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Traille Full Package

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0% found this document useful (0 votes)
288 views43 pages

Traille Full Package

Uploaded by

joelyanez1992
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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Uniform Residential Loan Application

This application is designed to be completed by the applicant(s) with the Lender's assistance. Applicants should complete this form as "Borrower" or "Co-Borrower,"
as applicable. Co-Borrower information must also be provided (and the appropriate box checked) when the income or assets of a person other than the Borrower
(including the Borrower's spouse) will be used as a basis for loan qualification or the income or assets of the Borrower's spouse or other person who has community
property rights pursuant to state law will not be used as a basis for loan qualification, but his or her liabilities must be considered because the spouse or other person
has community property rights pursuant to applicable law and Borrower resides in a community property state, the security property is located in a community property
state, or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan.

If this is an application for joint credit, Borrower and Co-Borrower each agree that we intend to apply for joint credit (sign below):

Borrower Co-Borrower

I. TYPE OF MORTGAGE AND TERMS OF LOAN


Mortgage VA x Conventional Other (explain): Agency Case Number Lender Case Number
Applied for: FHA USDA/Rural
505339244
Housing Service
Amount Interest Rate No. of Months Amortization Type: x Fixed Rate Other (explain):
$ 228,889.00 2.500 % 180 GPM ARM (type):

II. PROPERTY INFORMATION AND PURPOSE OF LOAN


Subject Property Address (street, city, state & ZIP) No. of Units
5105 MARSHALL CRK, FLOWER MOUND, TEXAS 75028-1656 1
Legal Description of Subject Property (attach description if necessary) LEGAL DESCRIPTION ATTACHED HERETO AND MADE A Year Built
PART HEREOF 1999
Purpose of Loan Purchase Construction Other (explain): Property will be:
x Refinance Construction-Permanent x Primary Residence Secondary Residence Investment

Complete this line if construction or construction-permanent loan.


Year Lot Original Cost Amount Existing Liens (a) Present Value of Lot (b) Cost of Improvements Total (a+b)
Acquired
$ $ $ $ $
Complete this line if this is a refinance loan.
Year Original Cost Amount Existing Liens Purpose of Refinance Describe Improvements made to be made
Acquired RATE/TERM
1999 $ 300,000.00 $ 226,541.35 Cost: $
Title will be held in what Name(s) Manner in which Title will be held Estate will be held in:
BARRINGTON L TRAILLE, MARLENE M TRAILLE JOINT TENANTS X Fee Simple
Source of Down Payment, Settlement Charges, and/or Subordinate Financing (explain) Leasehold (show
expiration date)

Borrower III. BORROWER INFORMATION Co-Borrower


Borrower's Name (include Jr. or Sr. if applicable) Co-Borrower's Name (include Jr. or Sr. if applicable)
BARRINGTON L TRAILLE MARLENE M TRAILLE
Social Security Number Home Phone (incl. area code) DOB (mm/dd/yyyy) Yrs. School Social Security Number Home Phone (incl. area code) DOB (mm/dd/yyyy) Yrs. School
100-60-7128 (469)569-2047 04/09/1951 16 092-62-8536 (972)436-3786 02/12/1949 16
X Married Unmarried (include single, Dependents (not listed by Co-Borrower) X Married Unmarried (include single, Dependents (not listed by Borrower)
Separated divorced, widowed) no.0 ages Separated divorced, widowed) no. 0 ages

X Own
Present Address (street, city, state, ZIP) X Own
21 No. Yrs. Present Address (street, city, state, ZIP)
Rent ______ 21 No. Yrs.
Rent ______
5105 MARSHALL CRK, FLOWER MOUND, TX 75028-1656 5105 MARSHALL CRK, FLOWER MOUND, TX 75028-1656

Mailing Address, if different from Present Address Mailing Address, if different from Present Address

Fannie Mae Form 1003 6/09


Freddie Mac Form 65 6/09 Borrower: ______ Page 1 Co-Borrower: ______
If residing at present address for less than two years, complete the following:
Former Address (street, city, state, ZIP) Own Rent ______ No. Yrs. Former Address (street, city, state, ZIP) Own Rent ______ No. Yrs.

Borrower IV. EMPLOYMENT INFORMATION Co-Borrower


Name & Address of Employer X Self Employed Yrs. on this job Name & Address of Employer Self Employed Yrs. on this job
Traille and Assoc LLC aka Tax Master 20 yrs 6 mos
150 W Main St Suite 2A
Lewisville, TX 75057 Yrs. employed in this Yrs. employed in this
line of work/profession line of work/profession
20
Position/Title/Type of Business Business Phone (incl. area code) Position/Title/Type of Business Business Phone (incl. area code)
Tax Prep /Accountant (972)436-3786
If employed in current position for less than two years or if currently employed in more than one position, complete the following:
Name & Address of Employer X Self Employed Dates (from - to) Name & Address of Employer Self Employed Dates (from - to)
Wolfgang Enterprises LTD Inc 01/01/1999
5105 Marshall Creek, FLOWER MOUND,
TX 75028 Monthly Income Monthly Income
$ -1,158.75 $

Position/Title/Type of Business Business Phone (incl. area code) Position/Title/Type of Business Business Phone (incl. area code)
Owner

Name & Address of EmployerX Self Employed Dates (from - to) Name & Address of Employer Self Employed Dates (from - to)
Life Styled LA 02/25/2016
5105 Marshall Creek, FLOWER MOUND,
TX 75028 Monthly Income Monthly Income
$ -1,320.65 $

Position/Title/Type of Business Business Phone (incl. area code) Position/Title/Type of Business Business Phone (incl. area code)
Accomodations
V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION
Gross Combined Monthly
Monthly Income Borrower Co-Borrower Total Housing Expense Present Proposed
Base Empl. Income* $ 13,468.47 $ $ 13,468.47 Rent $

Overtime First Mortgage (P&I) 1,924.00 $ 1,526.21


Bonuses Other Financing (P&I)

Commissions Hazard Insurance 100.00


Dividends/Interest Real Estate Taxes 660.89
Net Rental Income Mortgage Insurance

Other (before completing, see Homeowner Assn. Dues 75.00 79.17


the notice in "describe other
income," below) Other:

Total $ 13,468.47 $ $ 13,468.47 Total $ 1,999.00 $ 2,366.27


* Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.

Describe Other Income Notice: Alimony, child support, or separate maintenance income need not be revealed if the
Borrower (B) or Co-Borrower (C) does not choose to have it considered for repaying this loan.
B/C Monthly Amount

Fannie Mae Form 1003 6/09 Borrower: ______ Co-Borrower: ______


Freddie Mac Form 65 6/09 Page 2
VI. ASSETS AND LIABILITIES

This Statement and any appl icable support ing schedules may be completed jointly by both married and unmarried Co-Borrowers if their assets and liabilities are
sufficiently joined so that the Statement can be meaningfully and fairly presented on a combined basis; otherwise, separate Statements and Schedules are required.
If the Co-Borrower section was completed about a non-applicant spouse or other person, this Statement and supporting schedules must be completed about that spouse
or other person also.
Completed X Jointly Not Jointly
ASSETS Cash or Liabilities and Pledged Assets. List the creditor's name, address and account number for
Market Value all outstanding debts, including automobile loans, revolving charge accounts, real estate
loans, alimony, child support, stock pledges, etc. Use continuation sheet, if necessary.
Description Indicate by (*) those liabilities, which will be satisfied upon sale of real estate owned or
Cash deposit toward purchase held by: $ upon refinancing of the subject property.

Monthly Payment & Unpaid Balance


List checking and savings accounts below LIABILITIES Months Left to Pay
Name and address of Bank, S&L, or Credit Union Name and address of Company $ Payment/Months $ 17,110.00
BOA 11/17 CITICARDS CBNA 257.00
R

Acct. no. 5467 $ 50,419.09 Acct. no. 518941012433


Name and address of Bank, S&L, or Credit Union Name and address of Company $ Payment/Months $ 0.00
Net Negative Rents 732.88
0

Acct. no. $ Acct. no.

Name and address of Bank, S&L, or Credit Union Name and address of Company $ Payment/Months $ 226,603.74
CHASE BANK 1,924.00
* 118

Acct. no. $ Acct. no. 6460472024530


Name and address of Bank, S&L, or Credit Union Name and address of Company $ Payment/Months $

Acct. no. $ Acct. no.

Fannie Mae Form 1003 6/09


Freddie Mac Form 65 6/09 Borrower: ______ Page 3 Co-Borrower: ______
VI. ASSETS AND LIABILITIES (cont'd)
Stocks & Bonds (Company $ Name and address of Company $ Payment/Months $
name/number & description)

Acct. no.

Life Insurance net cash value $ Name and address of Company $ Payment/Months $

Face amount: $

Subtotal Liquid Assets $ 50,419.09


Real estate owned (enter market value $ 923,000.00
from schedule of real estate owned)

Vested interest in retirement fund $

Net worth of business(es) owned $


(attach financial statement) Acct. no.

Automobiles owned (make and year) $ Alimony/Child Support/Separate $


Maintenance Payments Owed to:

Other Assets (itemize) $ Job-Related Expense (child care, union dues, etc.) $

Total Monthly Payments $ 2,913.88


Net Worth
Total Assets a. $ 973,419.09 $ 729,705.35 Total Liabilities b. $ 243,713.74
(a minus b)

Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet.)

Insurance,
Property Address (enter S if sold, PS if pending Type of Present Amount of Gross Mortgage Net Rental
Maintenance,
sale or R if rental being held for income) Property Market Value Mortgages & Liens Rental Income Payments Income
Taxes & Misc.
13803 STARDUST LN, Dallas, SFR
TX 75234 R $228,000.00 $ $ $ 0.00 $ 194.63 $ -194.63
526 RENEE LN, Desoto, TX SFR
75115 R 220,000.00 0.00 538.25 -538.25

5105 MARSHALL CRK, SFR


FLOWER MOUND, TX 475,000.00 226,541.35 0.00 1,924.00 0.00 0.00
75028-1656

Totals $923,000.00 $ 226,541.35 $ $ 1,924.00 $ 732.88 $ -732.88


List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s):

Alternate Name Creditor Name Account Number

Fannie Mae Form 1003 6/09


Freddie Mac Form 65 6/09 Borrower: ______ Page 4 Co-Borrower: ______
VII. DETAILS OF TRANSACTION VIII. DECLARATIONS
a. Purchase price
$ 0.00 If you answer "Yes" to any questions a through i, Borrower Co-Borrower
b. Alterations, improvements, repairs please use continuation sheet for explanation.
0.00 Yes No Yes No

c. Land (if acquired separately) a. Are there any outstanding judgments against you? X X
b. Have you been declared bankrupt within the past 7 years? X X
d. Refinance (incl. debts to be paid off)
226,541.35 c. Have you had property foreclosed upon or given title X X
or deed in lieu thereof in the last 7 years?
e. Estimated prepaid items d. Are you a party to a lawsuit? X X
62.71
f. Estimated closing costs e. Have you directly or indirectly been obligated on any X X
2,222.55 loan which resulted in foreclosure, transfer of title
g. PMI, MIP, Funding Fee in lieu of foreclosure, or judgment?
0.00
(This would include such loans as home mortgage loans, SBA loans,
h. Discount (if Borrower will pay) home improvemen t loans, educational loans, manufactured (mobile) home
loans, any mortgage, financial obligation, bond, or loan guarante e. If
i. Total costs (add items a through h) "Yes," provide details, including date, name and address of Lender, FHA
228,826.61 or VA case number, if any, and reasons for the action.)
j. Subordinate financing f. Are you presently delinquent or in default on any Federal debt or X X
0.00 any other loan, mortgage, financial obligati on, bond, or loan
guarantee?
k. Borrower's closing costs paid
by Seller
0.00 g. Are you obligated to pay alimony, child support, or separate X X
maintenance?
l. Other Credits (explain)
Paid Outside Closing 700.00 h. Is any part of the down payment borrowed? X X

i. Are you a co-maker or endorser on a note? X X

j. Are you a U.S. citizen? X X


m. Loan amount (exclude PMI, MIP,
228,889.00 X X
Funding Fee financed) k. Are you a permanent resident alien?
n. PMI, MIP, Funding Fee financed
l. Do you intend to occupy the property as your primary residence? X X
.00
If "Yes," complete question m below.

o. Loan amount (add m & n) m. Have you had an ownership interest in a property in the last three X X
228,889.00 years?
p. Cash from/to Borrower (1) What type of property did you own - principal residence (PR),
(subtract j, k, l & o from i) second home (SH), or investment property (IP)? PR PR
-762.39
(2) How did you hold title to the home - by yourself (S),
jointly with your spouse (SP), or jointly with another person (O)? SP SP

IX. ACKNOWLEDGMENT AND AGREEMENT

Each of the undersigned specifically represents to Lender and to Lender's actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors
and assigns and agrees and acknowledges that: (1) the information provided in this application is true and correct as of the date set forth opposite my signature and
that any intentional or negligent misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to any person
who may suffer any loss due to reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, but not limited to, fine
or imprisonment or both under the provisions of Title 18, United States Code, Sec. 1001, et. seq.; (2) the loan requested pursuant to this application (the "Loan") will
be secured by a mortgage or deed of trust on the property described in this application; (3) the property will not be used for any illegal or prohibited purpose or use;
(4) all statements made in this application are made for the purpose of obtaining a residential mortgage loan; (5) the property will be occupied as indicated in this
applicati on; (6) t he Lender, its servicers, successors or assigns may retain the original and/or an electronic record of this application, whether or not the Loan is
approved; (7) the Lender and its agents, brokers, insurers, servicers, successors, and assigns may continuously rely on the information contained in the application,
and I am obligated to amend and/or supplement the information provided in this application if any of the material facts that I have represented herein should change
prior to closing of the Loan; (8) in the event that my payments on the Loan become delinquent, the Lender, its servicers, successors or assigns may, in addition to
any other rights and remedies that it may have relating to such delinquency, report my name and account information to one or more consumer reporting agencies;
(9) ownership of the Loan and/or administration of the Loan account may be transferred with such notice as may be required by law; (10) neither Lender nor its agents,
brokers, insurers, servicers, successors or assigns has made any representation or warranty, express or implied, to me regarding the property or the condition or value
of the property; and (11) my transmission of this application as an "electronic record" containing my "electronic signature," as those terms are defined in applicable
federal and/or state laws (excluding audio and video recordings), or my facsimile transmission of this application containing a facsimile of my signature, shall be as
effective, enforceable and valid as if a paper version of this application were delivered containing my original written signature.

