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HomeMy WebLinkAbout961621116456 MORTGAGOR: WADE W. DUNLAP Spouse of JILL DUNLAP PO BOX 1341 AFTON, WY 83110 JILL DUNLAP Spouse of WADE W. DUNLAP PO BOX 1341 AFTON, WY 83110 HUSBAND AND WIFE WADE W. DUNLAP Wyoming Mortgage WY /4XJNEWELL00000000000624041 1 02 5 1 1 N 10111IIIIIHI I� 110111011110101111I00I1I0111I1I I1I11 111111111 Space Above This Line For Recording Data MORTGAGE RECEIVED 10/27/2011 at 2:47 PM RECEIVING 961621 BOOK: 775 PAGE: 257 JEANNE WAGNER LINCOLN COUNTY CLERK, KEMMERER, WY 000257 DATE AND PARTIES. The date of this Mortgage (Security Instrument) is OCTOBER 26, 2011. The parties and their addresses are: LENDER: THE BANK OF STAR VALLEY Organized and existing under the laws of Wyoming 384 Washington P.O. Box 8007 Afton, WY 83110 1. CONVEYANCE. For good and valuable consideration, the receipt and sufficiency of which is acknowledged, and to secure the Secured Debts and Mortgagor's performance under this Security Instrument, Mortgagor does hereby grant, bargain, convey, mortgage and warrant to Lender, with the power of sale, the following described property: SEE EXHIBIT "A" ATTACHED HERETO AND MADE A PART HEREOF The property is located in Lincoln County at LOT 1 GEM VIEW ESTATES, FAIRVIEW, Wyoming 83119. Wolters Kluwer Financial Services ©1996, 2011 Bankers SystemsTM Page 1 iii 000258 Together with all rights, easements, appurtenances, royalties, mineral rights, oil and gas rights, all water and riparian rights, wells, ditches and water stock and all existing and future improvements, structures, fixtures, and replacements that may now, or at any time in the future, be part of the real estate described (all referred to as Property). This Security Instrument will remain in effect until the Secured Debts and all underlying agreements have been terminated in writing by Lender. 2. SECURED DEBTS. The term "Secured Debts" includes and this Security Instrument will secure each of the following: A. Specific Debts. The following debts and all extensions, renewals, refinancings, modifications and replacements. A promissory note or other agreement, No. 01702896, dated October 26, 2011, from Mortgagor to Lender, with a loan amount of $26,000.00. B. Sums Advanced. All sums advanced and expenses incurred by Lender under the terms of this Security Instrument. 3. PAYMENTS. Mortgagor agrees that all payments under the Secured Debts will be paid when due and in accordance with the terms of the Secured Debts and this Security Instrument. 4. PRIOR SECURITY INTERESTS. With regard to any other mortgage, deed of trust, security agreement or other lien document that created a prior security interest or encumbrance on the Property, Mortgagor agrees: A. To make all payments when due and to perform or comply with all covenants. B. To promptly deliver to Lender any notices that Mortgagor receives from the holder. C. Not to allow any modification or extension of, nor to request any future advances under any note or agreement secured by the lien document without Lender's prior written consent. 5. CLAIMS AGAINST TITLE. Mortgagor will pay all taxes, assessments, liens, encumbrances, lease payments, ground rents, utilities, and other charges relating to the Property when due. Lender may require Mortgagor to provide to Lender copies of all notices that such amounts are due and the receipts evidencing Mortgagor's payment. Mortgagor will defend title to the Property against any claims that would impair the lien of this Security Instrument. Mortgagor agrees to assign to Lender, as requested by Lender, any rights, claims or defenses Mortgagor may have against parties who supply labor or materials to maintain or improve the Property. 6. DUE ON SALE OR ENCUMBRANCE. Lender may, at its option, declare the entire balance of the Secured Debt to be immediately due and payable upon the creation of, or contract for the creation of, any lien, encumbrance, transfer or sale of all or any part of the Property. This right is subject to the restrictions imposed by federal law (12 C.F.R. 591), as applicable. 7. WARRANTIES AND REPRESENTATIONS. Mortgagor has the right and authority to enter into this Security Instrument. The execution and delivery of this Security Instrument will not violate any agreement governing Mortgagor or to which Mortgagor is a party. 