HomeMy WebLinkAbout10-3202BELOO COMMUNITY CREDIT UNION .
Plaintiff .
vs. .
CHARLES L. LAPENTA
AUTUMN A. LAPENTA
Defendants
COURT OF COMMONS PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
No .. ~ p - 3apa l,.~iv i 1 T+E1 h~
CIVIL ACTION - LAW
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N O T I C E
YOU HAVE BEEN SUED IN COURT. If you wish to defend against
the claims set forth in the following pages, you must take action
within twenty (20) days after this Complaint and Notice are
served, by entering a written appearance personally or by attorney
and filing in writing with the Court your defenses or objections
to the claims set forth against you. You are warned that if you
fail to do so the case may proceed without you and a judgment may
be entered against you by the Court without further notice for any
money claimed in the Complaint or for any other claim or relief
requested by the Plaintiff. You may lose money or property or
other rights important to you.
YOU SHOULD TAKE THIS PAPER TO YOUR LAWYER AT ONCE. IF YOU DO
NOT HAVE A LAWYER, GO TO OR TELEPHONE THE OFFICE SET FORTH BELOW.
THIS OFFICE CAN PROVIDE YOU WITH INFORMATION AOUT HIRING A LAWYER.
IF YOU CANNOT AFFORD TO HIRE A LAWYER, THIS OFFICE MAY BE
ABLE TO PROVIDE YOU WITH INFORMATION ABOUT AGENCIES THAT MAY OFFER
LEGAL SERVICES TO ELIGIBLE PERSONS AT A REDUCED FEE OR NO FEE.
Legal Services, Inc.
8 Irvine Row
Carlisle, Pennsylvania 17013
(717) 243-9400
*QaOO POAITY
Gc~ 48105
e.~a~ao87
N O T I C I A
Le han demandado a usted en la Corte. Si usted quiere
defenderse de estas demandas expuestas en las paginas siguientes,
usted tiene viente (20) dias de plazo al partir
de la fecha de la demanda y la notificacion. Usted debe
presentar una apariencia escrita o en persona o por abogado y
archivar en la Corte en forma escrita sus defensas o sus
objeciones a las demandas en contra de su persona. Sea
avisado que si usted no se defiende, la Corte tomara medidas y
puede entrar una Orden contra usted sin previo aviso 0
notificacion y por cualquier queja o alivio que es pedido en la
peticion de demanda. Usted puede perder dinero o sus propiedades
0 otros derechos importantes pars usted.
LLEVE ESTA DEMANDA A UN ABODAGO INMEDIATAMENTE. SI NO TIENE
ABOGADO O SI NO TIENE EL DINERO SUFICIENTE DE PAGAR TAL SERVICIO,
VAYA EN PERSONA O LLAME POR TELEFONO A LA OFICINA CUYA DIRECCION
SE ENCUENTRA ESCRITA ABAJO PARR AVERIGUAR DONDE SE PUEDE CONSEGUIR
ASISTENCIA LEGAL.
Legal Services, Inc.
8 Irvine Row
Carlisle, Pennsylvania 17013
(717) 243-9400
BELCO COMMUNITY CREDIT UNION
Plaintiff .
CHARLES L. LAPENTA .•
AUTUMN A. LAPENTA .
Defendants
COURT OF COMMON PLEAS
CUMBERLAND COUNTY, PENNSYLVANIA
NO..
CIVIL ACTION - LAW
COMPLAINT
1. Plaintiff is Belco Community Credit Union, hereinafter
referred to as "BELCO", a Pennsylvania Corporation with an
office at 449 Eisenhower Blvd., Harrisburg, Dauphin County,
Pennsylvania 17111.
2. Charles L. Lapenta, Defendant, is an adult individual with an
address at 902 Hummel Avenue, Lemoyne, PA 17043.
3. Autumn A. Lapenta, Defendant, is an adult individual with an
address at 902 Hummel Avenue, Lemoyne, PA 17043.
4. Defendants applied for a Signature Loan from Plaintiff
pursuant to the Application dated March 24, 2009 which is
attached hereto, marked Exhibit "A" and made part hereof. The
Social social security numbers have been redacted to protect
the privacy of the Defendants.
5. Defendants' delinquent balance on this account is $9,944.35
as of April 9, 2010.
6. Because of Defendants' failure to make monthly payments and
in accordance with the Open End Credit Plan, a copy which is
attached hereto, marked Exhibit "B" and made part hereof,
Defendant owes an attorney commission of $1491.66 for a total
of $11,436.01.
7. Defendants have failed and refused to bring their account
current.
8. Defendants are not members of the Armed Forces of the United
States of America, nor engaged in any way which would bring
them within the Soldiers and Sailors Relief Act of 1940, as
amended.
WHEREFORE, Plaintiff requests entry of judgment against Defendants
in the amount of $11,436.01, plus interest together with costs of
suit thereon.
Respectfully, Submitted,
Date : 1 ~ ~ ~ 1~/1, .
Arthur M. Feld, Esquire
Attorney I.D. No. 07172
1309 Bridge Street
New Cumberland, PA 17070
(717}770-0292
Belco Community Credit union Loan Application and
449 Eisenhower Boulevard Harrisburg Area: (717) 232-3526 A reement to Terms
Harrisburg, PA 17111-2302 Lancaster Area: (717) 393-1116
To11 Free: (800) 642-4482 ~~~ ~ rr
Married Applicants may apply for a separate account. Check the appropriate box to indicate Individual Credit or Joint Credit.
^ Individual Credit: Complete Applicant sections if only the applicant's income is considered for loan approval.
Complete Applicant and Co-Applicant sections: (t) if you are relying on income from alimony, child support, or separate maintenance
or on the income or assets of another person as the basis for repayment of credit requested, or; (2) if you reside in a Community
Property State, or; (3) if you ate relying on property {ocated in a Community Property State as a basis for repayment of the credit
requested. Community Property States include: AK, AZ, CA, ID, LA, NM, NV, TX, WA, VVI.
® Joint Credit: Complete Applicant and Co-Applicant sections ifyour co-applicant will be contractually liable for repayment of the loan and initial below:
We intend to apply for joint credit. (Applicant Initials) (Co-Applicant Initials)
PLEASE CHECK BELOW TO INDfCATE THE TYPE OF ACCOUNT(S) AND TYPE OF CREDIT FOR WHICH YOU ARE APPLYWG.
^ Account/Loan: ^ Individual ~ Joint Credit Cards: Number of Cards
(Including ATNYDebit Card Access to the AccountitAvailable} ^ Visa Classic
Amount Requested $ 9,708.72 ^ Visa Gold
Purpose/Collateral:CONSOLIDATtON ^ Visa Platinum
^ Other Loan Request SEE THE PAGE 4 FOR IMPORTANT INFORMATION ABOUT CREDIT CARDS
Repayment: ~ Payroll Deduction ~ Billing Notice ^ Automatic Payment (] Web Pay ~ Other
APPLICANT ~ ^ CO-APPLICANT ^HON-APPLICANT SPOUSEtOTHER
NAME (Last -First -Initial) ACCOUNT NUMBER NAME (Last -First -Initial) ACCOUNT NUMBER
CHARLES.L LAPENTA 809360 AUTUMN A LAPENTA
cnriei cr=ra IRiTy NUMBER MOTHER'S MAIDEN NAME ^'^' cc^"R~TY NUMBER MOTHER'S MAIDEN NAME
E-MAIL ADDRESS FAX NUMBER E-MAIL ADDRESS FAX NUMBER
LAPANTZ@GMAIL.COM
BIRTH DATE HOME PHONE BUSINESS PHONE/EXT. BIRTH DATE HOME PHONE BUSINESS PHONFJEXT.
07/20/1962 717.350.4444 0612011974 717.545.4703
PRESENT ADDRESS (Street -City -State -Zip) ®OWN ^ RENT PRESENT ADDRESS (Street -City -State -Zip) ^OVJN ^ RENT
902 HUMMEL Av 902 HUMMEL Av
Lemoyne, PA 17043 YEARS/MONTHS
AT THIS ADDRESS 3 0
LEMOYNE, PA 17043 YEARS(MONTHS
AT THIS ADDRESS 3 O
PREVIOUS ADDRESS (Street -City -State -.Zip) PREVIOUS ADDRESS (Street • City -State -Zip)
LEMOYNE, PA 17043
PURCHASE PRICE OF HOME: PRESENT HOME VALUE: PURCHASE PRICE OF HOME: PRESENT HOME VALUE:
$ $ $ $
MORTGAGE BALANCE MONTHLY PAYMENT (MORTGAGE/RENT) MORTGAGE BALANCE MONTHLY PAYMENT (MORTGAGElRENT}
$ $ $ $ 0.00
PLEASE COMPLETE ONLY IF YOU ARE APPLYING FOR JOINT CREDIT, SECURED CREDIT, OR IF PLEASE COMPLETE ONLY IF YOU ARE APPLYING FOR JOINT CREDIT, SECURED CREDIT, OR IF.
YOU RESIDE IN A COMMUNITY PROPERTY STATE: YOU RESIDE IN A COMMUNITY PROPERTY STATE:
MARRIED ~ SEPARATED ~ UNMARRIED (Single -Divorced -Widowed) ^ MARRIED ^ SEPARATED ~ UNMARRIED (Single -Divorced -Widowed)
EMPLOYMENT
NAME AND ADDRESS OF EMPLOYER
UNEMPLOYED
NAME AND ADDRESS OF EMPLOYER
CENTRAL DAUPIN SCHL DISTR
HIRE DATE F'OSI I TON HIRE DATE POSITION
03/01/1998 TEACHER
PRIOR EMPLOYER PRIOR EMPLOYER
GLOBAL CONSULTANTS
INCOME
OTHER INCOME NOTICE: Alimony, child support, or separate maintenance income need not OTHER INCOME NOTICE: Alimony, child support, or separate maintenance income need not
be revealed if you do not choose to have it considered. be revealed if you do not choose to have it considered.