Acknowledgment. Each of the undersigned hereby acknowledges that any owner of t he Loan, its servicers, successors and assigns, may verify or reverify any
information contained in this application or obtain any information or data relating to the Loan, for any legitimate business purpose through any source, including a
source named in this application or a consumer reporting agency.
Borrower's Signature Date Co-Borrower's Signature Date

X X

Fannie Mae Form 1003 6/09


Freddie Mac Form 65 6/09 Page 5
X. INFORMATION FOR GOVERNMENT MONITORING PURPOSES

////////////////////////////////////////////////////////////////////////////////
The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender's compliance with equal
////////////////////////////////////////////////////////////////////////////////
credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides
////////////////////////////////////////////////////////////////////////////////
that a lender may not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both
////////////////////////////////////////////////////////////////////////////////
////////////////////////////////////////////////////////////////////////////////
ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required
////////////////////////////////////////////////////////////////////////////////
to note the information on the basis of visual observation and surname if you have made this application in person. If you do not wish to furnish the information, please
////////////////////////////////////////////////////////////////////////////////
////////////////////////////////////////////////////////////////////////////////
check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable
////////////////////////////////////////////////////////////////////////////////
state law for the particular type of loan applied for.)
////////////////////////////////////////////////////////////////////////////////
////////////////////////////////////////////////////////////////////////////////
////////////////////////////////////////////////////////////////////////////////
////////////////////////////////////////////////////////////////////////////////
////////////////////////////////////////////////////////////////////////////////
////////////////////////////////////////////////////////////////////////////////
BORROWER X I do not wish to furnish this information CO-BORROWER X I do not wish to furnish this information
////////////////////////////////////////////////////////////////////////////////
////////////////////////////////////////////////////////////////////////////////
Ethnicity: Hispanic or Latino Not Hispanic or Latino Ethnicity: Hispanic or Latino Not Hispanic or Latino
////////////////////////////////////////////////////////////////////////////////
////////////////////////////////////////////////////////////////////////////////
Race: American Indian or Asian Black or African American Race: American Indian or Asian Black or African American
////////////////////////////////////////////////////////////////////////////////
Alaska Native Alaska Native
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Native Hawaiian or White Native Hawaiian or White
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Other Pacific Islander Other Pacific Islander
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Sex: Female X Male Sex: X Female Male
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To be Completed by Loan Originator:
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This information was provided:
////////////////////////////////////////////////////////////////////////////////
In a face-to-face interview
////////////////////////////////////////////////////////////////////////////////
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In a telephone interview
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By the applicant and was submitted by fax or mail
////////////////////////////////////////////////////////////////////////////////
X By the applicant and submitted via e-mail or the Internet
////////////////////////////////////////////////////////////////////////////////
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Loan Originator's Signature Date

X
Loan Originator's Name (print or type) Loan Originator Identifier Loan Originator's Phone Number (including area code)
Sandy Mallon 445274 (201)988-1186

Loan Origination Company's Name Loan Origination Company Identifier Loan Origination Company's Address
FLAGSTAR BANK, RED BANK0572 417490 125 HALF MILE RD, 61, RED BANK, NEW
JERSEY 07701

Fannie Mae Form 1003 6/09


Freddie Mac Form 65 6/09 Borrower: ______ Page 6 Co-Borrower: ______
CONTINUATION SHEET/RESIDENTIAL LOAN APPLICATION

Use this continuation sheet if you need Borrower: Agency Case Number:
more space to complete the Reside ntial
BARRINGTON L TRAILLE
Loan Application. Mark B for Borrower
or C for Co-Borrower Co-Borrower: Lender Case Number:
MARLENE M TRAILLE 505339244

Additional Employement Information


Additional Employers for BARRINGTON L TRAILLE
Company Self? Phone Position/Monthly Inc. Years/Dates
Chelsea United Holding LTD Yes Owner 01/01/2018
5105 Marshall Creek, FLOWER MOUND, TX 75028 -598.41

I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above
facts as applicable under the provisions of Title 18, United States Code, Section 1001, et seq.
Borrower's Signature Date Co-Borrower's Signature Date

X X

Fannie Mae Form 1003 6/09


Freddie Mac Form 65 6/09 Page 7
Demographic Information Addendum. This section asks about your ethnicity, sex, and race.

The purpose of collecting this information is to help ensure that all applicants are treated fairly and that the housing needs of
communities and neighborhoods are being fulfilled. For residential mortgage lending, Federal law requires that we ask applicants for
their demographic information (ethnicity, sex, and race) in order to monitor our compliance with equal credit opportunity, fair
housing, and home mortgage disclosure laws. You are not required to provide this information, but are encouraged to do so. You
may select one or more designations for "Ethnicity" and one or more designations for "Race." The law provides that we may not
discriminate on the basis of this information, or on whether you choose to provide it. However, if you choose not to provide the
information and you have made this application in person, Federal regulations require us to note your ethnicity, sex, and race on the
basis of visual observation or surname. The law also provides that we may not discriminate on the basis of age or marital status
information you provide in this application. If you do not wish to provide some or all of this information, please check below.

Ethnicity: Check one or more Race: Check one or more


Hispanic or Latino American Indian or Alaska Native - Print name of enrolled
Mexican Puerto Rican Cuban or principal tribe:
Other Hispanic or Latino - Print origin: Asian
Asian Indian Chinese Filipino
For example: Argentinean, Colombian, Dominican, Japanese Korean Vietnamese
Nicaraguan, Salvadoran, Spaniard, and so on. Other Asian - Print race:
Not Hispanic or Latino For example: Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.
X I do not wish to provide this information Black or African American
Native Hawaiian or Other Pacific Islander
Sex Native Haw aiian Guamanian or Chamorro Samoan
Female Other Pacific Islander - Print race:
X Male
I do not wish to provide this information Examples: Fijian, Tongan, and so on.
White
X I do not wish to provide this information

To Be Completed by Financial Institution (for application taken in person):

Was the ethnicity of the Borrower collected on the basis of visual observation or surname? O NO O YES
Was the sex of the Borrower collected on the basis of visual observation or surname? O NO O YES
Was the race of the Borrower collected on the basis of visual observation or surname? O NO O YES
The Demographic Information was provided through:

O Face-to-Face Interview (includes Electronic Media w/ Video Component) O Telephone Interview O Fax or Mail O
X Email or Internet

Borrower Name: BARRINGTON L TRAILLE


Uniform Residential Loan Application
Freddie Mac Form 65 Fannie Mae Form 1003
Revised 09/2017
Demographic Information Addendum. This section asks about your ethnicity, sex, and race.

The purpose of collecting this information is to help ensure that all applicants are treated fairly and that the housing needs of
communities and neighborhoods are being fulfilled. For residential mortgage lending, Federal law requires that we ask applicants for
their demographic information (ethnicity, sex, and race) in order to monitor our compliance with equal credit opportunity, fair
housing, and home mortgage disclosure laws. You are not required to provide this information, but are encouraged to do so. You
may select one or more designations for "Ethnicity" and one or more designations for "Race." The law provides that we may not
discriminate on the basis of this information, or on whether you choose to provide it. However, if you choose not to provide the
information and you have made this application in person, Federal regulations require us to note your ethnicity, sex, and race on the
basis of visual observation or surname. The law also provides that we may not discriminate on the basis of age or marital status
information you provide in this application. If you do not wish to provide some or all of this information, please check below.

Ethnicity: Check one or more Race: Check one or more


Hispanic or Latino American Indian or Alaska Native - Print name of enrolled
Mexican Puerto Rican Cuban or principal tribe:
Other Hispanic or Latino - Print origin: Asian
Asian Indian Chinese Filipino
For example: Argentinean, Colombian, Dominican, Japanese Korean Vietnamese
Nicaraguan, Salvadoran, Spaniard, and so on. Other Asian - Print race:
Not Hispanic or Latino For example: Hmong, Laotian, Thai, Pakistani, Cambodian, and so on.
X I do not wish to provide this information Black or African American
Native Hawaiian or Other Pacific Islander
Sex Native Haw aiian Guamanian or Chamorro Samoan
X Female Other Pacific Islander - Print race:
Male
I do not wish to provide this information Examples: Fijian, Tongan, and so on.
White
X I do not wish to provide this information

To Be Completed by Financial Institution (for application taken in person):

Was the ethnicity of the Borrower collected on the basis of visual observation or surname? O NO O YES
Was the sex of the Borrower collected on the basis of visual observation or surname? O NO O YES
Was the race of the Borrower collected on the basis of visual observation or surname? O NO O YES
The Demographic Information was provided through:

O Face-to-Face Interview (includes Electronic Media w/ Video Component) O Telephone Interview O Fax or Mail O
X Email or Internet

Borrower Name: MARLENE M TRAILLE


Uniform Residential Loan Application
Freddie Mac Form 65 Fannie Mae Form 1003
Revised 09/2017
This form is a statement of final loan terms and closing costs. Compare this
Closing Disclosure document with your Loan Estimate.

Closing Information Transaction Information Loan Information


Date Issued 12/22/2020 Borrower Barrington L Traille Loan Term 15 years
Closing Date 12/22/2020 5105 Marshall Crk Purpose Refinance
Disbursement Date 12/28/2020 Flower Mound , TX 75028-1656 Product Fixed Rate
Settlement Agent Mortgage Connect Of Texas, LLC
File # 1366315 Lender Alliant Credit Union, ACU Loan Type X Conventional FHA
Property 5105 Marshall Crk VA __________
Flower Mound , TX 75028-1656 Loan ID # 505339244
Appraised Prop. Value $475,000 MIC #

Loan Terms Can this amount increase after closing?


Loan Amount $228,889 NO

Interest Rate 2.5% NO

Monthly Principal & Interest


See Projected Payments below for your $1,526.21 NO
Estimated Total Monthly Payment

Does the loan have these features?


Prepayment Penalty NO
Balloon Payment NO

Projected Payments
Payment Calculation Years 1 - 15

Principal & Interest $1,526.21

Mortgage Insurance + 0

Estimated Escrow + 0
Amount can increase over time

Estimated Total
Monthly Payment $1,526.21
This estimate includes In escrow?
Estimated Taxes, Insurance $840.06 X Property Taxes NO
& Assessments a month X Homeowner's Insurance NO
Amount can increase over time
See page 4 for details X Other: HOA Dues NO
See Escrow Account on page 4 for details. You must pay for other property costs
separately.

Costs at Closing

Closing Costs $2,285.26 Includes $2,116.55 in Loan Costs + $168.71 in Other Costs -$0
in Lender Credits. See page 2 for details.

Cash to Close $0 Includes Closing Costs See Calculating Cash to Close on page 3 for details.
FromX To Borrower

Page 1
Closing Cost Details
Borrower-Paid Paid by
Others
Loan Costs At Closing Before Closing
A. Origination Charges $550.00
01 % of Loan Amount (Points)
02 Processing Fee $550.00
03
04
05
06
07
08
B. Services Borrower Did Not Shop For $1,566.55
01 Document Prep Fee - Tx to M.D. Gibson & Associates $150.00
02 Title - Lenders Title Insurance to Mortgage Connect of Texas LLC $764.00
03 Title - Policy/Guaranty Fee to Mortgage Connect of Texas LLC $2.00
04 Title - Settlement/Closing Fee to Mortgage Connect of Texas LLC $500.00
05 Title - Title Endorsement Fees to Mortgage Connect of Texas LLC $150.55
06
07
08
09
10
C. Services Borrower Did Shop For
01
02
03
04
05
06
07
08
D. TOTAL LOAN COSTS (Borrower-Paid) $2,116.55
Loan Costs Subtotals (A + B + C) $2,116.55

Other Costs
E. Taxes and Other Government Fees $106.00
01 Recording Fees Deed: Mortgage: $106.00 $106.00
02
F. Prepaids $62.71
01 Homeowner's Insurance Premium ( mo.)
02 Mortgage Insurance Premium ( mo.)
03 Prepaid Interest ($15.68 per day from 12/28/20 to 1/1/21) $62.71
04 Property Taxes ( mo.)
05
G. Initial Escrow Payment at Closing
01 Homeowner's Insurance per month for mo.
02 Mortgage Insurance per month for mo.
03 Property Taxes per month for mo.
04
05
06
07
08 Aggregate Adjustment
H. Other
01
02
03
04
05
06
07
08
I. TOTAL OTHER COSTS (Borrower-Paid) $168.71
Other Costs Subtotals (E + F + G + H) $168.71

J. TOTAL CLOSING COSTS (Borrower-Paid) $2,285.26


Closing Costs Subtotals (D + I) $2,285.26
Lender Credits

Page 2
Payoffs and Payments Use this table to see a summary of your payoffs and payments to others from your loan amount.
TO AMOUNT
Payoff: Alliant Credit Union
01 $226,603.74

02

03

04

05

06

07

08

09

10

11

12

13

14

15

K. TOTAL PAYOFFS AND PAYMENTS $226,603.74

Calculating Cash to Close Use this table to see what has changed from your Loan Estimate.
Loan Estimate Final Did this change?
Loan Amount $237,000.00 $228,889.00 YES This amount decreased
Total Closing Costs (J) -$9,743.00 -$2,285.26 YES See Total Loan Costs (D) and Total Other Costs (I)
Closing Costs Paid Before Closing $0 $0 NO
Total Payoffs and Payments (K) -$228,247.00 -$226,603.74 YES See Payoffs and Payments(K)
Cash to Close $990.00 $0
X From To From X To
Borrower Borrower Closing Costs Financed (Paid from your Loan Amount) $2,285.26

Page 3
Additional Information About This Loan
Loan Disclosures

Assumption Escrow Account


If you sell or transfer this property to another person, your lender For now, your loan
will allow, under certain conditions, this person to assume this will have an escrow account (also called an "impound" or "trust"
loan on the original terms. account) to pay the property costs listed below. Without an escrow
X will not allow assumption of this loan on the original terms. account, you would pay them directly, possibly in one or two large
payments a year. Your lender may be liable for penalties and interest
Demand Feature for failing to make a payment.
Your loan
has a demand feature, which permits your lender to require early Escrow
repayment of the loan. You should review your note for details. Escrowed Estimated total amount over year 1 for
X does not have a demand feature. Property Costs your escrowed property costs:
over Year 1
Non-Escrowed Estimated total amount over year 1 for
Late Payment
Property Costs your non-escrowed property costs:
If your payment is more than 15 days late, your lender will over Year 1
charge a late fee of 5% of your overdue payment of principal
and interest.

Negative Amortization (Increase in Loan Amount) You may have other property costs.
Under your loan terms, you Initial Escrow A cushion for the escrow account you pay
are scheduled to make monthly payments that do not pay all of Payment at closing. See Section G on page 2.
the interest due that month. As a result, your loan amount will
increase (negatively amortize), and your loan amount will likely Monthly Escrow The amount included in your total
become larger than your original loan amount. Increases in your Payment monthly payment.
loan amount lower the equity you have in this property.
X will not have an escrow account because X you declined it your
may have monthly payments that do not pay all of the interest lender does not offer one. You must directly pay your property
due that month. If you do, your loan amount will increase costs, such as taxes and homeowner's insurance. Contact your
(negatively amortize), and, as a result, your loan amount may lender to ask if your loan can have an escrow account.
become larger than your original loan amount. Increases in your
loan amount lower the equity you have in this property.
No Escrow
X do not have a negative amortization feature. Estimated $10,080.72 Estimated total amount over year 1. You
Property Costs must pay these costs directly, possibly in
Partial Payments over Year 1 one or two large payments a year.
Your lender Escrow Waiver Fee
may accept payments that are less than the full amount due
(partial payments) and apply them to your loan. In the future,
X may hold them in a separate account until you pay the rest of the Your property costs may change and, as a result, your escrow pay-
payment, and then apply the full payment to your loan. ment may change. You may be able to cancel your escrow account,
does not accept any partial payments. but if you do, you must pay your property costs directly. If you fail
If this loan is sold, your new lender may have a different policy. to pay your property taxes, your state or local government may (1)
impose fines and penalties or (2) place a tax lien on this property. If
Security Interest you fail to pay any of your property costs, your lender may (1) add
the amounts to your loan balance, (2) add an escrow account to your
You are granting a security interest in loan, or (3) require you to pay for property insurance that the lender
5105 Marshall Crk , Flower Mound , TX 75028-1656 buys on your behalf, which likely would cost more and provide fewer
benefits than what you could buy on your own.
You may lose this property if you do not make your payments or
satisfy other obligations for this loan.

