Preview
DOCKET NO.: HHB-CV-24-6084781-S SUPERIOR COURT
CORPORATE AMERICA JUDICIAL DISTRICT OF
FAMILY CREDIT UNION NEW BRITAIN
Vv. AT NEW BRITAIN
KATHLEEN E GOODFIELD,
BY AND THROUGH HER
POWER OF ATTORNEY,
LISA CHAMBERLAND, MAY 16, 2024
MOTION TO CITE IN PARTY DEFENDANT
Pursuant to C.P.B., § 9-18 and 9-22, Plaintiff moves the Court to cite KATHLEEN E
GOODFIELD, BY AND THROUGH HER POWER OF ATTORNEY, LISA
CHAMBERLAND as party Defendant. The Plaintiff's summons and complaint contained an
error and incorrectly listed Lisa Chamberland as Conservator instead of Power of Attorney.
WHEREFORE, the undersigned Plaintiff moves that the Court allow KATHLEEN E
GOODFIELD, BY AND THROUGH HER POWER OF ATTORNEY, LISA
CHAMBERLAND to be summoned to appear herein as a Defendant by way of the Amended
Summons and Complaint.
PLAINTIF: 0. RATE AMERICA FAMILY
CREDIT U. IN
By:
Melissa L. Simonik, Tts Attorney
The Law Office of Melissa L. Simonik, LLC
1001 Farmington Avenue, Suite 303
Bristol, CT 06010
Telephone: (860) 506-4409
ORDER
It appearing that the foregoing motion should be granted, it is hereby ordered, that on or
before , 2024, the Plaintiff summon KATHLEEN E GOODFIELD, BY AND
THROUGH HER POWER OF ATTORNEY, LISA CHAMBERLAND as a Defendant in this
action on or before the second day following , 2024, by causing some proper
officer to serve on it in the manner prescribed by law a true and attested copy of the order, a true and
attested or certified copy of the Amended Writ, Summons and Complaint in this action and a
Summon-Civil Form 103.1 and due return make.
BY THE COURT
Judge/ Assistant Clerk
Date:
CERTIFICATION
This is to certify that a copy of the foregoing has been sent to all counsel and pro se parties
of record, on May 16, 2024, to wit:
Kathleen E Goodfield
By and through her
Conservator of Person and Estate,
Lisa Chamberland
127 Butternut Lane
Bristol, CT 06010
Kathleen E Goodfield
By and through her
Power of Attorney,
Lisa Chamberland
127 Butternut Lane
Bristol, CT 06010
Melissa LYSimosik
Commissioner of the Superior Court
DOCKET NO.: HHB-CV-24-6084781-S SUPERIOR COURT
CORPORATE AMERICA JUDICIAL DISTRICT OF
FAMILY CREDIT UNION NEW BRITAIN
Vv. AT NEW BRITAIN
KATHLEEN E GOODFIELD,
BY AND THROUGH HER
POWER OF ATTORNEY,
LISA CHAMBERLAND. MAY 16, 2024
MEMORANDUM OF LAW IN SUPPORT OF
MOTION TO CITE IN PARTY DEFENDANT
The Plaintiff, CONNECTICUT BAIL BONDS GROUP, LLC, has moved to cite in
KATHLEEN E GOODFIELD, BY AND THROUGH HER POWER OF ATTORNEY,
LISA CHAMBERLAND as party defendant in the Plaintiff's action pursuant to Connecticut
Practice Book Section 10-69. KATHLEEN E GOODFIELD, BY AND THROUGH HER
POWER OF ATTORNEY, LISA CHAMBERLAND has an interest in the pending action.
PLAINTIF: = ORPORATE AMERICA FAMILY
CREDIT UNION
By:
Melissa. Simonik, Its Attorney
‘The Law Office of Melissa L. Simonik, LLC
1001 Farmington Avenue, Suite 303
Bristol, CT 06010
Telephone: (860) 506-4409
CERTIFICATION
This is to certify that a copy of the foregoing has been sent to all counsel and pro se patties
of record, on April 25, 2024, to wit:
Kathleen E Goodfield
By and through her
Conservator of Person and Estate,
Lisa Chamberland
127 Butternut Lane
Bristol, CT 06010
Kathleen E Goodfield
By and through her
Power of Attorney,
Lisa Chamberland
127 Butternut Lane
Bristol, CT 06010
Melissa L. Simonik
Commissioner of the Superior Court
men
SUMMONS - CIVIL For information on STATE OF CONNECTICUT
JD-CV-1 Rev. 2-22 ADA accommodations, SUPERIOR COURT |
C.G.S. §§ 51-346, 51-347, 51-349, 51-350, 52-45a, 52-48, 52-259;
P.B. §§ 3-1 through 3-21, 8-1, 10-13
contact a court clerk or www.jud.ct.gov o]
go to: www.jud.ct.gov/ADA.
