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NOTE AND DISCLOSURE STATEMENT
NAME AND ADDRESS OF BORRO ER(S) ~ LENDER'S NAME AND ADDRESS: '
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hpeM ~ Yo~1~M Pararwts. Me Fpt Ong S aa0_~ ' ~
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Mme. M ~ FiM Eaaq Fw11 P~F~ Sutli 01 1NyidaiilMa Alf ; i',
THE FOLLOWING CHARGES AND IUM~ AHE INCLUDED 1.' Net Balance of Prior
IN THE AMOUNT FINANCED A ARE{ NAT ~AART OF THE Account Renewed i
FINANCE CHARGE: ~
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Single Decreasing Credit Ufe Insu = "a" •Mrount of Credit (1 + 2) i~'!~~
4. peal, Estate Recording) • . -r,.
Joint Decreasing Credit Ufe Insu ~ Z .releasing Fees t
' 5. 'Abstract Costs S
Credit Disability Insurance Premium.... . 6. _
s' . 6. ~Attarney's'Fees t "'w ~ .
CREDIT INSURANCE ELE~T ~ . '
7.:~titte Insurance Premium i
`-CREDIT LIFE AND CREDIT DISABILITY y NCE ARE NOT 8.'DocumentaryStampTax S f. '
REQUIRED 8Y LENDER.
_ ~ 9. S
,The undersigned (check one box) _ ~ 10. ~ S _ ~ _ -
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~ request(s) Credit Life Insurance oll y, the cosj of which is 11. Total Closing Costs and Fees . • ~ 1
stated above. ~ ~ ~ 5 + ~ + 7 + 8 + 9 + 10) S~~
O request(s) Credit Ufe and Credit Disability lpsuiance, the cost 12. Life fnsurance Premium S
of which ~ stated above. ~ _ •
v~ ~ 13. 'Disability Insurance ~
~ do(e"s) not w tan r ~ .Premium ~ S '
Signs u ~19~ 14. %f?rt7pertyir>s<,rar>ce Premium S "4•
` - • - 15. ,`[otal Insurance Premiums
Sig reams ~ ~g~. X12 + 13 + 14)..........., i , .
~ ' 16. Amount Financed
~ Ti'?e Borrower may choose the person through vrhor>n the property . (3 ± 11 + 15) . . i ~ .
insurance is obtained, or provide such..gdv*rage through an 17. interest S~f~e~ -
existing policy.
18. 2% loan Fee
Cost of Property Insurance it obtained th ~ Lender (prepaid Finance Charge) S -
s ~ - 1s. FINANCE CHARGE -
(17 + i8) i~~e~
liWe request and authorize Lender_lro~in Property Insurance.
Signature: g TOtsl•0 ~
aymenis
Date Si ned' 116 1 i~~°~ • .
~ signature: Date Si~rted 21. ANNUAL PERCENTAGE RATE %
DELINQUENCY: In the event any installmen nQt paid when due, Borrower agrees to pay Lender a late charge of 5% of s8td installment. ,
DEFAULT: Failure to pay any installment w e~4ue, or death or insolvencyof any borrower, shall, at the option of Lender, and without notice
or demand, render the entire balance, less aeed~t for the unearned interest portion of the Finance Charge computed according to the Rule of ~
7$'s, immediately due and payable. After de It lheLnpaid balance shall bear i~ien3st at a rate of 10% per annum.
In the event this note is placed in the h s of an $ttorney for collection, Borrower agrees to pay actual and reasonable attorney's fees and
any court costs incurred, as determin the court in which suit is filed.
~ PREPAYMENT: Prepayment may be de in full or jn part at any time. lJpon prepayment in full. Borrower shaft be rebated the unearned
interest portion of the Finance Charge computed according to the Ruie of 78's. No rebate of the 2% Loan Fee will be made.
SECURITY: .
7 This loan is secured by proceeds and refunds of unearned premiums from credit insurance.
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This loan is secured by a mortgage on re~)~estate owned by Borrower located at Borrower's principal address stated above or located at:
i _ ~ Sa'oMSwr ~e Zi~si~~ 1311. •
Number _ ~ Street City Slate Zip Code
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'This Loan is secured by a Securit{? interest taken by agreement of even date covering: (1) the following described property, (2) the proceeds
1 thereof, (3) all property of the same type or character in which Borrowa• acquires rights, provided that as to consumer goods, other than
accessions, such rights are acquired within'10 days after Lender advances funds to or for Borrower.upon this loan or upon an future
loan made to Borrower by Lender, (4) all equipment, accessories and parts added or attached thereto, (5) alt insurance proc:eods from the
loss Or damage of the collateral, and (6) allunds of unearned insurance premwms. ,
(a) Motor Vehicle(s):
MAKE COLOR RIAL NO. BODY STYLE MODEL YEAR OTHER IDENTIFlCATION
O (b) The following described property now located in or about the Borrower's premises at the address above stated:
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