FILED: SCHOHARIE COUNTY CLERK 06/02/2021 11:10 AM
`NYSCEF DOC. NO. 7
`
`INDEX NO. 2021-2
`
`RECEIVED NYSCEF: 06/02/2021
`
`AFFIDAVIT
`
`OF FACTS
`
`AND SALE OF ACCOUNT
`(Debt
`Buyer
`Actions)
`
`BY CITIBANK,
`
`N.A.
`
`ss.
`
`) )
`
`)
`
`STATE
`
`OF MISSOURI
`
`COUNTY
`
`OF PLATTE
`
`Account
`
`Holder:
`
`JOSEPH
`
`POLIZZI
`
`SR
`
`Account
`
`#:
`
`ending
`
`in 8482
`
`SSN/EIN/TIN
`
`#:
`
`xxx-xx-2078
`
`The
`
`undersigned,
`
`being
`
`duly
`
`sworn,
`
`deposes
`
`and says:
`
`Creditor
`an Original
`N.A.
`of Citibank,
`I am an employee
`("Citibank"),
`the New York
`for The Supreme
`Civil
`Uniform
`202.27-a
`of
`Court
`Rules
`to Citibank's
`of and access
`books
`knowledge
`and I have
`personal
`Court,
`County
`to a pool
`of charged-off
`electronic
`("Business
`records,
`Records"),
`relating
`including
`by Citibank
`SPV I, LLC
`to Cavalry
`or assigned
`credit
`accounts
`sold
`("Debt
`Buyer"),
`the account
`8482
`of
`the consumer
`which
`(the "Sale"),
`included
`I1/22/2019
`("Account")
`identified
`in the exhibits
`attached
`JOSEPH
`POLIZZI
`SR ("Consumer")
`hereto
`and
`all of
`in the Account,
`of
`As part
`the Sale, Citibank
`assigned
`its interest
`incorporated
`herein.
`from the Accounts,
`and Citibank
`the right
`to any proceeds
`to Debt Buyer,
`transferred
`A true and correct
`to Debt Buyer.
`to the Account
`records
`the bill
`of
`relating
`to the Account
`as an exhibit
`pertains
`is attached
`to this
`affidavit.
`
`1.
`Section
`
`including
`business
`sale which
`
`in
`
`as defined
`and The
`and records
`consumer
`on
`
`copy
`
`of
`
`knowledge
`
`procedures
`of Citibank's
`personal
`have
`I also
`In my position,
`for creating
`2.
`to the Account
`("Business
`records
`Citibank's
`and maintaining
`business
`Records"),
`pertaining
`of consumer
`to the sale and assignment
`Citibank's
`procedures
`credit
`relating
`including
`course
`were made
`of business
`in the regular
`Records
`accounts.
`Business
`and it was
`Citibank's
`The Business
`were
`to make
`the regular
`course
`of such
`the Business
`Records.
`Records
`business
`at or near
`the time
`the events
`recorded.
`Based
`knowledge
`on my
`of Citibank's
`of
`made
`I have
`knowledge
`the facts
`set
`forth
`Business
`personal
`in this
`affidavit.
`Records,
`
`of
`
`to a credit
`parties
`were
`and Consumer
`Citibank
`3.
`the terms
`agreement
`("Agreement"),
`to charge-
`in the last billing
`are reflected
`prior
`by Citibank
`statement
`which
`sent
`to Consumer
`as an exhibit.
`is attached
`off, which
`for all goods,
`hereto
`Consumer
`agreed
`to pay Citibank
`and cash advances
`provided
`pursuant
`to the Agreement.
`The
`date and the ameürit
`services
`by Consumer
`are set
`the last payment,
`if any, made
`forth
`in an exhibit
`attached
`hereto
`and
`Consumer
`made
`a part
`hereof.
`defaulted
`and a demand
`for payment
`was made
`by Citibank.
`true
`and correct
`of
`the Agreement
`is attached
`to this affidavit.
`as an exhibit
`
`copy
`
`of
`
`of
`
`A
`
`1 of 11
`
`