Instructions are on page 2.
CJ Select if amount, legal interest, or property in demand, not including interest and costs, is LESS than $2,500.
[X] Select if amount, legal interest, or property in demand, not including interest and costs, is $2,500 or MORE.
CJ Select if claiming other relief in addition to, or in place of, money or damages.
TO: Any proper officer
By authority of the State of Connecticut, you are hereby commanded to make due and legal service of this summons and attached complaint.
‘Address of court clerk (Number, street, town and zip code) Telephone number of clerk Return Date (Must be a Tuesday)
20 Franklin Square, New Britain, CT 06051 (860 ) 515 -5180
Judicial District GA ‘At (City/Town) Case type code (See list on page 2)
1 Housing Session CJ Number: New Britain Major: C Minor: 40
For the plaintiff(s) enter the appearance of:
Name and address of atlorney, law firm or plaintiff f self-represented (Number, street, fown and zip code) Turis number (if alfomey or law firm)
The Law Office of Melissa L. Simonik, LLC, 1001 Farmington Avenue, Suite 303, Bristol, CT 06010 433411
Telephone number Signature of plaintiff (if self-represented)
(860 ) 506 - 4409
The attorney or law firm appearing for the plaintiff, or the plaintiff if E-mail address for delivery of papers under Section 10-13 of the
Connecticut Practice Book (if agree
self-represented, agrees to accept papers (service) electronically Ik] Yes [] No melissa@simoniklaw.com
in this case under Section 10-13 of the Connecticut Practice Book.
Parties Name (Last, First, Middle Initial) and address of each party (Number; street; P.O. Box; town; state; zip; country, if not USA)
First Name: Corporate America Family Credit Union P-01
plaintiff Address: 501 Middle Street, Bristol, CT 06010
Additional Name: P-02
plaintiff Address:
First Name: Kathleen E Goodfield, by and through her Power of Attorney, Lisa Chamberland
D-01
defendant Address: 127 Butternut Lane, Bristol, CT 06010
Additional Name: D-02
defendant Address:
Additional Name: D-03
defendant Address:
Additional Name: D-04
defendant Address:
Total number of plaintiffs: 1 Total number of defendants:1 (1 Form JD-CV-2 attached for additional parties
Notice to each defendant
4 You are being sued. This is a summons in a lawsuit. The complaint attached states the claims the plaintiff is making against you.
2. To receive further notices, you or your attorney must file an Appearance (form JD-CL-12) with the clerk at the address above. Generally,
it must be filed on or before the second day after the Return Date. The Return Date is not a hearing date. You do not have to come to
court on the Return Date unless you receive a separate notice telling you to appear.
If you or your attorney do not file an Appearance on time, a default judgment may be entered against you. You can get an Appearance
form at the court address above, or on-line at https://jud.ct.gov/webforms/.
If you believe that you have insu) iceth ay cover the claim being made against you in this lawsuit, you should immediately contact
your insurance representative ther acti you may take are described in the Connecticut Practice Book, which may be found in a
superior court law library or onjline at http: www.jud.ct.gov/pb.htm.
If you have questions about the summons and complaint, you should talk to an attorney.
The court staff is not allowed)to ive a ice on legal matters.
Date Signed (Sign and Ky l [x] Commissioner of Superior Court Name of person signing
05/16/2024 oO Clerk Melissa L. Simonik
If this summons is signed by Clerk: For Court Use Only
File Date
a. The signing has been done so that the plaintiff(s) will not be denied access to the courts.
b. It is the responsibility of the plaintiff(s) to ensure that service is made in the manner provided by law.
c. The court staff is not permitted to give any legal advice in connection with any lawsuit.
d The Clerk signing this summons at the request of the plaintiff(s) is not responsible in any way for any
errors or omissions in the summons, any allegations contained in the complaint, or the service of the
summons or complaint.
certify |have read and | Slaned (Sefr-represented plainti Date Docket Number
understand the above:
Page 1 of 2
Instructions
Type or print legibly. If you are a self-represented party, this summons must be signed by a clerk of the court.