Page 4
Closing Cost Details
Borrower-Paid Paid by
Others
Loan Costs At Closing Before Closing
A. Origination Charges $550.00
01 % of Loan Amount (Points)
02 Processing Fee $550.00
03
04
05
06
07
08
B. Services Borrower Did Not Shop For $1,566.55
01 Document Prep Fee - Tx to M.D. Gibson & Associates $150.00
02 Title - Lenders Title Insurance to Mortgage Connect of Texas LLC $764.00
03 Title - Policy/Guaranty Fee to Mortgage Connect of Texas LLC $2.00
04 Title - Settlement/Closing Fee to Mortgage Connect of Texas LLC $500.00
05 Title - Title Endorsement Fees to Mortgage Connect of Texas LLC $150.55
06
07
08
09
10
C. Services Borrower Did Shop For
01
02
03
04
05
06
07
08
D. TOTAL LOAN COSTS (Borrower-Paid) $2,116.55
Loan Costs Subtotals (A + B + C) $2,116.55

Other Costs
E. Taxes and Other Government Fees $106.00
01 Recording Fees Deed: Mortgage: $106.00 $106.00
02
F. Prepaids $62.71
01 Homeowner's Insurance Premium ( mo.)
02 Mortgage Insurance Premium ( mo.)
03 Prepaid Interest ($15.68 per day from 12/28/20 to 1/1/21) $62.71
04 Property Taxes ( mo.)
05
G. Initial Escrow Payment at Closing
01 Homeowner's Insurance per month for mo.
02 Mortgage Insurance per month for mo.
03 Property Taxes per month for mo.
04
05
06
07
08 Aggregate Adjustment
H. Other
01
02
03
04
05
06
07
08
I. TOTAL OTHER COSTS (Borrower-Paid) $168.71
Other Costs Subtotals (E + F + G + H) $168.71

J. TOTAL CLOSING COSTS (Borrower-Paid) $2,285.26


Closing Costs Subtotals (D + I) $2,285.26
Lender Credits

Page 2
Additional Information About This Loan
Loan Disclosures

Assumption Escrow Account


If you sell or transfer this property to another person, your lender For now, your loan
will allow, under certain conditions, this person to assume this will have an escrow account (also called an "impound" or "trust"
loan on the original terms. account) to pay the property costs listed below. Without an escrow
X will not allow assumption of this loan on the original terms. account, you would pay them directly, possibly in one or two large
payments a year. Your lender may be liable for penalties and interest
Demand Feature for failing to make a payment.
Your loan
has a demand feature, which permits your lender to require early Escrow
repayment of the loan. You should review your note for details. Escrowed Estimated total amount over year 1 for
X does not have a demand feature. Property Costs your escrowed property costs:
over Year 1
Non-Escrowed Estimated total amount over year 1 for
Late Payment
Property Costs your non-escrowed property costs:
If your payment is more than 15 days late, your lender will over Year 1
charge a late fee of 5% of your overdue payment of principal
and interest.

Negative Amortization (Increase in Loan Amount) You may have other property costs.
Under your loan terms, you Initial Escrow A cushion for the escrow account you pay
are scheduled to make monthly payments that do not pay all of Payment at closing. See Section G on page 2.
the interest due that month. As a result, your loan amount will
increase (negatively amortize), and your loan amount will likely Monthly Escrow The amount included in your total
become larger than your original loan amount. Increases in your Payment monthly payment.
loan amount lower the equity you have in this property.
X will not have an escrow account because X you declined it your
may have monthly payments that do not pay all of the interest lender does not offer one. You must directly pay your property
due that month. If you do, your loan amount will increase costs, such as taxes and homeowner's insurance. Contact your
(negatively amortize), and, as a result, your loan amount may lender to ask if your loan can have an escrow account.
become larger than your original loan amount. Increases in your
loan amount lower the equity you have in this property.
No Escrow
X do not have a negative amortization feature. Estimated $10,080.72 Estimated total amount over year 1. You
Property Costs must pay these costs directly, possibly in
Partial Payments over Year 1 one or two large payments a year.
Your lender Escrow Waiver Fee
may accept payments that are less than the full amount due
(partial payments) and apply them to your loan. In the future,
X may hold them in a separate account until you pay the rest of the Your property costs may change and, as a result, your escrow pay-
payment, and then apply the full payment to your loan. ment may change. You may be able to cancel your escrow account,
does not accept any partial payments. but if you do, you must pay your property costs directly. If you fail
If this loan is sold, your new lender may have a different policy. to pay your property taxes, your state or local government may (1)
impose fines and penalties or (2) place a tax lien on this property. If
Security Interest you fail to pay any of your property costs, your lender may (1) add
the amounts to your loan balance, (2) add an escrow account to your
You are granting a security interest in loan, or (3) require you to pay for property insurance that the lender
5105 Marshall Crk , Flower Mound , TX 75028-1656 buys on your behalf, which likely would cost more and provide fewer
benefits than what you could buy on your own.
You may lose this property if you do not make your payments or
satisfy other obligations for this loan.

Page 4
Loan Calculations Other Disclosures
Appraisal
Total of Payments. Total you will have paid after If the property was appraised for your loan, your lender is required to
you make all payments of principal, interest, give you a copy at no additional cost at least 3 days before closing. If
mortgage insurance, and loan costs, as scheduled. $276,896.42
you have not received it yet, please contact your lender at the
information listed below.
Finance Charge. The dollar amount the loan will
cost you. $46,940.87 Contract Details
See your note and security instrument for information about
what happens if you fail to make your payments,
Amount Financed. The loan amount available after what is a default on the loan,
paying your upfront finance charge. $227,776.29 situations in which your lender can require early repayment of the
loan, and
the rules for making payments before they are due.
Annual Percentage Rate (APR) Your costs over
the loan term expressed as a rate. This is not your
interest rate. 2.569% Liability after Foreclosure
If your lender forecloses on this property and the foreclosure does not
cover the amount of unpaid balance on this loan,
Total Interest Percentage (TIP). The total amount X state law may protect you from liability for the unpaid balance. If you
of interest that you will pay over the loan term as refinance or take on any additional debt on this property, you may
a percentage of your loan amount. 20.049% lose this protection and have to pay any debt remaining even after
foreclosure. You may want to consult a lawyer for more information.
state law does not protect you from liability for the unpaid balance.

Refinance
Refinancing this loan will depend on your future financial situation,
the property value, and market conditions. You may not be able to
refinance this loan.
Questions? If you have questions about the
loan terms or costs on this form, use the contact Tax Deductions
information below. To get more information If you borrow more than this property is worth, the interest on the
or make a complaint, contact the Consumer loan amount above this property's fair market value is not deductible
Financial Protection Bureau at from your federal income taxes. You should consult a tax advisor for
www.consumerfinance.gov/mortgage-closing more information.

Contact Information
Lender Mortgage Broker Settlement Agent
Name Flagstar Bank, FSB Mortgage Connect Of Texas, LLC

Address 125 Half Mile Rd, 61, Red Bank, NJ 07701 7301 State Highway 161 Ste 280, Irving, TX 75039

NMLS ID 417490
TX License ID 2101377
Contact Sandy Mallon Melissa South

Contact NMLS ID 445274


Contact TX License ID

Email [email protected] Flagstar@ mortgageconnectlp.com

Phone (201)988-1186 (866)789-1814

Confirm Receipt
By signing, you are only confirming that you have received this form. You do not have to accept this loan because you have signed or received
this form.

Barrington L Traille Date Marlene M Traille Date

Page 5
Addendum

Transaction Information
Borrower
Marlene M Traille
5105 Marshall Crk
Flower Mound , TX 75028-1656

Page 6
Loan Number: 505339244

SIGNATURE AFFIDAVIT AND AKA STATEMENT


SIGNATURE AFFIDAVIT

I, BARRINGTON L TRAILLE ,
certify that this is my true and correct signature:

BARRINGTON L TRAILLE
Borrower Sample Signature

AKA STATEMENT

I, BARRINGTON L TRAILLE ,
further certify that I am also known as:

Name Variation (Print) Sample Signature (Variation)

Name Variation (Print) Sample Signature (Variation)

Name Variation (Print) Sample Signature (Variation)

Name Variation (Print) Sample Signature (Variation)

Name Variation (Print) Sample Signature (Variation)

Name Variation (Print) Sample Signature (Variation)

Name Variation (Print) Sample Signature (Variation)

SIGNATURE AFFIDAVIT AND AKA STATEMENT


AKA.LSR 01/21/20
Page 1 of 2
State of TEXAS

County of Denton

Sworn to and subscribed before me on the day of , by

BARRINGTON L TRAILLE (name of principal signer).

Notary Public Signature

(SEAL)

SIGNATURE AFFIDAVIT AND AKA STATEMENT


AKA.LSR 01/21/20
Page 2 of 2
Loan Number: 505339244

SIGNATURE AFFIDAVIT AND AKA STATEMENT


SIGNATURE AFFIDAVIT

I, MARLENE M TRAILLE ,
certify that this is my true and correct signature:

MARLENE M TRAILLE
Borrower Sample Signature

AKA STATEMENT

I, MARLENE M TRAILLE ,
further certify that I am also known as:

Name Variation (Print) Sample Signature (Variation)

Name Variation (Print) Sample Signature (Variation)

Name Variation (Print) Sample Signature (Variation)

Name Variation (Print) Sample Signature (Variation)

Name Variation (Print) Sample Signature (Variation)

Name Variation (Print) Sample Signature (Variation)

Name Variation (Print) Sample Signature (Variation)

SIGNATURE AFFIDAVIT AND AKA STATEMENT


AKA.LSR 01/21/20
Page 1 of 2
State of TEXAS

County of Denton

Sworn to and subscribed before me on the day of , by

MARLENE M TRAILLE (name of principal signer).

Notary Public Signature

(SEAL)

SIGNATURE AFFIDAVIT AND AKA STATEMENT


AKA.LSR 01/21/20
Page 2 of 2
Form 4506-T Request for Transcript of Tax Return
(March 2019) Do not sign this form unless all applicable lines have been completed.
OMB No. 1545-1872
Request may be rejected if the form is incomplete or illegible.
Department of the Treasury For more information about Form 4506-T, visit www.irs.gov/form4506t. Loan Number:
Internal Revenue Service 505339244
Tip. Use Form 4506-T to order a transcript or other return information free of charge. See the product list below. You can quickly request transcripts by using our
automated self-help service tools. Please visit us at IRS.gov and click on "Get a Tax Transcript..." under "Tools" or call 1-800-908-9946. If you need a copy of
your return, use Form 4506, Request for Copy of Tax Return. There is a fee to get a copy of your return.
1a Name shown on tax return. If a joint return, enter the name 1b First social security number on tax return, individual taxpayer identification
shown first. BARRINGTON L TRAILLE number, or employer identification number (see instructions)
100-60-7128
2a If a joint return, enter spouse's name shown on tax return. 2b Second social security number or individual taxpayer identification
MARLENE M TRAILLE number if joint tax return
092-62-8536
3 Current name, address (including apt., room, or suite no.), city, state, and ZIP code (see instructions)
BARRINGTON L TRAILLE
5105 MARSHALL CRK, FLOWER MOUND, TX 75028-1656
4 Previous address shown on the last return filed if different from line 3 (see instructions)

5a If the transcript or tax information is to be mailed to a third party (such as a mortgage company), enter the third party's name, address, and
telephone number.
TALX Corporation, a provider of Equifax Verification Services 11432 Lackland Road,
Saint Louis, MO 63146
5b Customer file number (if applicable) (see instructions)

Caution: If the tax transcript is being mailed to a third party, ensure that you have filled in lines 6 through 9 before signing. Sign and date the form once
you have filled in these lines. Completing these steps helps to protect your privacy. Once the IRS discloses your tax transcript to the third party listed on
line 5a, the IRS has no control over what the third party does with the information. If you would like to limit the third party's authority to disclose your
transcript information, you can specify this limitation in your written agreement with the third party.
6 Transcript requested. Enter the tax form number here (1040, 1065, 1120, etc.) and check the appropriate box below. Enter only one tax form
number per request. 1040
a Return Transcript, which includes most of the line items of a tax return as filed with the IRS. A tax return transcript does not reflect changes
made to the account after the return is processed. Transcripts are only available for the following returns: Form 1040 series, Form 1065, Form
1120, Form 1120-A, Form 1120-H, Form 1120-L, and Form 1120S. Return transcripts are available for the current year and returns processed
during the prior 3 processing years. Most requests will be processed within 10 business days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
b Account Transcript, which contains information on t he financial status of the account, such as payments made on the account, penalty
assessments, and adjustments made by you or the IRS after the return was filed. Return information is limited to items such as tax liability and
estimated tax payments. Account transcripts are available for most returns. Most requests will be processed within 10 business days . . .
c Record of Account, which provides the most detailed information as it is a combination of the Return Transcript and the Account Transcript.
Available for current year and 3 prior tax years. Most requests will be processed within 10 business days . . . . . . . . . . . . . . . . . . . . . . .
7 Verification of Nonfiling, which is proof from the IRS that you did not file a return for the year. Current year requests are only available after June
15th. There are no availability restrictions on prior year requests. Most requests will be processed within 10 business days
8 Form W-2, Form 1099 series, Form 1098 series, or Form 5498 series transcript. The IRS can provide a transcript that includes data from these
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W-2 information for 2011, filed in 2012, will likely not be available from the IRS until 2013. If you need W-2 information for retirement purposes,
you should contact the Social Security Administration at 1-800-772-1213. Most requests will be processed within 10 business days . . . X
Caution: If you need a copy of Form W-2 or Form 1099, you should first contact the payer. To get a copy of the Form W-2 or Form 1099 filed with your
return, you must use Form 4506 and request a copy of your return, which includes all attachments.
9 Year or period requested. Enter the ending date of the year or period, using the mm/dd/yyyy format. If you are requesting more than four years or
periods, you must attach another Form 4506-T. For requests relating to quarterly tax returns, such as Form 941, you must enter each quarter or
tax period separately. 12/31/2019 12/31/2018 12/31/2017
Caution: Do not sign this form unless all applicable lines have been completed.
Signature of taxpayer(s). I declare that I am either the taxpayer whose name is shown on line 1a or 2a, or a person authorized to obtain the tax information
requested. If the request applies to a joint return, at least one spouse must sign. If signed by a corporate officer, 1 percent or more shareholder, partner,
managing member, guardian, tax matters partner, executor, receiver, administrator, trustee, or party other than the taxpayer, I certify that I have the authority
to execute Form 4506-T on behalf of the taxpayer. Note: This form must be received by IRS within 120 days of the signature date.
x Signatory attests that he/she has read the attestation clause and upon so reading declares that he/she Phone number of taxpayer on line 1a or 2a
has the authority to sign the Form 4506-T. See instructions.

(469)569-2047
Signature (see instructions) Date

Sign
Here
Title (if line 1a above is a corporation, partnership, estate, or trust)

Spouse's signature Date

For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 37667N Form 4506-T (Rev. 3-2019)
Page 1 of 2
Form 4506-T (Rev. 3-2019) Loan Number: 505339244 Page 2
Section references are to the Internal Revenue Code Chart for all other transcripts Corporations. Generally, Form 4506-T can be
unless otherwise noted. If you lived in signed by: (1) an officer having legal authority to bind
or your business was Mail or fax to: the corporation, (2) any person designated by the
Future Developments in: board of directors or other governing body, or (3) any
For the latest information about Form 4506-T and its officer or employee on written request by any
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Information about any recent developments affecting Arkansas, California,
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such as the last four digits of the taxpayer's Social signed by any person who was a member of the
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Tip. Use Form 4506, Request for Copy of Tax Return, Privacy Act and Paperwork Reduction Act Notice. We
to request copies of tax returns. 855-821-0094 ask for the information on this form to establish your
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sections 6103 and 6109 and their regulations require
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and return information are confidential, as required by
both, we will not input the information and the section 6103.
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T will vary depending on individual circumstances.
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Jersey, New York, North Kansas City, MO 64999 see Where to file on this page.
Carolina, Ohio, Individuals. Transcripts of jointly filed tax
Pennsylvania, Rhode Island, returns may be furnished to either spouse. Only
South Carolina, Vermont, one signature is required. Sign Form 4506-T exactly
Virginia, West Virginia 855-821-0094 as your name appeared on the original return. If you
changed your name, also sign your current name.