`

`FILED: SCHOHARIE COUNTY CLERK 06/02/2021 11:10 AM
`NYSCEF DOC. NO. 7
`
`INDEX NO. 2021-2
`
`RECEIVED NYSCEF: 06/02/2021
`
`in the exhibits
`the amount
`attached
`forth
`set
`owed
`the Sale, Censurser
`of
`the time
`At
`4.
`also show the name
`the last
`of Consumer;
`which
`a part
`and made
`exhibits
`hereto
`hereof,
`may
`the charge-off
`the date and
`of
`the date and amount
`the Account
`of
`four
`digits
`balance;
`number,
`of any post-charge-off
`if applicable,
`the last payment,
`if any;
`the total
`amount
`of
`amounts,
`made
`fees and charges;
`any post-charge-off
`credits
`or paymcats
`and post-charge-off
`interest
`above
`of
`the time
`the Sale.
`The
`statements
`and the balance
`due at
`or on behalf
`of Consumer;
`to the best of my personal
`knowledge.
`are true and correct
`
`by
`
`affirm
`I solemnly
`the foregoing
`of
`
`under
`paper
`
`the penalties
`are true.
`
`of perjury
`
`and upon
`
`personal
`
`knowledge
`
`that
`
`the contents
`
`EXECUTED
`
`on
`
`MAR
`
`2 Û
`
`, 20 20
`
`.
`
`Signature
`
`Name
`
`B Gauper
`
`ss.
`
`) )
`
`)
`
`STATE
`
`OF MISSOURI
`
`COUNTY
`
`OF PLATTE
`
`Subscribed
`
`and sworn
`
`to before me by
`
`B Gauper
`
`this
`
`day
`
`of
`
`MAR
`
`, 20 20
`
`.
`
`[SEAL]
`
`CAROLYN E HUGHES
`Notary Public - Notary Seal
`5tate of Missouri, Jacl<son County
`Commission #14927304
`My Commission Expires Jan 26, 2022
`
`.
`
`Pubile
`
`Notary
`
`My commission
`
`expires:
`
`Personally
`Produced
`
`known
`identification
`
`OR
`
`Type
`
`of
`
`identification
`
`produced:
`
`Citi Employee Badge
`
`__
`
`2
`
`2 of 11
`
`

`

`FILED: SCHOHARIE COUNTY CLERK 06/02/2021 11:10 AM
`NYSCEF DOC. NO. 7
`
`INDEX NO. 2021-2
`
`RECEIVED NYSCEF: 06/02/2021
`
`CERTIFICATE
`
`OF CONFORMITY
`
`I, J. Vogler
`of Missouri
`the State
`the acknowledgement
`that
`qualified
`I am duly
`Real
`Law
`of
`Property
`the
`proof
`upon
`State
`of Missouri,
`the
`laws
`thereof
`
`by
`
`the State
`an attorney-at-law
`of
`acquainted
`with
`and
`is fully
`or proof
`of deeds
`of
`real
`to make
`this
`certificate
`of New
`the State
`York
`document
`taken
`was
`foregoing
`prescribed
`in the manner
`in all
`respects.
`
`law in
`to
`
`to practice
`is licensed
`of Missouri
`who
`of Missouri
`the
`the State
`of
`laws
`pertaining
`to be recorded
`do hereby
`therein.
`certify
`of
`pursuant
`to Section
`299-a
`the
`the
`acknowledgement
`or
`that
`certify
`public
`in
`E. Hughes.
`a notary
`the
`of Missouri
`and
`conforms
`to
`the State
`
`property
`of
`conformity
`and
`hereby
`by Carolyn
`laws
`of
`
`the
`
`IN WITNESS
`
`WHEREOF,
`
`I have
`
`hereunto
`
`set my
`
`signature.
`
`this
`
`c20
`
`day
`
`of March
`
`2020.
`
`Idis
`J. V
`
`ri Bar
`ler
`
`# 51227
`
`3 of 11
`
`