EMPLOYMENTINCOME(GROSS) OTHER INCOME (GROSS) EMPLOYMENT INCOME (GROSS) OTHER INCOME (GROSS)
$ 500.00 PER $ PER $ 47,205.37 PER Annual $ PER
SOURCE SOURCE
REFERENCES
NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU
NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU ~ HOME NUMBER
RELATIONSHIP I I RELATIONSHIP
WHAT YOU OWE CREDITOR NAME
(Attach additional sheet(s) if necessary) INTEREST
RATE PRESENT
BALANCE MONTHLY
PAYMENT MARKET
VALUE PAST
DUE
Rent ~ First Mortgage
(incl. Tax & Ins.)
TRANS UNION
$
$
2nd MORTGAGE $ $
AUTO LOAN $ $
CREDIT CARD $ $
CREDIT CARD $ $
CREDIT CARD $ $
OTHER $ $
OTHER $ $
OTHER $ $
LIST ANY NAMES UNDER WHICH YOUR CREDIT REFERENCES AND CREDIT HISTORY CAN BE
CHECKED:
TOTALS
TO PROTECT YOUR LOAN THROUGH VOLUNTARY GROUP CREDIT INSURANCE, REVIEW AND COMPLETE THE APPLICATION ON PAGE 3.
6000 LASER IA FI11582 Rev 2.2009 ~~ ~ page 1 Of 4 COPYRIGHT 2005 Securian Financial Grnu~ ir+~ au .~~~,~~ .e~~..•^a
STATE NOTICES
OHIO RESIDENTS ONLY: The Ohio taws against discrimination require that all creditors make credit equally available to all creditworthy customers, and that credit
reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil Rights Commission administers compliance with this law.
WISCONSIN RESIDENTS: Marital Status: ~ Married ~ Unmarried ~ Legaliy Separated
If married: the name of my spouse is Spouse's SSN:
Spouse's Address (if different)
otice: No provision of any marita grope y agreemen , unl a era s a emen un er ec Ion , or cou ecree un er ec Ion wl a verse y a ec a rig s
of the Credit Union unless the Credit Union is furnished a copy of the agreement, statement or decree, or has actual knowledge of its terms, before the credit is
granted or the account is opened.
MARRIED WISCONSIN RESIDENTS APPLYING FOR AN INDIVIDUAL ACCOUNT: By signing here, I state that the credit being applied for, if granted, will be
incurred in the interest of the marriage or family of the Borrower(s). X
LOAN APPLICATION SIGNATURES
BY SIGNING BELOW, 1 AGREE AS FOLLOWS:
All the information in this application is true. I understand that section 1014 Title 18 U.S. Code makes it a federal crime to knowingly make a false statement on
this application. You have my permission to check it. You may retain this application even if not approved. 4 understand that you may receive information from
others about my credit and you may ansvrer questions and requests from others seeking creditor experience information about me or my accounts with you.
IF MY LOAN APPLICATION IS APPROVED:
Terms and Conditions: 1 acknowledge that I have read, understand and accept the terms and conditions of the Open-end Credit Plan, Disclosures, Credit
Agreement, and Security Agreement. I also understand that I may receive an Advance Receipt, that the Advance. Receipt is a part of my credit contract, and I
should be bound by the terms of the Advance Receipt. I acknowledge that I have received copies of these documents. If I have elected to apply for voluntary
credit insurance, l acknowledge that 4 have read and understand the terms of the insurance Application and Certificate of Group Insurance; I certify that all
information given in corinection with the Application is true and complete; and I acknowledge receipt of a copy of the Application and Certificate.
I also understand that by signing or endorsing any advance proceeds checks or vouchers, or by otherwise accepting, using or accessing advance proceeds
now or in the future, I also agree to the terms of the above documents. I further understand. and acknowledge that no additional signatures shall be required
for you to enforce the terms of the above agreements, but I may be asked, and shall be required to, provide additional signatures if you deem it necessary. I
also agree Eo provide Credit Union with any and all information necessary for you to perfect your security interest in any collateral pledged in connection with
my advances, either now or in the future.
Cross-collateralization: I understand and acknowledge that any and ali cof{ateraf given in connection with any advances shall secure all amounts I owe the
credit union now and in the future. However, non-purchase-money household goods shall not secure any loan or advance, and my principle dwelling will not
secure any advance under this Open-end Plan.
On-going credit checks: I understand that you may periodically update my credit information in order to evaluate my on-going credit worthiness, without any
additional signatures, for as long as my plan is open and/or an outstanding balance exists. You may use and communicate any information gathered for any
lawful purpose in any manner allowed by law.
Credit Insurance: Voluntary Credit Insurance is available to protect your loan. If you are interested in applying for coverage please complete the Insurance
Application on page 3.
PLEDGE OF SHARES: I grant and pledge to you a consensual lien on all sums on deposit to secure my obligations to the credit union pursuant to
applicable state law. "All sums on deposit" and "shares" for purposes of this pledge means all deposits in any share savings, share draft, club, certificate,
P.O.D., revocable trust or custodial accounts(s), whether jointly or individually held, that you have on deposit now or in the future, all of which are deemed
"general deposits" for the purpose of this pledge. My pledge does not include any IRA, Keogh, tax escrow, irrevocable trust or fiduciary account in which I do
not have vested ownership interest. In addition, I acknowledge and agree to impressment of the Credit Union's statutory lien rights under the Federal Credit
Union Act as of the date I opened my credit plan, which gives you the right to apply the sums in my account(s), to satisfy any obligations I owe to the credit
union, regardless of contributions at the time of default, and without further notice to me or any owner of the account(s).
SECURITY INTEREST AND LIEN ON ACCOUNT(S). (1) By signing the Master Application, or by accessing, using, or otherwise accepting any funds,
accounts or services, I grant the Credit Union a security interest in all goods, property, or other items purchased under this Plan either now or in
the future, or in any other collateral given now or at the time of any future advance, or given at any other time in connection with the Open-end
Plan, in accordance with my Security Agreement. I also agree to abide by the terms of the Security Agreement and any Advance Receipt or
similar document.
(2) By signing the Master Application andfor Account Card, or by accessing, using, or otherwise accepting any funds, accounts or services, 1 grant the credit
union, and you impress, a lien on any and all funds in any joint and individual share account(s), regardless of the source of the funds in the account(s) or
any owner's contributions, to secure any account owner's joint or individua{ obligations to you, now or in the future, whether direct, indirect, contingent or
secondary. This lien secures all debts I owe you pursuant to any loan or credit agreements; under this Open-end Credit Plan; arising from any insufficient
funds item; fees; costs, expenses; or otherwise. I understand and agree that the Credit Union has multiple rights which include a "consensual lien" a
"statutory lien" pursuant to 12 USC 1757 and 12 CFR 701.39, applicable state law and your "common law" right to set off, which authorize you to apply the
funds in any joint or individual account to any obligations owed to you if I default or fail to pay or satisfy any obligation to you without any legal process, court
proceeding or any notice to any owner of the account(s) affected hereunder or otherwise under this Agreement. I specifically agree that you have a right
to place an administrative freeze on any of my joint or individual account(s) and that such action shall not violate 11 USC 362 or other applicable
law. I agree that my account(s) are not assignable or transferable except to the Credit Union unless specifically authorized in writing by you. Obligations
secured by my primary residence, household goods and any funds in an IRA or Keogh account are not included in your lien or this security interest, unless
subject to specific pledge or security agreement. The Credit Union will not have any responsibility or liability to me or others relating to the dishonor or other
return of any check, draft, ACH transaction or other order occurring as a result of you exercising your lien rights or freezing any accounts in order to protect or
preserve such rights.
If I purchase voluntary credit insurance or other products in connection with this loan, I understand that a portion of the premium or fee I pay will be retained by
the credit union (or paid back to the credit union by the service provider) as compensation for making these services available to me.
Negative Information Notice: You may report information about my account to credit bureaus. Late payments, missed payments, or other defaults
on my account may be reflected in my credit report.
IMPORTANT NOTICE ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT
To heap the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record
information that identifies each person who opens an account. What this means for me: When I open an account, you will ask for my name, address, date of
birth, and other information that will allow you to identify me. You may also ask to see my driver's license or other identifying information.
SIGNATURE OF APPLICANT DATE SIGNATURE OF CO-APPLICANT DATE
X 03/24!2009 ~( 03/2412009
HAVE YOU OMITTED ANYTHING? REMEMBER: INCOMPLETE APPLICATIONS CANNOT BE PROCESSED.
TO PROTECT YOUR LOAN THROUGH VOLUNTARY GROUP CREDIT INSURANCE, REVIEW AND COMPLETE THE APPLICATION ON PAGE 3.
6000 LASER IA FIt1582 Rev 2-2009 ~ r/ ~ page 2 of 4 CGPYRIGHT 2005 Securian Financial C;rnun ~~~ au .~,.r.r~ .o~o~.=.+
CREDIT INSURANCE IS VOLUNTARY AND IS NOT REQUIRED TO OBTAIN YOUR LOAN
YOUR COVERAGE TERMINATES WHEN YOU REACH AGE 70 FOR CREDIT LIFE INSURANCE AND AGE 66 FOR CREDIT
DISABILITY INSURANCE.