For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 37667N Form 4506-T (Rev. 3-2019)
Page 2 of 2
Form 4506-T Request for Transcript of Tax Return
(March 2019) Do not sign this form unless all applicable lines have been completed.
OMB No. 1545-1872
Request may be rejected if the form is incomplete or illegible.
Department of the Treasury For more information about Form 4506-T, visit www.irs.gov/form4506t. Loan Number:
Internal Revenue Service 505339244
Tip. Use Form 4506-T to order a transcript or other return information free of charge. See the product list below. You can quickly request transcripts by using our
automated self-help service tools. Please visit us at IRS.gov and click on "Get a Tax Transcript..." under "Tools" or call 1-800-908-9946. If you need a copy of
your return, use Form 4506, Request for Copy of Tax Return. There is a fee to get a copy of your return.
1a Name shown on tax return. If a joint return, enter the name 1b First social security number on tax return, individual taxpayer identification
shown first. MARLENE M TRAILLE number, or employer identification number (see instructions)
092-62-8536
2a If a joint return, enter spouse's name shown on tax return. 2b Second social security number or individual taxpayer identification
BARRINGTON L TRAILLE number if joint tax return
100-60-7128
3 Current name, address (including apt., room, or suite no.), city, state, and ZIP code (see instructions)
MARLENE M TRAILLE
5105 MARSHALL CRK, FLOWER MOUND, TX 75028-1656
4 Previous address shown on the last return filed if different from line 3 (see instructions)

5a If the transcript or tax information is to be mailed to a third party (such as a mortgage company), enter the third party's name, address, and
telephone number.
TALX Corporation, a provider of Equifax Verification Services 11432 Lackland Road,
Saint Louis, MO 63146
5b Customer file number (if applicable) (see instructions)

Caution: If the tax transcript is being mailed to a third party, ensure that you have filled in lines 6 through 9 before signing. Sign and date the form once
you have filled in these lines. Completing these steps helps to protect your privacy. Once the IRS discloses your tax transcript to the third party listed on
line 5a, the IRS has no control over what the third party does with the information. If you would like to limit the third party's authority to disclose your
transcript information, you can specify this limitation in your written agreement with the third party.
6 Transcript requested. Enter the tax form number here (1040, 1065, 1120, etc.) and check the appropriate box below. Enter only one tax form
number per request. 1040
a Return Transcript, which includes most of the line items of a tax return as filed with the IRS. A tax return transcript does not reflect changes
made to the account after the return is processed. Transcripts are only available for the following returns: Form 1040 series, Form 1065, Form
1120, Form 1120-A, Form 1120-H, Form 1120-L, and Form 1120S. Return transcripts are available for the current year and returns processed
during the prior 3 processing years. Most requests will be processed within 10 business days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . X
b Account Transcript, which contains information on t he financial status of the account, such as payments made on the account, penalty
assessments, and adjustments made by you or the IRS after the return was filed. Return information is limited to items such as tax liability and
estimated tax payments. Account transcripts are available for most returns. Most requests will be processed within 10 business days . . .
c Record of Account, which provides the most detailed information as it is a combination of the Return Transcript and the Account Transcript.
Available for current year and 3 prior tax years. Most requests will be processed within 10 business days . . . . . . . . . . . . . . . . . . . . . . .
7 Verification of Nonfiling, which is proof from the IRS that you did not file a return for the year. Current year requests are only available after June
15th. There are no availability restrictions on prior year requests. Most requests will be processed within 10 business days
8 Form W-2, Form 1099 series, Form 1098 series, or Form 5498 series transcript. The IRS can provide a transcript that includes data from these
information returns. State or local information is not included with the Form W-2 information. The IRS may be able to provide this transcript
information for up to 10 years. Information for the current year is generally not available until the year after it is filed with the IRS. For example,
W-2 information for 2011, filed in 2012, will likely not be available from the IRS until 2013. If you need W-2 information for retirement purposes,
you should contact the Social Security Administration at 1-800-772-1213. Most requests will be processed within 10 business days . . . X
Caution: If you need a copy of Form W-2 or Form 1099, you should first contact the payer. To get a copy of the Form W-2 or Form 1099 filed with your
return, you must use Form 4506 and request a copy of your return, which includes all attachments.
9 Year or period requested. Enter the ending date of the year or period, using the mm/dd/yyyy format. If you are requesting more than four years or
periods, you must attach another Form 4506-T. For requests relating to quarterly tax returns, such as Form 941, you must enter each quarter or
tax period separately. 12/31/2019 12/31/2018 12/31/2017
Caution: Do not sign this form unless all applicable lines have been completed.
Signature of taxpayer(s). I declare that I am either the taxpayer whose name is shown on line 1a or 2a, or a person authorized to obtain the tax information
requested. If the request applies to a joint return, at least one spouse must sign. If signed by a corporate officer, 1 percent or more shareholder, partner,
managing member, guardian, tax matters partner, executor, receiver, administrator, trustee, or party other than the taxpayer, I certify that I have the authority
to execute Form 4506-T on behalf of the taxpayer. Note: This form must be received by IRS within 120 days of the signature date.
x Signatory attests that he/she has read the attestation clause and upon so reading declares that he/she Phone number of taxpayer on line 1a or 2a
has the authority to sign the Form 4506-T. See instructions.

(972)436-3786
Signature (see instructions) Date

Sign
Here
Title (if line 1a above is a corporation, partnership, estate, or trust)

Spouse's signature Date

For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 37667N Form 4506-T (Rev. 3-2019)
Page 1 of 2
Form 4506-T (Rev. 3-2019) Loan Number: 505339244 Page 2
Section references are to the Internal Revenue Code Chart for all other transcripts Corporations. Generally, Form 4506-T can be
unless otherwise noted. If you lived in signed by: (1) an officer having legal authority to bind
or your business was Mail or fax to: the corporation, (2) any person designated by the
Future Developments in: board of directors or other governing body, or (3) any
For the latest information about Form 4506-T and its officer or employee on written request by any
instructions, go to www.irs.gov/form4506t. Alabama, Alaska, Arizona, principal officer and attested to by the secretary or
Information about any recent developments affecting Arkansas, California,
other officer. A bona fide shareholder of record
Form 4506-T (such as legislation enacted after we Colorado, Connecticut,
Delaware, Florida, Georgia, Internal Revenue owning 1 percent or more of the outstanding stock
released it) will be posted on that page. of the corporation may submit a Form 4506-T but
What's New. The transcripts provided by the IRS Hawaii, Idaho, Illinois, Service
Indiana, Iowa, Kansas, RAIVS Team must provide documentation to support the
have been modified to protect taxpayers' privacy. requester's right to receive the information.
Transcripts only display partial personal information, Kentucky, Louisiana, P.O. Box 9941
Maryland, Minnesota, Mail Stop 6734 Partnerships. Generally, Form 4506-T can be
such as the last four digits of the taxpayer's Social signed by any person who was a member of the
Security Number. Full financial and tax information, Mississippi, Missouri, Ogden, UT 84409
Montana, Nebraska, partnership during any part of the tax period
such as wages and taxable income, is shown on the requested on line 9.
transcript. Nevada, New Jersey, New
Mexico, North Carolina, All others. See section 6103(e) if the taxpayer
A new optional Customer File Number field is available
North Dakota, Ohio, has died, is insolvent, is a dissolved corporation, or if
to use when requesting a transcript. You have the
option of inputting a number, such as a loan number, Oklahoma, Oregon, Rhode a trustee, guardian, executor, receiver, or
in this field. You can input up to 10 numeric Island, South Carolina, 855-298-1145 administrator is acting for the taxpayer.
characters. The customer file number should not South Dakota, Tennessee, Note: If you are Heir at law, Next of kin, or
contain an SSN. This number will print on the Texas, Utah, Virginia, Beneficiary you must be able to establish a material
transcript. The customer file number is an optional Washington, West Virginia, interest in the estate or trust.
field and not required. Wisconsin, Wyoming, a Documentation. For entities other than individuals,
foreign country, American you must attach the authorization document. For
General Instructions Samoa, Puerto Rico, example, this could be the letter from the principal
Caution: Do not sign this form unless all applicable Guam, the Commonwealth officer authorizing an employee of the corporation or
lines have been completed. of the Northern Mariana the letters testamentary authorizing an individual to
Purpose of form. Use Form 4506-T to request tax Islands, the U.S. Virgin act for an estate.
return information. You can also designate (on line Islands, A.P.O. or F.P.O. Signature by a representative. A representative can
5a) a third party to receive the information. Taxpayers address sign Form 4506-T for a taxpayer only if the taxpayer
using a tax year beginning in one calendar year and Maine, Massachusetts, Internal Revenue has specifically delegated this authority to the
ending in the following year (fiscal tax year) must file New Hampshire, New Service representative on Form 2848, line 5. The
Form 4506-T to request a return transcript. York, Pennsylvania, RAIVS Team representative must attach Form 2848 showing the
Note: If you are unsure of which type of transcript Vermont Stop 6705 S-2 delegation to Form 4506-T.
you need, request the Record of Account, as it Kansas City, MO 64999
provides the most detailed information.
Tip. Use Form 4506, Request for Copy of Tax Return, Privacy Act and Paperwork Reduction Act Notice. We
to request copies of tax returns. 855-821-0094 ask for the information on this form to establish your
Automated transcript request. You can quickly request right to gain access to the requested tax information
transcripts by using our automated self-help service tools. under the Internal Revenue Code. We need this
Please visit us at IRS.gov and click on "Get a Tax Line 1b. Enter your employer identification number information to properly identify the tax information
Transcript..." under "Tools" or call 1-800-908-9946. (EIN) if your request relates to a business return. and respond to your request. You are not required to
Where to file. Mail or fax Form 4506-T to the address Otherwise, enter the first social security number request any transcript; if you do request a transcript,
below for the state you lived in, or the state your (SSN) or your individual taxpayer identification
sections 6103 and 6109 and their regulations require
business was in, when that return was filed. There number (ITIN) shown on the return. For example, if
you are requesting Form 1040 that includes you to provide this information, including your SSN or
are two address charts: one for individual transcripts EIN. If you do not provide this information, we may
(Form 1040 series and Form W-2) and one for all Schedule C (Form 1040), enter your SSN.
not be able to process your request. Providing false
other transcripts. or fraudulent information may subject you to
If you are requesting more than one transcript or Line 3. Enter your current address. If you use a
P.O. box, include it on this line. penalties.
other product and the chart below shows two Routine uses of this information include giving it
different addresses, send your request to the address to the Department of Justice for civil and criminal
based on the address of your most recent return. Line 4. Enter the address shown on the last return
filed if different from the address entered on line 3. litigation, and cities, states, the District of Columbia,
and U.S. commonwealths and possessions for use in
Chart for individual transcripts Note: If the addresses on lines 3 and 4 are different administering their tax laws. We may also disclose
(Form 1040 series and Form W-2 and you have not changed your address with the this information to other countries under a tax treaty,
and Form 1099) IRS, file Form 8822, Change of Address. For a to federal and state agencies to enforce federal
If you filed an business address, file Form 8822-B, Change of nontax criminal laws, or to federal law enforcement
individual return and Mail or fax to: Address or Responsible Party - Business. and intelligence agencies to combat terrorism.
lived in: You are not required to provide the information
Line 5b. Enter up to 10 numeric characters to requested on a form that is subject to the Paperwork
Alabama, Kentucky, create a unique customer file number that will Reduction Act unless the form displays a valid OMB
Louisiana, Mississippi, appear on the transcript. The customer file number control number. Books or records relating to a form
Tennessee, Texas, a foreign Internal Revenue Service should not contain an SSN. Completion of this line or its instructions must be retained as long as their
country, American Samoa, RAIVS Team is not required. contents may become material in the administration
Puerto Rico, Guam, the Stop 6716 AUSC
of any Internal Revenue law. Generally, tax returns
Commonwealth of the Austin, TX 73301 Note. If you use an SSN, name or combination of
Northern Mariana Islands,
and return information are confidential, as required by
both, we will not input the information and the section 6103.
the U.S. Virgin Islands, or customer file number will be blank on the
A.P.O. or F.P.O. address 855-587-9604 The time needed to complete and file Form 4506-
transcript.
T will vary depending on individual circumstances.
Alaska, Arizona, Arkansas, The estimated average time is: Learning about the
Line 6. Enter only one tax form number per request.
California, Colorado, Hawaii, law or the form, 10 min.; Preparing the form, 12
Idaho, Illinois, Indiana, Iowa, Internal Revenue Service min.; and Copying, assembling, and sending the form
Signature and date. Form 4506-T must be signed
Kansas, Michigan, RAIVS Team to the IRS, 20 min.
Minnesota, Montana, Stop 37106 and dated by the taxpayer listed on line 1a or 2a.
The IRS must receive Form 4506-T within 120 days If you have comments concerning the accuracy
Nebraska, Nevada, New Fresno, CA 93888 of these time estimates or suggestions for making
of the date signed by the taxpayer or it will be
Mexico, North Dakota, Form 4506-T simpler, we would be happy to hear
rejected. Ensure that all applicable lines are
Oklahoma, Oregon, South from you. You can write to:
Dakota, Utah, Washington,
completed before signing.
Wisconsin, Wyoming 855-800-8105 Internal Revenue Service
You must check the box in the
Connecticut, Delaware, signature area to acknowledge you Tax Forms and Publications Division
District of Columbia, Florida, have the authority to sign and request 1111 Constitution Ave. NW, IR-6526
Georgia, Maine, Maryland, Internal Revenue Service the information. The form will not be Washington, DC 20224
Massachusetts, Missouri, RAIVS Team processed and returned to you if the
New Hampshire, New Stop 6705 S-2 box is unchecked. Do not send the form to this address. Instead,
Jersey, New York, North Kansas City, MO 64999 see Where to file on this page.
Carolina, Ohio, Individuals. Transcripts of jointly filed tax
Pennsylvania, Rhode Island, returns may be furnished to either spouse. Only
South Carolina, Vermont, one signature is required. Sign Form 4506-T exactly
Virginia, West Virginia 855-821-0094 as your name appeared on the original return. If you
changed your name, also sign your current name.

For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 37667N Form 4506-T (Rev. 3-2019)
Page 2 of 2
Loan Number: 505339244
Request for Taxpayer Give Form to the
Form W-9 Identification Number and Certification requester. Do not
(Rev. October 2018)
send to the IRS.
Department of the Treasury Go to www.irs.gov/FormW9 for instructions and the latest information.
Internal Revenue Service

1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
BARRINGTON L TRAILLE
2 Business name/disregarded entity name, if different from above

3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven 4 Exemptions (codes apply
boxes: only to certain entities, not
Individual/sole proprietor or C Corporation S Corporation Partnership Trust/estate individuals; see instructions
single-member LLC on page 3):
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)
Exempt payee code (if any)
Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC Exemption from FATCA
is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC reporting code (if any)
that is disregarded from the owner should check the appropriate box for the tax classification of its owner.
(Applies to accounts maintained
Other (see instructions) outside the U.S.)

5 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional)
5105 MARSHALL CRK

6 City, state, and ZIP code


FLOWER MOUND, TEXAS 75028-1656
7 List account number(s) here (optional)
505339244
Part I Taxpayer Identification Number (TIN)

Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
100-60-7128
TIN, later.
or
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Employer identification number
Give the Requester for guidelines on whose number to enter.

