Preview
FILED: ERIE COUNTY CLERK 04/03/2024 03:10 PM INDEX NO. 800094/2024
NYSCEF DOC. NO. 16 RECEIVED NYSCEF: 04/03/2024
" "
EXHIBI
FILED: INDEX
INDEX NO. NO. 800094/2024
800094/2024
FILED : ERIE
ERIE COUNTY
COUNTY CLERK
CLERK 04/03/2024
01/ 03:10
02 / 202 4 05 : O 6 PM
PM)
NYSCEF
NYSCEF DOC.
DOC. NO.
NO. 16
1 NYSCEF:
RECEIVED
RECEIVED 01/02/2024
NYSCEF: 04/03/2024
CONSUMER CREDIT TRANSACTION
SUPREME COURT
COUNTY OF ERIE STATE OF NEW YORK
FIVE STAR BANK
100 Chestnut Street
Rochester, NY 14604
Plaintiff '
SUMMONS
vs.
SHAWN P. THOMAS
Case No.:
404 Ellicott Creek Road
Tonawanda, NY 14150,
Defendant.
To The Above Named Defendant:
YOU ARE HEREBY SUMMONED to answer the Complaint in this action and to serve a copy of
your Answer on Plaintiff's attorney within twenty (20) days after the service of this Summons, exclusive
of the day of service, or within thirty (30) days after service is completed if this Summons is not
personally delivered to you within the State of New York. In case of your failure to appear or answer,
judgment will be taken against you by default for the relief demanded in the Complaint.
Plaintiff designates Erie County as the place of trial. The basis of venue is the place of
transaction. Defendant resides in the County of Erie, New York. The consumer credit transaction took
place in Erie County, New York. Plaintiff maintains a place of business at 100 Chestnut Street, Rochester,
NY 14604.
Dated: December 21, 2023
Rochester, New York
DS ŒVIA T G L AN LLP
Ate neysforPlaintiff
Office and Post Office Address:
1900 Bausch & Lomb Place
Rochester, NY 14604
Tel: 585.987.2800
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800094/2024
FILED : ERIE
ERIE COUNTY
COUNTY CLERK
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01/ 02 / 202 4 03:10
05 : O 6 PM
PMl
NYSCEF
NYSCEF DOC.
DOC. NO.
NO. 16
1 RECEIVED NYSCEF:
RECEIVED 01/02/2024
NYSCEF: 04/03/2024
IMPORTANT NOTICE
Previously, you were served with a validation notice pursuant to the Fair Debt Collection Practices
Act. That notice concerns your dealings with us as a debt collector. It does not affect your dealings with
the Court, and in particular, it does not change the time in which you must answer this complaint. This
legal pleading is a command from the Court, and you must follow its instructions and respond within the
time period set forth in the summons, even if you dispilte the validity or amount of the debt as set forth in
the validation notice. The validation notice also does not affect our relations with the Court. As a law
firm, we may file papers in this suit according to the Court's rules and the Judge's instructions.
We are a debt collector, and this is an attempt to collect a debt. Any information we obtain will be
used for that purpose.
If tf ou have any questions regarding this matter please contact LORIPFEIL AT 1- 888-757-7553 OR 1-585-
987-2800 ext. 2856.
(9406369:}
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FILED : ERIE
ERIE COUNTY
COUNTY CLERK
CLERK 04/03/2024
01/ 02 / 202 4 0503:10
: O 6 PM
PM)
NYSCEF
NYSCEF DOC.
DOC. NO.
NO. 16
1 RECEIVED NYSCEF:
RECEIVED 01/02/2024
NYSCEF: 04/03/2024
SUPREME COURT
COUNTY OF ERIE STATE OF NEW YORK
FIVE STAR BANK,
VERIFIED
Plaintiff, COMPLAINT
VS.
SHAWN P. THOMAS, Case No.:
Defendant.
