) Loan Orig. Fee $ 0.00 $ 0.00
include a transaction IIlvolvll1g the purchase of group credIt Itfe msurance.
Finance charges will begin to accrue on a Loan when the Loan is posted (d) Recording Fees $ 4i,}.~x..~ ~ $ 0.00
to my Account. (e) Mortgage Tax $ 0.00 $ 0.00
My FINANCE CllARGE will ho fi,..o<I 'his w'y' (Q Till. S''',h $ "...,." $ 0,00
(') Start each day with my opehing Principal balance. ( ) T'tl I $ , $ 0 00
. g 'e nsurance 0.00 .
(tI) Snbl"cl .ny p'rm.nls .nd oil", credits 10 P,incip~ .nd .dd Ln." 0 00
and other debits to Principal that day. For this calculation, other debits does (h) Flood Cert Fee $ 18.00 $ .
not include insurance premiums if I have purchased group credit life (i) Sl:~lill\ Fa; $ '2.'2.5".00 0.130
inso,'"ca, This gi,.. · d.ByP,i.eip.1 b.lanca, , , If yon h", paid on my b'b.lf, .11 0' p"l of II" clo.ln$ co.ta Idonlifi.d
,(iii) Add np'.1I Ih. d.dy Pn'''p.1 bal!",,"s fo, th, bdh.g ,ycI" and .1."" I will "imb.." YOII fo, Ih... c..,. if my Cro<lit LID" is I"mi.at.d
d'v,d. II" 1.1.1 by ,h. .omb" of d.y. '0 Ih. bdlr.. cyei" Th"" ,h. A v..ag. ..d cl...o<I fo, any ""'0 wilhi. 3 Y"" from Ih, d.l. of Ih" Ag"""OI,
D.i1y B.lan", , " , n"" .lo.ln, co'ls will b.p.yabl. in full opo. d'ID..d by yon ~.d roo
(I,) Molriply Ih. A'..... Daoly B.lanc~ by 'h. ,d~,'y P'nodoc Rat., Ih:m may, ao yo.. 'Plio." .h",. lho ....1. .. ", .dv.." on my Cred" LID"
multiply this total by the number of days In the bllltng ,cycle. TIm IS tile payable to you. Applicable finance charges WIll accrue on the amount of the
FINANCE CHARGE for the month. advance until the balance is paid in full.
all", ct,,,,.. will inolod. any L.I. Ch"... I b"om. oblig.'.d '0 p'y P.ymon' i. cssh incind.. P'yro,ol by ,,"ifi.d check 0' mlO"y o,d..,
and any other charges you lInpose ~hat I agree to pay.
Group credit life insurance premiums will include the amount of the See ADDITIONAL TEHMS on the back of this agreement.
monlhly premiums for the life insurance I ha'~e r~qllest~d. .
My monthly Minimum Payment on ~rJ~CIP81, Fmance Charges, Life
Insurance premiums and Olher Charges w,1I 111 110 event be less than $ I 0,
unless my total balance is less than $10, in which case it is .all, due. My
monthly payments will be applied to Fmahce Charges before Pnnclpal.
Any Minimum Payment I do not make by the Payment Due Date shown
on my Statement is late. You may charge me a Late Charge of $.02 per ~I
of the amount of the Minimum Payment if I alll more than 15 days late 1I1
making that payment.
NOTICE, S" ""'" .ld, .IIb" "'''m.nl fo, lrnl"rl',ollr'f''',,"on "''''din, .ddltion.llern" .." yoo, ,i.h" I. .1I",n.. hllll., "91l',li419
SA Page I ' 038
liSnC il.llk U CD' 106B II" (J IAl3 )
D.I.d..bru.r,.20;, 2004 :' . !f;,:--.
d/diJ;;i}J!; ~4cL_ j;;Z;;,j
'," . "", ....'it :d"JA..K'~TllUllT~
,1i~0w.. /11. ;t-':/';.J..~lt l--1./-U. - ~
I .~ . ,.....
t.,,'i:l:I:S- 'M. ThSEI<..., T11.\J.\.T\:::.~
~. \
"..
I.
