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HomeMy WebLinkAbout02-06-06 In the Estate of: Estate No.: ~\d-.DC\o~~ ~'" \.... S~,~ 'ts. Date: ~\<).\\o I CLAIM AGAINST DECEDENT'S ESTATE The claimant certifies that there is due and owing by the decedent in accordance with the attached statement of account or other basis for the claim the sum of $ '\ &'\ \.0 . "2. \ I solemnly affirm under the penalties of perjury that the contents of the foregoing claim are true to the best of my knowledge, information, and belief. ~""\().t\ ~~\~SlI'MO'\ ~ Name of Claimant c...,~~~ \ ~c.... 'mant or person authorized to Ions on behalf of claimant. Q.""4.~ ~\.,tOo\.t'~ - tJ\CV\~~ Nam~ and Title of Person Signing Claim \ \:).,..)\\.."", ~\~\- <;.\.. \b~ . Address c..~ ~\.. \'0\3 . ( .., \. ) "). '-t '\ - ~ ~ \.c \0 Telephone Number FILED: RECORDED: Claims Docket Liber Folio i' .) - --, ,t j C'" ", \ ,."j or...,.! ; s -~. :} f~'- f209 DiscloEMre Statement, Note and Security Agreement Borrower(s) (Name and mailing address) Lender (Name, address, city and state) CITIFINANCIAL SERVICES, INC. 1 VALLEY STREET SUITE 103 CARLISLE PA 17013 Account No. RALPH L SMITH 98 LONG ST DRIVE CARLISLE PA 17013 343640 Date of Loan 07/14/2005 ANNUAL PERCENTAGE RATE FINANCE CHARGE Amount Financed Total of Payments The cost of Borrower's credit as The dollar amount the credit will The amount of credit provided to The amount Borrower will have a yearly rate. cost Borrower. Borrower or on Borrower's behal . paid after Borrower has made all payments as scheduled. 15.99 % $ 4,587.69 $ 10,000.11 $ 14,587.80 Payment Schedule: Security : If checked, Borrower is giving a security Number of Amount of When P1j.ments interest in: Payments Payments Are ue D D Motor Vehicle Mobile Home 60 $243.13 MONTHLY BEGINNING 08/14/2005 o Real Property D Other: $ Late Charge: If a payment is late, Borrower will be $ charged a late charge equal to 1 . 5 % per month on $ the past due amount until paid in full, minimum charge $ 1.00 . See the contract documents for any additional information about nonpayment, default, Prepa~ment: If Borrower pays off early, Borrower may any required repayment in full before the scheduled date, and prepayment refunds and be entItled to a refund of part of the [mance charge. penalties. Additional Information: PRECOMPUTED INTEREST $ 4,437.69 SERVICE CHARGE $ 150.00 DATE CHARGES BEGIN 07/14/2005 First Payment Due Date Extension Charge: $N/A (included in Finance Charge.) INSURANCE DISCLOSURE Required Insurance: If Borrower obtains credit that is secured by Borrower's interest in improved real property (including a mobile or manufactured home that is part of real property), then Lender requires Borrower to provide fire and extended coverage for the replacement value of the improvements. If the collateral securing the credit is a motor vehicle (including a recreational vehicle, boat, or movable mobile home), Borrower must provide collision and comprehensive casualty insurance in an amount sufficient to satisfy the unpaid balance of the loan or equal to the value of the collateral, whichever is less. All such policies and renewals thereof must name Lender as loss payee and must be maintained by Borrower, until the credit is repaid in full. Borrower may obtain a new insurance policy or provide an existing policy from any insurer that is acceptable to Lender. If Borrower obtains the collateral protection coverage or Automobile Physical Damage Insurance at Lender's office, Borrower acknowledges that such insurance (1) may cost more than insurance that is available from another insurer, (2) will only protect Lender's interest in the collateral and does not protect Borrower's interest, and (3) does not protect Borrower from claims by other persons. Optional Insurance: Credit life insurance, credit disability insurance, credit personal property insurance, involuntary unemployment insurance, and any other insurance products that are not required per the above paragraph are optional to Borrower and are not required in order to obtain credit. If Borrower desires voluntarily to purchase any of these optional insurance products, Borrower must sign below and in other required documents and will receive an insurance certificate or policy detailing the coverage terms and conditions that apply to the insurance. Borrower should refer to the terms and conditions contained in the