Plaintiff, Five Star Bank, by its attorneys Woods Oviatt Gilman LLP, for its Verified
Complaint against defendant, alleges that:
THE PARTES:
1. Plaintiff is a New York bank authorized to do business in the State of New York,
with an office located in the County of Monroe at 100 Chestnut Street, Rochester, NY 14604.
2. Upon information and belief, defendant SHAWN P. THOMAS (hereinafter
"Defendant") is an individual and resides in the County of Erie, and State of New York.
THE LOAN AGREEMENT:
3. On August 13, 2022, Defendant signed and entered into an installment Auto Loan
Agreement ("Agreement") a true copy of which is attached hereto as Exhibit A.
4. Pursuant to the terms of the Agreement Defendant agreed to pay Plaintiff the total
amount of $47,177.76 in 84 equal monthly installments of $561.64, which includes interest (as
calculated at the contractual rate of 16.74% per annum on the principal sum).
5. The last four digits of the Defendant's account number with Plaintiff is
******7176.
(9406369: }
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NO. 800094/2024
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COUNTY CLERK 01/
CLERK 04/03/2024
O2 / 202 4 0503:10
: O 6 PMPM
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NYSCEF DOC.
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NO. 16 RECEIVED NYSCEF: 04/03/2024
6. Pursuant to the terms of the Agreement, the Defendant agreed to repay the sums
advanced and due under the Agreement directly to Plaintiff and Plaintiff is the original creditor
identified in the Agreement.
7. By its terms, upon the execution of the Agreement, the Agreement was
immediately assigned from the Seller identified in the Agreement to Plaintiff.
8. Plaintiff is the owner and holder of the Agreement.
THE DEFAULT:
9. Defendant breached the Agreement by failing to make the required payments in
accordance with the terms of the Agreement, which is an event of default under the terms of the
Agreement (the "Default").
10. The last payment on the Agreement was made on April 24, 2023 in the amount of
$570.00.
..
11. Due to the Default, Plaintiff accelerated the unpaid balance due under the
Agreement.
12. Despite due demand, the Defendant has failed to pay the balance remaining
unpaid on the Agreement.
THE AMOUNT DUE:
13. After application of any applicable credits, the principal sum of $1,047.14,
accrued interest of $1,l 61.48, late charges of $247.95, account charges of $150.00, plus per diem
interest of $0.48 from November 21, 2023, the unpaid balance on the Agreement, remains due to
Plaintiff (the "Indebtedness"),
{9406369:)
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FILED : ERIE
ERIE COUNTY
COUNTY CLERK
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01/ 02 / 202 4 0503:10
: 0 6 PM
PM)
NYSCEF
NYSCEF DOC.
DOC. NO.
NO. 16
1 RECEIVED NYSCEF:
RECEIVED 01/02/2024
NYSCEF: 04/03/2024
AS AND FOR A FIRST CAUSE OF ACTION
14. Plaintiff repeats and realleges each and every allegation contained in the preceding
paragraphs as though fully set forth herein.
15. Pursuant to the terms of the Agreement, in the event of default, Defendant agreed
to pay Plaintiff all sums due and owing under the Agreement.
16. Defendant remains in default under the terms of the Agreement and has failed to
pay Plaintiff all sums due and owing under the Agreement.
17, Due to the Defendant's breach of the Agreement, Plaintiff has been damaged in
the amount of the Indebtedness.
I8. Defendant owes Plaintiff the Indebtedness, as set forth hereinabove and Plaintiff
is entitled to a judgment against the Defendant for such sum.
AS AND FOR A SECOND CAUSE OF ACTION
19, Plaintiff repeats and realleges each and every allegation contained in the preceding
paragraphs as though fully set forth herein.
20. Pursuant to the terms of the Agreement, in the event of default, Defendant agreed
to pay Plaintiff's costs and attorney fees for collection of the amounts due under the Agreement.
21. Defendant owes Plaintiff costs and attorney's fees in an amount to be determined by
the Court.