8. PROPERTY CONDITION, ALTERATIONS AND INSPECTION. Mortgagor will keep the Property in good condition and make all repairs that are reasonably necessary. Mortgagor will not commit or allow any waste, impairment, or deterioration of the Property. Mortgagor will keep the Property free of noxious weeds and grasses. Mortgagor agrees that the nature of the occupancy and use will not substantially change without Lender's prior written consent. Mortgagor will not permit any change in any license, restrictive covenant or easement without Lender's prior written consent. Mortgagor will notify Lender of all demands, proceedings, claims, and actions against Mortgagor, and of any Toss or damage to the Property. Lender or Lender's agents may, at Lender's option, enter the Property at any reasonable time for the purpose of inspecting the Property. Lender will give Mortgagor notice at the time of or before an inspection specifying a reasonable purpose for the inspection. Any inspection of the Property will be entirely for Lender's benefit and Mortgagor will in no way rely on Lender's inspection. 9. AUTHORITY TO PERFORM. If Mortgagor fails to perform any duty or any of the covenants contained in this Security Instrument, Lender may, without notice, perform or cause them to be performed. Mortgagor appoints Lender as attorney in fact to sign Mortgagor's name or pay any amount necessary for performance. Lender's right to perform for Mortgagor will not create an obligation to perform, and Lender's failure to perform will not preclude Lender from exercising any of Lender's other rights under the law or this Security Instrument. If any construction WADE W. DUNLAP Wyoming Mortgage WY/ 4 XJNEWELL00000000000624041102511N 1IIIHH IIIII0111 01111101011101110111111111 1 11101110111 0111 01111111111111111111111111010011111Hill X011 1111 Wolters Kluwer Financial Services ©1996, 2011 Bankers SystemsTM Page 2 WADE W. DUNLAP Wyoming Mortgage WY/ 4XJNEWELL00000000000624041 102511 N 1111111,11111111111111 000259 on the Property is discontinued or not carried on in a reasonable manner, Lender may take all steps necessary to protect Lender's security interest in the Property, including completion of the construction. 10. ASSIGNMENT OF LEASES AND RENTS. Mortgagor assigns, grants, bargains, conveys, mortgages and warrants to Lender as additional security all the right, title and interest in the following (Property): existing or future leases, subleases, licenses, guaranties and any other written or verbal agreements for the use and occupancy of the Property, including any extensions, renewals, modifications or replacements (Leases); and rents, issues and profits (Rents). In the event any item listed as Leases or Rents is determined to be personal property, this Assignment will also be regarded as a security agreement. Mortgagor will promptly provide Lender with copies of the Leases and will certify these Leases are true and correct copies. The existing Leases will be provided on execution of the Assignment, and all future Leases and any other information with respect to these Leases will be provided immediately after they are executed. Mortgagor may collect, receive, enjoy and use the Rents so long as Mortgagor is not in default. Upon default, Mortgagor will receive any Rents in trust for Lender and Mortgagor will not commingle the Rents with any other funds. Mortgagor agrees that this Security Instrument is immediately effective between Mortgagor and Lender. This Security Instrument will remain effective during any statutory redemption period until the Secured Debts are satisfied. As long as this Assignment is in effect, Mortgagor warrants and represents that no default exists under the Leases, and the parties subject to the Leases have not violated any applicable law on leases, licenses and landlords and tenants. 11. DEFAULT. Mortgagor will be in default if any of the following events (known separately and collectively as an Event of Default) occur: A. Payments. Mortgagor fails to make a payment in full when due. B. Insolvency or Bankruptcy. The death, dissolution or insolvency of, appointment of a receiver by or on behalf of, application of any debtor relief law, the assignment for the benefit of creditors by or on behalf of, the voluntary or involuntary termination of existence by, or the commencement of any proceeding under any present or future federal or state insolvency, bankruptcy, reorganization, composition or debtor relief law by or against Mortgagor, Borrower, or any co- signer, endorser, surety or guarantor of this Security Instrument or any other obligations Borrower has