applicable insurance certificate or policy issued for the exact description of benefits and exclusions. Borrower is encouraged to inquire about coverage and refund provisions. If the initial amount of coverage for credit life insurance and/or credit personal property insurance set forth in Borrower'sinsurance certificate or policy is equal to the Total of Payments stated above, it may exceed the amount necessary to payoff Borrower's loan at any given time. Any excess insurance coverage amount that may become payable will be paid to the appropriate party as designated in the insurance certificate or policy. Borrower acknowledges that if optional credit personal property insurance is purchased, Borrower'sproperty coverage under other policies such as homeowner's or renter's insurance may be adversely affected. Borrower's regular monthly loan payment if Borrower elects not to purchase insurance will be $ 243.13 Termination of Optional Insurance: Borrower may cancel any of the optional insurance products obtained at Lender's office at any time upon Borrower's written request for cancellation to Lender. If Borrower is in default under the terms of this agreement, Borrower authorizes the insurer to terminate any and/or all optional insurance products upon Lender's request. Upon termination of any insurance for any reason, Borrower authorizes and directs that the insurer deliver the premium refund, if any, to Lender, which will apply it to Borrower's outstanding loan balance. Borrower hereby irrevocably and unconditionally assigns to Lender any right, title or interest which Borrower may have in any premium refund ("Refund"). Such assignment is absolute and not intended as security. Borrower acknowledges and agrees that the Refund shall be the sole property of Lender and that Borrower shall have no interest in the Refund. Lender agrees to pay to Borrower any amount by which the Refund received by Lender exceeds the outstanding loan balance. I1we request the following insurance: Cost/Premium: Insurance Type: Insurance Term (in mos.): . (-::.:~ ,./ ;;;'f}:D~~~:" " ""'/ /"/ First'Borrower's"Signature .//' I~;" l ;// '. .".' $ $ $ $ NONE $ NONE NONE NONE Date Second Borrower's Signature Date NONE TERMS: In this Disclosure Statement, Note and Security Agreement, the word "Borrower" refers to the persons signing below as Borrower, whether one or more. If more than one Borrower signs, each will be responsible, individually and together, for all promises made and for repaying the loan in full. The word "Lender" refers to the Lender, whose name and address are shown above. PROMISE TO PAY: Borrower promises to pay to the order of Lender the Total of Payments (which includes precornpu.ted interest:charges afl{! Service Charges) shown above in substantially equal, consecutive monthly installments shown above, except that any appropriate'adjustmeDtS will be ~e to the fIrst and fInal payments, from the Date Charges Begin until the Total of Payments is fully paid. Each payment will be appli~d to./i combined total of the Amount Financed and precomputed interest charges. If any part of the balance remains unpaid on the fmal payment date, Lender, at its qption, may collect interest from and after maturity upon the then unpaid Amount Financed at the maximum rate permitted by the :then ll~lllicable law or, if no maximum rate is prescribed, then at the rate of interest prevailing under this Disclosure Statement, Note and Security Agreement.- . " The amount shown as "Service Charge" above has been paid by Borrower as a prepaid charge and is in addition to the precomp~d interest on,the loan. Any Service Ch~rg~s are earned prior to interest on the loan balance. Prepaid Service Charges are not refundable to Borrowe,r,in the evei1t of early payment or termmatIon of the account. I . . ; PREPAYMENT: Borrower may prepay this loan in whole or in part at any time. If Borrower prepays in full or if Lender accelei'llies the unpaid balance because of Borrower'sdefault, Borrower will be given a refund of the unearned portion of the Finance Charge. computed by the Rule of 78's. No refund of less than $1.00 will be given. Partial prepayment will not result in a refund of interest. Borrower's Initials: PA 25431-10 7/2003 Original (Branch) Copy (Customer) Page 1 of 3 RALPH L SMITH 343640 07/14/2005 SECURITY AGREEMENT: ~ A. If this box is checked, this loan is unsecured. o B. If this box is checked, to secure the payment and performance hereof, Borrower gives to Lender a security interest under the Uniform Commercial Code in any property for which a description is completed below and all parts and equipment now or later added to the property and any proceeds of the property, all of which will be called "Property". See below for additional terms applicable to this security interest. 