If there is more than one defendant, make a copy of the summons for each additional defendant. Each defendant must receive a copy of
this summons. Each copy of the summons must show who signed the summons and when it was signed. If there are more than two
plaintiffs or more than four defendants, complete the Civil Summons Continuation of Parties (form JD-CV-2) and attach it to the original
and all copies of the summons.
Attach the summons to the complaint, and attach a copy of the summons to each copy of the complaint. Include a copy of the Civil
Summons Continuation of Parties form, if applicable.
After service has been made by a proper officer, file the original papers and the officer's return of service with the clerk of the court.
Use this summons for the case type codes shown below.
Do not use this summons for the following actions:
(a) Family matters (for example divorce, child support, (e) Administrative appeals
custody, parentage, and visitation matters) (f) Proceedings pertaining to arbitration
(b) Any actions or proceedings in which an attachment, (g) Summary Process (Eviction) actions
garnishment or replevy is sought (h) Entry and Detainer proceedings
(c) Applications for change of name (i) Housing Code Enforcement actions
(d) Probate appeals
Case Type Codes
MAJOR CODE | MAJOR CODE
Major! | MINOR DESCRIPTION Major MINOR DESCRIPTION
DESCRIPTION DESCRIPTION Minor.
Minor
Contracts C00 Construction - All other Property P00 Foreclosure
C10 Construction - State and Local P40 Partition
C20 Insurance Policy P20 Quiet Title/Discharge of Mortgage or Lien
C30 Specific Performance P30 Asset Forfeiture
C40 Collections P90 All other
C50 Uninsured/Underinsured Motorist Coverage
ceo Uniform Limited Liability Company Act - C.G.S. 34-243
C90 All other Torts (Other T02 Defective Premises - Private - Snow or Ice
than Vehicular) T03 Defective Premises - Private - Other
Eminent E00 State Highway Condemnation 1 Defective Premises - Public - Snow or Ice
Domain E10 Redevelopment Condemnation T12 Defective Premises - Public - Other
£20 Other State or Municipal Agencies T20 Products Liability - Other than Vehicular
E30 Public Utilities & Gas Transmission Companies T28 Malpractice - Medical
E90 All other T29 Malpractice - Legal
T30 Malpractice - All other
T40 Assault and Battery
| Housing H10 Housing - Retum of Security Deposit T50 Defamation
H12 Housing - Rent andlor Damages Tél Animals - Dog
H 40 Housing - Housing - Audita Querela/Injunction Té6g Animals - Other
H50 Housing - Administrative Appeal T70 False Arrest
H60 Housing - Municipal Enforcement 7 Fire Damage
H90 Housing - All Other T90 All other
Miscellaneous M00 Injunction vot Motor Vehicles! - Driver and/or Passenger(s) vs. Driver(s)
M10 Receivership Vehicular Torts
Receivership for Abandoned/Blighted Property v04 Motor Vehicles’ - Pedestrian vs. Driver
M15 vos Motor Vehicles* - Property Damage only
M20 Mandamus vo6 Motor Vehicle’ - Products Liability Including Warranty
M30 Habeas Corpus (extradition, release from Penal Institution) Motor Vehicle* - All other
vog
M40 Arbitration vi0 Boats
M50 Declaratory Judgment v20 Airplanes
M63 Bar Discipline v30 Railroads
M66 Department of Labor Unemployment Compensation Snowmobiles
Enforcement v40
Bar Discipline - Inactive Status v0 All other
M68 *Motor Vehicles include cars, trucks,
M70 Municipal Ordinance and Regulation Enforcement motorcycles, and motor scooters.
M80 Foreign Civil Judgments - C.G.S. 52-604 & C.G.S. 502-30
M83 ‘Small Claims Transfer to Regular Docket Wills, Estates Wwi0 Construction of Wills and Trusts
M84 Foreign Protective Order and Trusts ws0 All other
M89 CHRO Action in the Public Interest - P.A. 19:93
M 90 All other
Page 2 of 2
DOCKET NO.: HHB-CV-24-6084781-S SUPERIOR COURT
CORPORATE AMERICA JUDICIAL DISTRICT OF
FAMILY CREDIT UNION NEW BRITAIN
ve. AT NEW BRITAIN
KATHLEEN E GOODFIELD,
BY AND THROUGH HER
POWER OF ATTORNEY,
LISA CHAMBERLAND MAY 16, 2024
AMENDED COMPLAINT
1 The Plaintiff, CORPORATE AMERICA FAMILY CREDIT UNION, is an
Illinois credit union doing business at 501 Middle Street, Bristol, Connecticut.