`

`FILED: SCHOHARIE COUNTY CLERK 06/02/2021 11:10 AM
`NYSCEF DOC. NO. 7
`
`INDEX NO. 2021-2
`
`RECEIVED NYSCEF: 06/02/2021
`
`ID: CV8MUMAA021819
`Contract
`Document
`ID: CV8MUMAAO22119C2
`Document
`ID: 111419CV 1MU3FMBI
`
`BILL
`
`OF SALE
`
`AND ASSIGNMENT
`
`BILL
`
`AND ASSIGNMENT
`OF SALE
`dated November
`is by Citibank,
`THIS
`22, 2019,
`N.A.,
`at 5800
`the United
`the laws
`association
`crgañized
`under
`of
`South
`located
`national
`States,
`banking
`SPV I, LLC,
`Sioux
`Falls,SD
`57108
`(the
`to Cavalry
`the
`organized
`under
`Corporate
`Place,
`"Bank")
`at 500 Sv=mk
`the State
`of Delaware,
`with
`place
`its headqüarters/principal
`of business
`laws
`of
`NY 10595
`("Buyer").
`Suite
`Lake Drive,
`400, Valhalla,
`
`a
`
`received
`value
`For
`dated
`Agreement
`and the Bank
`Buyer
`set over
`bargain,
`in Exhibit
`described
`
`and
`
`to the
`subject
`18, 2019
`February
`(the
`"Agreement"),
`deliver
`to Buyer,
`and
`1 to the Addendum
`
`conditions
`and
`terms
`of
`2 dated
`No.
`and Addendum
`the Bank
`does hereby
`transfer,
`and
`to Buyer's
`successors
`and the final
`electronic
`file.
`
`the Master
`
`and Sale
`between
`
`Purchase
`2019,
`21,
`assign,
`cañvey,
`grant,
`the Accounts
`assigns,
`
`February
`sell,
`and
`
`Citibank,
`
`N.A.
`
`By:
`
`(Si
`
`_,
`ture)
`
`Name:
`
`emy Gok:ban
`
`Titic:
`
`Authorized
`
`Party
`
`Cavalry 021819
`
`4 of 11
`
`

`

`FILED: SCHOHARIE COUNTY CLERK 06/02/2021 11:10 AM
`NYSCEF DOC. NO. 7
`
`INDEX NO. 2021-2
`
`RECEIVED NYSCEF: 06/02/2021
`
`ID: CV8MUMAA021819
`Contract
`ID: CV8MUMAAO22119C2
`Document
`ID: 1I1419CV1MU3FMA1
`Document
`
`Exhibit
`
`1
`
`The
`iridividual
`by the Bank
`
`Accaüñts
`to Buyer,
`
`are described
`transferred
`decraed
`the same
`attached
`
`in the final
`hereto
`this
`
`by
`
`electronic
`reference.
`
`file
`
`and delivered
`
`Lot
`Brands
`Fresh
`
`Flow
`
`ID
`Sale
`111419CV1MU3FM
`
`# of
`Accounts
`14,311
`
`Sale Balance
`
`Cut-Off
`11/14/2019
`
`Date
`
`Cavalry 021819
`
`. g -
`
`5 of 11
`
`

`

`FILED: SCHOHARIE COUNTY CLERK 06/02/2021 11:10 AM
`NYSCEF DOC. NO. 7
`
`INDEX NO. 2021-2
`
`RECEIVED NYSCEF: 06/02/2021
`
`Citi®'Double
`
`Casti
`
`Card
`
`JOSEPH POLlZZI SR
`Member Since 2016 Account number ending in:8482
`Billing Perlod:08/23/19-09/23/19
`
`STATEMENT
`SEPTEMBER
`payment
`due:
`Minimum
`New balance
`as of 09/23/19:
`Payment
`due date:
`See the back of this statement
`paying interest on purchases.
`
`for !rnportant
`
`S2,060.43
`$2,060.43
`09/23/19
`Inf ormation about how to avoid
`
`Late Payment Warning:lf we do not receive your minimum payment by the
`date listed above. you may have to pay a late fee of up to $39 and your APRs
`may be increased up to the Penalty APR of 29.99%.
`you make only the minirnum payment each
`"'n'==-.
`Payment Warning:lf
`period, you will pay more in interest and it will
`take you longer
`to pay off your
`balance. For example:
`If you make no addth.u!
`charges using this card
`and each month you pay.-
`
`the
`You will pay off
`balance shown on this
`in about.-
`staternent
`
`And you will end up
`paying an estimated
`total of.-
`
`www.citicards.com
`Customer Service 1-855-473-4583
`services only 1-800-325·2865
`TTY-hearing-Impaired
`BOX 6500 SIOUX FALLS, SD 57117
`
`Summary
`balance
`
`Account
`Previous
`Payments
`Credits
`Purchases
`Cash advances
`Fees
`Interest
`New balance
`
`Limit
`Credit
`limit
`Credit
`includes $600 cash advance Ilmit
`
`$2,019.33
`-S0.00
`-S0.00
`+$0.00
`+$0.00
`+$0.00
`+$41.10
`$2,060.43
`
`$1,700
`
`Only the rninimurn payrnent
`For information about credit counseling services, call 1-877-337-8188NewYork
`residents may contact the New York State Banking Department to obtain a comparative
`listing of credit card rates, fees and grace periods by calling 1·877-226-S697.
`
`1month(s)
`
`S2,060
`
`anywhere
`from virtually
`Pay your bill
`with the Citi Mobile' App and Citi" Online
`Todownload
`Text'App15'to Mycitl (692484)
`or go to your device'sappstore.
`Orvisit www.citicards.com
`
`payment
`Minimum
`New balance
`due date
`Payment
`
`due
`
`Amount
`
`enclosed:
`
`$2,060.43
`$2,060.43
`09/23/19
`
`000000 MC 32 A O
`
`JOSEPH POLlZZI SR
`129 POLlZZI RD
`HOWES CAVE NY 12092-300S
`
`Account
`
`number
`
`ending in 8482
`
`CITI CARDS
`PO Box 70166
`P"!Mc!;Ma
`PA 19176-0166
`
`15009
`
`O206043
`
`O206043
`
`0004500
`
`8482
`
`1618
`
`6 of 11
`
`