1. Motor vehicle/mobile home: Make, No. Cylinders Year/Model Model No. Or Name Body Type Identification Number 2. Other Property: D C. If this box is checked, Borrower'sloan is secured by a Deed of Trust or Mortgage of even date on real property which requires Lender's written consent to a sale or transfer of the encumbered real property located at . See either the Deed of Trust or the Mortgage for terms applicable to Lender's interest in Borrower's real property ("Property"). OWNERSHIP OF PROPERTY: Borrower represents that the Property is owned by Borrower free and clear of all liens and encumbrances except those of which Borrower has informed Lender in writing. Prior to any default, Borrower may keep and use the Property at Borrower's own risk, subject to the provisions of the Uniform Commercial Code. If the Property includes a motor vehicle or mobile home, Borrower will, upon request, deliver the certificate of title to the motor vehicle or mobile home to Lender. USE OF PROPERTY: Borrower will not sell, lease, encumber, or otherwise dispose of the Property without Lender's prior written consent. Borrower will keep the Property at Borrower's address (as shown on page 1) unless Lender has granted permission in writing for the Property to be located elsewhere. The Property will be used only in the state in which Borrower lives unless the Property is a motor vehicle, in which case it will be used outside the state only in the course of Borrower's normal use of the Property. Borrower will not use or permit the use of the Property for hire or for illegal purposes. TAXES AND FEES: Borrower will pay all taxes, assessments, and other fees payable on the Property. If Borrower fails to pay such amounts, Lender may pay such amounts for Borrower and the amounts paid by Lender will be added to the unpaid balance of the loan. INSURANCE: If Borrower purchases any insurance' at Lender's office, Borrower understands and acknowledges that (1) the insurance company may be affiliated with Lender, (2) Lender's employee(s) may be an agent for the insurance company, (3) such employee(s) is not acting as the agent, broker or fiduciary for Borrower on this loan, but may be the agent of the insurance company, and (4) Lender or the insurance company may realize some benefit from the sale of that insurance. If Borrower fails to obtain or maintain any required insurance or fails to designate an agent through whom the insurance is to be obtained, Lender may purchase such required insurance for Borrower through an agent of Lender's choice, and the amounts paid by Lender will be added to the unpaid balance of the loan. FINANCING STATEMENTS: Borrower will sign all financing statements, continuation statements, security interest filing statements, and similar documents with respect to the Property at Lender's request. RETURNED CHECK FEE: Lender may charge a fee not to exceed $ 20 . 00 ,if a check, negotiable order of withdrawal or share draft is returned for insufficient funds or insufficient credit. LATE CHARGE: If any installment is paid more than 10 days after the scheduled payment date, Borrower agrees to pay a late charge equal to 1.5 % per month on the past due amount until it is paid in full, with a minimum late charge of $ 1 . 00 . Lender may, at its option, waive any late charge or portion thereof without waiving its right to require a late charge with regard to any other late payment. DEFERMENTS: Borrower agrees to pay a deferment charge equal to 11h % per month on the amount deferred for the period of deferment if Lender, in its sole discretion, agrees to allow Borrower, upon Borrower's request, to defer payment of any monthly installment prior to or on its due date without Borrower being considered in default. Any such deferment will extend the final payment date by one month for each deferment authorized by Borrower and Lender. All other terms and conditions of the Disclosure Statement, Note and Security Agreement including the