2. The Defendant, KATHLEEN E GOODFIELD, is an individual residing at 127
Butternut Lane, Bristol, Connecticut 06010.
3 On or about February 8, 2010, the Defendant, KATHLEEN E GOODFIELD,
applied for and received a Visa Card with a Five Thousand and 00/100 ($5,000.00) Dollars
credit limit.
4 The Defendant, KATHLEEN E GOODFIELD, pursuant to the Visa Card
agreement promised to pay the Plaintiff, CORPORATE AMERICA FAMILY CREDIT
UNION, monthly installments of 2% of the unpaid balance with interest on the unpaid balance
at the rate of 15.15% per annum until the balance is paid in full.
5 On October 27, 2022, Lisa Chamberland was appointed as Power of Attorney of
Kathleen E Goodfield.
6 The Defendant has been in default since October 12, 2024. Late fees and interest
continue to accrue on the account and the principal balance owed to the Plaintiff as of this date
is Nine Thousand Two Hundred Seven and 16/100 ($9,207.16) Dollars, which balance the
Defendant has neglected and refused to pay on demand. Said agreement contains provisions for
interest and attorney’s fees.
7
Despite demand, the Defendant has failed to pay the balance due.
WHEREFORE, THE PLAINTIFF CLAIMS:
1 Fair, reasonable and adequate damages, which are within the jurisdiction of the
Court;
2 Late fees, Interest, Costs, Attorney’s Fees; and
3 Such other and equitable relief as this Court deems it.
Notice is hereby given to the Defendants that the Plaintiff intends to seek satisfaction of
any judgment rendered in the Plaintiff's favor in this action from any debts accruing to the
Defendants by reason of the Defendants’ personal services.
Caitlin Gaughan, of Bristol, Connecticut is hereby recognized in the sum of $250.00 to
prosecute, etc.
Hereof fail not but of this writ with your doings thereon make due service and return
according to law.
Dated at Bristol, Connecticut, on May 16, 2024.
PLAINTIFF — C PORATE AMERICA
FAMILY CREDIT} UNION
By
Melissa’. Simonik
The Law Office of Melissa L. Simonik, LLC
1001 Farmington Avenue, Suite 303
Bristol, CT 06010
Telephone: (860) 506-4409
Please enter the appeai afice of
The Law Of e of Mel sa L.
Simonik, LL) (43341 1)/for the Plaintiff.
Melissa L. Simonik
THIS IS A COMMUNICATION FROM A DEBT COLLECTOR. IT IS AN ATTEMPT
TO COLLECT A DEBT AND ANY FURTHER INFORMATION WILL BE USED
FOR THAT PURPOSE.
DOCKET NO.: HHB-CV-24-6084781-S SUPERIOR COURT
CORPORATE AMERICA JUDICIAL DISTRICT OF
FAMILY CREDIT UNION NEW BRITAIN
Vv. AT NEW BRITAIN
KATHLEEN E GOODFIELD,
BY AND THROUGH HER
POWER OF ATTORNEY,
LISA CHAMBERLAND MAY 16, 2024
AMOUNT IN DEMAND
The amount in demand is more than Two Thousand Five Hundred and 00/100
($2,500.00) Dollars exclusive of interest and costs.
The amount in demand is based upon and express or impli¢d ise to pay a definite
sum.
Melissa L. Sisfonik, (433411)
Commissioner of Superior Court
EXHIBIT A
LQANLINER.
Married Applicants; May apply for a separate account. Application
Individual Credit: You must complete the Applicant section about yourself and the Other section about
1. you live in or the property pledged as collateral is locate d in a community property state (AK, AZ, CA,yourID, spouse if:
2, your spouse will use the account, or . NM, NV, TX, WA, WI),
3. you are relying on your spouse's income as a basis for re| payment. If you are relying
on income from alimony, child support, or separate maintenance,
complete the Other section to the extent possible about tl he person on whose payments you are relying.