APPLICATION FOR GROUP CREDIT INSURANCE
Minnesota Life Insurance Company, 400 Robert Street North, St. Paul, MN 55101-2098
CREDIT LIFE INSURANCE CREDIT DISABILITY INSURANCE
GROUP POLICY NUMBER INSURANCE MAXIMUM GROUP POLICY NUMBER MAXIMUM MONTHLY DISABILITY EENEFIT MAXIMUM LOAN REPAYMENT PERIOD
33029-G-500 $50,000 33030-G-500 NA NA
MAXIMUM LOAN REPAYMENT PERIOD MAX. AGGREGATE DISABILITY BENEFIT WAITING PERIOD RETROACTIVE BENEFIT
NA NA 14 Days No
I (we) are applying for the credit insurance coverages} selected below and agree to pay the required premium. I (we)
understand that fees may be paid by the insurer in connection with this coverage to the Creditor. I (we) understand that the
purchase of this insurance is voluntary and not required in order to obtain credit, and that I (we} may terminate it at any time.
I (we) understand that if joint life insurance is selected, we must be jointly and individually liable under the loan, and that
co-signers and guarantors are not eligible for insurance.
The following questions, 1 and 2, must be answered to determine my (our) eligibility for insurance:
APPLICANT CO-APPLICANT
YES No YES No 1. (Applicable to life insurance coverage only) Are you under age 66 on this date?
^ ^ ^ ^ 2. {Applicable to disability coverage only) Are you under age 66 on this date AND
^ ^ ^ ^ are you presently working outside your home for wages or profit for 30 hours or
more per week and have been so working for 30 days or more before this date?
In additi , i o to xc $1, o uestion st o a er or r {igibility.
^ - i the st two ye e u m i y vi o ea for:
c he attack or a e e, e, is r A uired
Iciency Sy m I
My (our) answers to the above questions are true to the best of my (our) knowledge and belief. If my co-applicant or I answer
"No" to questions 1 or 2, we understand that that person is not eligible for insurance and wilt not be insured. ~Ear~4
.. .r
The effective date of my (our) insurance will be the date of this application.
Any person who knowingly and with intent to defraud any insurance company or other person-files an application for
insurance or statement of claim containing any materially false information or conceals for the purpose of
misleading, information concerning any fact material thereto commits a fraudulent insurance act, which is a crime
and subjects such person to criminal and civil penalties.
Do not sign this application if any applicable spaces are blank. This application will not be used in a contest if all
applicable blank spaces have not been completed, the debtor has not signed and dated the application and if the
application has not been witnessed.
THIS INSURANCE CONTAINS LIMITATIONS/EXCLUSIONS PERTAINING TO BENEFITS PAYABLE.
COVERAGE REQUESTED ('MONTHLY PREMIUM PER $100.00 OF OUTSTANDING LOAN BALANCE.)
^ Yes ®No Single Life 6.2¢' ^ Yes ®No Joint Life 10.8¢` ^ Yes ®No Credit Disability sEtOW
X 03/24!2009 ~ ' X 03!24!2009 I
No. of Equal Monthly Premium No. of Equal Monthly Premium No. of Equal Monthly Premium No, of Equal Moirthly Premium - No. of Equal Monthly Premium
Monthly 4nstallments Rate' Mon[hly Installments Rate' Monthly Installments Rate' Monthly Installments Rate' Monthly Installments Rate•
8 35.7¢ 56 13.2¢ 104 9.8¢ 152 8.5¢ 200 7.8¢
16 25.8¢ 64 12.4¢ 112 9.6¢ 160 8.4¢ 208 7.8¢
24 20.8¢ 72 11.6¢ 120 9.3¢ 168 8.3¢ 216 7.7¢
32 17.7¢ 80 11.1¢ 128 9.0¢ 176 8.1¢ 224 7.7¢
40 15.7¢ 88 10.6¢ 136 8.8¢ 184 8.0¢ 232 7.6¢
48 14.3¢ 96 10.2¢ 144 8.6¢ 192 7.9¢ 240 7.6¢
MHC-98-4567.37 A 7-2002
~x A
finM ~ ASFR lA FN1582 Rev 2-2009 Wane 3 of 4 COPYRIGHT 2005 Securian Financial Groun Inc Au rlnnrt ,P~o~.~>.+
IMPORTANT CREDIT CARD DISCLOSURE
The following disclosure represents important details concerning Your Credit Card. The information about costs of the Card is accurate as of
03/24/2009 You can call or write us at the telephone number or address shown herein to inquire if any changes occurred since the effective
date.
VISA Classic VISA Gotd VISA Platinum
Annual Percentage Rate (APR) for ~ 2
99p/
7 7 ° ~ 0
99°/
° 9
890/
0
Purchases . . .
^ If checked, the following ^ If checked, the following ^ If checked, the following
applies to Purchases: applies to Purchases: applies to Purchases:
Promo Rate until % Promo Rate until % Promo Rate until
after that ,after that ,after that
12.99% 10.99% 9.99%
Other APRs Cash Advance APR: 12.99°~ Cash Advance APR: 10.99°~ Cash Advance APR: 9.99°,6
Balance Transfer APR: 12.99°~ Balance Transfer APR: 10.99°~ Balance Transfer APR: 9.99°~6
Penalty Rate: If you fail to timely Penalty Rate: If you fail to timely Penalty Rate: If you fail to timely
make any payment due during the make any payment due during the make any payment due during the
promotional period your APR will promotional period your APR will promotional period your APR will
increase to the standard rate increase to the standard rate increase to the stahdard rate
disclosed above. disclosed above. disclosed above.
^ If checked, the following ^ If checked, the following ^ If checked, the following
applies to Cash Advances applies to Gash Advances applies to Cash Advances
and Balance Transfers: and Balance Transfers: and Balance Transfers:
°~i Promo Rate until °,6 Promo Rate until °k Promo Rate until
after that ,after that ,after that
12.99% 10.99% 9.99°,6
Variable-rate Information N/A
Grace Period for Purchases 25 Days from statement of closing date for repayment of purchases to
avoid finance charges.
Method of Computing the Balance for
Purchases Average Daily Balance (including new purchases).
Annual Fees None
Minimum Finance Charge None
Foreign Transaction Fee: A fee of 1 % of the transaction amount will be charged in U.S. dollars for all foreign transactions including
purchases, cash advances, and credits to your account.
Transaction Fee for Purchases: None
Over-the-Limit Fee: None
Late Payment Fee: $30.00
Return Check Fee: $30.00
Card Replacement Fee: $2.50
Document Copy Fee: You will be charged $6.00 for each copy of a sales draft and $2.00 per page for a statement that you request (except
when the request is made in connection with a billing error made by the credit union).
Rush Fee: $45.00 per card.
~X./~
8000 LASER IA FI11582 Rev 2-2009 oaae 4 of 4 COPYRIGHT 2005 Securian Financial Group, Inc. All rights reser+ed.
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Belco Community Credit Unian
403 N. 2nd Street Harrisburg Area: (717) 232-3526
P.O. Box 82 Lancaster Area: (717) 393-1116
Harrisburg, PA 17108 ToII Free: (800) 642-4482
BORROWER 1 NAME MEMBER ACCOUNT NUMBER DATE
CHARLES L LAPENTA 809360L2 03!30/2009
AUTUMN A LAPENTA
SECURITY INFORMATION
THE ADVANCE IS SECURED BY YOUR SHARES, ALL PROPERTY SECURING OTHER PLAN ADVANCES AND LOANS RECEIVED IN THE PAST OR 1N THE FUTURE, AND THE
FOLLOWWG:
SHARES ACCOUNT NUMBER AMOUNT ACCOUNT NUMBER AMOUNT
PLEDGED: $ $
MOTOR YEAR MAKE MODEL BODY TYPE SERIAL or VIN NUMBER
VEHICLE:
OTHER
COLLATERAL:
OTHER
COLLATERAL:
SUBSEQUENT ELECTION FOR VOLUNTARY CREDIT INSURANCE (SEPARATE APPLICATION REQUIRED)
A Borrower (and Co-Borrower for Joint Life only) may voluntarily elect to become insured for Credit Life or Disability that the Borrower originally rejected or was
not available at the time the Credit Plan Agreement was signed. An application for Group Credit Insurance and eligibility must be completed and signed by the
borrower(s). This subsequent election will apply to all future sub-accounts opened under the Credit Plan Agreement, unless a Credit Insurance Waiver is
requested and signed by the borrower for a specific subaccount.
YOU ELECT THE FOLLOWING: COST PER $100 OF YOUR MONTHLY LOAN BALANCE: NAME OF INSURED(S):
Single Credit Disability SEE SEPARATE RATE SCHEDULE
Single Credit Life $.062
Joint Credit Life $.108
® CREDIT INSURANCE WAIVER
By signing below you elect not to be insured for: ®Single Credit Life ®Joint Credit Life ® Credit Disability insurance on your Loan subaccount
No. 8093SOL2 effective 03/30/2009 (date). You understand that all other Subaccounts that were initially covered under the Credit
Agreement you signed on (date) will continue to be covered, unless you have signed a similar statement.
CREDIT INFORMATION
DAILY PERIODIC RATE gNNUAL PERCENTAGE RATE INTEREST RATE IS: MARGIN NEW BALANCE THIS SUBACCOUN7
0.049315 0~ 18.00 0~ 18.00 0~ $ 9,708.72
AMOUNT ADVANCED PAYMENT AMOUNT DUE DATE PAYMENT FREQUENCY LINE OF CREDIT LIMIT REMAINING LIMIT
$ 9,708.72 $ 246.69 04!30/2009 Monthly $
OTHER FEES (Amount and Description) GAP (a portion will be CPI
retained by us)
$ $ $ 0.00
SIGNATURES
OPEN-END CREDIT PLAN
ADVANCE RECEIPT
By accepting, using, or accessing the advance proceeds outlined above, Borrower agrees to abide by the terms of the Credit Agreement and GRANTS TO
THE CREDIT UNION A SECURITY INTEREST IN THE PROPERTY DESCRIBED ABOVE. This pledge of security is governed by the Security Agreement
that Borrower entered into when the Open-end Plan was opened. Property given as security for this loan or for any other loan will secure all amounts I owe the
credit union now and in the future. This includes a security interest in all my shares in the credit union. However, for purposes of this advance, the credit union
specifically waives any security interest it may have in my dwelling as explained in the Security Agreement. Non-purchase money household-goods will not
secure future advances.