Part II Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal
Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
notified me that I am no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not
apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual
retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but
you must provide your correct TIN. See the instructions for Part II, later.
Sign Signature of
Here U.S. person Date

General Instructions identification number (TIN) which may be your social security number (SSN),
Section references are to the Internal Revenue Code unless otherwise noted. individual taxpayer identification number (ITIN), adoption taxpayer
identification number (ATIN), or employer identification number (EIN), to
Future developments. For the latest information about developments related to report on an information return the amount paid to you, or other amount
Form W-9 and its instructions, such as legislation enacted after they were reportable on an information return. Examples of information returns include,
published, go to www.irs.gov/FormW9. but are not limited to, the following.
Purpose of Form Form 1099-INT (interest earned or paid)
Form 1099-DIV (dividends, including those from stocks or mutual funds)
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer

Form W-9 (Rev. 10-2018) Cat. No. 10231X


Form W-9 (Rev. 10-2018) Page 2

Form 1099-MISC (various types of income, prizes, awards, or gross eliminate U.S. tax on certain types of income. However, most tax treaties
proceeds) contain a provision known as a "saving clause." Exceptions specified in the
Form 1099-B (stock or mutual fund sales and certain other transactions saving clause may permit an exemption from tax to continue for certain
by brokers) types of income even after the payee has otherwise become a U.S. resident
Form 1099-S (proceeds from real estate transactions) alien for tax purposes.
Form 1099-K (merchant card and third party network transactions)
If you are a U.S. resident alien who is relying on an exception contained in
Form 1098 (home mortgage interest), 1098-E (student loan interest),
the saving clause of a tax treaty to claim an exemption from U.S. tax on
1098-T (tuition)
certain types of income, you must attach a statement to Form W-9 that
Form 1099-C (canceled debt)
specifies the following five items.
Form 1099-A (acquisition or abandonment of secured property)
1. The treaty country. Generally, this must be the same treaty under
Use Form W-9 only if you are a U.S. person (including a resident alien), to
which you claimed exemption from tax as a nonresident alien.
provide your correct TIN.
2. The treaty article addressing the income.
If you do not return Form W-9 to the requester with a TIN, you might be 3. The article number (or location) in the tax treaty that contains the
subject to backup withholding. See What is backup withholding, later. saving clause and its exceptions.
4. The type and amount of income that qualifies for the exemption from tax.
By signing the filled-out form, you:
5. Sufficient facts to justify the exemption from tax under the terms of
1. Certify that the TIN you are giving is correct (or you are waiting for a the treaty article.
number to be issued),
Example. Article 20 of the U.S.-China income tax treaty allows an
2. Certify that you are not subject to backup withholding, or
exemption from tax for scholarship income received by a Chinese student
3. Claim exemption from backup withholding if you are a U.S. exempt
temporarily present in the United States. Under U.S. law, this student will
payee. If applicable, you are also certifying that as a U.S. person, your
become a resident alien for tax purposes if his or her stay in the United
allocable share of any partnership income from a U.S. trade or business is
States exceeds 5 calendar years. However, paragraph 2 of the first Protocol
not subject to the withholding tax on foreign partners' share of effectively
to the U.S.-China treaty (dated April 30, 1984) allows the provisions of
connected income, and
Article 20 to continue to apply even after the Chinese student becomes a
4. Certify that FATCA code(s) entered on this form (if any) indicating
resident alien of the United States. A Chinese student who qualifies for this
that you are exempt from the FATCA reporting, is correct. See What is
exception (under paragraph 2 of the first protocol) and is relying on this
FATCA reporting, later, for further information.
exception to claim an exemption from tax on his or her scholarship or
Note: If you are a U.S. person and a requester gives you a form other than fellowship income would attach to Form W-9 a statement that includes the
Form W-9 to request your TIN, you must use the requester's form if it is information described above to support that exemption.
substantially similar to this Form W-9.
If you are a nonresident alien or a foreign entity, give the requester the
Definition of a U.S. person. For federal tax purposes, you are considered a appropriate completed Form W-8 or Form 8233.
U.S. person if you are:
Backup Withholding
An individual who is a U.S. citizen or U.S. resident alien;
A partnership, corporation, company, or association created or organized What is backup withholding? Persons making certain payments to you must
in the United States or under the laws of the United States; under certain conditions withhold and pay to the IRS 24% of such payments.
An estate (other than a foreign estate); or This is called "backup withholding." Payments that may be subject to
A domestic trust (as defined in Regulations section 301.7701-7). backup withholding include interest, tax-exempt interest, dividends, broker
and barter exchange transactions, rents, royalties, nonemployee pay,
Special rules for partnerships. Partnerships that conduct a trade or business
payments made in settlement of payment card and third party network
in the United States are generally required to pay a withholding tax under
transactions, and certain payments from fishing boat operators. Real estate
section 1446 on any foreign partners' share of effectively connected taxable
transactions are not subject to backup withholding.
income from such business. Further, in certain cases where a Form W-9 has
not been received, the rules under section 1446 require a partnership to You will not be subject to backup withholding on payments you receive if
presume that a partner is a foreign person, and pay the section 1446 you give the requester your correct TIN, make the proper certifications, and
withholding tax. Therefore, if you are a U.S. person that is a partner in a report all your taxable interest and dividends on your tax return.
partnership conducting a trade or business in the United States, provide Payments you receive will be subject to backup withholding if:
Form W-9 to the partnership to establish your U.S. status and avoid section 1. You do not furnish your TIN to the requester,
1446 withholding on your share of partnership income. 2. You do not certify your TIN when required (see the instructions for
In the cases below, the following person must give Form W-9 to the Part II for details),
partnership for purposes of establishing its U.S. status and avoiding 3. The IRS tells the requester that you furnished an incorrect TIN,
withholding on its allocable share of net income from the partnership 4. The IRS tells you that you are subject to backup withholding because
conducting a trade or business in the United States. you did not report all your interest and dividends on your tax return (for
reportable interest and dividends only), or
In the case of a disregarded entity with a U.S. owner, the U.S. owner of
5. You do not certify to the requester that you are not subject to backup
the disregarded entity and not the entity;
withholding under 4 above (for reportable interest and dividend accounts
In the case of a grantor trust with a U.S. grantor or other U.S. owner,
opened after 1983 only).
generally, the U.S. grantor or other U.S. owner of the grantor trust and not
the trust; and Certain payees and payments are exempt from backup withholding. See
In the case of a U.S. trust (other than a grantor trust), the U.S. trust Exempt payee code, later, and the separate Instructions for the Requester of
(other than a grantor trust) and not the beneficiaries of the trust. Form W-9 for more information.

Foreign person. If you are a foreign person or the U.S. branch of a foreign Also see Special rules for partnerships, earlier.
bank that has elected to be treated as a U.S. person, do not use Form W-9.
Instead, use the appropriate Form W-8 or Form 8233 (see Pub. 515, What is FATCA Reporting?
Withholding of Tax on Nonresident Aliens and Foreign Entities). The Foreign Account Tax Compliance Act (FATCA) requires a participating
Nonresident alien who becomes a resident alien. Generally, only a foreign financial institution to report all United States account holders that
nonresident alien individual may use the terms of a tax treaty to reduce or are specified United States persons. Certain payees are exempt from FATCA

Form W-9 (Rev. 10-2018) Cat. No. 10231X


Form W-9 (Rev. 10-2018) Page 3

reporting. See Exemption from FATCA reporting code, later, and the foreign person, the owner must complete an appropriate Form W-8 instead of
Instructions for the Requester of Form W-9 for more information. a Form W-9. This is the case even if the foreign person has a U.S. TIN.
Line 2
Updating Your Information
If you have a business name, trade name, DBA name, or disregarded entity
You must provide updated information to any person to whom you claimed
name, you may enter it on line 2.
to be an exempt payee if you are no longer an exempt payee and anticipate
receiving reportable payments in the future from this person. For example, Line 3
you may need to provide updated information if you are a C corporation that Check the appropriate box on line 3 for the U.S. federal tax classification of
elects to be an S corporation, or if you no longer are tax exempt. In the person whose name is entered on line 1. Check only one box on line 3.
addition, you must furnish a new Form W-9 if the name or TIN changes for IF the entity/person on line 1 is THEN check the box for . . .
the account; for example, if the grantor of a grantor trust dies.
a(n) . . .
Penalties Corporation Corporation
Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, Individual Individual/sole proprietor or
you are subject to a penalty of $50 for each such failure unless your failure Sole proprietorship, or single-member LLC
is due to reasonable cause and not to willful neglect. Single-member limited liability
Civil penalty for false information with respect to withholding. If you make a company (LLC) owned by an
false statement with no reasonable basis that results in no backup individual and disregarded for U.S.
withholding, you are subject to a $500 penalty. federal tax purposes.

Criminal penalty for falsifying information. Willfully falsifying certifications or LLC treated as a partnership for Limited liability company and
affirmations may subject you to criminal penalties including fines and/or U.S. federal tax purposes, enter the appropriate tax
imprisonment. LLC that has filed Form 8832 or classification. (P= Partnership;
2553 to be taxed as a corporation, C= C corporation; or S= S
Misuse of TINs. If the requester discloses or uses TINs in violation of federal
or corporation)
law, the requester may be subject to civil and criminal penalties.
LLC that is disregarded as an
Specific Instructions entity separate from its owner but
the owner is another LLC that is
Line 1 not disregarded for U.S. federal tax
You must enter one of the following on this line; do not leave this line blank. purposes.
The name should match the name on your tax return.
Partnership Partnership
If this Form W-9 is for a joint account (other than an account maintained
by a foreign financial institution (FFI)), list first, and then circle, the name of Trust/estate Trust/estate
the person or entity whose number you entered in Part I of Form W-9. If you
are providing Form W-9 to an FFI to document a joint account, each holder Line 4, Exemptions
of the account that is a U.S. person must provide a Form W-9. If you are exempt from backup withholding and/or FATCA reporting, enter in
a. Individual. Generally, enter the name shown on your tax return. If you the appropriate space on line 4 any code(s) that may apply to you.
have changed your last name without informing the Social Security Exempt payee code.
Administration (SSA) of the name change, enter your first name, the last Generally, individuals (including sole proprietors) are not exempt from
name as shown on your social security card, and your new last name. backup withholding.
Note: ITIN applicant: Enter your individual name as it was entered on your Except as provided below, corporations are exempt from backup
Form W-7 application, line 1a. This should also be the same as the name you withholding for certain payments, including interest and dividends.
entered on the Form 1040/1040A/1040EZ you filed with your application. Corporations are not exempt from backup withholding for payments made
in settlement of payment card or third party network transactions.
b. Sole proprietor or single-member LLC. Enter your individual name as Corporations are not exempt from backup withholding with respect to
shown on your 1040/1040A/1040EZ on line 1. You may enter your business, attorneys' fees or gross proceeds paid to attorneys, and corporations that
trade, or "doing business as" (DBA) name on line 2. provide medical or health care services are not exempt with respect to
c. Partnership, LLC that is not a single-member LLC, C corporation, or S payments reportable on Form 1099-MISC.
corporation. Enter the entity's name as shown on the entity's tax return on The following codes identify payees that are exempt from backup
line 1 and any business, trade, or DBA name on line 2. withholding. Enter the appropriate code in the space in line 4.
d. Other entities. Enter your name as shown on required U.S. federal tax 1 - An organization exempt from tax under section 501(a), any IRA, or a
documents on line 1. This name should match the name shown on the custodial account under section 403(b)(7) if the account satisfies the
charter or other legal document creating the entity. You may enter any requirements of section 401(f)(2)
business, trade, or DBA name on line 2. 2 - The United States or any of its agencies or instrumentalities
3 - A state, the District of Columbia, a U.S. commonwealth or possession,
e. Disregarded entity. For U.S. federal tax purposes, an entity that is
or any of their political subdivisions or instrumentalities
disregarded as an entity separate from its owner is treated as a "disregarded
4 - A foreign government or any of its political subdivisions, agencies, or
entity." See Regulations section 301.7701-2(c)(2)(iii). Enter the owner's
instrumentalities
name on line 1. The name of the entity entered on line 1 should never be a
5 - A corporation
disregarded entity. The name on line 1 should be the name shown on the
6 - A dealer in securities or commodities required to register in the United
income tax return on which the income should be reported. For example, if a
States, the District of Columbia, or a U.S. commonwealth or possession
foreign LLC that is treated as a disregarded entity for U.S. federal tax
7 - A futures commission merchant registered with the Commodity
purposes has a single owner that is a U.S. person, the U.S. owner's name is
Futures Trading Commission
required to be provided on line 1. If the direct owner of the entity is also a
8 - A real estate investment trust
disregarded entity, enter the first owner that is not disregarded for federal
9 - An entity registered at all times during the tax year under the
tax purposes. Enter the disregarded entity's name on line 2, "Business
Investment Company Act of 1940
name/disregarded entity name." If the owner of the disregarded entity is a

Form W-9 (Rev. 10-2018) Cat. No. 10231X


Form W-9 (Rev. 10-2018) Page 4

10 - A common trust fund operated by a bank under section 584(a) M - A tax exempt trust under a section 403(b) plan or section 457(g) plan
11 - A financial institution
Note: You may wish to consult with the financial institution requesting this
12 - A middleman known in the investment community as a nominee or custodian
form to determine whether the FATCA code and/or exempt payee code
13 - A trust exempt from tax under section 664 or described in section 4947
should be completed.
The following chart shows types of payments that may be exempt from
backup withholding. The chart applies to the exempt payees listed above, 1 Line 5
through 13. Enter your address (number, street, and apartment or suite number). This is
IF the payment is for . . . THEN the payment is exempt where the requester of this Form W-9 will mail your information returns. If
for. . . this address differs from the one the requester already has on file, write
NEW at the top. If a new address is provided, there is still a chance the old
Interest and dividend payments All exempt payees except for 7 address will be used until the payor changes your address in their records.
Broker transactions Exempt payees 1 through 4 and 6 Line 6
through 11 and all C corporations.
Enter your city, state, and ZIP code.
S corporations must not enter an
exempt payee code because they Part I. Taxpayer Identification Number (TIN)
are exempt only for sales of
noncovered securities acquired Enter your TIN in the appropriate box. If you are a resident alien and you do
prior to 2012. not have and are not eligible to get an SSN, your TIN is your IRS individual
taxpayer identification number (ITIN). Enter it in the social security number
Barter exchange transactions and Exempt payees 1 through 4 box. If you do not have an ITIN, see How to get a TIN below.
patronage dividends
If you are a sole proprietor and you have an EIN, you may enter either
Payments over $600 required to Generally, exempt payees 1 your SSN or EIN.
be reported and direct sales over through 52
If you are a single-member LLC that is disregarded as an entity separate
$5,0001
from its owner, enter the owner's SSN (or EIN, if the owner has one). Do
Payments made in settlement of Exempt payees 1 through 4 not enter the disregarded entity's EIN. If the LLC is classified as a
payment card or third party corporation or partnership, enter the entity's EIN.
network transactions
1
Note: See What Name and Number To Give the Requester, later, for further
See Form 1099-MISC, Miscellaneous Income, and its instructions.
2
clarification of name and TIN combinations.
However, the following payments made to a corporation and reportable on
Form 1099-MISC are not exempt from backup withholding: medical and How to get a TIN. If you do not have a TIN, apply for one immediately. To apply
health care payments, attorneys' fees, gross proceeds paid to an attorney for an SSN, get Form SS-5, Application for a Social Security Card, from your local
reportable under section 6045(f), and payments for services paid by a federal SSA office or get this form online at w w w .SSA.gov. You may also get this form
executive agency. by calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer
Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer
Exemption from FATCA reporting code. The following codes identify payees Identification Number, to apply for an EIN. You can apply for an EIN online by
that are exempt from reporting under FATCA. These codes apply to persons accessing the IRS website at w w w .irs.gov/Businesses and clicking on Employer
submitting this form for accounts maintained outside of the United States by Identification Number (EIN) under Starting a Business. Go to w w w .irs.gov/Forms
certain foreign financial institutions. Therefore, if you are only submitting this to view, download, or print Form W-7 and/or Form SS-4. Or, you can go to
form for an account you hold in the United States, you may leave this field w w w .irs.gov/OrderForms to place an order and have Form W-7 and/or SS-4 mailed
blank. Consult with the person requesting this form if you are uncertain if the to you within 10 business days.
financial institution is subject to these requirements. A requester may
If you are asked to complete Form W-9 but do not have a TIN, apply for a
indicate that a code is not required by providing you with a Form W-9 with
TIN and write "Applied For" in the space for the TIN, sign and date the form,
"Not Applicable" (or any similar indication) written or printed on the line for a
and give it to the requester. For interest and dividend payments, and certain
FATCA exemption code.
payments made with respect to readily tradable instruments, generally you
A - An organization exempt from tax under section 501(a) or any will have 60 days to get a TIN and give it to the requester before you are
individual retirement plan as defined in section 7701(a)(37) subject to backup withholding on payments. The 60-day rule does not apply
B - The United States or any of its agencies or instrumentalities to other types of payments. You will be subject to backup withholding on all
C - A state, the District of Columbia, a U.S. commonwealth or such payments until you provide your TIN to the requester.
possession, or any of their political subdivisions or instrumentalities
Note: Entering "Applied For" means that you have already applied for a TIN
D - A corporation the stock of which is regularly traded on one or more
or that you intend to apply for one soon.
established securities markets, as described in Regulations section
1.1472-1(c)(1)(i) Caution: A disregarded U.S. entity that has a foreign owner must use the
E - A corporation that is a member of the same expanded affiliated group appropriate Form W-8.
as a corporation described in Regulations section 1.1472-1(c)(1)(i) Part II. Certification
F - A dealer in securities, commodities, or derivative financial instruments
(including notional principal contracts, futures, forwards, and options) that is To establish to the withholding agent that you are a U.S. person, or resident
registered as such under the laws of the United States or any state alien, sign Form W-9. You may be requested to sign by the withholding
G - A real estate investment trust agent even if item 1, 4, or 5 below indicates otherwise.
H - A regulated investment company as defined in section 851 or an For a joint account, only the person whose TIN is shown in Part I should
entity registered at all times during the tax year under the Investment sign (when required). In the case of a disregarded entity, the person
Company Act of 1940 identified on line 1 must sign. Exempt payees, see Exempt payee code,
I - A common trust fund as defined in section 584(a) earlier.
J - A bank as defined in section 581
Signature requirements. Complete the certification as indicated in items 1
K - A broker
through 5 below.
L - A trust exempt from tax under section 664 or described in section
4947(a)(1)