WHEREFORE, Plaintiff respectfully demands judgment against the Defendant as follows:
A. On the first cause of action, the principal sum of $1,047.14, accrued interest of
$1,161.48, late charges of $247.95 and account charges of $150.00 plus per diem interest of
$0.48 from November 21, 2023 until the entry of judgment;
(9406369:}
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FILED : ERIE
ERIE COUNTY
COUNTY CLERK
CLERK 04/03/2024
02 / 202 4 03:10
05 : O 6 PM INDEX
INDEX NO. NO. 800094/2024
800094/2024
01/ PM)
NYSCEF DOC.
NYSCEF DOC. NO.
NO. 16
1 RECEIVED NYSCEF:
RECEIVED 01/02/2024
NYSCEF: 04/03/2024
B. On the second cause of action, for costs and attorney's fees as determined by the
Court;
C. Granting such other and further relief as the Court de s just and proper.
December 2023 By:
Dated: 21,
New York John fyf Andre , Esq.
Rochester,
WOO VIATT GILMAN LLP
Atto for Plaintif
O and Post Office Address:
1900 Bausch & Lomb Place
Rochester, NY 14604
Tel: 585.987.2800
{9406369:}
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INDEX NO. 8 O0094/2
NO. O2 4
800094/2024
FILED:
IFILED : ERIE
ERIE COUNTY
COUNTY CLERK
CLERK 04/03/2024
01/ 02 / 202 4 0503:10
: O 6 PM
PM)
NYSCEF
NYSCEF DOC.
DOC. NO.
NO. 16
1 RECEIVED NYSCEF:
RECEIVED 01/02/2
NYSCEF: O2 4
04/03/2024
VERIFICATION
STATE OF NEW YORK )
COUNTY OF MONROE ) SS:
Douglas A. Roach, being duly sworn, deposes and says that he is an Assistant Vice
President for Five Star Bank, the financial institution in the within entitled action; that he has
read the foregoing complaint and knows the contents thereof; that the same is true to his own
knowledge, except as to the matters therein stated to be alleged upon information and belief, and
as to those matters he believes them to be true.
\ *
Douglas A. Roach
Sworn to before me on this
day of 2023.
ota Public
LORILEE J. PPEll
Notary Public, State of New York
Qualified in Monroe County
Reg. No, 01PF4972161
Comrnfssion Expires September 17, 2024
(9406369: }
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FILED: ERIE
ERIE COUNTY
COUNTY CLERK
CLERK 04/03/2024
01/02/2024 03:10 PM)
05:06 PM INDEX
INDEX NO.NO. 800094/2024
800094/2024
NYSCEF DOC.
NYSCEF DOC. NO.
NO. 162 RECEIVED
RECEIVEDNYSCEF:
NYSCEF: 04/03/2024
01/02/2024
EXHIBIT A
. [yg q, INDEXNO.NO. 800094/2024
FILED: ERIE COUNTY CLERK 04/03/2024 03:10 PM INDEX 800094/2024
N SCEFDOC.
NYSCEF DOC. NO.