Negative Information Notice: You may report information about my account to credit bureaus. Late payments, missed payments, or other defaults
on my account maybe reflected in my credit report.
BORROWER'S SIGNATURE DATE CO-BORROWER'S SIGNATURE DATE
)( 03/30!2009 X 03/30/2009
REQUESTED:
FOR CREDIT UNION USE ONLY
MEMBER PAYS PREMIUM FOR: I CHECK NUMBER: I PLAN/SUBACGOUNT NO.: I BRANCH NUMBER: I PROCESSED BY:
DATE LOAN OFFICER COMMENTS: LOAN OFFICER INITIALS
PIO and close L14 and L1
~~,
6400 LASER IA FI11583 Rev 2-2009
Copyright 2005 Securian Financial Group, Inc. All rights reserved.
Belco Community Credit Union
403 N. 2nd Street
Harrisburg Area: (717) 232-3526 OPEN-END CREDIT PLAN,
P.O. Box 82
Lancaster Area: (717) 393-1 t 16 DISCLOSURES, CREDIT AGREEMENT,
Harrisburg, PA 17108
To11 Free: (800) 642-4482 AND SECURITY AGREEMENT
ACCOUNT NUMBER
809360
BORROWER'S NAME AND ADDRESS 902 RUNNEL AV DATE OF BIRTH
CHARLES L LAPENTA Lemoyne, PA 17043 07!20/1962
CO-BORROWER'S NAME AND ADDRESS 902 RUNNEL AV DATE OF BIRTH
AUTUMN A LAPENTA LEMOI(NE, PA 17043 06/20/1974
AN OPEN-END CREDIT PLAN FROM YOUR CREDIT UNION
This Open-end Credit Plan is a quick and convenient way for you to obtain a loan when you need it. This is an open-end, multi-featured credit plan. We
anticipate that you will borrow money (called "advances") from time to time under the Plan. Several types of credit, called "subaccounts", are available under
the Plan. Finance charges will accrue for any outstanding balance on the plan. We may, but do not have to, set credit limits on certain subaccounts or on the
entire plan as a whole. The amount of credit available against any credit limit may vary in accordance with the payments you make against your outstanding
balance. When you signed your credit application, you agreed to the terms and conditions of the Open-end Plan, Credit Agreement, Security
Agreement, Rates and Fees Addehdum, Advance Receipt, and any similar document in connection with your Plan. Future advances will be
governed by these terms even without your future signature. However, we may require you to sign further documentation in order to protect the
Credit Union's security interests or for other appropriate purposes. Advances may be applied for by telephone, email, Internet, fax, mail or in person.
MEMBER'S DISCLOSURE STATEMENT
HOW TO COMPUTE THE FINANCE CHARGE: The Finance Charge is the total cost to you of obtaining credit through this credit plan. The Finance Charge
begins to accrue on the date of each advance and accrues for each day the balance remains unpaid. The unpaid balance for each day is multiplied by the
daily periodic rate to determine the Finance Charge for that day. The sum of these daily charges is the Finance Charge you will pay. The unpaid principal
balance is that balance which is in your account at the close of business after all transactions, including payments and new borrowings, have been entered.
[~] Share or CD Secured Variable Rate: If this is a share or CD secured loan, the Annual Percentage Rate may increase or decrease during the term of this
Transaction if the share or CD rate increases or decreases. Your initial rate will be the share or CD rate plus a margin of 2% and will vary thereafter as
described herein. An increase or decrease will take effect quarterly on the first of January, April, July, and October following a change in the share or CD rate.
The interest rate will not increase above the maximum rate allowed by law. Any increase will take the form of more payments of the same amount.
Security Interest: Collateral is required for all advances. The credit union will take a security interest in all your shares and deposits in the credit union,
including future additions, as security for advances under this plan. Additionally, the credit union will take a security interest in the property purchased with the
advance or in property identified in the Advance/Revolving Request form or other security agreement for each secured advance under this plan. Property
given as security for any other loan-held by the credit union will also secure all amounts you owe under this plan (see Security Agreement on page 4).
Property Insurance: You are required to carry insurance against loss by fire, theft, or collision and comprehensive coverage on motor vehicles and other
property pledged as security on your loan. The insurance may be obtained by any insurance broker of your choice. The insurer waives all rights of
subrogation agaihst the consumer. If you do not obtain property insurance, the credit union will provide it for you, at your expense.
Late Charge: if a payment is 30 days late, you will be charged 5% of the payment due
CreditlDebit Cards: The Credit Union will issue you debit cards, loan drafts, or credit cards (including, but not limited to drafts, cards, plates, coupon books,
debit cards or other consumer credit devices) if they are now or in the future made part of your open-end credit plan.
Overdraft Protection: If you request Overdraft Protection, any overdrafts on your share draft account will be charged against your Personal line of credit and
will be subject to the Finance Charge applicable to your Personal line of Credit.
CREDIT PLAN RATES & FEES
See separate Open-end Credit Plan Rates & Fees Addendum for Type of Transactions, Credit Plan Rates, and Fees that will apply to your Plan
~X. g
NOTICE: SEE ATTACHED NOTICE FOR IMPORTANT INFORMATION REGARDING YOUR RIGHTS TO DISPUTE BILLING ERRORS.
6301 LASER IA F60646 Rev. 12-2005 page 1 Of 8 COPYRIGHT 2005 Securian Financial Group, Inc. All rights reserved.
BORROWER'S NAME ACCOUNT NUMBER
CHARLES L LAPENTA 09360
~~- ~• --- rn~, m~ HIVIJ MINC'- WILL MtAN ArvY PERSON WHO EXECUTES THE OPEN-END CREDIT PLAN BY SIGNING THE MASTER
APPLICATION, OR ANY ADVANCE/REVOLVfNG REQUEST OR SIMILAR DOCUMENT, OR ANY PERSON WHO ENDORSES P, PROCEEDS CHECK OR OTHERWISE ACCEPTS,
ACCESSES, OR USES PLAN FUNDS IN ANY WAY. 7HE WORDS "YOU," "YOUR" AND "YOURS" MEAN THE CREDIT UNION.
CREDIT AGREEMENT
Agreement to Terms: By signing the Master Application, and/or by
accepting, using, or accessing any proceeds under this plan, I agree to the
terms and conditions of the Open-end Credit Plan, Disclosures, Credit
Agreement, and Security Agreement, and any and ail Advance Receipts, and
any future amendments thereto, and promise to pay you all amounts due.
Advances, Credit Limits, Plan Access, and Periodic Statements: 1 may
apply for advances under this Plan in any manner allowed by the Credit
Union, including telephone, e-mail, internet, fax, mail or in person. You
reserve the right to refuse to make an advance without affecting the liability of
any co-borrower. Advances will at no time exceed any credit limits as set
forth in the laan policy of the credit union. if an advance is approved, you
may issue a prbceeds check or draft to me; or deposit advance proceeds
into my share account or share draft account; or issue to me credit cards or
ATM/Debit cards in order to directly access my Plan and obtain advances. I
will receive a periodic statement describing the activity oh my Plan during the
applicable billing cycle.
Liability for Unauthorized Use: If I use an ATM/Debit card to access my
plan, I may be liable for the unauthorized use of the card. I must tell the
Credit Union at once if I believe my ATM/Debit card has been lost, stolen, or
used without my permission. I may contact the Credit Union at: Belco
Community Credit Union, 403 N. 2nd Street, P.O. Box 82, Harrisburg, PA
17108 or call (800) 642-4482. I will not be liable for unauthorized use that
occurs after I notify the Credit Union of the loss, theft, or possible
unauthorized use. If the card is used to obtain advances directly from the
Plan, my total liability will not exceed $50.00. If the authorized withdrawal is
from a share draft account, my liability is governed by the Regulation E
disclosures I received at the time I received my ATMlDebit card, even if the
withdrawal results in an advance being made from my overdraft subaccount
under my Open-end Credit P{an.
I also have certain rights and responsibilities under the Fair Credit Billing Act
if I believe my periodic statement is incorrect. See Billing Rights Notice at the
end of this Credit Agreement.
Advance Receipts: If I take an advance under this Plan, I will receive an
Advance Receipt outlining the transaction and describing any collateral given
as security for that advance. The Advance Receipt is part of the credit
contract and I must abide by the terms described therein.
Payments: The minimum monthly payment and due date will be set and
disclosed to me at the time each advance is made. My minimum payment will be
based upon the amount of my outstanding balances immediately after my most
recent advance. My minimum payment will not change unless I request
additional advances or fail to keep my agreement. I may pay the credit balance
in full or in part at any time without penalty. However, minimum periodic
payments are required on each loan account as long as any balance exists.
Late Charges: If I make a late payment, I agree to pay a late charge if one is
disclosed on the face of this document.
Credit Insurance: Credit life and/or credit disability insurance is voluntary
and not a condition of opening my Plan or obtaining any advance. Borrower
will only have this coverage if Borrower applies for the coverage, meets the
eligibi{ity requirements, ahd agrees to pay the premiums. The premium will be
charged and collected monthly and will become part of Borrower's minimum
monthly payment. Credit insurance will cover all advances under the Plan
now and in the future (subject to any limitations, restrictions or exclusions
contained in the Certificate) and premiums will be charged according to the
outstanding balance of the Plan. If Borrower fails to pay the insurance
premiums, Credit Union may cancel the coverage or, at its option, pay the
premiums and add them to Borrower's outstanding plan balance, upon which
interest will accrue. Borrower may cancel coverage at any time by informing
the Credit Union of the intent to do so. Credit Union retains a portion of the
premium (or a portion is paid back to the credit union by the service provider)
as compensation for making this service available. See Certificate for specific
terms and conditions of the insurance contract.