expiration dates of insurance coverages, remain unchanged by authorized deferments. LOAN CHARGES: If a law that applies to this loan and that sets maximum loan charges, is finally interpreted so that the interest or other loan charges collected or to be collected in connection with this loan exceed the permitted limits, then (i) any such loan charge will be reduced by the amount necessary to reduce the charge to the permitted limit, and (ii) any sums already collected from Borrower that exceeded permitted limits will be refunded to Borrower. Lender may choose to make this refund by reducing the principal owed under this loan or by making a direct payment to Borrower. If a refund reduces principal, the reduction will be treated as a partial prepayment without any prepayment charge. DEFAULT: Borrower will be in default if: 1. Borrower does not make any scheduled payment on time; 2. Borrower is (or any other person puts Borrower) in bankruptcy, insolvency or receivership; 3. Any of Borrower's creditors attempts by legal process to take and keep any property of Borrower, including the Property securing this loan; 4. Borrower fails to fulfill any promise made under this agreement; or 5. A default occurs under any Real Estate Mortgage or Deed of Trust which secures this loan or under any other mortgage or deed of trust on the real property. If Borrower defaults, Lender may require Borrower to repay the entire unpaid Principal balance and any accrued interest at once. Lender's failure to exercise or delay in exercising any of its rights when default occurs does not constitute a waiver of those or any other rights under this agreement. Borrower may also be required to pay reasonable attorney's fees, court costs, and the actual and reasonable expenses of repossessing, storing, and selling the Property which secures the loan. EFFECTS OF DEFAULT: If Borrower defaults, Borrower will deliver the Property to Lender or, upon Lender's demand, assemble the Property and make it available to Lender at a reasonably convenient place. Lender may, without previous notice or demand and without legal process, peacefully enter any place where the Property is located and take possession of it. Lender may dispose of the Property in any way it wishes, subject to applicable state law. The Property may be sold with notice at a private or public sale at a location chosen by Lender. At such a sale, Lender may purchase the Property. The proceeds of the sale or other disposition, minus the expenses of taking, removing, holding, repairing, and selling the Property including reasonable attorney's fees, and minus the cost of paying off and removing any liens or claims on the Property, will be credited to the unpaid balance of Borrower's loan. If the proceeds of the sale are not sufficient to payoff the entire balance plus costs, Borrowers agree to pay the remaining amount upon demand. If Borrower has left other property in the repossessed Property, Lender may hold such property temporarily for Borrower without any responsibility or liability for the property. N o~ice of the time and place of a public sale or notice of the time after which a private sale or other disposition of the Property will occur is reasonable if mailed to the Borrower'saddress at least five days before the sale or disposition. The notice may be mailed to the Borrower'slast address shown on Lender's records. Borrower's Initials: PA 25431-10 7/2003 Original (Branch) Copy (Customer) Page 2 of3 RALPH L SMITH 343640 07/14/2005 LAW THAT APPLIES: Pennsylvania law and federal law, as applicable, govern this Disclosure Statement, Note and Security Agreement. If any part is unenforceable, this will not make any other part unenforceable. In no event will Borrower be required to pay interest or charges in excess of those permitted by law. OTHER RIGHTS: Lender may accept payments after maturity or after a default without waiving its rights with respect to any subsequent default in payment. Borrower agrees that Lender may extend time for payment after maturity without notice. The terms of this agreement can be waived or changed only in a writing signed by Lender. Where the context requires, singular words may be read in the plural and plural words in the singular, and references to the masculine gender may be read to apply to the feminine gender. OTHER TERMS: Each Borrower under this Disclosure Statement, Note