Form W-9 (Rev. 10-2018) Cat. No. 10231X


Form W-9 (Rev. 10-2018) Page 5

1. Interest, dividend, and barter exchange accounts opened before 1984 For this type of account: Give name and EIN of:
and broker accounts considered active during 1983. You must give your
15. Grantor trust filing under the The trust
correct TIN, but you do not have to sign the certification.
Form 1041 Filing Method or the
2. Interest, dividend, broker, and barter exchange accounts opened after Optional Form 1099 Filing
1983 and broker accounts considered inactive during 1983. You must sign the Method 2 (see Regulations
certification or backup withholding will apply. If you are subject to backup section 1.671-4(b)(2)(i)(B))
withholding and you are merely providing your correct TIN to the requester, you
must cross out item 2 in the certification before signing the form. 1
List first and circle the name of the person whose number you furnish. If
3. Real estate transactions. You must sign the certification. You may only one person on a joint account has an SSN, that person's number must
cross out item 2 of the certification. be furnished.
2
4. Other payments. You must give your correct TIN, but you do not Circle the minor's name and furnish the minor's SSN.
3
have to sign the certification unless you have been notified that you have You must show your individual name and you may also enter your business
previously given an incorrect TIN. "Other payments" include payments made or DBA name on the "Business name/disregarded entity" name line. You may
use either your SSN or EIN (if you have one), but the IRS encourages you to use
in the course of the requester's trade or business for rents, royalties, goods
your SSN.
(other than bills for merchandise), medical and health care services (including 4
List first and circle the name of the trust, estate, or pension trust. (Do not
payments to corporations), payments to a nonemployee for services, furnish the TIN of the personal representative or trustee unless the legal
payments made in settlement of payment card and third party network entity itself is not designated in the account title.) Also see Special rules for
transactions, payments to certain fishing boat crew members and fishermen, partnerships, earlier.
and gross proceeds paid to attorneys (including payments to corporations). *Note: The grantor also must provide a Form W-9 to trustee of trust.
5. Mortgage interest paid by you, acquisition or abandonment of secured Note: If no name is circled when more than one name is listed, the number
property, cancellation of debt, qualified tuition program payments (under section will be considered to be that of the first name listed.
529), ABLE accounts (under section 529A), IRA, Coverdell ESA, Archer MSA or
HSA contributions or distributions, and pension distributions. You must give your Secure Your Tax Records From Identity Theft
correct TIN, but you do not have to sign the certification. Identity theft occurs when someone uses your personal information such as
your name, SSN, or other identifying information, without your permission, to
What Name and Number To Give the Requester commit fraud or other crimes. An identity thief may use your SSN to get a
job or may file a tax return using your SSN to receive a refund.
For this type of account: Give name and SSN of:
To reduce your risk:
1. Individual The individual Protect your SSN,
2. Two or more individuals (joint The actual owner of the account or, Ensure your employer is protecting your SSN, and
account) other than an account if combined funds, the first individual Be careful when choosing a tax preparer.
maintained by an FFI on the account1
If your tax records are affected by identity theft and you receive a notice
3. Two or more U.S. persons (joint Each holder of the account
from the IRS, respond right away to the name and phone number printed on
account maintained by an FFI)
the IRS notice or letter.
4. Custodial account of a minor The minor2
(Uniform Gift to Minors Act) If your tax records are not currently affected by identity theft but you
5. a. The usual revocable savings The grantor-trustee1 think you are at risk due to a lost or stolen purse or wallet, questionable
trust (grantor is also trustee) credit card activity or credit report, contact the IRS Identity Theft Hotline at
b. So-called trust account that The actual owner1 1-800-908-4490 or submit Form 14039.
is not a legal or valid trust For more informat ion, see Pub. 5027, Identity Theft Information for
under state law Taxpayers.
3
6. Sole proprietorship or disregarded The owner
Victims of identity theft who are experiencing economic harm or a
entity owned by an individual
systemic problem, or are seeking help in resolving tax problems that have not
7. Grantor trust filing under The grantor*
been resolved through normal channels, may be eligible for Taxpayer
Optional Form 1099 Filing
Advocate Service (TAS) assistance. You can reach TAS by calling the TAS
Method 1 (see Regulations
toll-free case intake line at 1-877-777-4778 or TTY/TDD 1-800-829-4059.
section 1.671-4(b)(2)(i)(A))
Protect yourself from suspicious emails or phishing schemes. Phishing is the
For this type of account: Give name and EIN of: creation and use of email and websites designed to mimic legitimate
business emails and websites. The most common act is sending an email to
8. Disregarded entity not owned by The owner
a user falsely claiming to be an established legitimate enterprise in an
an individual
attempt to scam the user into surrendering private information that will be
9. A valid trust, estate, or pension Legal entity4
used for identity theft.
trust
10. Corporate or LLC electing The corporation
corporate status on Form 8832
or Form 2553
11. Association, club, religious, The organization
charitable, educational, or other
tax-exempt organization
12. Partnership or multi-member LLC The partnership
13. A broker or registered nominee The broker or nominee
14. Account with the Department of The public entity
Agriculture in the name of a
public entity (such as a state or
local government, school
district, or prison) that receives
agricultural program payments

Form W-9 (Rev. 10-2018) Cat. No. 10231X


Form W-9 (Rev. 10-2018) Page 6

The IRS does not initiate contacts with taxpayers via emails. Also, the IRS Privacy Act Notice
does not request personal detailed information through email or ask Section 6109 of the Internal Revenue Code requires you to provide your
taxpayers for the PIN numbers, passwords, or similar secret access correct TIN to persons (including federal agencies) who are required to file
information for their credit card, bank, or other financial accounts. information returns with the IRS to report interest, dividends, or certain other
If you receive an unsolicited email claiming to be from the IRS, forward income paid to you; mortgage interest you paid; the acquisition or
this message to [email protected]. You may also report misuse of the IRS abandonment of secured property; the cancellation of debt; or contributions
name, logo, or other IRS property to the Treasury Inspector General for Tax you made to an IRA, Archer MSA, or HSA. The person collecting this form
Administration (TIGTA) at 1-800-366-4484. You can forward suspicious uses the information on the form to file information returns with the IRS,
emails to the Federal Trade Commission at [email protected] or report them at reporting the above information. Routine uses of this information include
www.ftc.gov/complaint. You can contact the FTC at www.ftc.gov/idtheft or giving it to the Department of Justice for civil and criminal litigation and to
877-IDTHEFT (877-438-4338). If you have been the victim of identity theft, cities, states, the District of Columbia, and U.S. commonwealths and
see www.IdentityTheft.gov and Pub. 5027. possessions for use in administering their laws. The information also may be
Visit www.irs.gov/IdentityTheft to learn more about identity theft and disclosed to other countries under a treaty, to federal and state agencies to
how to reduce your risk. enforce civil and criminal laws, or to federal law enforcement and intelligence
agencies to combat terrorism. You must provide your TIN whether or not you
are required to file a tax return. Under section 3406, payers must generally
withhold a percentage of taxable interest, dividend, and certain other
payments to a payee who does not give a TIN to the payer. Certain penalties
may also apply for providing false or fraudulent information.

Form W-9 (Rev. 10-2018) Cat. No. 10231X


Loan Number: 505339244
Request for Taxpayer Give Form to the
Form W-9 Identification Number and Certification requester. Do not
(Rev. October 2018)
send to the IRS.
Department of the Treasury Go to www.irs.gov/FormW9 for instructions and the latest information.
Internal Revenue Service

1 Name (as shown on your income tax return). Name is required on this line; do not leave this line blank.
MARLENE M TRAILLE
2 Business name/disregarded entity name, if different from above

3 Check appropriate box for federal tax classification of the person whose name is entered on line 1. Check only one of the following seven 4 Exemptions (codes apply
boxes: only to certain entities, not
Individual/sole proprietor or C Corporation S Corporation Partnership Trust/estate individuals; see instructions
single-member LLC on page 3):
Limited liability company. Enter the tax classification (C=C corporation, S=S corporation, P=Partnership)
Exempt payee code (if any)
Note: Check the appropriate box in the line above for the tax classification of the single-member owner. Do not check
LLC if the LLC is classified as a single-member LLC that is disregarded from the owner unless the owner of the LLC Exemption from FATCA
is another LLC that is not disregarded from the owner for U.S. federal tax purposes. Otherwise, a single-member LLC reporting code (if any)
that is disregarded from the owner should check the appropriate box for the tax classification of its owner.
(Applies to accounts maintained
Other (see instructions) outside the U.S.)

5 Address (number, street, and apt. or suite no.) See instructions. Requester's name and address (optional)
5105 MARSHALL CRK

6 City, state, and ZIP code


FLOWER MOUND, TEXAS 75028-1656
7 List account number(s) here (optional)
505339244
Part I Taxpayer Identification Number (TIN)

Enter your TIN in the appropriate box. The TIN provided must match the name given on line 1 to avoid Social security number
backup withholding. For individuals, this is generally your social security number (SSN). However, for a
resident alien, sole proprietor, or disregarded entity, see the instructions for Part I, later. For other
entities, it is your employer identification number (EIN). If you do not have a number, see How to get a
092-62-8536
TIN, later.
or
Note: If the account is in more than one name, see the instructions for line 1. Also see What Name and Number To Employer identification number
Give the Requester for guidelines on whose number to enter.

Part II Certification
Under penalties of perjury, I certify that:
1. The number shown on this form is my correct taxpayer identification number (or I am waiting for a number to be issued to me); and
2. I am not subject to backup withholding because: (a) I am exempt from backup withholding, or (b) I have not been notified by the Internal
Revenue Service (IRS) that I am subject to backup withholding as a result of a failure to report all interest or dividends, or (c) the IRS has
notified me that I am no longer subject to backup withholding; and
3. I am a U.S. citizen or other U.S. person (defined below); and
4. The FATCA code(s) entered on this form (if any) indicating that I am exempt from FATCA reporting is correct.
Certification instructions. You must cross out item 2 above if you have been notified by the IRS that you are currently subject to backup
withholding because you have failed to report all interest and dividends on your tax return. For real estate transactions, item 2 does not
apply. For mortgage interest paid, acquisition or abandonment of secured property, cancellation of debt, contributions to an individual
retirement arrangement (IRA), and generally, payments other than interest and dividends, you are not required to sign the certification, but
you must provide your correct TIN. See the instructions for Part II, later.
Sign Signature of
Here U.S. person Date

General Instructions identification number (TIN) which may be your social security number (SSN),
Section references are to the Internal Revenue Code unless otherwise noted. individual taxpayer identification number (ITIN), adoption taxpayer
identification number (ATIN), or employer identification number (EIN), to
Future developments. For the latest information about developments related to report on an information return the amount paid to you, or other amount
Form W-9 and its instructions, such as legislation enacted after they were reportable on an information return. Examples of information returns include,
published, go to www.irs.gov/FormW9. but are not limited to, the following.
Purpose of Form Form 1099-INT (interest earned or paid)
Form 1099-DIV (dividends, including those from stocks or mutual funds)
An individual or entity (Form W-9 requester) who is required to file an
information return with the IRS must obtain your correct taxpayer

Form W-9 (Rev. 10-2018) Cat. No. 10231X


Form W-9 (Rev. 10-2018) Page 2

Form 1099-MISC (various types of income, prizes, awards, or gross eliminate U.S. tax on certain types of income. However, most tax treaties
proceeds) contain a provision known as a "saving clause." Exceptions specified in the
Form 1099-B (stock or mutual fund sales and certain other transactions saving clause may permit an exemption from tax to continue for certain
by brokers) types of income even after the payee has otherwise become a U.S. resident
Form 1099-S (proceeds from real estate transactions) alien for tax purposes.
Form 1099-K (merchant card and third party network transactions)
If you are a U.S. resident alien who is relying on an exception contained in
Form 1098 (home mortgage interest), 1098-E (student loan interest),
the saving clause of a tax treaty to claim an exemption from U.S. tax on
1098-T (tuition)
certain types of income, you must attach a statement to Form W-9 that
Form 1099-C (canceled debt)
specifies the following five items.
Form 1099-A (acquisition or abandonment of secured property)
1. The treaty country. Generally, this must be the same treaty under
Use Form W-9 only if you are a U.S. person (including a resident alien), to
which you claimed exemption from tax as a nonresident alien.
provide your correct TIN.
2. The treaty article addressing the income.
If you do not return Form W-9 to the requester with a TIN, you might be 3. The article number (or location) in the tax treaty that contains the
subject to backup withholding. See What is backup withholding, later. saving clause and its exceptions.
4. The type and amount of income that qualifies for the exemption from tax.
By signing the filled-out form, you:
5. Sufficient facts to justify the exemption from tax under the terms of
1. Certify that the TIN you are giving is correct (or you are waiting for a the treaty article.
number to be issued),
Example. Article 20 of the U.S.-China income tax treaty allows an
2. Certify that you are not subject to backup withholding, or
exemption from tax for scholarship income received by a Chinese student
3. Claim exemption from backup withholding if you are a U.S. exempt
temporarily present in the United States. Under U.S. law, this student will
payee. If applicable, you are also certifying that as a U.S. person, your
become a resident alien for tax purposes if his or her stay in the United
allocable share of any partnership income from a U.S. trade or business is
States exceeds 5 calendar years. However, paragraph 2 of the first Protocol
not subject to the withholding tax on foreign partners' share of effectively
to the U.S.-China treaty (dated April 30, 1984) allows the provisions of
connected income, and
Article 20 to continue to apply even after the Chinese student becomes a
4. Certify that FATCA code(s) entered on this form (if any) indicating
resident alien of the United States. A Chinese student who qualifies for this
that you are exempt from the FATCA reporting, is correct. See What is
exception (under paragraph 2 of the first protocol) and is relying on this
FATCA reporting, later, for further information.
exception to claim an exemption from tax on his or her scholarship or
Note: If you are a U.S. person and a requester gives you a form other than fellowship income would attach to Form W-9 a statement that includes the
Form W-9 to request your TIN, you must use the requester's form if it is information described above to support that exemption.
substantially similar to this Form W-9.
If you are a nonresident alien or a foreign entity, give the requester the
Definition of a U.S. person. For federal tax purposes, you are considered a appropriate completed Form W-8 or Form 8233.
U.S. person if you are:
Backup Withholding
An individual who is a U.S. citizen or U.S. resident alien;
A partnership, corporation, company, or association created or organized What is backup withholding? Persons making certain payments to you must
in the United States or under the laws of the United States; under certain conditions withhold and pay to the IRS 24% of such payments.
An estate (other than a foreign estate); or This is called "backup withholding." Payments that may be subject to
A domestic trust (as defined in Regulations section 301.7701-7). backup withholding include interest, tax-exempt interest, dividends, broker
and barter exchange transactions, rents, royalties, nonemployee pay,
Special rules for partnerships. Partnerships that conduct a trade or business
payments made in settlement of payment card and third party network
in the United States are generally required to pay a withholding tax under
transactions, and certain payments from fishing boat operators. Real estate
section 1446 on any foreign partners' share of effectively connected taxable
transactions are not subject to backup withholding.
income from such business. Further, in certain cases where a Form W-9 has
not been received, the rules under section 1446 require a partnership to You will not be subject to backup withholding on payments you receive if
presume that a partner is a foreign person, and pay the section 1446 you give the requester your correct TIN, make the proper certifications, and
withholding tax. Therefore, if you are a U.S. person that is a partner in a report all your taxable interest and dividends on your tax return.
partnership conducting a trade or business in the United States, provide Payments you receive will be subject to backup withholding if:
Form W-9 to the partnership to establish your U.S. status and avoid section 1. You do not furnish your TIN to the requester,
1446 withholding on your share of partnership income. 2. You do not certify your TIN when required (see the instructions for
In the cases below, the following person must give Form W-9 to the Part II for details),
partnership for purposes of establishing its U.S. status and avoiding 3. The IRS tells the requester that you furnished an incorrect TIN,
withholding on its allocable share of net income from the partnership 4. The IRS tells you that you are subject to backup withholding because
conducting a trade or business in the United States. you did not report all your interest and dividends on your tax return (for
reportable interest and dividends only), or
In the case of a disregarded entity with a U.S. owner, the U.S. owner of
5. You do not certify to the requester that you are not subject to backup
the disregarded entity and not the entity;
withholding under 4 above (for reportable interest and dividend accounts
In the case of a grantor trust with a U.S. grantor or other U.S. owner,
opened after 1983 only).
generally, the U.S. grantor or other U.S. owner of the grantor trust and not
the trust; and Certain payees and payments are exempt from backup withholding. See
In the case of a U.S. trust (other than a grantor trust), the U.S. trust Exempt payee code, later, and the separate Instructions for the Requester of
(other than a grantor trust) and not the beneficiaries of the trust. Form W-9 for more information.