NO. 162 RECEIVEDNYSCEF:
RECEIVED NYSCEF: 04/03/2024
01/02/2024
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Preview
FILED: ERIE COUNTY CLERK 04/03/2024 03:10 PM INDEX NO. 800094/2024 NYSCEF DOC. NO. 16 RECEIVED NYSCEF: 04/03/2024 " " EXHIBI FILED: INDEX INDEX NO. NO. 800094/2024 800094/2024 FILED : ERIE ERIE COUNTY COUNTY CLERK CLERK 04/03/2024 01/ 03:10 02 / 202 4 05 : O 6 PM PM) NYSCEF NYSCEF DOC. DOC. NO. NO. 16 1 NYSCEF: RECEIVED RECEIVED 01/02/2024 NYSCEF: 04/03/2024 CONSUMER CREDIT TRANSACTION SUPREME COURT COUNTY OF ERIE STATE OF NEW YORK FIVE STAR BANK 100 Chestnut Street Rochester, NY 14604 Plaintiff ' SUMMONS vs. SHAWN P. THOMAS Case No.: 404 Ellicott Creek Road Tonawanda, NY 14150, Defendant. To The Above Named Defendant: YOU ARE HEREBY SUMMONED to answer the Complaint in this action and to serve a copy of your Answer on Plaintiff's attorney within twenty (20) days after the service of this Summons, exclusive of the day of service, or within thirty (30) days after service is completed if this Summons is not personally delivered to you within the State of New York. In case of your failure to appear or answer, judgment will be taken against you by default for the relief demanded in the Complaint. Plaintiff designates Erie County as the place of trial. The basis of venue is the place of transaction. Defendant resides in the County of Erie, New York. The consumer credit transaction took place in Erie County, New York. Plaintiff maintains a place of business at 100 Chestnut Street, Rochester, NY 14604. Dated: December 21, 2023 Rochester, New York DS ŒVIA T G L AN LLP Ate neysforPlaintiff Office and Post Office Address: 1900 Bausch & Lomb Place Rochester, NY 14604 Tel: 585.987.2800 (9406369:} 1 of 7 FILED: INDEX INDEX NO. NO. 800094/2024 800094/2024 FILED : ERIE ERIE COUNTY COUNTY CLERK CLERK 04/03/2024 01/ 02 / 202 4 03:10 05 : O 6 PM PMl NYSCEF NYSCEF DOC. DOC. NO. NO. 16 1 RECEIVED NYSCEF: RECEIVED 01/02/2024 NYSCEF: 04/03/2024 IMPORTANT NOTICE Previously, you were served with a validation notice pursuant to the Fair Debt Collection Practices Act. That notice concerns your dealings with us as a debt collector. It does not affect your dealings with the Court, and in particular, it does not change the time in which you must answer this complaint. This legal pleading is a command from the Court, and you must follow its instructions and respond within the time period set forth in the summons, even if you dispilte the validity or amount of the debt as set forth in the validation notice. The validation notice also does not affect our relations with the Court. As a law firm, we may file papers in this suit according to the Court's rules and the Judge's instructions. We are a debt collector, and this is an attempt to collect a debt. Any information we obtain will be used for that purpose. If tf ou have any questions regarding this matter please contact LORIPFEIL AT 1- 888-757-7553 OR 1-585- 987-2800 ext. 2856. (9406369:} 2 of 7 FILED: INDEX INDEX NO. NO. 800094/2024 800094/202 4 FILED : ERIE ERIE COUNTY COUNTY CLERK CLERK 04/03/2024 01/ 02 / 202 4 0503:10 : O 6 PM PM) NYSCEF NYSCEF DOC. DOC. NO. NO. 16 1 RECEIVED NYSCEF: RECEIVED 01/02/2024 NYSCEF: 04/03/2024 SUPREME COURT COUNTY OF ERIE STATE OF NEW YORK FIVE STAR BANK, VERIFIED Plaintiff, COMPLAINT VS. SHAWN P. THOMAS, Case No.: Defendant. Plaintiff, Five Star Bank, by its attorneys Woods Oviatt Gilman LLP, for its Verified Complaint against defendant, alleges that: THE PARTES: 1. Plaintiff is a New York bank authorized to do business in the State of New York, with an office located in the County of Monroe at 100 Chestnut Street, Rochester, NY 14604. 