with Lender. C. Death or Incompetency. Mortgagor dies or is declared legally incompetent. D. Failure to Perform. Mortgagor fails to perform any condition or to keep any promise or covenant of this Security Instrument. E. Other Documents. A default occurs under the terms of any other document relating to the Secured Debts. F. Other Agreements. Mortgagor is in default on any other debt or agreement Mortgagor has with Lender. G. Misrepresentation. Mortgagor makes any verbal or written statement or provides any financial information that is untrue, inaccurate, or conceals a material fact at the time it is made or provided. H. Judgment. Mortgagor fails to satisfy or appeal any judgment against Mortgagor. I. Forfeiture. The Property is used in a manner or for a purpose that threatens confiscation by a legal authority. J. Name Change. Mortgagor changes Mortgagor's name or assumes an additional name without notifying Lender before making such a change. K. Property Transfer. Mortgagor transfers all or a substantial part of Mortgagor's money or property. This condition of default, as it relates to the transfer of the Property, is subject to the restrictions contained in the DUE ON SALE section. L. Property Value. Lender determines in good faith that the value of the Property has declined or is impaired. M. Insecurity. Lender determines in good faith that a material adverse change has occurred in Mortgagor's financial condition from the conditions set forth in Mortgagor's most recent financial statement before the date of this Security Instrument or that the prospect for payment or performance of the Secured Debts is impaired for any reason. 12. REMEDIES. On or after the occurrence of an Event of Default, Lender may use any and all remedies Lender has under state or federal law or in any document relating to the Secured Debts, including, without limitation, the power to sell the Property. Any amounts advanced on Mortgagor's behalf will be immediately due and may be Wolters Kluwer Financial Services 1996, 2011 Bankers SystemsTM Page 3 000260: added to the balance owing under the Secured Debts. Lender may make a claim for any and all insurance benefits or refunds that may be available on Mortgagor's default. Subject to any right to cure, required time schedules or any other notice rights Mortgagor may have under federal and state law, Lender may make all or any part of the amount owing by the terms of the Secured Debts immediately due and foreclose this Security Instrument in a manner provided by law upon the occurrence of an Event of Default or anytime thereafter. Upon any sale of the Property, Lender will make and deliver a special or limited warranty deed that conveys the property sold to the purchaser or purchasers. Under this special or limited warranty deed, Lender will covenant that Lender has not caused or allowed a lien or an encumbrance to burden the Property and that Lender will specially warrant and defend the Property's title of the purchaser or purchasers at the sale against all lawful claims and demand of all persons claiming by, through or under Lender. The recitals in any deed of conveyance will be prima facie evidence of the facts set forth therein. All remedies are distinct, cumulative and not exclusive, and Lender is entitled to all remedies provided at law or equity, whether or not expressly set forth. The acceptance by Lender of any sum in payment or partial payment on the Secured Debts after the balance is due or is accelerated or after foreclosure proceedings are filed will not constitute a waiver of Lender's right to require full and complete cure of any existing default. By not exercising any remedy, Lender does not waive Lender's right to later consider the event a default if it continues or happens again. 13. COLLECTION EXPENSES AND ATTORNEYS' FEES. On or after the occurrence of an Event of Default, to the extent permitted by law, Mortgagor agrees to pay all expenses of collection, enforcement or protection of Lender's rights and remedies under this Security Instrument or any other document relating to the Secured Debts. Mortgagor agrees to pay expenses for Lender to inspect and preserve the Property and for any recordation costs of releasing the Property from this Security Instrument. Expenses include, but are not limited to, reasonable attorneys' fees after default and referral to an attorney not a salaried employee of Lender. These expenses are due and payable immediately. If not paid immediately, these expenses will bear interest from the date of payment until paid in full at the highest interest rate in effect as provided for in the terms of the Secured Debts. In addition, to the extent permitted by the United States Bankruptcy Code, Mortgagor agrees to pay the reasonable attorneys' fees incurred by Lender to protect Lender's rights and interests in connection with any bankruptcy proceedings initiated by or against Mortgagor. 