12\ GROTt.P CREDIT LIFE INSURANCE. This section applies if I
elect to purchase group credit life insurance cove~ing my indebte~nes.s. You
will ea'ih monih, figure the charge for such msurance. by . dlvldmg the
A verage Daily Balance by One thousand (1 000) and multIplYIng .the result
by the insurancl. rate to get the Monthly CredIt In~urance .Premlum. The
insurance rate will initially be t~at In my applicatton for Insuran.ce. The
Monthly Credit Insurance PremIUm may ~lie~eaf~er vary penod!cally to
reilect directly changes in the group credit hfe Insurance premIUm rate
payable by you. "
My monthly purchase.of insurance will be identified on. my. monthly
statement as a transaction 10 the same manner as a Loan but It will not be
added to Principal for Finance Charge purposes.:
13. ALLOCATION OF PAYMENTS. We have the right to apply
payments to your Account at our discretion. This incJude;s,but is not limited
to, the ri~ht to apply payments to promotional ba,lances before
non-promotional balances.
14. ADDITIONAL PAYMENTS. I may prepay all (lr any part of my
Loan indebtedness at any time without penalty. However, no payment in
excess of the Minimum Payment due in any month will affect my obligation
to make future monthly Minimum Payments while there is a balance
outstanding. Since my FINANCE CHARGE is figured by applying the
daily Periodic Rate to the Average Daily Balance on my Account at the end
of each billing cycle, if I intend to pay the Account in full I'll telephone you
for an exact payoffbaJance for the day I want to pay.
15. CREDITING PAYMENTS. You will credit all payments on the
business day received if they are sent to the address, in the manner and
within the lime indicated in the Statemellt. Other payments will be credited
within the period permitted by federal law.
16. DEFAULT. You can, without advance notice to me, terminate my
credit line and require payment of the full amount I owe you at once if:
I . I engage in fraud or material misrepresentation at anytime in
connection with the Account.
2. I fail to make payments when due, or to pay any charge or fee when
due.
3. My action or inaction adversely affects the residence which secures
the Account or your security interest in the residence. This would include,
but is not limited to, sale or transfer of title to or any interest in the property
without your consent, death of the sole obligor on the Credit Account,
failure to maintain required insurance on the residence, failure to pay
property taxes, use of the residence for illegal purposes{ taking the residence
by eminent domain, or foreclosure by a creditor that ho ds a prior mortgage.
You can refuse to make additional Loans or reduce the Credit Line if:
I. The value of my residence securing this Account declines
significantly below its appraisal value for purposes of the Account.
2. You reasonably believe I will not be able to meet the repayment
requirements due to a material change in my financial circumstances, or I
file for or am placed in bankruptcy.
3. I am in default of a material obligation in the Agreement. All my
obligations specified in this Agreement and the Mortgage are material
obligations.
4. Government action prevents you from imposing the APR provided
for or impairs your security interest such that the value of the security
interest is less than 120 percent of the Credit Line.
5. A regulatory agency has notified you that continued advances would
constitute an unsafe and unsound practice.
6. The maximum APR is reached.
i 7. REVIEW AND TERMINATION. I understand that you will
review my Account and check my credit record from time to time. I agree
to provide you with information relating to my financial condition at your
request. If you learn during your review, or at any other time, that one or
more of the conditions specified in Section 16 above appl)' to me or my
Account, you may take the appropriate action specified In Section 16 with
respect to my Account. If a condition exists which pennits you to terminate
my Account and require payment in full of the outstanding balance, you may,
ll:t ~our option, .take any other action permitt~d by law, jncl!lding but not
hmlted to changmg my payment terms, decreasmg my Credit Lme or refusing
to make additional Loans to me. You may terminate my Account and reguire
payment in full of the outstanding balance at any later time if the condition
continues to exist or if another condition permitting such action exists.
If a condition exists which permits you to refuse to make aqditional Loans
or reduce my Credit Line, I am responsible for requesting reinstatement in
writing if such condition has been remedied. I will pay any reasonable
appraisal, title and credit report fees you incur in investigating whether my
Credit Line may be reinstated, unless such fees are prohibited by state law.
18. COLLECTION COSTS. I agree to pay your actual expenses after
default, including, but not limited to, the cost of any appraisal and reasonable
attorney's fees not in excess of 15% of the amount payable.