2. Upon information and belief, defendant SHAWN P. THOMAS (hereinafter "Defendant") is an individual and resides in the County of Erie, and State of New York. THE LOAN AGREEMENT: 3. On August 13, 2022, Defendant signed and entered into an installment Auto Loan Agreement ("Agreement") a true copy of which is attached hereto as Exhibit A. 4. Pursuant to the terms of the Agreement Defendant agreed to pay Plaintiff the total amount of $47,177.76 in 84 equal monthly installments of $561.64, which includes interest (as calculated at the contractual rate of 16.74% per annum on the principal sum). 5. The last four digits of the Defendant's account number with Plaintiff is ******7176. (9406369: } 3 of 7 INDEX NO. INDEX 800094/2024 NO. 800094/2024 FILED: (FILED: ERIE ERIE COUNTY COUNTY CLERK 01/ CLERK 04/03/2024 O2 / 202 4 0503:10 : O 6 PMPM NYSCEF 1 . RECE1VED NYSCEF: 01/02/2024 NYSCEF DOC. DOC. NO. NO. 16 RECEIVED NYSCEF: 04/03/2024 6. Pursuant to the terms of the Agreement, the Defendant agreed to repay the sums advanced and due under the Agreement directly to Plaintiff and Plaintiff is the original creditor identified in the Agreement. 7. By its terms, upon the execution of the Agreement, the Agreement was immediately assigned from the Seller identified in the Agreement to Plaintiff. 8. Plaintiff is the owner and holder of the Agreement. THE DEFAULT: 9. Defendant breached the Agreement by failing to make the required payments in accordance with the terms of the Agreement, which is an event of default under the terms of the Agreement (the "Default"). 10. The last payment on the Agreement was made on April 24, 2023 in the amount of $570.00. .. 11. Due to the Default, Plaintiff accelerated the unpaid balance due under the Agreement. 12. Despite due demand, the Defendant has failed to pay the balance remaining unpaid on the Agreement. THE AMOUNT DUE: 13. After application of any applicable credits, the principal sum of $1,047.14, accrued interest of $1,l 61.48, late charges of $247.95, account charges of $150.00, plus per diem interest of $0.48 from November 21, 2023, the unpaid balance on the Agreement, remains due to Plaintiff (the "Indebtedness"), {9406369:) 4 of 7 FILED: INDEX INDEX NO. NO. 800094/2024 800094/2024 FILED : ERIE ERIE COUNTY COUNTY CLERK CLERK 04/03/2024 01/ 02 / 202 4 0503:10 : 0 6 PM PM) NYSCEF NYSCEF DOC. DOC. NO. NO. 16 1 RECEIVED NYSCEF: RECEIVED 01/02/2024 NYSCEF: 04/03/2024 AS AND FOR A FIRST CAUSE OF ACTION 14. Plaintiff repeats and realleges each and every allegation contained in the preceding paragraphs as though fully set forth herein. 15. Pursuant to the terms of the Agreement, in the event of default, Defendant agreed to pay Plaintiff all sums due and owing under the Agreement. 16. Defendant remains in default under the terms of the Agreement and has failed to pay Plaintiff all sums due and owing under the Agreement. 