Joint Credit: Each Applicant must individually complete the appropriate section below. If Co-Borrower is spouse of the Applicant, mark the Co-Applicant
box.
Guarantor: Complete the Other section if you are a guarantor on an account/loan.
OU LOANLINER Account/Loan: 0 individual O Joint DY Credit Card Account: [] Individual Joint =
(including ATM/Debit Card Access to the Account if Available) (See Disclosure Table or Agreement for Terms)
Amount Requested $ 0.00 Credit Limit Requested $ 5,000.00
Purpose/Collateral: Other
Repayment: C] Payroll Deduction C] Cash
If Authorized User, Nari L1b0
O Military Allotment © Automatic Payment
PAYMENT PROTECTION |
"AYMENT PROTECTION | Are you interested in having your loan protected? []Yes
If you answer "yes", then the credit union will disclose the cost of this voluntary payment
protection to you. A separate election which discloses the terms and conditions must be
signed for protection to be effective.
APPLICANT OTHER | Bl co-appuicant [] spouse [1] otHer
NAME NAME
ALBERT GOODFIELD KATHLEEN E GOODFIELO
OTHER'S MAIDEN NAME ee NUMBER MOTHER'S MAIDEN NAME [ACCOUNT NUMBER
MARGARET DEWEY
SOCIAL SECURITY NUMBER Toriver's TIGENSE WOWBERSTATE SOCIAL SECURITY NUMBER DRIVER'S TICENSE NUMBERISTATE
cT cT
AGES OF DEPENDENTS: EMAIL ADDRESS AGES OF DEPENDENTS EMAIL ADDRESS
BIRTH DATE HOME PHONE BUSINESS PHONETEXT. BIRTH DATE HOME PHONE BUSINESS PHONEIEXT.
(860) 585-8261 (860) 585-8261 860 673-0423
PRESENT ADDRESS (Street - City - State - Zip) PRESENT ADDRESS (Gireat City - State - Zp)
19 MATTHEWS ST Gtown [) rent
18 MATTHEWS ST [Baown Ly nent
TERRYVILLE, CT 06786-5002 LENGTH AT RESIDENCE LENGTH AT RESIDENCE
7-2-2004 TERRWILLE, CT 06788-5002
PREVIOUS ADORESS (Strat - City - State - Zip) Clown CTrewt PREVIOUS ADDRESS (Street - City > State Zip) CE own T) rent
LENGTH AT RESIDENCE LENGTH AT RESIDENCE
o COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY
PROPERTY STAT! PROPERTY STATE:
LOmarnico Ciseparateo [1] unmarnien (single - Divorced
- Widoives) Lmarnieo Liserarateo [J UNMARRIED (Single - Divorced - widowed)
EMPLOYMENT/INCOME EMPLOYMENT/INCOME,
NAME AND. REYIRED FROM GM NAME AND CEWIS MILLS HIGH SCH.
emacoven” ‘ADDRESS OF
EMPLOYER 28 LYON RO
BURLINGTON cr 206013
TITLEIGRADE START DATE HOURS AT WORK THTLEIGRADE START DATE HOURS AT WORK
6-1-2000 0 FOOD SERVICE 9 2005 20
SUPERVISOR'S NAME IF SELF EMPLOYED, TYPE OF BUSINESS SUPERVISOR'S NAME IF SELF EMPLOYED, TYPE OF BUSINESS
DOLORES
NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEEO NOT BE INOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT Gé|
REVEALED IF YOU D0 NOT CHOOSE TO HAVE IT CONSIDERED. IREVEALEO IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED.