19. ADDITIONAL SECURITY INTEREST. You have the right to
hold or to use any amount which I have in any deposit account with you that
is not an IRA or HRIO account to pay what I owe you. No other security
agreement or mortgage other than the Mortgage identIfied in Section 4 above
will secure my indebtedness under this Account.
20. CHECKS. All Checks that you give to me for use with this
Account will remain your property and must be returned to you on request.
You will not be responsible for the failure of any person to honor or accept
such Checks.
2\. CANCELLATION. I may at any time request that you no longer
make Loans to me on the Account by written notice to you at your address
herein. If two or more customers sign this Agreement you can refuse to make
Loans on the Account upon receiving such written notice from anyone of us.
Termination of the right to obtain adClitional Loans will not affect my liability
to pay you any amounts owed to or to become due on the Account. If my
Account is closed, I will stop using the Account and will destroy any unused
checks. After cancellation Fursuant to this Section 21, the right to obtain
Loans may. be reinstated i all customers signing this Agreement request
reinstatement in writing.
22. AMENDMENTS. You may change the terms of this Agreement by
mailing or delivering a notice to me at least 15 days before the effective date
of the amendment. The amendment will be effective only if I agree to the
amendment. Any amendment will apply to existin~ amounts owed on my
Account unless otherwise specified. The terms of thIS Agreement may not be
changed without your prior written consent.
Notwithstanding the above, my agreement to any amendment is not
required when the amendment involves a reduction in the finance or other
charge, a change in insignificant terms, any change that benefits me or any
amendment resulting from my default or delinquency.
23. JOINT ACCOUNT. If I am one of two or more customers signing
this Agreement, I agree that we shall all be responsible to perform its terms. I
also agree you may enforce it against each of us. Any notice which you are to
send to me may be sent to any of us.
24. TAX DEDUCTABILlTY. I understand that I should consult a tax
advisor regarding the deductibility of interest and charges for the Account.
25. APPLICABLE LAW. This Agreement will be governed by federal
law a~d the laws of the St~te of New York, except as to certain matters
involVing the Mortgage, whIch Will be governed by the laws of the state in
which the property securing the Mortgage is located.
YOUR BILLING RIGHTS
KEEP THIS NOTICE FOR FUTURE USE
This notice contains important information about your rights and ollr responsIbilities under the Fair Credit Billing Act.
Notify us In Case of Errors or Questions About Your Bill
If you think your bill is wrong, or if you need more information about
a transaction on your bill, write us on a separate sheet at the address listed
on your bill. Write to us as soon as possible. We must hear from you no
later than 60 days after we sent you the first bill on which the error or
problem appeared. You can telephone us, but doing so will not preserve
your nghts.
In your Jetter, give the following information:
. Your name and account number
. The dollar amount of the suspected error.
. Describe the error and explain, if you can, why you believe there is an
error. If you need more information, describe the item you are not
sure about.
. If you have authorized us to pay your bill automatically from your
saYlng~ or checkmg account, you can stop the payment on any amo"n! you
,think IS wrong. To ,top the payment your letter must reach us three
busmess days ,before the automatic payment is scheduled to occur.
Your Rights and Our Responslbilitil!s After We Receive Your Written
Notice
We must acknowledge your let'er within 30 days, unless we have
corrected the error by then. Within 90 days, we must either correct the error
or explain why we believe the bill was correct.
HSRC Bank USA
.After we receive youI' letter, we cannot try to collect any amount you
question, or report yo.u as ~elinquent. We can continue to bill you for the
amount you questIOn, mcll!dlt~g finance charges, and we can apply any unpaid
amount ag~mst your .credlt. hn:ut. You do not have to pay any questioned
amount whIle we are mvestlgatmg, but you are still obligated to pay the parts
of your bill that are not in question.
If we find that we made a mistake on Jour bill, you will not have to pay
fit:'ance charges related to any questione amount. If we didn't make a
mlstak.e, you may have to pay fina!lce charges, and you will have to make up
any mlssed payments on toe questIOned amount. In either case, we will send
you a statement ofthe amount you owe and the date that is due.