14. ENVIRONMENTAL LAWS AND HAZARDOUS SUBSTANCES. As used in this section, (1) Environmental Law means, without limitation, the Comprehensive Environmental Response, Compensation and Liability Act (CERCLA, 42 U.S.C. 9601 et seq.), all other federal, state and local laws, regulations, ordinances, court orders, attorney general opinions or interpretive letters concerning the public health, safety, welfare, environment or a hazardous substance; and (2) Hazardous Substance means any toxic, radioactive or hazardous material, waste, pollutant or contaminant which has characteristics which render the substance dangerous or potentially dangerous to the public health, safety, welfare or environment. The term includes, without limitation, any substances defined as "hazardous material," "toxic substance," "hazardous waste," "hazardous substance," or "regulated substance" under any Environmental Law. Mortgagor represents, warrants and agrees that: A. Except as previously disclosed and acknowledged in writing to Lender, no Hazardous Substance is or will be located, stored or released on or in the Property. This restriction does not apply to small quantities of Hazardous Substances that are generally recognized to be appropriate for the normal use and maintenance of the Property. B. Except as previously disclosed and acknowledged in writing to Lender, Mortgagor and every tenant have been, are, and will remain in full compliance with any applicable Environmental Law. C. Mortgagor will immediately notify Lender if a release or threatened release of a Hazardous Substance occurs on, under or about the Property or there is a violation of any Environmental Law concerning the Property. In such an event, Mortgagor will take all necessary remedial action in accordance with any Environmental Law. D. Mortgagor will immediately notify Lender in writing as soon as Mortgagor has reason to believe there is any pending or threatened investigation, claim, or proceeding relating to the release or threatened release of any Hazardous Substance or the violation of any Environmental Law. WADE W. DUNLAP Wyoming Mortgage WY /4XJNEWELL00000000000624041 1 02 5 1 1 N 1111111 11111111 11111111 11111 111111111011 111 111111111111 111 1 X Wolters Kluwer Financial Services 0 1996, 2011 Bankers SystemsTM Page 4 000261 15. CONDEMNATION. Mortgagor will give Lender prompt notice of any pending or threatened action by private or public entities to purchase or take any or all of the Property through condemnation, eminent domain, or any other means. Mortgagor authorizes Lender to intervene in Mortgagor's name in any of the above described actions or claims. Mortgagor assigns to Lender the proceeds of any award or claim for damages connected with a condemnation or other taking of all or any part of the Property. Such proceeds will be considered payments and will be applied as provided in this Security Instrument. This assignment of proceeds is subject to the terms of any prior mortgage, deed of trust, security agreement or other lien document. 16. ESCROW FOR TAXES AND INSURANCE. Mortgagor will not be required to pay to Lender funds for taxes and insurance in escrow. 17. WAIVERS. Except to the extent prohibited by law, Mortgagor waives all homestead exemption rights relating to the Property. 18. APPLICABLE LAW. This Security Instrument is governed by the laws of Wyoming, the United States of America, and to the extent required, by the laws of the jurisdiction where the Property is located, except to the extent such state laws are preempted by federal law. 19. JOINT AND INDIVIDUAL LIABILITY AND SUCCESSORS. Each Mortgagor's obligations under this Security Instrument are independent of the obligations of any other Mortgagor. Lender may sue each Mortgagor individually or together with any other Mortgagor. Lender may release any part of the Property and Mortgagor will still be obligated under this Security Instrument for the remaining Property. Mortgagor agrees that Lender and any party to this Security Instrument may extend, modify or make any change in the terms of this Security Instrument or any evidence of debt without Mortgagor's consent. Such a change will not release Mortgagor from the terms of this Security Instrument. The duties and benefits of this Security Instrument will bind and benefit the successors and assigns of Lender and Mortgagor. 