EMPLOYMENT INCOME OTHER INCOME PER MONTH EMPLOYMENT INCOME OTHER INCOME PER MONTH
$,0.01 Per M $ 1780.00 s $9.49 Per H
P $
D ver O cross $ 1183.57
IO ner © sross $
MILITARY: IS DUTY STATION TRANSFER EXPECTED DURING NEXT EAR? L] YES L] NO MILITARY: IS DUTY STATION TRANSFER EXPECTED DURING NEXT YEAR? Lives []no
WHERE ENDING/SEPARATION DATE WHERE ENDING/SEPARATION DATE
PRE IOUS EMPLOYER NAME AND ADDRESS IF EMPLOYED LESS THAN STARTING DATE Fino Peake
OO ER NAME AND ADDRESS TF EMPLOVED LESS THAW ‘STARTING DATE
ENDING DATE ENDING DATE
REFERENCE RELATIONSHIP RECATIONSAIP
REFERENCE
Brother SON
NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU
ANDRE GOODFIELO HOME PHONE ‘TROY ROBILLARD HOME PHONE
185 KENNEY ST (260}589-7864 185 REDSTONE HILL RO
BRISTOL, CT 06030 BRITOL,CT 06010 (860)845-2189
© CUNA MUTUAL GROUP, 1980, 82, 84, 86, 89, 2000, 03, 04, 07, ALL RIGHTS RESERVED PAGE 1
DILDO2 (AXX129)-6
CREDITOR ‘wa, OTHER THAN THIS CREDIT UNION INTER EST
PaONTHLY
WHAT YOU OWE (Attach additional sheet(s) if necessary) ‘OWED BY
E PRESENT BALANCE, YMENT APPLICANT] OTHER]
Oo
is)
O
Oo
$ $
$ $
UST ANY NAMES UNDER WHICH YOUR CREDIT REFERENCES AND CREDIT HISTORY CAN BE CHECKED:
TOTALS $ 0.00 $ 0.00
WHAT YOU OWN LIST LOCATION OF PROPERTY OR FINANCIAL INSTITUTION MARKET VALUE PLEOGED AS COLLATERAL ‘OWNED BY
FOR ANOTHER LOAN APPLICANT] OTHER
Yes NO
Yes NO
yes No
yes NO
YES NO
yes No
S$ yes NO
$ Oo Yes No
OTHER INFORMATION ABOUT YOU J] vou austen ves" Any GUESTION OTHER THAN 6, XPLAWON AN ATTACHED SHEET APPLICANT OTHER
ARE YOU A U.S. CITIZEN OR PERMANENT RESIDENT ALIEN?
DO YOU CURRENTLY HAVE ANY OUTSTANDING JUDGMENTS OR HAVE YOU EVER FILED FOR BANKRUPTCY, HAD A DEBT ADJUSTMENT PLAN Oo CT
CONFIRMED UNDER CHAPTER 13, HAD PROPERTY FORECLOSED UPON OR REPOSSESSED IN THE LAST 7 YEARS, OR BEEN A PARTY IN A LAWSUIT? DO a
1S YOUR INCOME LIKELY TO DECLINE IN THE NEXT TWO YEARS?
‘ARE YOU A CO-MAKER, CO-SIGNER OR GUARANTOR ON ANY LOAN NOT LISTED ABOVE? 0 O
FOR WHOM (Name of Others Obligated on Loan): TO WHOM (Name of Craditor): [zl |
STATE LAW NOTICES OHIO RESIDENTS ONLY: The Ohio laws unless the Credit Union is furnished 2 copy of the agreement, statement or
against discrimination require that all creditors decree, or has actual knowled: je of its terms, before ranted
make credit equally available to all creditworthy customers, and that credit or the account is opened. (2) $ lease sign if you are
not applyi
the credit is
ing applied for, fg ranted,
for this)
reporting agencies maintain separate credit stories on each individual account or loan with your spouse. The credit be
upon request. The Ohio Civil Rights Commission administers compliance will be incurred inthe interest of the marriage or family of the
with this law. undersigned
WISCONSIN RESIDENTS ONLY: (1) No rovision of any marital property [xX 2-8-2010
agreement, unilateral statement under ection 766.59, or court decree
under Section 766.70 will adversely affect the rights of the Credit Union SIGNATURE FOR WISCONSIN RESIDENTS ONLY DATE
SIGN) JATURES
1, You promise that everything you have stated in this application is . If you are applying for a credit card, you understand that the use of]
correct to the best of your knowledge and that the above information is a
complete listing of what you owe. If there are any important changes you your Card will constitute acknowledgment of receipt and agreement to the|
terms of the credit card agreement and disclosures. ou grant us a
will notify us in writing immediately. You authorize the Credit Union to security interest in all individual and joint share and/or deposit accounts
obtain credit reports in connection with this application for credit and for you have with us now and in the future to secure your credit card