~f you fail to pay th~ amount that ~e think you owe, we may report you
as d:h~'l.u.ent. H~wever,. If our explanatlO.n does not satisfy you and you write
to u~ wltmn ten Clays telling us that you still refuse to pay, we must tell anyone
we report you to that you have a question about your bill. And, we must tell
you the name of anyone we reported you to. We must tell anyone we report
you to that the matter has been settled between us when it finally is.
If we don'; follow these ruies, we car.'t collect the first $50 of (lit:
questioned amount, even if your bill was correct.
Page 2
0389668419
CD 4106 Rev (11103)
.-""
Unit rm R~sidential Loan A Iication
ThiE ~DDlic:ltion iE dgEiongd to bg comolgtgd bv tha DDo/ieontlal with tha landar'a ouiatoMa. ApplieDl'\tc .hould eomploto thi. form aI "gorrower I or "Co-gorrowor,"
as applicable, Co-Borrower intormation must also be provided (and the appropriate box checked) when Othe income or assets at a person other than the "Borrower"
lincluding the Borrower'5 5pOuse) will be used as a basis for loan qualification or [i] the income or assets at the Borrower's spouse will not be used as a basis tor
loan qualification, but his or her liabilities must be considared because the Borrower resides in a community property state, the security property Is located in a
community property state, or the Borrower i.s relying on other property located in a community property state as a basis for repayment of the loan.
460 BRENTWATER RD, CAMP HILL PA 17011
legal Description of Subject Property (attach description if necessary)
Mortgage
Applied for:
Purpose of Loan Purchase Construction Other (I)(pllln):
ORefinance Construction-Permanent
Complete this line If construction or construction-permanent loan.
Year Lot Original Cost Amount Existing Liens (al Present Value of lot
Acquired
Property will be:
rrPrlmary oSecondary
UUResidence Residence
O,nvestment
(b) Cost ot Improvements
Total (a + b)
$ $
Complete this line if this i. a refinance loan,
Year Originai Cost Amount Existing liens
Acquired
$
$
$
Purpose of Refinence
Describe Improvements Omade Oto be mada
$ $
Title will be held in what Name(s) CHESTER , LOIS JASEK
Cost: $
Manner in which Title will be held
Estate will be held in:
WFee Simple
o Leasehold
(show expiration
datel
Source of Down Payment, Settlement Charges and/or Subordinate Financing (explein)
Borrower's Name (include Jr. or Sr. if applicable)
Co-Borrower's Name (include Jr. or Sr. if applicable)
CHESTER J. JASEK
Social Security Number
DDBIMM/DDIYYYY) Yrs. Schoo Social Security Number Home Phone (Incl. area code) DOB(MM/DD/YYYY) Yrs. School
07/11/1926
117-14-1889 717-730-0268
CiJ Married 0 Unmarried (includ. aingl.,
O divorcad, widowad)
Separated
Present Addrass (stroet, city, state, ZIP)
Rent 37. 0
o Married DUnmarried (includ. single.
O divorced, widowed)
Separated
No. Yrs, Present Address (street, city, state, ZIP)
Rent
No. Yrs.
460 BRENTWATER RD
CAMP HILL, PA 17011
Mailing Address, if different from Present Address
Mailing Address, if different from Present Address
res ng at present a
Former Address (street, city, state, ZIP)
e 0 OW "g:
No. Yrs. Former Address (street, city, state, ZIP) DOwn ORent
No. Yrs.