20. AMENDMENT, INTEGRATION AND SEVERABILITY. This Security Instrument may not be amended or modified by oral agreement. No amendment or modification of this Security Instrument is effective unless made in writing and executed by Mortgagor and Lender. This Security Instrument and any other documents relating to the Secured Debts are the complete and final expression of the agreement. If any provision of this Security Instrument is unenforceable, then the unenforceable provision will be severed and the remaining provisions will still be enforceable. 21. INTERPRETATION. Whenever used, the singular includes the plural and the plural includes the singular. The section headings are for convenience only and are not to be used to interpret or define the terms of this Security Instrument. 22. NOTICE, ADDITIONAL DOCUMENTS AND RECORDING FEES. Unless otherwise required by law, any notice will be given by delivering it or mailing it by first class mail to the appropriate party's address listed in the DATE AND PARTIES section, or to any other address designated in writing. Notice to one Mortgagor will be deemed to be notice to all Mortgagors. Mortgagor will inform Lender in writing of any change in Mortgagor's name, address or other application information. Mortgagor will provide Lender any other, correct and complete information Lender requests to effectively mortgage or convey the Property. Mortgagor agrees to pay all expenses, charges and taxes in connection with the preparation and recording of this Security Instrument. Mortgagor agrees to sign, deliver, and file any additional documents or certifications that Lender may consider necessary to perfect, continue, and preserve Mortgagor's obligations under this Security Instrument and to confirm Lender's lien status on any Property, and Mortgagor agrees to pay all expenses, charges and taxes in connection with the preparation and recording thereof. Time is of the essence. WADE W. DUNLAP Wyoming Mortgage WY /4XJNEWELL00000000000624041 10251 1 N 1IIIIIIIII01001001101 Hk 1011 1101I11111111I1I0 I1I00111I1X010111011I11110IM ,0,11111 Wolters Kluwer Financial Services 1996, 2011 Bankers Systems"' Page 5 000262 SIGNATURES. By signing, Mortgagor agrees to the terms and covenants contained in this Security Instrument. Mortgagor also acknowledges receipt of a copy of this Security Instrument. MORTGAGOR: .7 >,--�2 WA W. D P Individually Date JI DUNLAP In ividually LENDER: The Bank Of Star Valley By L,anc: P. Robinson, Vice President ACKNOWLE MENT. (Individual) Date rc /2G /7v ti ic /2-(c i k A. OF OF ■Y---Cr,VC-42-1/1 ss. This instrument was ack owledge efore me this o7G1a day of 07O/ 1 by WADE W. DUNLAP spouse of JILL DUNLAP, and JILL DUNLAP spouse of WADE W. DUNLAP. My commission expires: 9 -/5-/S -P�z�i (Notary Public) WADE W. DUNLAP Wyoming Mortgage WY/ 4XJNEWELL00000000000624041102511N IIIIII111101001 X111111 X111 0 1 7 0 2 6 9 6/ 1 2 4 4/ 1 0 2 6 2 0 1 1 GLORIA K. BYERS NOTARY PUBLIC County of Lincoln State of MY Com Wyoming misson Expires September 15, 2015 Wolters Kluwer Financial Services ©1996, 2011 Bankers SystemsTM Page 6 (Lender Acknowledgment) 1111 My commission expires: 11 D JASMINE NEWELL NOTARY PUBLIC COUNTY OF j STATE OF LINCOLN :'4 WYOMING MY COMMISSION EXPIRES NOVEMBER 20, 2013 WADE W. DUNLAP Wyoming Mortgage WY/ 4XJNEWELL00000000000624041102511N 111111111111111111111111111111111111101111111111111111111111111101111111111 111111III 1 000263 1 OF ®Y tk F V1 1 1 ss. edged b This instrument was ackno ed g re me this 134 of 0 0 19 t D- 1 f Lance P. Robinson as Vice President of The Bank Of Star Valley. by Wolters Kluwer Financial Services m1996, 2011 Bankers SystemsTM Page 7 EXHIBIT "A" 000264 Lot 1 of Gem View Estates, Lincoln County, Wyoming, as described on the official plat No. 305-B filed December 21, 2005, as Instrument No. 914639 of the records of the Lincoln County Clerk. WADP W T)TTNT,AP JTT,T, DUNLAP PO BOX 1341 AFTON, WY 83110 [APPLICANT'S NAME AND ADDRESS] The Bank Of Star Valley 384 Washington P.O. Box 8007 Afton, WY 83110 [LENDER NAME AND ADDRESS] No. 01702896 Date 10/26/2011 Prop. Address LOT 1 GEM VTF,W FSTATFS FATRVTFW, WY 83119 