Default: The following provision applies to borrowers in Idaho, Kansas,
and Maine: I will be in default if (1) I do not make a payment of the required
amount when due; or (2) you believe the prospect of payment, performance,
or realization on any property given as security is significantly impaired.
The fo//owing provision applies to borrowers in Wisconsin: I will be in
default if any of the following occur: (a) I fail to make a payment when due on
two (2) occasions within any 12-month period; OR (b) 1 breach any term or
condition of this Open-end Plan, which breach materially impairs my ability to
pay amounts when due or materially impairs the condition, value, or
protection of your rights to or in any collateral securing this transaction.
When I am in default, I am entitled to notice of such default and I have a right
to cure the default within fifteen (15) calendar days after the date of mailing of
such notice. If I fail to cure the default, the full amount of the unpaid balance
due shall become immediately payable.
The following provision applies to all other borrowers: I shall be
considered in default if any of the following occur: (1) If I break any promise
made under this Credit Agreement or under the Security Agreement; or (2) if I
do not use the money you advanced me for the purpose stated in my
application; or (3) if you should; in good faith, believe that prospect of payment,
performance or realization of the collateral, if any, is impaired; or (4} if I die; or
(5) if I file a petition in bankruptcy, insolvency, or receivership or am put
involuntarily into such proceedings; or (6) if the collateral, if any, given as
security for this account is lost, damaged or destroyed, or if it is levied against,
attached or garnished; or (7) if I do not pay on time any of my current or future.
debts to you. If I default; you may, at your option, declare this .account.
immediately due and payable, and I must immediately pay to you at that time
the 1ota1 unpaid balance, as well as the Finance Charge to dale, any late
charges and costs of collection permitted under taw, including reasonable
attorney's fees. Costs of collection include, but are not limited to,-repossession
tees, appraisals, environmental site assessments,. casualty damage insurance
coverage, and attorney's fees for any action taken by an attorney.in ordertb
collect this loan or preserve or protect the credit' union's [fights and- remedies,
including, wi±hout limitation, pre-suit demands for payment, pre-suit mediationor
settlement negotiations, investigation and assessment of the credit unions'
rights, participation in bankruptcy cases, matters, and prbceedings (including,
without limitation, filing propfs of claim, pursuing reaffirmation. agreements,
attending meetings of creditirs, and pursuing complaints, motions, and
objections that relate in any way to the. credit union's collateral or .right to
payment), collateral disposition, non-bankruptcy suits and/or administrative
actions;- and appeals: The principal balance in default shall bear interest at the
contract rate; or (8) if anyone is in default of any security agreement given in
connection with any advance under this Plan; (9) If !make any false or
misleading statements in any credit application or update of credit information;
(10) I am in default of any other loan or security agreement I have with the
Credit Union; or (11) I use the Plan for any illegal purpose or transaction as
determined by applicable law.
Illegal Use and Internet Gambling: I agree that all transactions that I initiate
by use of any advance or any card which accesses my Plan are legal in the
jurisdiction where I live and/or where the transaction occurred. Internet
gambling may be illegal in the jurisdiction in which I am located, including the
United States. My Plan and any card which accesses my Plan may only be
used for legal transactions. Display of a payment card logo by an online
merchant does not mean that internet gambling transactions are lawful in all
jurisdictions in which I may be located. I agree to repay according to the
terms of this Agreement all transactions I initiate by taking an advance or
using my card(s), whether deemed legal or illegal.
Acfion Upon Defau/f: The following provision applies to borrowers in
Colorado, Disfricf of Columbia, Kansas, Maine, Massachusetfs,
Missouri, Nebraska, and West Virginia: Once 1 have defaulted, and after
the expiration of any right I may have under applicable state law to cure my
default, you can demand immediate payment of the entire unpaid balance of
the plan without giving me advance notice. The principal balance in default
shall bear interest at the contract rate, or a default rate if one has been
disclosed to me, or another rate if required by app{icable law.
The following provisions applies to borrowers in Wisconsin:
Right to Cure Default: ff I am in default under this Agreement, you must give
a notice of default to me pursuant to Wisconsin Statutes sec. 425.104 -
425.105. I shall have fifteen (15) calendar days from the date the notice is
mailed to me to cure the default. In the event of an uncured default, you shalt
have all the rights and remedies for default provided under the Wisconsin
Consumer Act. You may waive any default without waiving any other
subsequent or prior default by rne. Upon default, you are not entitled to
possession of the collateral until you have obtained a judgment authorizing
recovery of the collateral; however, f may voluntarily surrender the collateral
at any time without judicial proceedings. I am entitled to a court hearing on
the issue of default before you can repossess the collateral; however, if I
voluntarily surrender the collateral, I waive this right.
~~~
page 2 of 8
BORROWERSNAME
ACCOUNT NUMBER
CHARLES L LAPENTA 809360
~•~ ~• -- mom, wir AwV -MINC-- WILL MtAN ANY PERSON WHO EXECUTES THE OPEN-END CREDIT PLAN BY SIGNING THE MASTER
APPLICATION, OR ANY ADVANCEIREVOLVING REQUEST OR SIMILAR DOCUMENT, OR ANY PERSON WHO ENDORSES A PROCEEDS CHECK OR OTHERWISE ACCEPTS,
ACCESSES, OR USES PLAN FUNDS IN ANY WAY. THE WORDS "YOU," "YOUR" AND "YOURS" MEAN THE CREDV7 UNION.
No Right To Cure: Pursuant to Wis. Stat. Sec. 425.105(3), 1 shall not have
the right to cure a default if the following occur twice during the preceding
twelve (12) months: (a) 1 was in default on the open-end plan; (b) You gave
me notice of the right to cure such previous default in accordance with
Wis.Stat.Sec. 425.1D4; and (c) I cured the previous default.
Nothing in this Agreement shall be construed to restrict your ability to
exercise your rights under the Wisconsin Consumer Act, Ws.Stat.Sec.
409.105 and 409.504 or 425.207(2) or any similar or other rights if so
permitted under applicable Wisconsin law.
The following provision applies to borrowers in all other states: Once I
have defaulted, you may, at your option, declare all amounts under the Plan
immediately due and payable, and I must immediately pay to you at that time
the total unpaid balance, as well as the Finance Charge to date, any fate
charges and costs of collection permitted under law, including reasonable
attorney's fees. The principal balance in default shall bear interest at the
contract rate, or a default rate if one has been disclosed to me, or another
rate if required by applicable law.
Additional Provisions:
1. 1 agree to provide you with a current financial statement if so requested
and that no advance will be made until you have reviewed the financial
statement.
2. !n case any provision of this agreement is held invalid for any reason
such determination shall not affect the remaining provisions of the
agreement. But the agreement shall be enforced as if such provision was
never included.
3. I admit that i have received a copy of this agreement, and that 1 have fully
read and understand all of its terms and conditions.
4. My signing and endorsing any checks or drafts issued under this
agreement shows my acceptance of its terms and conditions.
Change in Terms: You may change the terms of this Plan at any time after
giving any notice that may be required by applicable law. Any change in the
interest rate will apply to future advances and, at our discretion and subject to
any requirements of applicable law, will also apply to unpaid balances.
Collection Costs: I agree to pay all costs incurred by the Credit Union in
collecting any amount I owe or in enforcing or protecting the Credit Union's
rights under this Plan, including but not limited to, repossession and collateral
disposition fees and costs; fees and costs incurred in locating collateral;
appraisals; casualty damage insurance coverage; attorneys' fees of 20% of
the unpaid balance or such greater amount as may be reasonable. I also
agree to pay any additional amounts incurred by the Credit Union as a result
of any appellate, bankruptcy or post-judgment proceedings, except as may
be specifically limited orprohibited by applicable law.
Borrower Responsibility: (promise to notify you of any change in my name,
address or employment. I promise not to apply for an advance if I know there
is a reasonable probability that I will be unable to repay my obligation
according to the terms of the credit extension. I promise to inform you of any
new information which relates to my ability to repay my obligation. I promise
not to submit false or inaccurate ihformation or willfully conceal information
regarding my creditworthiness, credit standing, or credit capacity.
Joint. Plans: If this Plan has more than one borrower, it is a joint Plan and
each of us is individually and jointly responsible for paying all amounts owed.
You can enforce your rights under this Plan against ariy one of us individually
or against all of us together. If we give you inconsistent instructions, you can
refuse to follow those instructions. Unless your written policy requires all of us
to sign for an advance, each of us authorizes the other(s) to obtain advances
individually and agrees to repay advances made to the other(s). Any notice
mailed to one shall be considered notice mailed to ail, unless applicable law
requires individual notice. Any of us can remove ourselves from responsibility
as a joint or co-borrower by notifying the Credit Union in writing. However,
this will not relieve any of us from joint or several liability for any obligations
already incurred.
Termination: I understand that you may terminate this credit and security
agreement under the following conditions:
1. Upon adverse re-evaluation of my creditworthiness.
2. If I should fail to meet the terms of the agreements.
3. Notice to Wisconsin Borrowers: If I am a married Wisconsin borrower who
has been extended individual credit, the Credit Union can terminate this
Plan if it receives a written notice of termination from my spouse pursuant
to Wis. Stat. 766.565(5). See State Notices below for further
information.
4. At my option, or your option, with good cause and upon written notice.
I understand that termination will not affect my obligation to pay the balance
outstanding incurred prior to notice.
Unlawful Transactions: I warrant and agree that my Open-end Credit Plan
will not be used to make or facilitate any illegal transaction(s) as determined
by applicable law; and that any such use, including any such authorized use,
will constitute an event of default under this Agreement. I agree that the
Credit Union will not have any liability, responsibility or culpability whatsoever
for any such use by me or any authorized user(s). I further agree to
indemnify and hold the Credit Union harmless from any suits, liability,
damages or adverse action of any kind that results directly or indirectly from
such illegal use.