- Not Provided _
Position/Title/Type of BusineliS
PosltionlTitle/Type of Business
Name & Address of Employer Uself Employed Dates (from - to) Name & Address of Employer o Salf Employed Dates (from - to)
Monthly Income Monthly Income
$ $
Position/Title/Type of Business jBusiness Phone Ilncl. a"a code) Position/Title/Type of Business IBusiness Phone linci. area code)
Name & Address of Employer o Self Employed Dates (from - tal Name & Address of Employer o Self Employed Dates (from - tol
Monthly Income Monthly Income
$ $
POsition/Title/Type of Business I Business Phone (incl. area code) Position/Title/Type of Business 1 Business Phone fincl. area codel
Freddie Mac Form 65 01/04
Fannie Mae Form 100301/04
Page 1 of 4
lnitials:_
e-21U 1030B)
Ii)
VMP Mortgage Solutions (800)521-7291
Ap#:0389668419
6~t>g996g€O:#d'rf
-:SI9!I!UI
.IBOWI mz.1D
toOtLO coo~ w.o, e91"l aIUU9,
tono 59 WJO~ oeV'J a!ppaJ~
t 10 Z a09d
00' t69 B9
'q sell!llq81118lol 00' 60E tEZ
00'9Et t $
$ 00' 000' OOE
IluewA8d AI4lUOW ,alol
$ 'e sless'rf lelol
$', ('o~a
s9np Uo!un 9Je:J PI!4:J) 9suadx3 p9~eI9l:!-qor
9:JueU9~U!eL^J 9~eJed9
(9Z!lU911) SI9SS\f J9410
'au '100
S4~UOL^J/1U9UJAed $
~B.qS ~OT;~BAQ mo~~
AuedUJo:) JO SS9Jppe pue 9UJeN
EEtOtOO'l:t
'au '100
(le9A pue 9~elU) paUMO S91!qOUJOln'it
(lu9UJ91els lel:JueulI 4:Jelle)
P9UMO (S9)SS9ulsnq 10 41JOM 19N
punJ lU9UJ9J!19J U! IS9J9lUI P9~S9^
00'6tL'Ot
00'B6
OO'OOO'OOE
(p9UMO 9~e~S9 le9J 10 91np94os UJOJI
9nle^ ~9~JeUJ J9~ual P9UMO 9~e~S9 le9l:!
SlesS'rf Plnb!1 (elolqns
$ :~unOlUe 9:JB:!
9n1B^ 4se:J lau a:Juemsu! alll
OO'tZE't
9
,
OO'Ott
SJ.H:):&:H
$ S4~UOL^JnuaUJAed $
AUBdUJo:) 10 ssaJppe pUB 9UJeN
LtEB6ZZtLtU
'au 'Ioo\,
TS
00'06S'E 00' tL Y N ~NYQ YSn J.S'l:tI~
S41UOL^J/~ualUAed $ AuedUJo:) 10 SS9JppB pUB aUJBN
~OESB90S
'ou'IOO\l
LE
OO'EtS'~ 00' ZZT NOJ.-NOa: :&:HJ.
s4IUOL^J!1U9UJAed $ AuedUJo:) JO SSlJppB pue 9UJBN
S6Z6000SS0Et
'OU "1:1:;)
OS
00' ESt' Et 00'E9Z :):) J.:!:!'I.zt
s41UOL^J/luaUJAed $ AuedUJo:) JO SS9Jppe pue 9UJeN
6Zt9Zt
'OU "1:>::'J'f
tL
OO'O~B'St OO'ZZZ 'l:t:!lHV YNaN
$ S4~UOL^J/~uaUJAed $ AuedUJoJ JO SS9Jppe pue 9UJeN
OOSBtEStZS
'OU'IOO
IUOI~dlJ:JSBp 'lI
$ J9qlUnU/9lUeu AuedUJoJ) spUOS 'Ii s~:JO~S
'OU '13::1
UO!Un l!paJ:) JO 'l'llS '~uee 10 SSBJppe pue 9lUeN
$
'OU '1~:)
UO!Un ~!P9J;) JO 'l'llS '~uee 10 SsaJppe pue 9UJeN
$
'OU'IOO\l
UOlUn ~!P9JJ JO 'l'llS '~uee 10 ssaJppe pue 9lUeN
$
'OU'lO::l
00'Z5S'6t
Lt
OO'OZt
aJ.s :)QSH
UO!Un ~!P9JJ JO 'l'llS '~uee 10 SS9Jppe pue alUeN
MOleq IlUnO:l:le s6UIA8S PU8 6uPI:l1I4:1 lll1
a:lUe18S Pledun
$ S4~UOL^J/luaUJAed $
Aed Ol U91 S4lUOW
'l1lUew,{8d Al4luoW
AUBdUJoJ 10 SS9Jppe pue 9UJeN
S31l111S'rf11
'AU9do,d 109!qns a4110 6U!OU9Ulle, uodn '0 peUMO
al91se 19aJ 10 al9S uodn pe!!SlleS eq II'M 40!4M Sa!l!i'qell as041 (,I Aq aleolPUI 'A.9sse09U J! 'la94S UO!19nUI~UOO BSn
'Ole 'S90pald ~OOIS 'I,oddns PI'40 'AuoWlle 'SU90I 9191S9 lea. 'slunoooe 96.940 6ul^IMe. 'su901 el'qowoln9 6ulpnlOU!