Foreign person. If you are a foreign person or the U.S. branch of a foreign Also see Special rules for partnerships, earlier.
bank that has elected to be treated as a U.S. person, do not use Form W-9.
Instead, use the appropriate Form W-8 or Form 8233 (see Pub. 515, What is FATCA Reporting?
Withholding of Tax on Nonresident Aliens and Foreign Entities). The Foreign Account Tax Compliance Act (FATCA) requires a participating
Nonresident alien who becomes a resident alien. Generally, only a foreign financial institution to report all United States account holders that
nonresident alien individual may use the terms of a tax treaty to reduce or are specified United States persons. Certain payees are exempt from FATCA

Form W-9 (Rev. 10-2018) Cat. No. 10231X


Form W-9 (Rev. 10-2018) Page 3

reporting. See Exemption from FATCA reporting code, later, and the foreign person, the owner must complete an appropriate Form W-8 instead of
Instructions for the Requester of Form W-9 for more information. a Form W-9. This is the case even if the foreign person has a U.S. TIN.
Line 2
Updating Your Information
If you have a business name, trade name, DBA name, or disregarded entity
You must provide updated information to any person to whom you claimed
name, you may enter it on line 2.
to be an exempt payee if you are no longer an exempt payee and anticipate
receiving reportable payments in the future from this person. For example, Line 3
you may need to provide updated information if you are a C corporation that Check the appropriate box on line 3 for the U.S. federal tax classification of
elects to be an S corporation, or if you no longer are tax exempt. In the person whose name is entered on line 1. Check only one box on line 3.
addition, you must furnish a new Form W-9 if the name or TIN changes for IF the entity/person on line 1 is THEN check the box for . . .
the account; for example, if the grantor of a grantor trust dies.
a(n) . . .
Penalties Corporation Corporation
Failure to furnish TIN. If you fail to furnish your correct TIN to a requester, Individual Individual/sole proprietor or
you are subject to a penalty of $50 for each such failure unless your failure Sole proprietorship, or single-member LLC
is due to reasonable cause and not to willful neglect. Single-member limited liability
Civil penalty for false information with respect to withholding. If you make a company (LLC) owned by an
false statement with no reasonable basis that results in no backup individual and disregarded for U.S.
withholding, you are subject to a $500 penalty. federal tax purposes.

Criminal penalty for falsifying information. Willfully falsifying certifications or LLC treated as a partnership for Limited liability company and
affirmations may subject you to criminal penalties including fines and/or U.S. federal tax purposes, enter the appropriate tax
imprisonment. LLC that has filed Form 8832 or classification. (P= Partnership;
2553 to be taxed as a corporation, C= C corporation; or S= S
Misuse of TINs. If the requester discloses or uses TINs in violation of federal
or corporation)
law, the requester may be subject to civil and criminal penalties.
LLC that is disregarded as an
Specific Instructions entity separate from its owner but
the owner is another LLC that is
Line 1 not disregarded for U.S. federal tax
You must enter one of the following on this line; do not leave this line blank. purposes.
The name should match the name on your tax return.
Partnership Partnership
If this Form W-9 is for a joint account (other than an account maintained
by a foreign financial institution (FFI)), list first, and then circle, the name of Trust/estate Trust/estate
the person or entity whose number you entered in Part I of Form W-9. If you
are providing Form W-9 to an FFI to document a joint account, each holder Line 4, Exemptions
of the account that is a U.S. person must provide a Form W-9. If you are exempt from backup withholding and/or FATCA reporting, enter in
a. Individual. Generally, enter the name shown on your tax return. If you the appropriate space on line 4 any code(s) that may apply to you.
have changed your last name without informing the Social Security Exempt payee code.
Administration (SSA) of the name change, enter your first name, the last Generally, individuals (including sole proprietors) are not exempt from
name as shown on your social security card, and your new last name. backup withholding.
Note: ITIN applicant: Enter your individual name as it was entered on your Except as provided below, corporations are exempt from backup
Form W-7 application, line 1a. This should also be the same as the name you withholding for certain payments, including interest and dividends.
entered on the Form 1040/1040A/1040EZ you filed with your application. Corporations are not exempt from backup withholding for payments made
in settlement of payment card or third party network transactions.
b. Sole proprietor or single-member LLC. Enter your individual name as Corporations are not exempt from backup withholding with respect to
shown on your 1040/1040A/1040EZ on line 1. You may enter your business, attorneys' fees or gross proceeds paid to attorneys, and corporations that
trade, or "doing business as" (DBA) name on line 2. provide medical or health care services are not exempt with respect to
c. Partnership, LLC that is not a single-member LLC, C corporation, or S payments reportable on Form 1099-MISC.
corporation. Enter the entity's name as shown on the entity's tax return on The following codes identify payees that are exempt from backup
line 1 and any business, trade, or DBA name on line 2. withholding. Enter the appropriate code in the space in line 4.
d. Other entities. Enter your name as shown on required U.S. federal tax 1 - An organization exempt from tax under section 501(a), any IRA, or a
documents on line 1. This name should match the name shown on the custodial account under section 403(b)(7) if the account satisfies the
charter or other legal document creating the entity. You may enter any requirements of section 401(f)(2)
business, trade, or DBA name on line 2. 2 - The United States or any of its agencies or instrumentalities
3 - A state, the District of Columbia, a U.S. commonwealth or possession,
e. Disregarded entity. For U.S. federal tax purposes, an entity that is
or any of their political subdivisions or instrumentalities
disregarded as an entity separate from its owner is treated as a "disregarded
4 - A foreign government or any of its political subdivisions, agencies, or
entity." See Regulations section 301.7701-2(c)(2)(iii). Enter the owner's
instrumentalities
name on line 1. The name of the entity entered on line 1 should never be a
5 - A corporation
disregarded entity. The name on line 1 should be the name shown on the
6 - A dealer in securities or commodities required to register in the United
income tax return on which the income should be reported. For example, if a
States, the District of Columbia, or a U.S. commonwealth or possession
foreign LLC that is treated as a disregarded entity for U.S. federal tax
7 - A futures commission merchant registered with the Commodity
purposes has a single owner that is a U.S. person, the U.S. owner's name is
Futures Trading Commission
required to be provided on line 1. If the direct owner of the entity is also a
8 - A real estate investment trust
disregarded entity, enter the first owner that is not disregarded for federal
9 - An entity registered at all times during the tax year under the
tax purposes. Enter the disregarded entity's name on line 2, "Business
Investment Company Act of 1940
name/disregarded entity name." If the owner of the disregarded entity is a

Form W-9 (Rev. 10-2018) Cat. No. 10231X


Form W-9 (Rev. 10-2018) Page 4

10 - A common trust fund operated by a bank under section 584(a) M - A tax exempt trust under a section 403(b) plan or section 457(g) plan
11 - A financial institution
Note: You may wish to consult with the financial institution requesting this
12 - A middleman known in the investment community as a nominee or custodian
form to determine whether the FATCA code and/or exempt payee code
13 - A trust exempt from tax under section 664 or described in section 4947
should be completed.
The following chart shows types of payments that may be exempt from
backup withholding. The chart applies to the exempt payees listed above, 1 Line 5
through 13. Enter your address (number, street, and apartment or suite number). This is
IF the payment is for . . . THEN the payment is exempt where the requester of this Form W-9 will mail your information returns. If
for. . . this address differs from the one the requester already has on file, write
NEW at the top. If a new address is provided, there is still a chance the old
Interest and dividend payments All exempt payees except for 7 address will be used until the payor changes your address in their records.
Broker transactions Exempt payees 1 through 4 and 6 Line 6
through 11 and all C corporations.
Enter your city, state, and ZIP code.
S corporations must not enter an
exempt payee code because they Part I. Taxpayer Identification Number (TIN)
are exempt only for sales of
noncovered securities acquired Enter your TIN in the appropriate box. If you are a resident alien and you do
prior to 2012. not have and are not eligible to get an SSN, your TIN is your IRS individual
taxpayer identification number (ITIN). Enter it in the social security number
Barter exchange transactions and Exempt payees 1 through 4 box. If you do not have an ITIN, see How to get a TIN below.
patronage dividends
If you are a sole proprietor and you have an EIN, you may enter either
Payments over $600 required to Generally, exempt payees 1 your SSN or EIN.
be reported and direct sales over through 52
If you are a single-member LLC that is disregarded as an entity separate
$5,0001
from its owner, enter the owner's SSN (or EIN, if the owner has one). Do
Payments made in settlement of Exempt payees 1 through 4 not enter the disregarded entity's EIN. If the LLC is classified as a
payment card or third party corporation or partnership, enter the entity's EIN.
network transactions
1
Note: See What Name and Number To Give the Requester, later, for further
See Form 1099-MISC, Miscellaneous Income, and its instructions.
2
clarification of name and TIN combinations.
However, the following payments made to a corporation and reportable on
Form 1099-MISC are not exempt from backup withholding: medical and How to get a TIN. If you do not have a TIN, apply for one immediately. To apply
health care payments, attorneys' fees, gross proceeds paid to an attorney for an SSN, get Form SS-5, Application for a Social Security Card, from your local
reportable under section 6045(f), and payments for services paid by a federal SSA office or get this form online at w w w .SSA.gov. You may also get this form
executive agency. by calling 1-800-772-1213. Use Form W-7, Application for IRS Individual Taxpayer
Identification Number, to apply for an ITIN, or Form SS-4, Application for Employer
Exemption from FATCA reporting code. The following codes identify payees Identification Number, to apply for an EIN. You can apply for an EIN online by
that are exempt from reporting under FATCA. These codes apply to persons accessing the IRS website at w w w .irs.gov/Businesses and clicking on Employer
submitting this form for accounts maintained outside of the United States by Identification Number (EIN) under Starting a Business. Go to w w w .irs.gov/Forms
certain foreign financial institutions. Therefore, if you are only submitting this to view, download, or print Form W-7 and/or Form SS-4. Or, you can go to
form for an account you hold in the United States, you may leave this field w w w .irs.gov/OrderForms to place an order and have Form W-7 and/or SS-4 mailed
blank. Consult with the person requesting this form if you are uncertain if the to you within 10 business days.
financial institution is subject to these requirements. A requester may
If you are asked to complete Form W-9 but do not have a TIN, apply for a
indicate that a code is not required by providing you with a Form W-9 with
TIN and write "Applied For" in the space for the TIN, sign and date the form,
"Not Applicable" (or any similar indication) written or printed on the line for a
and give it to the requester. For interest and dividend payments, and certain
FATCA exemption code.
payments made with respect to readily tradable instruments, generally you
A - An organization exempt from tax under section 501(a) or any will have 60 days to get a TIN and give it to the requester before you are
individual retirement plan as defined in section 7701(a)(37) subject to backup withholding on payments. The 60-day rule does not apply
B - The United States or any of its agencies or instrumentalities to other types of payments. You will be subject to backup withholding on all
C - A state, the District of Columbia, a U.S. commonwealth or such payments until you provide your TIN to the requester.
possession, or any of their political subdivisions or instrumentalities
Note: Entering "Applied For" means that you have already applied for a TIN
D - A corporation the stock of which is regularly traded on one or more
or that you intend to apply for one soon.
established securities markets, as described in Regulations section
1.1472-1(c)(1)(i) Caution: A disregarded U.S. entity that has a foreign owner must use the
E - A corporation that is a member of the same expanded affiliated group appropriate Form W-8.
as a corporation described in Regulations section 1.1472-1(c)(1)(i) Part II. Certification
F - A dealer in securities, commodities, or derivative financial instruments
(including notional principal contracts, futures, forwards, and options) that is To establish to the withholding agent that you are a U.S. person, or resident
registered as such under the laws of the United States or any state alien, sign Form W-9. You may be requested to sign by the withholding
G - A real estate investment trust agent even if item 1, 4, or 5 below indicates otherwise.
H - A regulated investment company as defined in section 851 or an For a joint account, only the person whose TIN is shown in Part I should
entity registered at all times during the tax year under the Investment sign (when required). In the case of a disregarded entity, the person
Company Act of 1940 identified on line 1 must sign. Exempt payees, see Exempt payee code,
I - A common trust fund as defined in section 584(a) earlier.
J - A bank as defined in section 581
Signature requirements. Complete the certification as indicated in items 1
K - A broker
through 5 below.
L - A trust exempt from tax under section 664 or described in section
4947(a)(1)