and Security Agreement, if more than one, agrees that Lender may obtain approval from one Borrower to change the repayment terms and release any Property securing the loan, or add parties to or release parties from this agreement, without notice to any other Borrower and without releasing any other Borrower from his responsibilities. Lender does not have to notify Borrower before instituting suit if the note is not paid, and Lender can sue any or all Borrowers upon the default by any Borrower. Borrower, endorsers, sureties and guarantors, to the extent permitted by law, severally waive their right to require Lender to demand payment of amounts due, to give notice of amounts that have not been paid, to receive notice of any extensions of time to pay which Lender allows to any Borrower and to require Lender to show particular diligence in bringing suit against anyone responsible for repayment of this loan, and additionally, waive benefit of homestead and exemption laws now in force or later enacted, including stay of execution and condemnation, on any Property securing this loan and waive the benefit of valuation and appraisement. This Disclosure Statement, Note and Security Agreement shall be the joint and several obligation of all makers, sureties, guarantors and endorsers and shall be binding upon them, their heirs, successors, legal representatives and assigns. If any part of the Disclosure Statement, Note and Security Agreement and, if applicable, the Mortgage or Deed of Trust and accompanying Itemization of Amount Financed and Arbitration Agreement is unenforceable, this will not make any other part unenforceable. REFINANCING: The overall cost of refinancing an existing loan balance may be greater than the cost of keeping the existing loan and obtaining a second loan for any additional funds Borrower wishes to borrow. AUTHORIZATION TO USE CREDIT REPORT: By signing below, Borrower authorizes Lender to obtain, review and use information contained in the Borrower'scredit report in order to determine whether the Borrower may qualify for products and services offered by Lender. This authorization terminates when Borrower's outstanding balance due under this Disclosure Statement, Note and Security Agreement is paid in full. Borrower may cancel such authorization at any time by writing the following: Transaction Processing, 300 St. Paul Place, BSP13A, Baltimore, MD 21202. In order to process Borrower's request, Lender must be provided Borrower's full name, address, social security number and account number. ARBITRATION. Borrower, Non-Obligor(s) (if any) and Lender have entered into a separate Arbitration Agreement on this date, the terms of which are incorporated and made a part of this Disclosure Statement, Note and Security Agreement by this reference. The following notice applies only if this box is checked. D NOTICE ANY HOLDER OF TillS CONSUMER CREDIT CONTRACT IS SUBJECT TO ALL CLAIMS AND DEFENSES WIllCH THE DEBTOR COULD ASSERT AGAINST THE SELLER OF GOODS OR SERVICES OBTAINED WITH THE PROCEEDS HEREOF. RECOVERY HEREUNDER BY THE DEBTOR SHALL NOT EXCEED AMOUNTS PAID BY THE DEBTOR HEREUNDER. By signing below, Borrower agrees to the terms contained herein, acknowledges receipt of a copy of this Disclosure Statement, Note and Security Agreement and, if applicable, the Mortgage or Deed of Trust and of the accompanying Itemization of Amount Financed and Arbitration Agreement, and authorizes the disbursements stated therein. \J'j , ;:. "'K \ \ <.,..,,} "~ ':"'-~ "~ ",,.-..,'~~~ SIGNED: ;;:~=~~>:/~:// :~.~,,', , v '/' ,:;'? RALPH L SMITH // (Seal) -Borrower WITNESSES: \ I CIAL SERV!CES, INC. ) , Ii 4' "-.". , / [l' l' /'), ). \" -"'-/1,(: ~,)>."'- if? .,. .'1\..... ...~,_.) I ';.' t"._<'-X- (,.,"'" (Name an Title) 07/14/2005 18: 22: 50 " .~ SECURITY INTJEREST OF NON OBLIGOR: Borrower only is personally liable for paym nt of the loan. Nonobligor is liable and bound by all other terms, conditions, covenants, and agreements contained in this Disclosure Statement, Note and Security Agreement, including but not limited to the right and power of Lender to repossess and sell the Property securing this loan, in the event of default by Borrower in payment of this loan. (Seal) -Borrower (Seal) -Borrower 'j, 7 /1\." 1/ '-;'/L (Seal) Signature Date (Seal) Signature Date \ V., ., PA 25431-10 7/2003 Original (Branch) Copy (Customer) Page 3 of3