17, Due to the Defendant's breach of the Agreement, Plaintiff has been damaged in the amount of the Indebtedness. I8. Defendant owes Plaintiff the Indebtedness, as set forth hereinabove and Plaintiff is entitled to a judgment against the Defendant for such sum. AS AND FOR A SECOND CAUSE OF ACTION 19, Plaintiff repeats and realleges each and every allegation contained in the preceding paragraphs as though fully set forth herein. 20. Pursuant to the terms of the Agreement, in the event of default, Defendant agreed to pay Plaintiff's costs and attorney fees for collection of the amounts due under the Agreement. 21. Defendant owes Plaintiff costs and attorney's fees in an amount to be determined by the Court. WHEREFORE, Plaintiff respectfully demands judgment against the Defendant as follows: A. On the first cause of action, the principal sum of $1,047.14, accrued interest of $1,161.48, late charges of $247.95 and account charges of $150.00 plus per diem interest of $0.48 from November 21, 2023 until the entry of judgment; (9406369:} 5 of 7 FILED: FILED : ERIE ERIE COUNTY COUNTY CLERK CLERK 04/03/2024 02 / 202 4 03:10 05 : O 6 PM INDEX INDEX NO. NO. 800094/2024 800094/2024 01/ PM) NYSCEF DOC. NYSCEF DOC. NO. NO. 16 1 RECEIVED NYSCEF: RECEIVED 01/02/2024 NYSCEF: 04/03/2024 B. On the second cause of action, for costs and attorney's fees as determined by the Court; C. Granting such other and further relief as the Court de s just and proper. December 2023 By: Dated: 21, New York John fyf Andre , Esq. Rochester, WOO VIATT GILMAN LLP Atto for Plaintif O and Post Office Address: 1900 Bausch & Lomb Place Rochester, NY 14604 Tel: 585.987.2800 {9406369:} 6 of 7 INDEX INDEX NO. 8 O0094/2 NO. O2 4 800094/2024 FILED: IFILED : ERIE ERIE COUNTY COUNTY CLERK CLERK 04/03/2024 01/ 02 / 202 4 0503:10 : O 6 PM PM) NYSCEF NYSCEF DOC. DOC. NO. NO. 16 1 RECEIVED NYSCEF: RECEIVED 01/02/2 NYSCEF: O2 4 04/03/2024 VERIFICATION STATE OF NEW YORK ) COUNTY OF MONROE ) SS: Douglas A. Roach, being duly sworn, deposes and says that he is an Assistant Vice President for Five Star Bank, the financial institution in the within entitled action; that he has read the foregoing complaint and knows the contents thereof; that the same is true to his own knowledge, except as to the matters therein stated to be alleged upon information and belief, and as to those matters he believes them to be true. \ * Douglas A. Roach Sworn to before me on this day of 2023. ota Public LORILEE J. PPEll Notary Public, State of New York Qualified in Monroe County Reg. No, 01PF4972161 Comrnfssion Expires September 17, 2024 (9406369: } 7 of 7 FILED: FILED: ERIE ERIE COUNTY COUNTY CLERK CLERK 04/03/2024 01/02/2024 03:10 PM) 05:06 PM INDEX INDEX NO.NO. 800094/2024 800094/2024 NYSCEF DOC. NYSCEF DOC. NO. NO. 162 RECEIVED RECEIVEDNYSCEF: NYSCEF: 04/03/2024 01/02/2024 EXHIBIT A . [yg q, INDEXNO.NO. 800094/2024 FILED: ERIE COUNTY CLERK 04/03/2024 03:10 PM INDEX 800094/2024 N SCEFDOC. NYSCEF DOC. NO. NO. 162 RECEIVEDNYSCEF: RECEIVED NYSCEF: 04/03/2024 01/02/2024 RETAIL MSTAWENTCONTRACT wonsW and .yn meanule a e mt mean anyone 41 thscontract asaDwer.Tre Setera after thesale tranferstsnchts1ander lhisContracl.anyone duerights. having ANHBAL H1Alb E Amount Tinanced htalof Payments PERCENTAE RATE ( I Altr. 1%me"alor nedit grwided TotalSale Price , Thecostatmycedil rme to The amunt IwdlEmnpardalrwr The irdaicost ofmypurchas cri asa ) :doN.r imesM the oronmyheftall. Ihave ma(e 4IIscheduled credit, pany me. enfitw icosime, '8Y"*ªt5· inducingmydowspayniew 16. 