`

`FILED: SCHOHARIE COUNTY CLERK 06/02/2021 11:10 AM
`NYSCEF DOC. NO. 7
`
`INDEX NO. 2021-2
`
`RECEIVED NYSCEF: 06/02/2021
`
`www.citicards.com
`
`JOSEPH POLIZZI SR
`
`Customer Service 1-855-473-4583
`TTY-hearing-Irnpaired
`services only I-800-325-2865
`
`Page 2 of 2
`
`Account
`Summary
`Post
`Trans.
`Description
`date
`date
`Amount
`......................................................................................................................................................
`
`Fees
`
`Total
`
`charged
`fees charged In this billing period
`
`$0.00
`
`Interest
`
`charged
`Description
`Date
`Amount
`........................................................................,...........-.-.......-...._...............-.......................
`09/23
`INTERESTCHARGEDTO STANDARD PURCH
`$400
`$41.10
`Total
`charged in this billing period
`
`interest
`
`2019
`
`totals
`
`year-to-date
`
`fees charged in 2019
`$223.00
`Total
`_.......................-....................
`........................_....................-...........................
`interest
`charged in 2019
`Total
`$307.97
`
`................,.
`
`calculation
`charge
`Interest
`Days in blmng cycle·32
`YourAnnual Percentage Rate (APR)ls the annualinterest rate on your account.
`.,,..................................................................................................................................................
`e Balance subject
`Annual percenta
`Balance type
`rate (AP )
`rate
`to interest
`charge
`Interest
`............................_........................................................................-............................................
`CHAS
`Standard Purch
`$2,039.17 (D)
`$41.10
`22.99% (V)
`.....................................................................................................................................................
`.ADyANC
`Standard AdV
`
`S0.00
`
`27.24% (V)
`
`50.00 (D)
`
`Your Annual Percentage Rate (APR)is the annuat interest rate on your account. APRsfollowed
`by (V) may vary. Balancesfollowed by (D) are determined by the dally balance rnethod
`(including current
`transactions).
`
`messages
`Account
`your pay by phone or online
`Please note that
`if we received
`payment
`between
`5 p.m. ET and midnight
`ET on the last day of your billing period,
`your payment
`until your next statement.
`will not be reflected
`
`©2018 Citibank, N.A.
`Citi, Citi with Arc Design are registered
`
`service marks of Citigroup
`
`Inc.
`
`7 of 11
`
`