Governing Law: These agreements shall be construed and enforced in
accordance with the laws of the State of Pennsylvania.
State Notices:
NOTICES TO WISCONSIN BORROWERS: (1) If I am married and am
extended individual credit, Wisconsin Statutes Section 766.56(3)(b) requires
the Credit Union to notify my spouse of the extension of credit. If Credit Union
receives a written notice of termination from Borrower's spouse pursuant to
Wis. Stat. Section 766.565(5) in connection with this Plan, Credit Union
reserves the right to declare Borrower in default of the Plan and to cal{ the
entire extension of credit due and payable notwithstanding Wis. Stat.
Sections 425.103 and 425.105, to the extent not prohibited by law. If the Plan
is called due and payable, I shall have certain rights to cure the default (see
the "Actions Upon Default" paragraph above).
(2) Additionally, no provision of a marital property agreement, a unilateral
agreement under Wis: Stat. Section 766.59, or a court decree under
Wis.Stat. 766.70 adversely affects the interest of the Credit Union unless
prior to the time the credit is extended, the Credit Union is furnished with a
copy of the agreement or statement, or has actual knowledge of the adverse
provision when the obligation to the Credit Union is incurred.
NORTH DAKOTA NOTICE TO BORROWERS PURCHASING A MOTOR
VEHICLE -THE MOTOR VEHICLE IN THIS TRANSACTION MAY BE
SUBJECT TO REPOSSESSION. IF IT IS REPOSSESSED AND SOLD TO
SOMEONE ELSE, AND ALL AMOUNTS DUE TO THE SECURED PARTY
ARE NOT RECEIVED 1N THAT SALE, THE BORROWER MAY HAVE TO
PAY THE DIFFERENCE.
NOTICE TO UTAH BORROWERS: This written agreement is a final
expression of the agreement between me and the Credit Union. This written
agreement may not be contradicted by evidence of any oral agreement.
NOTICE FOR ARIZONA OWNERS OF PROPERTY: It is unlawful for a
borrower to fail to return a motor vehicle that is subject to a security interest
within thirty days after I have received notice of default. The notice will be
mailed to the address I provided, on this document unless I have given the
Credit Union a new address. It is my responsibility to notify the Credit Union if
my address changes. The maximum penalty for unlawful failure to return a
motor vehicle is once year in prison and/or a fine of $150,000.
The following is required by Vermont Law: NOTICE TO CO-SIGNER
-------- MY SIGNAtURE ON THIS PLAN MEANS THAT / AM EQUALLY
LIABLE FOR REPAYMENT OF THIS PLAN. IF THE BORROWER DOES
NOT PAY, THE CREDIT UNION HAS A LEGAL RfGHT TO COLLECT
FROM ME.
L.~.C~
page 3 of 8
BORROWER S NAME ACCOUNT NUMBER
CHARLES L LAPENTA 809360
••• •• rvlC, IVIT HrvV -MINC- WILL MtAN ANY F'tRSON WHO EXECUTES THE OPEN-END CREDIT PLAN BY SIGNING THE MASTER
APPLICATION, OR ANY ADVANCE/REVOLVING REQUEST OR SIMILAR DOCUMENT, OR ANY PERSON WHO ENDORSES A PROCEEpS CHECK OR OTHERWISE ACCEPTS.
ACCESSES, OR USES PLAN FUNDS IN ANY WAY. THE WORDS "YOU," "YOUR" AND "YOURS" MEAN THE CREDIT UNION.
Contractual Pledge of Shares: t pledge all my shares and deposits
in the credit union, including future additions, as security for
advances under this Open-end Credit Plan. In case I default, you
may apply these shares and deposits to the payment of all sums
due at the time of default, including costs of collection and
reasonable attorney's fees. No lien or right to impress a lien on
shares and deposits shall apply to any of my shares which may be
held in an "Individual Retirement Account" or "Keogh Plan."
MARRIED WISCONSIN RESIDENTS:
Marital Status: ~ Married ~ Unmarried ~ Legally Separated
The name of my spouse is
Spouse's SSN
Address (if different)
The credit being granted is incurred in the interest of the marriage or
family of the Borrower(s).
BILLING RIGHTS NOTICE -KEEP THIS NOTICE FOR FUTURE USE
This notice contains important information about my rights and your
responsibilities under the Fair Credit Billing Act.
Notify You In Case of Errors or Questions About My Statement
If I think my statement is wrong, or if I need more information about a
transaction shown on it, I will write to you at the address listed on my
statement, as soon as possible. You must hear from me no later than 60
days after you sent me the first statement on which the error or problem
appeared. I may telephone you, but doing so will not preserve my rights.
In my fetter, 1 will give you the following information:
1. My name and account number.
2. The dollar amount of the suspected error.
3. A description of the error and an explanation if {can why 1 believe there
is an error. If I need more information I will describe the item I am not sure
about.
My Rights and Your Responsibilities After You Receive My Written
Notice
You must acknowledge my letter within 30 days, unless you have corrected
the error by then. Within 90 days, you must either correct the error or
explain why you believe the statement was correct.
After you receive my letter, you cannot try to collect any amount 1 question,
or report me as delinquent. You can continue to bill me for the amount I
question, including finance charges, and you can apply any unpaid amount
against my credit limit. 1 do not have to pay any questioned amaunt while
you are investigating, but I am still obligated to pay the parts of my
statement that are not in question.
If you find that you made a mistake on my statement, I will not have to pay
any finance charges related to any questioned amount. If you didn't make a
mistake, I may have to pay finance charges and I will have to make up any
missed payments on the questioned amount. In either case, you will send
me a statement of the amount I owe and the date that it is due.
If I fail to pay the amount that you think I owe, you may report me as
delinquent. However, if your explanation does not satisfy me and I write to
you within ten days telling you that I still refuse to pay, you must tell anyone
you report me to that I have a question about my statement. And, you must
tell me the name of anyone you reported me to. You must tell anyone you
report me to that the matter has been settled between us when it finally is.
If you don't follow these rules, you can't collect the first $50 of the
questioned amount, even if my statement was correct.
SECURITY AGREEMENT
Security Interest; PLEDGE OF SHARES; Statutory Lien; Set-off;
Administrative Freeze: By signing the Open-end Credit Plan, or by
accessing, using, or otherwise accepting any funds, accounts or services
under my plan: (a) I grant the Credit Union a security interest in all goods,
property, or other items purchased under this Plah either now or in the future,
or in any other property given now or at the time of any future advance, or
given at any other time in connection with the Open-end Plan ("Collateral").
Any required description of the Collateral shall appear on my Advance
Receipt or similar document and the Advance Receipt shall become part of
this Security Agreement as if incorporated herein. The security interest.
includes all increases, substitutions and additions to the secured property,
proceeds from any insurance on the secured property and all earnings
received from the secured property. The security interest also includes all
accessions. Accessions are things which are attached to or installed in the
property now or in the future. The security interest also includes any
replacements for the property which I buy within 10 days of the Advance or
any extensions, renewals or refinancing of the Advance. If the value of the
property declines, I promise to give you more security if asked to do so. I also
agree to abide by the terms of the Security Agreement and any Advance
Receipt or similar document. (b) I grant and pledge to you a consensual
lien on all sums on deposit to secure my obligations to the Credit Union
pursuant to applicable state law. If I have a credit card account(s) under
my plan, this pledge of shares also applies to the credit card
account(s). "All sums on deposit" and "shares" for purposes of this pledge
means all deposits ih any share savings, share draft, club, certificate, P.O.D.,
revocable trust or custodial accounts(s), whether jointly or individually held,
that you have on deposit now or in th'e future, all of which are deemed
"general deposits" for the purpose of this pledge. My pledge does not
include any IRA, Keogh, tax escrow, irrevocable trust or fiduciary accbunt in
which I do not have vested ownership interest. (c) I acknowledge and
agree to impressment of the Credit Union's statutory lien rights under
the Federal Credit Union Act andlor applicable state law as of the date 1
opened my credit plan, which gives you the right to apply the sums in my
account(s), to satisfy any obligations I owe to the credit union, regardless of
contributions at the time of default., and without further notice to me or any
owner of the account(s). (d) I acknowledge and agree to your "common
law" right to set off under applicable state law which authorizes you to
apply the funds in any joint or individual account to any obligations owed to
you if I default or fail to pay or satisfy any obligation to you without any legal
process, court proceeding or any notice to any owner of the account(s)
affected hereunder or otherwise under this Agreement. (e} I specifically
agree that you have the right to place an administrative freeze on any
of my joint or individual account(s) and that such action shall not
violate 11 USC 362 or other applicable law.
Multiple Rights; Cumulative Remedies: I understand and agree that the
Credit Union has multiple rights as enumerated above and that the remedies
are cumulative. Nothing herein shall limit or restrict the remedies available to
you following any event of default under the terms of my Open-end Plan.
CROSS-COLLATERALIZATION: Property given as security under this
Plan or for any other loan l have with the Credit Union will secure all
amounts I owe the credit union now and in the future. However,
property securing another debt will not secure advances under the
Plan if such property is my dwelling (unless the proper rescission
notices are given and any other legal requirements are satisfied), or
are non-purchase-money household goods. Obligations secured by my
primary residence, household goods and any funds in an IRA or Keogh
account are not included in your lien or this security interest, unless subject
to specific pledge or security agreement.
Non-Transferability: I agree that my account(s) are not assignable or
transferable except to the Credit Union unless specifically authorized in
writing by you.