'slqep OUIPuelslno 119 JO! Jaqwnu lun0009 PU9 SseJppe 'eweu S"ol!paJO 941 Isn "IBIIII pe6peld pUI .e!llllqll1
AllU!Or ~ONc::J A'~UlorDP9~9IdlUOJ
'Osle Bsnods ~e41 ~noqe p9~9IdlUO:J 9q ~snUJ S91np94:JS flU!~Joddns pue ~uaUJa~eIS S!4~ '9snods e ~noqe pa~9IdlUO:J seM UO!~:Jas JaMOJJOe-o:) a4~
II 'pa'!nbaJ aJe S91np94:JS pue S~U9UJ9~e~s 9~eJed9S 9S!MJ94~O :s!seq P9U!qUJOO B UO P9lU9S9Jd AfJ!BJ pue Allnlflu!Ue9lU 9q ue:J IUBlU9~e~s a4~ le41 OS P9U!0! AI~U9!:J!jjnS
aJe S9!~!I!qe!l pue sl9sse J!a4~ II SJ9MOJJOa-o:) p9!JJeUJun pue p9!JJeUJ 410q Aq AI~U!O! pa~9IdUJo:J 9q ABUJ S91np94:JS BU!~Joddns 9IqB:J!lddB AUB pUB lU9UJ9IB~S SI41
9n18^
l811JeW JO 41eO
:Aq PIB4 9se40md pJeMO~ ~!SOdBP 4Se;)
UO!ldlJ:JSBa
Sl3SS'rf
OO'OOB'Ot
OO'OOO'Bt
XJ.I'l:tn:):!S 'IYI:)OS
NOISN:!d
a
a
~UnOlU'it AI4~UOL^J
'UIO\'lul 6UIAldB. .01 P..epl'uOO II eAeu 01 "0040 IOU seop (:)1 .e",ouolI-OO .0
ISI 19MOJlOS eulll pele'^B. 'q IOU peeu ewooll! eoueU'lulew ele.edes .0 'I.oddnt PII40 . AUOWIIII :80IION 8WUOUI '8410 eq!.o.ea
;)/8
"sJueweJ8J. l.fOu.UI~ pu. .u"nte" XlrJ .. lfDn. llOJ,-w..uewnnop IIIUOIHPr_ epfA,od at pe':ir.~3.t C~l ),aw (U)".MO.'uQti pdAOldW3 Jles .
8E'ZOE
'.-$ 06-~-66t _.
18lOl 00' OOB 8Z
:J9410
$ 00.00B'8Z
,elol
00'99t
OO'EE
sana 'USsv J9UM09UJOH
9:JUBmsul 9flefluoL^J
S9xe1 9~e~s3 leal:!
9:JuemSUI pJBZBH
(!'lIdl flu!:Jueu!~ J94~O
II'lId) aflefl~JoL^J ~SJ!::l
00'OOB'8Z
OO'OOB'BZ
(MOleq :ewooul 'a410
aqposap.. U! BOq.OU 841 aas
'6ullaldwoo aJo/aol JB410
aUJo:JullelUal:! ~9N
ISaJa~UI/SPU9P!^'a
SUO!SSllUUJOJ
sBsnu08
aUJ11J9^0
,alUO:Jul '!dlU3 Bsee
.' :,--",~:"~".~71'*""?"'~':''''l',-~~~_..".._.,..~.,."->.-.~--.-_"....,,,
,,"". '"c:,~L,,:v"'i";,.........._.,:jIC""i"'.'"
Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet.)
,- ~.
P'op7."Y ^dd,... I'nte, 5 If ,old, "5 if pending oala Typa of Pra...m ,~ Amoum of Gross
or A if rental being held for incomel Property Market Velue Mortgages & Liens Aental Income
460 DaEN~TER RD
CAMP HILL, PA 17011
Mortgage
Payments
Insurance, Net
Maintenance, Rentallncome
Taxes & Misc.