`

`FILED: SCHOHARIE COUNTY CLERK 06/02/2021 11:10 AM
`NYSCEF DOC. NO. 7
`
`INDEX NO. 2021-2
`
`RECEIVED NYSCEF: 06/02/2021
`
`Citi°
`
`Doublé
`
`Casfi
`
`Card
`
`JOSEPH POLIZZI SR
`Member Since 2016 Account number ending in: 8482
`Billing Period:07/23/19-08/22/19
`
`STATEMENT
`AUGUST
`due:
`payment
`Minimum
`as of 08/22/19:
`New ba!ance
`due
`Payment
`date:
`See the back of this statement
`paying Interest on purchases.
`
`for Important
`
`$905.80
`$2,019.33
`09/20/19
`informallon about how to avoid
`
`Late Payment Warning:If we do not receive your minimum payment by the
`date listed above, you may have to pay a late fee of up to $39 and your APRs
`may be increased up to the Penalty APR of 29.99%.
`Minimum Payment Warning:1f you make only the minimum payment each
`take you longer
`to pay off your
`period, you will pay more In interest and it will
`balance. For example:
`If you make no additlanal
`charges using this card
`and each month you pay...
`
`the
`You will pay off
`balance shown on this
`statement
`in about.-
`
`And you will end up
`aying an estimated
`otal of-.
`
`Only the minimum payment
`7 year(s)
`For information about credit counseling services, call1·877-337-8188New York
`residents inav contact t he New York 5tate Banking Department to obtain a comparative
`listing of credit card rates, fees and grace periods by calling 1·877-226-5697.
`
`$3,118
`
`www.citicards.com
`customer Service 1-855-473-4583
`TTY-hearing-Impaired
`services only 1-800-325-2865
`BOX 6500 510UX FALLS. SD 57117
`
`Your account
`is past due. Please pay at
`the minimum payment
`due, which
`least
`a past due amount
`includes
`of $489.19 and
`an overlimit
`amount
`of $319.33.
`
`Summary
`balance
`
`Account
`Previous
`Payments
`Credits
`Purchases
`Cash advances
`Fees
`Interest
`New balance
`
`Limit
`Credit
`limit
`Credit
`Includes S600 cash advance limit
`
`$1,942.05
`-$0.00
`-$0.00
`+$0.00
`+$0.00
`+$39.00
`+$38.28
`$2,019.33
`
`$1,700
`
`from virtually
`Pay your bill
`anywhere
`with the Citl Mobile' App and CItP Online
`Todownload-
`Text 'Apptsilo Myciti (692484)
`or go to your device'sappstore.
`or visit www.citicards.com
`
`payment
`M5!==.T;
`New balance
`due date
`Payment
`
`due
`
`Amount
`
`enclosed:
`
`$905.80
`$2,019.33
`09/20/19
`
`000000 MC 32 A o
`
`JOSEPH POLlZZI SR
`129 POLIZZI RD
`HOWESCAVE NY 12092-3005
`
`Account
`
`number ending in 8482
`
`CITI CARDS
`PO Box 70166
`Philadelphia PA 19176-0166
`
`15009
`
`0090580
`
`0201933
`
`0004500
`
`8482
`
`1612
`
`8 of 11
`
`

`

`FILED: SCHOHARIE COUNTY CLERK 06/02/2021 11:10 AM
`NYSCEF DOC. NO. 7
`
`INDEX NO. 2021-2
`
`RECEIVED NYSCEF: 06/02/2021
`
`www.citlcards.com
`
`JOSEPH POLIZZI SR
`
`Customer Service 1-855-473-4583
`TTY-hearing-irnpaired
`services only I-800-325-2865
`
`Page 2 of 2
`
`Account
`Summary
`Post
`Trans.
`Arnount
`Description
`date
`date
`.................-...................................................................................................................................
`
`Fees
`
`charged
`
`Date
`08/22
`Total
`
`Description
`LATE FEE • JUL PAYMENT PAST DUE
`fees charged In this billing period
`
`Interest
`
`charged
`
`Arnount
`$39.00
`$39.00
`
`Amount
`Description
`Date
`.................................................................
`.....-........................................
`$38.28
`INTERESTCHARGEDTO STANDARD PURCH
`08/22
`$38.28
`charged In this bll!Ing period
`Total
`
`Interest
`
`20t9
`
`totals
`
`year-to-date
`
`$223.00
`fees charged in 2019
`Total
`...................................................................................................................................................
`interest
`$266.87
`charged In 2019
`Total
`
`Interest
`
`charge
`
`.I°°CÛ.
`
`..
`
`...
`
`calculation
`Days in billing cycle:31
`st a e on ou acco t
`he annual
`. . .. .'"..!Ô.P
`e Balance subject
`Annual percenta
`charge
`Interest
`to Interest
`rate
`rate (AP )
`Balance type
`.....................................................................................................................................................
`,PURC AS
`Standard Purch
`.AD ANC
`Standard Adv
`
`22.99% (V)
`
`SL960.51(D)
`
`27.24% (V)
`
`$0.00 (D)
`
`$38.28
`
`$0.00
`
`Your Annual Percentage Rate (APR)is the annual interest rate on your account, APRsfollowed
`by (V) may vary. Balances followed by (D) are determined by the daily balance method
`transactions).
`(including current
`
`messages
`Account
`in Fall 2019, your CitP Double Cash Card will allow you to convert
`Coming
`to ThankYotP Points which can be redeemed
`for 9ift cards,
`your cash rewards
`and more. More details are coming soon.
`at select
`purchases
`retailers,
`travel,
`from Citi, visit www.thankyou.com.
`To learn more about ThankYou Rewards
`between
`payment
`your pay by phone or online
`if we received
`Please note that
`your payment
`ET on the last day of your billing
`5 p.m. ET and midnight
`period,
`until your next statement.
`will not be reflected
`©2018 Citibank, N.A.
`Citi, Citi with Arc Design are registered
`
`service marks of Citigroup
`
`Inc.
`
`9 of 11
`
`