74 U 680,55 of5 100D,00 -- - 5 27497,21 * 47177.76 s fi8177,76 MrPaymeniSchedulewillbr etaeam esumatt No.ofPayments AmourdofPaymer s Wlie aPaynientsArc Due Sardyd a nigivmgdsecunty inIhe mlerest n 1olor voicrocasspuichasud, 54 I 5 >O'l.04 Iden nig rm,_ N/A lity,hqinalng 2( SEP 2T tate Chargei dopymenhs $ N/A fdemorotonlottiys.lwiiltaieript IDMafNpayment. p,symi:8ipysuessa w lopay Iwiltrial apenals NyCoritract documenis wtUhaveaddithdInf'rmationabout nonpaympt,defaull, antrequired repayrnEng laftillhtfore thescheduleddale and prepaymeot refundshild peiialties. Inthis ComtrMI, youm WESTHERRCHEiVXI T 0F WTLLI AMSVI LLE HusCoidrohem Mud B½er. Alldehans lhaSok 8040 TRANSITR3D WILLI AMSVIRE, NY 14221 We are Ifthere ismorethan each ofussilbeoldigated. SHA eneBuys, andlogethy, themyegsy WNP THOHA5354 SCHENCK ST APT1 NORTH TONAWANDA reparately laran6ornsdueyousqdthe Num(a) Addren NY1 portermance ofapagreements asoveDteawks contract Description elvehiclei (seeinsurance Renutra·ents lip CWe action) °ª 'dª8 5 Auti 22 Itemation ofAmnuniFIIaneti Equippef _ A.I _.RS, -AMJNFlo 0the with - A.C.- PB. -PR 27894.28 .. . Cash ihavatraded la Dowapsymsgit vehlefa· thefalleMng -¬$ Year andMAe Dacriptiori -- . Trade-fn ... Valea o(Trade-to hisorsice: Property Iam regriire I d intnce on INe VuMelgendorsed t AGEt|T OR BRONER 0FMYGHal as st ·u DUT1MAY CH00SE Tlit ’ N/A IITLENGLDERoFC0l.LATERAL: . tron P asoft to IMrdAGE' HGISTimith +1 N/A PHYSICAL CanipicheBSlV8 5 . ,deductible. Colsl0n5 * le. 1NSURANCECOMPANY: . linpaidCash PJict Balma PolkyNulahtL Illective I -s AGENT: Nue: _ _ Address: 26994, 28 )guaraathal therequIrad TelephoneNumber: Tocredil Insurme insurance covert usaiownin theImurance Requirenun(s seclIon was gDialAnd fromJhespalunmed above. company Ualillityhisurance coveriggelorherlyInulyandproperty damage isnotIncluded 2 orprovided forblth|sCoatniot, nyInsuiince co ovelveduitoughyw,the ceslot suchlawance -s. 125.00 82,93 Pmmiss toPay: Iprainisetopay10you (ti- "Assi lhaTolul ;sice"} $ste PHeeintthe Vehicle Trada.lmif showa thove,etiatb efote theide o by nkmtheCash Dowopayment,assigningtheToGAPIowamCo. "IntDr9sl" in||il5contrBCt)at thh CorAra6, and oa paying1tie A·noutimanced plusIbncredit service cmarge(eanelS_..+5. theAlmUBIP· arita ·sRainshown ahwe,fpromsetoinal:6papients opotbeforeIkepayman1due above. datesslurmiTo * F /E ;TARflANK,WARSAW, NY14569 (the a 4s N/A %ssipat*) h RFWEST AND tCllEDULE OrGROlJP Ill5UMNCE hnderstMd thatGroup Credil LifefrsmtnerindGtlupCre0ll Accideiitand Health 7 4 I lurther understand ht I may are Insurance votonleyand ageriotrequired Inabtarn thru sonn.Amust Imimi safect anothei.oson -tooreridelhisc oveas it 1choose10became l understarid insurse, t tInst rancewill be mdur maccordance with t he t erlificatiof (1ernrws 27497.21 ine.I01s0f.eserWtheflRht tolennL1ateiny cuaragoata i176012 you l owriting.The groupinsurarico thatwH)hethent o isshownbelow. ! tiy o0tifying costofi nsurbace for l hGentire tem!0f CL%naw if4300pl3E aDNt4wl Jefainig Hiewenowns. .__ 1WANToptmeal Grouo Credit Litain renc. __ WE WANT oplmal cred!| lairJuli surne. · asmmt|E r's oraseologg __ ..._.. _ . ,,. Creup $ N/A ___ InH-ico-anyers __ gWAN1 0[illerial Greep Credil ANidrandleallÞ Insurance. $