1-FA $
300,000 $
$
$
$
$ $
an account number s :
Account Number
a. Purchase price $
b. Alterations, improvements, repairs
c. Land (if acquired separately)
d. Refinance (incl. debts to be paid off)
e. Estimated prepaid items
f. Estimated closing costs
PMI, MIP, Funding Fee
h. Discount (if Borrower will pey)
I. Total costs (add items a throu
j.
k. Borrower's closin costs paid by Seller
I. Other Credits (explain)
If you anSWer "Ves" to any questions a through I, please
use continuation sheet for explanation.
Borrower
Co.B.mower
Ves No
e. Are there any outstanding judgments against you?
b. Have you been declared bankrupt within the past 7 years?
c. Have you had property foraclosed upon or given title or deed in
lieu thereof in the last 7 years?
d. Are you a party to a lawsuit?
e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure,
transfer of title in lieu of foreclosure, or judgment? (This would include such loans as home
mortgage loans, SBA loans, homa improvement loans, educational loans, manufactured
(mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee. If "Yes,"
provide details, including date, name and address of Lender, FHA
or VA case number, if any, and reasons for the action.) 0 wOO
Ve. No
OGJDD
OGJOD
DGJDD
OGJDO
f.
m. Loan amount
(exclude PMI, MIP, Funding Fee financed)
n. PMI, MIP, Funding Fae financed
o. Loan amount (edd m & n)
p. Cash from/to Borrower
Isubtract j, k, I & 0 from i)
I.
Are you presently delinquent or In default on any Federal debt or
any other loan, mortgage, financial obligation, bond, or loan
guarantae? If "Yas," give details as described in the preceding 0 r-1 0 0
quastlon. LX..J
g. Are you obligated to pay alimony, child support, or separate D r-l 0 D
maintenance? LX..]
h. Is any part of the down payment borrowed? D GJ D D
Are ~~ CO-~k~ o~ndorser~n ~ note~ _ _ _ _ __ 0 GJ 0 0
j. Are you a U.S. citizen? GJ D D 0
k. Are you a permanent resident alien? 0 GJ 0 0
GJDOD
DGJDD
i.
51 000.00
Do yoU Intend to occupy the property as your primary
residence? If "Yes," complete question m below.
m. Heve you had an ownership interest in a property in the last
three years?
(1) What type of property did you own - - principal residence
(PRl, second home (SHl, or investment property (IP)?
(2) How did you hold title to the home - - solely by yourself (5),
jOintly with your spouse (SPl, or jointly with enother person
(a)?
51 000.00
(51,000.00)
Each of the undersigned specifically represents to Lender and to Lender's actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors
and assigns and agrees and acknowledges that: (1) the information provided in this application is true and correct as of the date set forth opposite my signature and
that any intentional or negligent misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to any
person who may suffer any loss due to reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, but not limited
to, fine or imprisonment or both under the provisions of Title 18, United States Code, Sec. 1001, et seq.; (2) the loan requested pursuant to this application (the
"Loan") will be secured by a mortgage or deed of trust on the property described herein; (3) the property will not be used for any illegal or prohibited purpose or use;
(4) all statements made in this application ere made for the purposa of obtaining a residential mortgage loan; (5) the property will be occupied as indicated herein; (6)
any owner or servicer of the Loan may verify or reverify any informetion contained in the application from any source named in this application, and Lender, its
successors or assigns may retain tha original and/or an electronic record of this application, even if the Loan is not approved; (7) the Lender and its agents, brokers,
insurers, servicers, successors and assigns may continuously rely on the information contained in the application, and I am obligated to amend and/or supplement the
information provicjed in this application If any of the material facts that I have represented herein should change prior to closing of the Loan; (8) in the event that my
payments on the Loan become delinquent, the owner or servicer of the Loan may, in addition to any other rights and remedies that it may have relating to such
delinquency, report my name and account information to one or more consumer credit reporting agencies; (9) OwnerShip of the Loan and/or administration of the Loan
account may be transferred with such notice as may be required by law; (10) neither Lender nor its agents, brOkars, Insurers, servicers, 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 of this application containing a facsimile of my signature, shall be as effective, enforceable and valid as if a paper version of
this application were delivered containing my original written signature.