No Liability for Dishonor: The Credit Union wilt not have any responsibility
or liability to me or others relating to the dishonor or other return of any
check, draft, ACH transaction or other order occurring as a result of you
exercising your lien rights or freezing any accounts in order to protect or
preserve such rights.
page 4 of 8
~.JC ,
BORROWER'S NAME ACCOUNT NUMBER
CHARLES L LAPENTA 809360
IN THESE AGREEMENTS, THE WORDS "!," "ME," "MY" AND "MINE" WILL MEAN ANY PERSON WHO EXECUTES THE OPEN-END CREDIT PLAN BY SIGNING THE MASTER
APPLICATION, OR ANY ADVANCE/REVOLVING REQUEST OR SIMILAR DOCUMENT, OR ANY PERSON WHO ENDORSES F. PROCEEDS CHECK OR OTHERWISE ACCEPTS,
ACCESSES, OR USES PLAN FUNDS IN ANY WAY. 7HE WORDS "YOU," "YOUR" AND "YOURS" MEAN THE CREDIT UNION.
Ownership of the Collateral: Depending on the nature of the advance
and/or the preference of the Credit Union, the property given as Collateral
may be property already owned by me or may be the property purchased
with the advance proceeds. If I am granting a security interest in property
already owned by me, I promise that i own the property, free of all security
interests except that given to the credit union and except for any other
interests disclosed by me to the credit union prior to the advance. I promise
that I have informed you of any and all co-owners of the Collateral and/or any
other person with an interest in or claim against the property. If i am using
the advance proceeds to buy the property that shall be used as Collateral, I
agree to use those advance proceeds for the sole purpose of buying that
Collateral. I agree not to sell or lease the Collateral or to use it as security for
a loan with another creditor until the advance is repaid. t agree not to allow
another security interest or lien to attach to the Collateral either by my actions
or by operation of the law.
Protecting the Security Interest: If my state issues a title for the Collateral, I
agree to have your security interest shown on the title and to take any other
steps necessary for you to perfect your security interest in that titled property.
1 may have to sign and/or file a financing statement or similar instrument to
perfect your security interest and/or to protect your security interest from the
claims of others. If asked to do so, I agree to sign a financing statement or
other required document. I also agree to do whatever else you think is
necessary to protect your security interest in the Collateral.
collateral you may collect from me reasonable expenses incurred in the
retaking, holding and preparing the collateral for and arranging the sale of the
collateral. You may also collect reasonable attorney's fees and legal
expenses, permitted by applicable law, incurred in connection with
disposition of the property. Unless I default, 1 may keep possession of the
property (collateral) described and use it in any lawful manner consistent with
this agreement or with the insurance policy on the collateral. i understand
that you have certain rights and legal remedies available to you under the
Uniform Commercial Code and other applicable laws, and that you may use
these rights to enforce payment if I default. in that event, i will at your request
assemble the property (collateral) and make it available to you at a place of
your choosing. If you decide to waive this default, it will not constitute a
waiver of any other subsequent defaults.
Attorney-in-Fact: You are hereby appointed as my Attorney-in-Fact to
perform any acts which you feel are necessary to protect the collateral and
the security interest which this agreement creates.
Co-borrowers: If there is more than one borrower, our obligations under this
agreement are joint and several, each being equally responsible to fulfill the
terms of the agreement.
Survival of Obligations: This security agreement not only binds me, but my
executors, administrators, heirs and assigns.
Use of the Collateral: Until the advance has been paid in full, I agree to (1)
use the Collateral carefully and for the purpose it was intended and keep it in
good repair; (2) Obtain your written permission before making major changes
to the Collateral or changing the address where the Collateral is kept; (3)
inform you in writing before I change my address; (4) allow you to inspect the
Collateral; (5) Promptly notify you if the Collateral is damaged, stolen or
abused;'(6} Not use the Collateral for any unlawful purpose.
Property Insurance: I will maintain insurance to cover any vehicle or other
property in which you have a security interest. This insurance will be in a form
and an amount satisfactory to you. I will supply you with proof of such
insurance until all sums owed to you and secured by this property are repaid.
If I fail to maintain such insurance, you may, but are not required to, obtain
insurance of your own and add the cost of such to the sums owed. This cost
will bear interest at the contract rate until paid. I further assign to you the right
to receive the proceeds of any insurance on such property, and direct any
insurer to pay those proceeds directly to you. I authorize you to endorse any
check or draft provided as the proceeds of such insurance, and apply those
proceeds to the sums owed to you.
I further authorize you to provide your Insurance Service Center with the
necessary information for verification of adequate coverage.
I acknowledge that insurance, or any extension thereof, placed by you is
without benefit to me individually but is primarily for the protection of you.
Notices: You may meet all requirements for sending me a notice of any kind
if you send it to me by means of United States mail, at my last given address.
You may also meet this requirement by delivering these notices to me
electronically provided that I have agreed to receive notices by electronic
means, such as email.
Additional Advances: Any additional advances made to me for the payment
of taxes or assessments or liens of any kind, or premiums on authorized
insurance and the interest owing thereon shall also be secured by this
agreement.
Disposition of Collateral: If a default as defined in the credit agreement
should occur, you have the authority, upon such default, to repossess and
sell the collateral in a lawful manner. In such cases, you or your authorized
representatives may, at your option, enter the premises where the collateral
is kept and take possession, subject to applicable laws. You have the right to
render the property pledged as collateral unusable and dispose of the
collateral on the premises where the collateral is kept. {f you decide to sell the
collateral at a public sale, private sale or otherwise dispose of the collateral,
you will notify me of the time and place of the intended disposition ten (10)
days prior to the sale or disposition. If you sell or otherwise dispose of the
Additional Security: Should you feel at any time that-the security presented
has diminished in value, or for any other reason feel that additiohal security is
required, I agree to assign to you within (10) days whatever additional
security you feel is necessary to protect yourself against possible loss.
Agreement to Terms: My signing and endorsing any checks or drafts
issued under this agreement, or otherwise using, accessing, or accepting
any advance proceeds, shows my acceptance of its terms and conditions.
6300 4/04
page 5 of 8
~---../~
BORROWER'S NAME ACCOUNT NUMBER
CHARLES L LAPENTA 809360
CREDITOR BENEFICIARY (POLICYHOLDER)
BELCO COMMUNITY CREDIT UNION
MINNESOTA LIFE CERTIFICATE OF
GROUP CREDIT INSURANCE
Minnesota Life Insurance Company 400 Robert Street North St. Paul, Minnesota 55101-2098
CREDIT LIFE INSURANCE CREDIT DISABILITY INSURANCE
GROUP POLICY NUMBER INSURANCE MAXIMUM GROUP POLICY NUMBER MAXIMUM MONTHLY DISABILITY BENEFIT PAAXIMUM LOAN REPAYMENT PERIOD
33029-G-500 $50,000 33030-G-500 NA NA
MAXIMUM LOAN REPAYMENT PERIOD MAX. AGGREGATE DISABILITY BENEFIT WAITING PERIOD F2ETROACTIVE BENEFIT
180 Months NA 14 Days No
This certificate is issued in consideration of your application and the payment of the required premium. It summarizes the main
provisions of the group policy(ies) that affect you. You may examine the group policy(ies) at the principal office of the
policyholder during regular business hours. No coverage is provided for any unused portion of your line of credit.
Notice of your right to examine this certificate for 30 days.
It is important to us that you are satisfied with this insurance. If you are not satisfied, you may return this certificate to us or to
your insurance representative within 30 days of its receipt, and you will receive a full refund of any premiums you have paid
within 30 days after we receive your notice of cancellation.
LIFE INSURANCE
What is the amount of the death benefit?
The death benefit will be the lesser of:
(1) the unpaid balance of your loan on the date of your death; or
(2) the maximum amount of insurance specified on your application. The death benefit will include up to two months of
delinquent payments.
If you are jointly insured and your co-debtor dies, the death benefit will be determined on the same basis. Only one death
benefit is payable, even if both jointly insured debtors should die on the same date.
The death benefit will be payable when we receive a certified copy of the death certificate and a statement from the
policyholder.
How would a -pre-exist m t c ition ct yo -age?
With respect to life insur e g exc $1,0 u to pr fisting co one sion; as to each advance
on your loan, we will not y tha v e if th ur thi hs r .the e 'of the advance and is
caused by apre-existing 1 n a el
Apre-existing medical co is -e ase sical o received medical advice,
consultation, diagnosis or t ment sician i e six th pe at the date of the advance,
Is there a suicide exclusion?
As to each advance on your loan, we will not pay any life insurance claim if you, whether sane or insane, die by suicide within
one year after the date of the advance, but we will refund your premium paid for insurance on that advance. In the case of joint
credit life insurance, we will continue the surviving joint insured's coverage and make a refund in accordance with the refund
provisions of this certificate.
If both joint insureds commit suicide within one year after the date of the advance, we will refund the premium paid for the joint
life insurance coverage on that advance.
What if joint life insurance is terminated because of suicide, contestability or ineligibility?
If joint life insurance is terminated with respect to one of the joint insureds in accordance with the provisions on suicide,
contestability or age eligibility contained in this certificate, a refund will be made which is equal to the difference between the
premium actually charged for the joint life coverage and the premium that would have been charged if only single coverage had
been issued and the joint life certificate will be replaced by a single life certificate.
What if your life insurance coverage is issued in excess of the insurance maximum?
If we issue your insurance in excess of the insurance maximum in error, we have the right within 60 days from the effective
date of the certificate to reduce the excess coverage and refund the excess premium charge paid, provided you are alive on
the adjustment or termination date.
