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Dec �0,06 08;43a Deneen 952-472-7450 p,2 <br /> Borrower Signature Authorization <br /> PAvacy Act Notlee:This iriortnation is 6o be ined by the apenoy collecUnp it or its ass�pneea in determintnp whelhar you quaiy es a piwpecdve maqapa under <br /> its propram. It wip n�be dsdosed oeRside the ap�cY esocept aa requmed and parmitled by Isw.You do tat hove b p�ovide fhla i�tion�but if you do not your <br /> applieation 1br ePP�I as a p�ve moA6aDor or bonowe� mey ba deleysd a rejecbd. The intortnabon nqueaDad irt tHm form ia auU�orlxed b!i TiNe 88, USC, <br /> Ct�r 37 (i(VA); by 12 USC, n 1701 et xq• (ff HUDIFHAy, by 42 USC, SeeUon 1452b(d HUDICPD);and Title 42 USC, 1477 et eaq-, or 7 USC, 1921 et <br /> eaq.('rf U9DNFmHA). <br /> Part I-General Information <br /> � ���5� 2. Name and address of LendedBroker <br /> CHARLES COG&LL Minn Star Mortgage <br /> JENNIFER A COGBILt 1098 Loma Linds Ave <br /> 1590 LONG LAKE BLV Orono,MN 56364 <br /> Long Lake, A1N 55356 TEL: 952�72-7445 FAX: 95Z�72-0370 <br /> �p�; 4.L�n Number <br /> �y�q f�006 (�O(3BILL <br /> Part ll -BorrowsrAutho�ization <br /> l hereby authorize the Lender/Broker to verify my past and present ernployment earnings record.s, bank acxounts. stock <br /> holdings, and any other asset balances that are needed to process my morlgage loan application. I further auihorize <br /> the LenderBroker to order a aonsumer credit repart and verify �ther credit inforir�ation, including past and preseM <br /> mo�tgage and landlord references. It is understood that a copy of this form wili also secve as authorizafion. <br /> The information the L.enderBraker obtains is only to be used in the processing of my application for a mongage loan. <br /> � � c <br /> .��7-��� <br /> gprrpwer CHARLEg COGBILL/SS N:600-16-068 Dete <br /> ��+�—� <br /> Bocrower .IFN A SiLt/SSN:607-2�s20 Oate <br /> CALYX form Bsa.hp 10l98 <br />