Borrower's Signature Date Co-Borrower's Signature Date
x
x
The following information is requasted by the Federal Governmant for certain types of loans related to a dwelling in order to monitor the lender's 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 law
provides that a lender may disqriminate neither on tha basis of this information, nor 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
required to note the information on the basis of visual observation or surname. If you do not wish to furnish the information, please check the box below. (Lender
must review the above material to assure that the disclosures satiSfy all requirements to which the lender is subject under applicable state law for the particular type
of loan applied for.)
BORROWER W, do not wish to furnish this information.
Ethn city: Hispanic or Latino DNot Hispanic or Latino
Race' m.."cinTriO'an or 0 Dllllck or
. Alaska Native Asian African American
Native Hawaiian or 0
Other Plcific 1"lnder White
CO.BORROWER
Ethnlc/ty:
Race:
Femlle
To be Completed by Interviewer
This application was taken by:
DFace-to.face interview
OMail
WTelePhone
D,nternet
Male
Interviewer's Name (print or type)
ex:
0, do not wish to furnish this information.
o His anie or Latino 0 Not Hispanic or Latino
O moncan n Ian or 0 0 ac or
Alaska Native Asian African American
DNative Hawaiian or 0
Other Pacific Isl.nder White
DFemale OMaie
Name and Address of Interviewer's Employer
ex:
RACHAEL LIEBEL (R745293)
Interviewer's Signature
02/02/2004
Date
HSBC Mortgage Corporation
2929 WALIlEN AVENUE
IlEPEW, NY 14043--260
(USA)
Interviewer's Phone Number (incl. erea Code)
800-975-4722
G-21U (0308)
<Il
Page 3 of 4
Freddie Mae Form 65 01104
Fannie Mae Form t003 Ot/04
Ap#:0389668419
6~tB996B~O:#d'r/
,-'
vOIlO ~OO l wJO:/ eeV>j e!uue:/
vOllO 99 WJO,j oeV\! e!ppeJ,j
v jO V e6ed
, :IBOC:Olmz-b
x
x
e,eo
:aJn,eu5!s S,JaMOJJOa-oJ
e,eo
:aJn,elJ6IS S,JaMOJJOa
'bas ,a 'lOO L UO!lOeS 'apoJ sa,e,s pa,lun 'SL al'!1 )0 SUO!sIMJd alj, Japun alqeolldde se
s,oe) aMqe alj, jO ALJe 6uIUJaolJOO Sl\.J9lJJa,e,s aSle) Aue a~elJJ AI6u!MOlJ~ 0, 'lj,oq JO 'l\.J9lJJUospdlJJ! JO au!) Aq alqeljs!und elJJpo leJapa,j e 51 ,I ,ell' pue,sJapun Allnj 9MII
-===--=-----
00'6H'Ol$
00'S6$
Stll~OoL
00'9L~'6$
~65 00'91$
t6~19ES109E09~099
X3WV g
L5L6105661
A:3:NN:[d ::JJ:' Nf)ErW g
00'~9$
9 00' 0'[$
L1EL~~0-9E~EYL~::J
'!IEiOHNOXX:!l Ei
00'9~~$
n 00' O~$
6SLOE06565-
f)g::J::JN/d::JJ:' g
OO'ESL$
~~ OO'~E$
BOll~9~-Bl01V6f)::J
an'!:l SNVS a
eOUlltllg
SON ~llId Attt~uON
~eqwnN ~unooov :lVd
~o~;pe~:l ;:r;:rog
:JaqlJJnN 9seJ JepUa1
:J9MOJJOa-oJ
>l:!lSVJ:' 'J:' l:I:!loLS:!lH::J
'J9MOJJOS-OJ JOj ~ JO JaMOJJOS
JO) 8 ~JeV\l 'uo"eo!ldd\;f
ue01Ie!,uaplsa~ alj, a,8ldlJJoo
0, aoeds aJOlJJp88U noA
jl laalls UOllenUIl\.JOQ SI41 esn
:J8qlJJnN aseJ AOuafl\;f
:JaMOJJOa
UO!~eO!ldd" ueol le!~Uap!Sal:l/~aa4S UO!~enU!~UO~