This loan is due 10/25/2014 (maturity). On that date, the entire principal balance of the loan and unpaid interest then due will be payable in full. Based on the loan for which you have applied, the balloon payment is estimated to be 20,046.53 assuming all other payments are made when due. THIS LOAN MUST EITHER BE PAID IN FULL AT MATURITY OR REFINANCED TO A MARKET LEVEL FIXED -RATE MORTGAGE. YOU MUST REPAY THE ENTIRE PRINCIPAL BALANCE OF THE LOAN AND UNPAID INTEREST THEN DUE IF YOU DO NOT QUALIFY FOR THE CONDITIONAL RIGHT TO REFINANCE AS SPECIFIED IN THE NOTE ADDENDUM AND THE MORTGAGE RIDER. THE LENDER IS UNDER NO OBLIGATION TO REFINANCE THE LOAN IF QUALIFICATION CONDITIONS ARE NOT MET. YOU WILL, THEREFORE, BE REQUIRED TO MAKE PAYMENT OUT OF OTHER ASSETS THAT YOU MAY OWN, OR YOU WILL HAVE TO FIND A LENDER, WHICH MAY BE THE LENDER YOU HAVE THIS LOAN WITH, WILLING TO LEND YOU THE MONEY. IF YOU REFINANCE THIS LOAN AT MATURITY, YOU MAY HAVE TO PAY SOME OR ALL OF THE CLOSING COSTS NORMALLY ASSOCIATED WITH A NEW LOAN EVEN IF YOU OBTAIN REFINANCING FROM THE SAME LENDER. At least 90 but not more than 120 days prior to the expected maturity, the lender shall send you a notice of maturity with the current estimate of the balloon payment and a reminder of the date it will mature. 12 You will be sent notice of the estimated balloon payment at least 10 days before the expected maturity date of your loan. Even if the lender is not under any obligation to refinance the balloon payment, it will consider an application to refinance this loan at the time payment is due on the same basis as all other new mortgage applications. Applicant(s) acknowledge receipt of a copy of this disclosure on today's date. `/L.1 [Signature] WADE W. DUNLAP Balloon Payment Application Disclosure VMP® Bankers SystemsTM Wolters Kluwer Financial Services 1990, 2007 111111IIIII01011I0010111IIII 111111111111111 III111,111,1111 1 1 APPLICATION DISCLOSURE BALLOON PAYMENT MORTGAGE This disclosure is given to provide information concerning the loan applied for. This is not a commitment to make a loan. IN [Sig re] JI DUNLAP Initials: 000265 MA K 0/21.00 (0 07 (07021.00 Page 1 of 1 000266 [APPLICANT'S NAME AND ADDRESS] The Bank Of Star Valley 384 Washington P.O. Box 8007 Afton, WY 83110 [LENDER NAME AND ADDRESS] No. 01702896 Date 10/26/2011 Prop. Address LOT 1 GEM VIEW ESTATES FAIRVIEW, WY 83119 This loan is due 10/25/2014 APPLICATION DISCLOSURE BALLOON PAYMENT MORTGAGE This disclosure is given to provide information concerning the loan applied for. This is not a commitment to make a loan. (maturity). On that date, the entire principal balance of the loan and unpaid interest then due will be payable in full. Based on the loan for which you have applied, the balloon payment is estimated to be 20, 046.53 made when due. assuming all other payments are THIS LOAN MUST EITHER BE PAID IN FULL AT MATURITY OR REFINANCED TO A MARKET LEVEL FIXED -RATE MORTGAGE. YOU MUST REPAY THE ENTIRE PRINCIPAL BALANCE OF THE LOAN AND UNPAID INTEREST THEN DUE IF YOU DO NOT QUALIFY FOR THE CONDITIONAL RIGHT TO REFINANCE AS SPECIFIED IN THE NOTE ADDENDUM AND THE MORTGAGE RIDER. THE LENDER IS UNDER NO OBLIGATION TO REFINANCE THE LOAN IF QUALIFICATION CONDITIONS ARE NOT MET. YOU WILL, THEREFORE, BE REQUIRED TO MAKE PAYMENT OUT OF OTHER ASSETS THAT YOU MAY OWN, OR YOU WILL HAVE TO FIND A LENDER, WHICH MAY BE THE LENDER YOU HAVE THIS LOAN WITH, WILLING TO LEND YOU THE MONEY. IF YOU REFINANCE THIS LOAN AT MATURITY, YOU MAY HAVE TO PAY SOME OR ALL OF THE CLOSING COSTS NORMALLY ASSOCIATED WITH A NEW LOAN EVEN IF YOU OBTAIN REFINANCING FROM THE SAME LENDER. At least 90 but not more than 120 days prior to the expected maturity, the lender shall send you a notice of maturity with the current estimate of the balloon payment and a reminder of the date it will mature. Di You will be sent notice of the estimated balloon payment at least 10 days before the expected maturity date of your loan. Even if the lender is not under any obligation to refinance the balloon payment, it will consider an application to refinance this loan at the time payment is due on the same basis as all other new mortgage applications. Applicant(s) acknowledge receipt of a copy of this disclosure on today's date. 0 [Signature] [Sig re] Balloon Payment Application Disclosure VMP® Bankers SystemsTM Wolters Kluwer Financial Services 1990, 2007 1111111,11111 BPMAD -BK 2/20/2007 �[eQPC (0702).00 Initials: ,J J Page e 1 1 of of 1 1