Form W-9 (Rev. 10-2018) Cat. No. 10231X


Form W-9 (Rev. 10-2018) Page 5

1. Interest, dividend, and barter exchange accounts opened before 1984 For this type of account: Give name and EIN of:
and broker accounts considered active during 1983. You must give your
15. Grantor trust filing under the The trust
correct TIN, but you do not have to sign the certification.
Form 1041 Filing Method or the
2. Interest, dividend, broker, and barter exchange accounts opened after Optional Form 1099 Filing
1983 and broker accounts considered inactive during 1983. You must sign the Method 2 (see Regulations
certification or backup withholding will apply. If you are subject to backup section 1.671-4(b)(2)(i)(B))
withholding and you are merely providing your correct TIN to the requester, you
must cross out item 2 in the certification before signing the form. 1
List first and circle the name of the person whose number you furnish. If
3. Real estate transactions. You must sign the certification. You may only one person on a joint account has an SSN, that person's number must
cross out item 2 of the certification. be furnished.
2
4. Other payments. You must give your correct TIN, but you do not Circle the minor's name and furnish the minor's SSN.
3
have to sign the certification unless you have been notified that you have You must show your individual name and you may also enter your business
previously given an incorrect TIN. "Other payments" include payments made or DBA name on the "Business name/disregarded entity" name line. You may
use either your SSN or EIN (if you have one), but the IRS encourages you to use
in the course of the requester's trade or business for rents, royalties, goods
your SSN.
(other than bills for merchandise), medical and health care services (including 4
List first and circle the name of the trust, estate, or pension trust. (Do not
payments to corporations), payments to a nonemployee for services, furnish the TIN of the personal representative or trustee unless the legal
payments made in settlement of payment card and third party network entity itself is not designated in the account title.) Also see Special rules for
transactions, payments to certain fishing boat crew members and fishermen, partnerships, earlier.
and gross proceeds paid to attorneys (including payments to corporations). *Note: The grantor also must provide a Form W-9 to trustee of trust.
5. Mortgage interest paid by you, acquisition or abandonment of secured Note: If no name is circled when more than one name is listed, the number
property, cancellation of debt, qualified tuition program payments (under section will be considered to be that of the first name listed.
529), ABLE accounts (under section 529A), IRA, Coverdell ESA, Archer MSA or
HSA contributions or distributions, and pension distributions. You must give your Secure Your Tax Records From Identity Theft
correct TIN, but you do not have to sign the certification. Identity theft occurs when someone uses your personal information such as
your name, SSN, or other identifying information, without your permission, to
What Name and Number To Give the Requester commit fraud or other crimes. An identity thief may use your SSN to get a
job or may file a tax return using your SSN to receive a refund.
For this type of account: Give name and SSN of:
To reduce your risk:
1. Individual The individual Protect your SSN,
2. Two or more individuals (joint The actual owner of the account or, Ensure your employer is protecting your SSN, and
account) other than an account if combined funds, the first individual Be careful when choosing a tax preparer.
maintained by an FFI on the account1
If your tax records are affected by identity theft and you receive a notice
3. Two or more U.S. persons (joint Each holder of the account
from the IRS, respond right away to the name and phone number printed on
account maintained by an FFI)
the IRS notice or letter.
4. Custodial account of a minor The minor2
(Uniform Gift to Minors Act) If your tax records are not currently affected by identity theft but you
5. a. The usual revocable savings The grantor-trustee1 think you are at risk due to a lost or stolen purse or wallet, questionable
trust (grantor is also trustee) credit card activity or credit report, contact the IRS Identity Theft Hotline at
b. So-called trust account that The actual owner1 1-800-908-4490 or submit Form 14039.
is not a legal or valid trust For more informat ion, see Pub. 5027, Identity Theft Information for
under state law Taxpayers.
3
6. Sole proprietorship or disregarded The owner
Victims of identity theft who are experiencing economic harm or a
entity owned by an individual
systemic problem, or are seeking help in resolving tax problems that have not
7. Grantor trust filing under The grantor*
been resolved through normal channels, may be eligible for Taxpayer
Optional Form 1099 Filing
Advocate Service (TAS) assistance. You can reach TAS by calling the TAS
Method 1 (see Regulations
toll-free case intake line at 1-877-777-4778 or TTY/TDD 1-800-829-4059.
section 1.671-4(b)(2)(i)(A))
Protect yourself from suspicious emails or phishing schemes. Phishing is the
For this type of account: Give name and EIN of: creation and use of email and websites designed to mimic legitimate
business emails and websites. The most common act is sending an email to
8. Disregarded entity not owned by The owner
a user falsely claiming to be an established legitimate enterprise in an
an individual
attempt to scam the user into surrendering private information that will be
9. A valid trust, estate, or pension Legal entity4
used for identity theft.
trust
10. Corporate or LLC electing The corporation
corporate status on Form 8832
or Form 2553
11. Association, club, religious, The organization
charitable, educational, or other
tax-exempt organization
12. Partnership or multi-member LLC The partnership
13. A broker or registered nominee The broker or nominee
14. Account with the Department of The public entity
Agriculture in the name of a
public entity (such as a state or
local government, school
district, or prison) that receives
agricultural program payments

Form W-9 (Rev. 10-2018) Cat. No. 10231X


Form W-9 (Rev. 10-2018) Page 6

The IRS does not initiate contacts with taxpayers via emails. Also, the IRS Privacy Act Notice
does not request personal detailed information through email or ask Section 6109 of the Internal Revenue Code requires you to provide your
taxpayers for the PIN numbers, passwords, or similar secret access correct TIN to persons (including federal agencies) who are required to file
information for their credit card, bank, or other financial accounts. information returns with the IRS to report interest, dividends, or certain other
If you receive an unsolicited email claiming to be from the IRS, forward income paid to you; mortgage interest you paid; the acquisition or
this message to [email protected]. You may also report misuse of the IRS abandonment of secured property; the cancellation of debt; or contributions
name, logo, or other IRS property to the Treasury Inspector General for Tax you made to an IRA, Archer MSA, or HSA. The person collecting this form
Administration (TIGTA) at 1-800-366-4484. You can forward suspicious uses the information on the form to file information returns with the IRS,
emails to the Federal Trade Commission at [email protected] or report them at reporting the above information. Routine uses of this information include
www.ftc.gov/complaint. You can contact the FTC at www.ftc.gov/idtheft or giving it to the Department of Justice for civil and criminal litigation and to
877-IDTHEFT (877-438-4338). If you have been the victim of identity theft, cities, states, the District of Columbia, and U.S. commonwealths and
see www.IdentityTheft.gov and Pub. 5027. possessions for use in administering their laws. The information also may be
Visit www.irs.gov/IdentityTheft to learn more about identity theft and disclosed to other countries under a treaty, to federal and state agencies to
how to reduce your risk. enforce civil and criminal laws, or to federal law enforcement and intelligence
agencies to combat terrorism. You must provide your TIN whether or not you
are required to file a tax return. Under section 3406, payers must generally
withhold a percentage of taxable interest, dividend, and certain other
payments to a payee who does not give a TIN to the payer. Certain penalties
may also apply for providing false or fraudulent information.

Form W-9 (Rev. 10-2018) Cat. No. 10231X


Form SSA-89 (02-2018)
Discontinue Previous Editions Page 1 of 2
Social Security Administration OMB No. 0960-0760

Authorization for the Social Security Administration (SSA)


To Release Social Security Number (SSN) Verification
Printed Name: Date of Birth: Social Security Number:

BARRINGTON L TRAILLE APRIL 9, 1951 100-60-7128


I want this information released because I am conducting the following business transaction:
Mortgage Application

Reason(s) for using CBSV: (Please select all that apply)


X Mortgage Service Banking Service
Background Check License Requirement
X Credit Check Other
with the following company ("the Company"):

Company Name:

Company Address:
I authorize the Social Security Administration to verify my name and SSN to the Company and/or the Company's Agent,
if applicable, for the purpose I identified.

The name and address of the Company's Agent is:


TALX Corporation
11432 Lackland Road, St. Louis, MO 63146

I am the individual to whom the Social Security number was issued or the parent or legal guardian of a minor, or the legal
guardian of a legally incompetent adult. I declare and affirm under the penalty of perjury that the information contained
herein is true and correct. I acknowledge that if I make any representation that I know is false to obtain information from
Social Security records, I could be found guilty of a misdemeanor and fined up to $5,000.

This consent is valid only for 90 days from the date signed, unless indicated otherwise by the individual named above.
If you wish to change this timeframe, fill in the following:

This consent is valid for days from the date signed. (Please initial.)
Signature: Date Signed:
Relationship (if not the individual to whom the SSN was issued):
Contact information of individual signing authorization:

Address: 5105 MARSHALL CRK

City/State/ZIP: FLOWER MOUND, TEXAS 75028-1656

Phone Number: (469)569-2047


Form SSA-89 (02-2018) Page 2 of 2

Privacy Act Statement


Collection and Use of Personal Information

Sections 205(a) and 1106 of the Social Security Act, as amended, allow us to collect this information. Furnishing us this
information is voluntary. However, failing to provide all or part of the information may prevent us from releasing
information to a designated company or company's agent.

We will use the information to verify your name and Social Security number (SSN). In addition, we may share this
information in accordance with the Privacy Act and other Federal laws. For example, where authorized, we may use and
disclose this information in computer matching programs, in which our records are compared with other records to
establish or verify a person's eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts
under these programs.

A list of routine uses is available in our Privacy Act System of Records Notice (SORN) 60-0058, entitled Master Files of SSN
Holders and SSN Applications. A ddit ional information and a full listing of all our SORNs are available on our website at
www.socialsecurity.gov/foia/bluebook.

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as
amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we
display a valid Office of Management and Budget control number. We estimate that it will take about 3 minutes to
complete the form. You may send comments on our time estimate above to: SSA, 6401 Security Blvd., Baltimore, MD
21235-6401. Send to this address only comments relating to our time estimate, not the completed form.

TEAR OFF

NOTICE TO NUMBER HOLDER


The Company and/or its Agent have entered into an agreement with SSA that, among other things, includes restrictions
on the further use and disclosure of SSA's verification of your SSN. To view a copy of the entire model agreement, visit
http://www.ssa.gov/cbsv/docs/SampleUserAgreement.pdf.
Form SSA-89 (02-2018)
Discontinue Previous Editions Page 1 of 2
Social Security Administration OMB No. 0960-0760

Authorization for the Social Security Administration (SSA)


To Release Social Security Number (SSN) Verification
Printed Name: Date of Birth: Social Security Number:

MARLENE M TRAILLE FEBRUARY 12, 1949 092-62-8536


I want this information released because I am conducting the following business transaction:
Mortgage Application

Reason(s) for using CBSV: (Please select all that apply)


X Mortgage Service Banking Service
Background Check License Requirement
X Credit Check Other
with the following company ("the Company"):

Company Name:

Company Address:
I authorize the Social Security Administration to verify my name and SSN to the Company and/or the Company's Agent,
if applicable, for the purpose I identified.

The name and address of the Company's Agent is:


TALX Corporation
11432 Lackland Road, St. Louis, MO 63146

I am the individual to whom the Social Security number was issued or the parent or legal guardian of a minor, or the legal
guardian of a legally incompetent adult. I declare and affirm under the penalty of perjury that the information contained
herein is true and correct. I acknowledge that if I make any representation that I know is false to obtain information from
Social Security records, I could be found guilty of a misdemeanor and fined up to $5,000.

This consent is valid only for 90 days from the date signed, unless indicated otherwise by the individual named above.
If you wish to change this timeframe, fill in the following:

This consent is valid for days from the date signed. (Please initial.)
Signature: Date Signed:
Relationship (if not the individual to whom the SSN was issued):
Contact information of individual signing authorization:

Address: 5105 MARSHALL CRK

City/State/ZIP: FLOWER MOUND, TEXAS 75028-1656

Phone Number: (972)436-3786


Form SSA-89 (02-2018) Page 2 of 2

Privacy Act Statement


Collection and Use of Personal Information

Sections 205(a) and 1106 of the Social Security Act, as amended, allow us to collect this information. Furnishing us this
information is voluntary. However, failing to provide all or part of the information may prevent us from releasing
information to a designated company or company's agent.

We will use the information to verify your name and Social Security number (SSN). In addition, we may share this
information in accordance with the Privacy Act and other Federal laws. For example, where authorized, we may use and
disclose this information in computer matching programs, in which our records are compared with other records to
establish or verify a person's eligibility for Federal benefit programs and for repayment of incorrect or delinquent debts
under these programs.

A list of routine uses is available in our Privacy Act System of Records Notice (SORN) 60-0058, entitled Master Files of SSN
Holders and SSN Applications. A ddit ional information and a full listing of all our SORNs are available on our website at
www.socialsecurity.gov/foia/bluebook.

Paperwork Reduction Act Statement - This information collection meets the requirements of 44 U.S.C. § 3507, as
amended by section 2 of the Paperwork Reduction Act of 1995. You do not need to answer these questions unless we
display a valid Office of Management and Budget control number. We estimate that it will take about 3 minutes to
complete the form. You may send comments on our time estimate above to: SSA, 6401 Security Blvd., Baltimore, MD
21235-6401. Send to this address only comments relating to our time estimate, not the completed form.

TEAR OFF

NOTICE TO NUMBER HOLDER


The Company and/or its Agent have entered into an agreement with SSA that, among other things, includes restrictions
on the further use and disclosure of SSA's verification of your SSN. To view a copy of the entire model agreement, visit
http://www.ssa.gov/cbsv/docs/SampleUserAgreement.pdf.
TAX RECORD INFORMATION SHEET
THIS FORM MUST BE COMPLETED AND SIGNED BY TITLE OFFICER,
ESCROW OFFICER AND/OR CLOSING ATTORNEY.
THIS SHEET MUST BE COMPLETELY FILLED OUT OR IT WILL BE RETURNED FOR COMPLETION.

INSTRUCTIONS FOR COMPLETION OF TAX RECORDS:


1. Tax legal description must be exactly as shown on tax records.
2. Show taxing authority only where we are escrowing for payment x even if we are not escrowing for payment.
3. Tax bills & information are obtained from this sheet. Therefore, it must be completed in full. Include any Assessments, Municipal Utility
District Charges, Ground Rents, etc. that are escrowed for payment. Indicate estimated taxes if applicable. Attach copies of paid tax certificates
and tax receipts.

The following information is certified by:_____________________________________________________________________________________


MORTGAGE CONNECT OF TEXAS, LLC
DATE LOAN CLOSED:_______________________________ TITLE/ESCROW/CLOSING ATTORNEY

REFINANCE [ X ] YES [ ] NO
LOAN # 505339244
BORROWER(S) NAME: BARRINGTON L TRAILLE, MARLENE M TRAILLE

TAXES FOR CURRENT YEAR LISTED IN NAME OF:_____________________________________________________________________________________


____________________________________________________________________________________________________________________________________
PROPERTY ADDRESS: 5105 MARSHALL CRK, FLOWER MOUND, TEXAS 75028-1656

CURRENT TAX ASSESSMENT BASED ON:


[ ] ACREAGE [ ] VACANT [ ] PARTIAL CONSTRUCTION [ ] COMPLETE CONSTRUCTION
LEGAL DESCRIPTION:
SECTION_____________ BLOCK ______________________ LOT(S) ___________________________ TRACT _________________________
MAP _______________________ UNIT # ________________________ TWNSHP _________________ RANGE _________________________
SUBDIVISION __________________________________________________________________________________________________________
METES & BOUNDS [ ] YES [X ] NO

TYPE OF TAX ____________________________________________ LAST AMOUNT PAID _______________________________________


CURRENT TAXES PAID THRU DATE ________________________ NEXT DUE DATE ___________________________________________
NEXT AMOUNT DUE ______________________________________ THIS AMOUNT IS [ ] ESTIMATE [ ] ACTUAL
PAYMENT FREQUENCY:
[ ] ANNUAL [ ] SEMI-ANNUAL [ ] QUARTERLY [ ] TRI-ANNUAL [ ] OTHER:
_____________________________
TAXING AUTHORITY NAME & ADDRESS: PARCEL/PROPERTY ID/TMS#
__________________________________________________________ ___________________________________________________________
__________________________________________________________ PARCEL/PROPERTY ID/TMS#
____________________________________________ ______________ ___________________________________________________________

TYPE OF TAX ____________________________________________ LAST AMOUNT PAID ____________________ ____________________


CURRENT TAXES PAID THRU DATE ________________________ NEXT DUE DATE ___________________________________________
NEXT AMOUNT DUE ____________________________________ __ THIS AMOUNT IS [ ] ESTIMATE [ ] ACTUAL
PAYMENT FREQUENCY:
[ ] ANNUAL [ ] SEMI-ANNUAL [ ] QUARTERLY [ ] TRI-ANNUAL [ ] OTHER: _____________________________
TAXING AUTHORITY NAME & ADDRESS: PARCEL/PROPERTY ID/TMS#
____________________________________________ ______________ ___________________________________________________________
_____________________________ _____________________________ PARCEL/PROPERTY ID/TMS#
__________________________________________________________ ___________________________________________________________

TAX RECORD INFORMATION SHEET


GATAX.LSR 12/03/20 Page 1 of 2
Loan Number: 505339244

MORTGAGE FRAUD IS
INVESTIGATED BY THE FBI

Mortgage Fraud is investigated by the Federal Bureau of Investigation and is punishable


by up to 30 years in federal prison or $1,000,000 fine, or both. It is illegal for a person
to make any false statement regarding income, assets, debt, or matters of identification,
or to willfully overvalue any land or property, in a loan and credit application for the
purpose of influencing in any way the action of a financial institution.
Some of the applicable Federal criminal statutes which may be charged in connection with Mortgage
Fraud include:

18 U.S.C. § 1001 - Statements or entries generally


18 U.S.C. § 1010 - HUD and Federal Housing Administration Transactions
18 U.S.C. § 1014 - Loan and credit applications generally
18 U.S.C. § 1028 - Fraud and related activity in connection with identification documents
18 U.S.C. § 1341 - Fraud and swindles by Mail
18 U.S.C. § 1342 - Fictitious name or address
18 U.S.C. § 1343 - Fraud by wire
18 U.S.C. § 1344 - Bank Fraud
42 U.S.C. § 408(a) - False Social Security Number

Unauthorized use of the FBI seal, name, and initials is subject to prosecution under Sections 701, and 709, and 712 of Title 18
of the United States Code. This advisement may not be changed or alerted without the specific written consent of the Federal
Bureau of Investigation, and is not an endorsement of any product or service.

FRAUDNS.MSC
11/23/11

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