`

`FILED: SCHOHARIE COUNTY CLERK 06/02/2021 11:10 AM
`NYSCEF DOC. NO. 7
`
`INDEX NO. 2021-2
`
`RECEIVED NYSCEF: 06/02/2021
`
`1
`
`~
`
`NUMBER
`ACCOUNT
`SALE SEGMENT
`IRRODUGT IDENTIFIER CODE
`PRODUGT1DESCRIPTION
`SALE ID
`SALE AMOUNT
`PRINCIPAL
`PRE CHARG.E OFFilNTEREST
`PRE CHARGE OliF FEES
`PÖST ClinRGE ÖFF lÑJEliEST
`POST CHARGE OFF FEES
`ORIGÏÑAL
`LOANJBALANCE
`CHARGE OFF BALANGE
`CURRENT BALANCE
`ACCOUNT OPEN DATE
`DEFAULT DATE
`HARGE ÓËIfDAT
`LÂ57 liAYÑlENT
`AMOUNT
`LAST PAYMENT'DATE
`LAST PURCHASE AMOUNT
`LAST PURGHASE DATE
`I LUII BAlÃNCE
`TRANSFER4MOUNT
`LAST BAIANCE
`TRANSFERIDATE
`LAST CASH ADVANCE
`AMOUNT
`LAST CASH ADVANCE
`DATE
`TOTAL PAYMENTS'PdST-CHA-ñGEW
`TOTAL NSFIPOST CHARGE OFF
`TOTAL CREDITS POST CHARGE OFF
`CONSUMER
`FIRST AND MIDDLE NAME
`LAST NAME
`CONSUMER
`CONSUMER
`RESIDENCE ADDRESS 1
`GOÑ~SUMER RESIDENCE ADDRESS 2
`CONSUMER
`RESIDENCE CITY
`CONSUMER
`STATE
`ZIP CODE
`CONSUMER
`COÑSUÑlER
`IfESIDENCE COUNTRY
`CONSUMER
`RESIDENCE PHONE
`BAD,NUMBER.INDICATOR
`SSN OR SIN
`CONSUMER
`CONSUMER
`BlÑTffDATE
`AWARENESS
`INDICATOR
`LANGUAGE
`INDICATOR
`FIRM-
`LAW
`ATTORNEY
`ATTORNEYIÑÀME
`ATTORNEY
`PHONE
`ATTORNEY
`ADDRESS
`ATtTORNEY CITY
`
`-
`
`848
`
`111419CV1MU3FM
`$2,019.
`
`$2,050.43
`
`23-Sep-19
`$45.40
`
`20-Feb-19]
`
`25-Feb-19
`
`$0.00
`$0.00
`$0.00
`JOSEPH
`POLlZZI SR
`
`2078
`
`10 of 11
`
`

`

`FILED: SCHOHARIE COUNTY CLERK 06/02/2021 11:10 AM
`NYSCEF DOC. NO. 7
`
`INDEX NO. 2021-2
`
`RECEIVED NYSCEF: 06/02/2021
`
`T2-
`
`T
`
`52% NE SATIORNEY
`STATE
`ZIR;CODE
`SATIORNEY
`BÄNRRUPTGWGHAPTER
`IfANKRUlfTGV
`ÉÌ[E 15ATE
`PRINCIPAL
`BICRROOFiOF$1.AIM
`TBltil51tÖÖfÖ
`C
`lÑTEREST
`Ble!PROOF OE CtfAINI EEE
`[E a B ÑKliiffKCeeflifÑifigigEit
`TRUSTEE
`BANKRUPTGY
`CO"BORROWER
`lilRST4NDWIIDDI.E
`I.AST NAME
`OeBORROWER
`CO¼BORROWER SSN OR SIN
`Ri-ORiáCEOUNT
`NUNIBER1
`PillOR ACCOUNT
`NUMBER-2
`[ N LÏNIBER
`(icis AcifollÑ
`RRIOR ACCO0NINÛMBER
`RRIOR áCCOUNT
`NUMBEñ
`I ENfflÑ5iliEVEL
`1 ..
`LENDING1ËVEl
`2
`
`4
`5
`
`NAM
`
`11 of 11
`
`