YOUR CERTIFICATE CONTAINS PRE-EXISTING CONDITION EXCLUSIONS. WITH RESPECT TO LIFE INSURANCE
COVERAGE IN EXCESS OF $1,000 SUBJECT TO THE PRE-EXISTING CONDITION EXCLUSION, A BENEFIT MAY NOT BE
PAYABLE WITH RESPECT TO AN ADVANCE IF DEATH OCCURS WITHIN 6 MONTHS AFTER THE DATE OF THE ADVANCE
AND DEATH RESULTS FROM APRE-EXISTING CONDITION. A BENEFIT MAY NOT BE PAYABLE WITH RESPECT TO AN
ADVANCE IF TOTAL DISABILITY COMMENCES WITHIN 6 MONTHS AFTER THE DATE OF THE ADVANCE AND RESULTS
FROM APRE-EXISTING CONDITION. REFER TO YOUR CERTIFICATE FOR FURTHER DETAILS.
IN NO EVENT IS LIFE INSURANCE COVERAGE TO REMAIN IN FORCE BEYOND THE DATE AGE 66 IS ATTAINED. IN NO
EVENT IS DISABILITY INSURANCE COVERAGE TO REMAIN IN FORCE BEYOND THE DATE AGE 66 iS ATTAINED.
MHC-98567.37 B ~X~ ~ Certificate continued on page 7 & 8.
6301 LASER IA F60646 Rev. t2-2005 page 6 Of g COPYRIGHT 2005 Securian Financial Group, Inc. All rights reserved.
BORROWER'S NAME ACCOUNT NUMBER
CHARLES L LAPENTA 809360
DISABILITY INSURANCE
What is the amount of your monthly disability benefit?
Your monthly disability benefit will be an amount equal to your minimum installment payment as specified in your loan
agreement, excluding any delinquencies and/or late fees, due in the month in which total disability commences.
If your minimum installment payment increases according to a procedure specified in your loan agreement to recognize
periodic changes in the loan interest rate (variable interest loan), we will increase your monthly disability benefit accordingly
provided the date of minimum installment payment increase is after total disability commences.
In no event will any other increase (or decrease) in your minimum installment payment, after total disability commences, serve
to change the amount of monthly disability benefit payable.
Disability benefits will be payable when we receive proof you have become totally disabled while you are insured and prior to
your 66th birthday. Also, you must be under the regular care of a physician for the sickness or injury. We will pay the monthly
disability benefit at the end of each month of continuous total disability following the expiration of the waiting period. If the
retroactive benefit is effective, we wi{{ pay the monthly disability benefit at the end of each month of continuous total disability
from the date total disability commences but benefits will not begin until the waiting period expires.
What is the definition of total disability?
During the first twelve months of disability, your complete and continuous inability, due either to sickness or injury, to perform
the duties of your regular occupation. Thereafter, your complete and continuous inability, due either to sickness or injury, to
engage in ahy occupation for which you are reasonably fitted by age, education, training or experience.
For how long will monthly disability benefits be paid?
We will pay the. monthly disability benefit for any continuous period of total disability until any one of the following conditions are
met:
(1) the payments total an amount equal to the unpaid balance of your loan on the date total disability commences,
including principal .and interest, under the terms of the loan note or agreement; or
(2) your loan is charged off or discharged through payment or prepayment; or
(3) you reach age 66.
What if you suffer recurrent periods of total disability?
If, following a period of total disability, you engage on a full-time basis in any occupation for a continuous period of three
months or more, any subsequent period of total disability resulting from the same or related cause or causes will be considered
a new period of total disability. However, if the period during which you engage in any occupation is less than three months,
any subsequent period of total disability resulting from the same or related cause or causes will be considered a continuation of
the preceding. period of total disability.
If you are totally disabled and sustain an additional sickness or injury which would be in and of itself totally disabling, the
additional sickness or injury will not be considered a new period of total disability.
What disabilities are not covered?
We will not insure any loss resulting directly or indirectly from any total disability caused by:
(1) intentionally self-inflicted injuries; or
(2) normal pregnancies; or
(3) as to each advance on your loan; apre-existing illness, disease,. or physical condition for which you received medical
advice, consultation or treatment within the six month period immediately prior to the date of the advance. However,
total disability resulting from any such condition will not be excluded if total disability commences more than six months
after the date of the advance. The date of an advance is the date on which you request the advance in accordance with
your prearranged line of credit with the creditor.
When must notice of a disability claim be given?
You must give us notice within 30 days or as soon as possible after the occurrence or commencement of any loss covered by
the group policy. The notice of claim must be in writing and given to our authorized agent or sent to our home office in St. Paul,
Minnesota. We shall have the right to have you examined at our own expense as often as may reasonably be required while a
disabi{ity claim is being considered or paid.
As deemed necessary to determine continued disability we may also request written proof of loss during the course of a claim.
What is the effect of the actively-at-work requirement in your certificate?
If you do not meet the actively-at-work requirement, and have correctly stated such in your signed application and the
certificate is issued in error, we may, during the first 60 days from the effective date of the certificate, void coverage and refund
the full premium. charge paid you, provided you have not become disabled and have not met the requirements of the
elimination period or waiting period on the date coverage is voided.
GENERAL PROVISIONS
To whom wilt benefits be payable?
Claim payments will be made to the policyholder to reduce or extinguish your loan. if claim payments are more than the
balance of your loan, remaining payments will be made to you or to a secondary beneficiary, if named, or to the insured
debtor's estate. In the event of the simultaneous death of joint insureds and if the order of the deaths cannot be determined,
any excess benefits remaining payable will be divided equally between and paid to each joint insured's secondary beneficiary, if
named, otherwise to each joint insured's estate.
f~
page 7 of 8
BORROWER'S NAME
ACCOUNT NUMBER
CHARLES L LAPENTA 809360
How are premiums calculated?
Premiums for your insurance are calculated each month on the remaining insured outstanding balance of your loan and are
computed by multiplying the premium rate in effect under the group policy times the amount of insured debt. The premium rate
is subject to change upon 30 days prior written notice to you.
How are refunds calculated?
If the premium you were charged is greater than the premium required for your amount of insurance, the unearned premium
will be refunded to you. All overcharged premium is unearned. However, refunds of less than $10.00 will not be made.
When does your insurance terminate?
Your insurance will terminate on the date any of the following events occurs:
(1) your loan is charged off or discharged through payment, prepayment, renewal or refinancing; or
(2) your open-end loan account terminates; or
(3) the policyholder transfers the loan without recourse and no longer services the loan; or
(4) any required loan repayment which includes your insurance premium is more than 90 days overdue; or
(5) you request in writing that your insurance be terminated; or
(6) the group policy terminates provided you receive 30 days written notice; or
(7} you die. If joint life insurance is in force, your insurance terminates on both you and your co-debtor on the date either
you oryour co-debtor dies; or
(8) you reach age 66 and have disability insurance; or
(9) you reach age 70 and have life insurance. If joint life insurance is in force and insurance terminates on one of you due
to attainment of age 70, insurance will continue on the other insured under a single life certificate if that person is under
age 70.
Termination of your insurance shall be without prejudice to any claim that occurred prior to such termination.
If, in error, premiums continue to be charged to you when you exceed the age at which coverage is to terminate, and you
correctly stated your age in your signed application, we may terminate coverage as of the next billing date, provided you are
alive on the termination date and/or have not become disabled and have not met the requirements of the elimination period or
waiting period on the termination date.
What if your age is misstated?
Subject to the contestable provision, if you stated you were under age 66 and you applied for disability coverage or you stated
you were under age 66 and you applied for life coverage but you were not, we will refund your premium when we discover this
and no benefits will be paid. If you applied forjoint life insurance, this also applies to your co-debtor.
What are the effects of the age limitations in your certificate?
If you exceed the eligibility age, and have correctly stated your age in your application, and the certificate is issued in error, we
may, during the first 60 days from the effective date of the certificate, void coverage and refund the full charge paid by you,
provided you are alive on the termination date and/or you have not become disabled and have not met the requirements of the
elimination period or waiting period on the termination date. If a certificate is issued in error to a joint insured and his/her
coverage is voided as set forth above, the eligible joint insured's coverage will continue and a refund will be made in
accordance with the provisions of this certificate.
Can we contest your insurance?
After your insurance has been in force during your lifetime for two years from the effective date of your insurance (excluding
any period during which you are disabled), we cannot contest your insurance for any loss that is incurred more than two years
after the effective date, except for the nonpayment of premium.
In the case of joint life insurance, if coverage is terminated with respect to one of the joint insureds the other joint insured's
coverage will continue and a refund will be made in accordance with the "What if joint life insurance is terminated because of
suicide, contestability or ineligibility?" provision.
Cx.g
page 8 of 8
,.
,.
VERIFICATION
~ ~~' ~ ~~ states subject to the
penalties of 18 Pa C.S.Section 4904 relating to unsworn
falsification to authorities, that he/she is the
~~~ ~r-QG~P.~I'I ~`~On ~DD~ ~i /1 ~7~~ ~ f or the Pl .
aintiff in
this matter, that he/she is authorized to make this
affidavit on its behalf and that the facts set forth in the
foregoing pleading is true and correct to the best of
his/her knowledge, information and belief.
7,/Q
OF <4/4f
David 1D. Buell e Renee X Simpson
Prothonotary �ra!•_ • 1St Deputy Prothonotary
p 4 :(
�irkS. Sohonage, fSQ }a %`= Irene E. Morrow
Solicitor 7750 2nd Deputy Prothonotary
Office of the Prothonotary
Cumberland County, Pennsylvania
- 320 .. CIVIL TERM
ORDER OF TERMINATION OF COURT CASES
AND NOW THIS 29TH DAY OF OCTOBER, 2013,AFTER MAILING NOTICE OF
INTENTION TO PROCEED AND RECEIVING NO RESPONSE-THE ABOVE
CASE IS HEREBY TERMINATED WITH PREJUDICE IN ACCORDANCE WITH
PA R.C.P.230.2.
BY THE COURT,
DAVID D. BUELL
PROTHONOTARY
One Courthouse Square • Suite 100 • CarCis[e, PA 17013 • (717)240-6195 • Ea., ,(717)240-6573