any update, increase, renewal, extension or collection of the credit account. When you are in default, you authorize us to apply the balance in
received. You understand that the Credit Union will rely on the information ‘these accounts ‘to any amounts due. Shares and deposits in an Individual
in this application and our credit report to make its decision, If you Retirement Account, and any other account that would lose special
Tequest, the Credit Union will tell you the name and address of any credit treatment under state or federal law if given as security, are not subject taxto
bureau from which it received a credit report on you, It is a federal crime the security interest you have given in your shares and deposits,
to willfully and deliberately rovide incomplete or incorrect information on
loan applications made to feederal credit unions or state chartered credit
unions insured py NCUA. _4
XT VD
APPLICANT'S SIGNATURE
Ee
LBERT GOODFIELD
JN 2 iF cea oa | [LX
DATE OTHER SIGNATURE
Clad ig So
KATHLEEN & GOODFIELD
fis ; (SEA)
DATE
|
FOR CREDIT UNION USE ONLY
DATE APPROVED. LOAN APPROVED LIMITS: USR DEBT RATIO EMPERIGA
TYPE 14 APPLICANT 798
2-8-2010 DENI 34.207
O (Adverse Action Notice Sent) \VRP1 Platinum Advantage Rewards $ 5,000.00 JOINT APPLICANT 790
i
APPROVED Bu. eI 2515
em (0
pen "a
ZL
2-8-2010
DATE
Xx (imabely
Vip t Y
OTHER 2-8-2010
DATE
PAGE 2 T DILDOZ (AXX129)-0
=
Annual Percentage Other APR's Variable Rate Grace Method of Annual | Minimum] Transaction
Rate (APR) for Purchases Information Period for Computing Fee Finance Fee for
Purchases| the Balance Charge Purchases
Preview
DOCKET NO.: HHB-CV-24-6084781-S SUPERIOR COURT CORPORATE AMERICA JUDICIAL DISTRICT OF FAMILY CREDIT UNION NEW BRITAIN Vv. AT NEW BRITAIN KATHLEEN E GOODFIELD, BY AND THROUGH HER POWER OF ATTORNEY, LISA CHAMBERLAND, MAY 16, 2024 MOTION TO CITE IN PARTY DEFENDANT Pursuant to C.P.B., § 9-18 and 9-22, Plaintiff moves the Court to cite KATHLEEN E GOODFIELD, BY AND THROUGH HER POWER OF ATTORNEY, LISA CHAMBERLAND as party Defendant. The Plaintiff's summons and complaint contained an error and incorrectly listed Lisa Chamberland as Conservator instead of Power of Attorney. WHEREFORE, the undersigned Plaintiff moves that the Court allow KATHLEEN E GOODFIELD, BY AND THROUGH HER POWER OF ATTORNEY, LISA CHAMBERLAND to be summoned to appear herein as a Defendant by way of the Amended Summons and Complaint. PLAINTIF: 0. RATE AMERICA FAMILY CREDIT U. IN By: Melissa L. Simonik, Tts Attorney The Law Office of Melissa L. Simonik, LLC 1001 Farmington Avenue, Suite 303 Bristol, CT 06010 Telephone: (860) 506-4409 ORDER It appearing that the foregoing motion should be granted, it is hereby ordered, that on or before , 2024, the Plaintiff summon KATHLEEN E GOODFIELD, BY AND THROUGH HER POWER OF ATTORNEY, LISA CHAMBERLAND as a Defendant in this action on or before the second day following , 2024, by causing some proper officer to serve on it in the manner prescribed by law a true and attested copy of the order, a true and attested or certified copy of the Amended Writ, Summons and Complaint in this action and a Summon-Civil Form 103.1 and due return make. BY THE COURT Judge/ Assistant Clerk Date: CERTIFICATION This is to certify that a copy of the foregoing has been sent to all counsel and pro se parties of record, on May 16, 2024, to wit: Kathleen E Goodfield By and through her Conservator of Person and Estate, Lisa Chamberland 127 Butternut Lane Bristol, CT 06010 Kathleen E Goodfield By and through her Power of Attorney, Lisa Chamberland 127 Butternut Lane Bristol, CT 06010 Melissa LYSimosik Commissioner of the Superior Court DOCKET NO.: HHB-CV-24-6084781-S SUPERIOR COURT CORPORATE AMERICA JUDICIAL DISTRICT OF FAMILY CREDIT UNION NEW BRITAIN Vv. AT NEW BRITAIN KATHLEEN E GOODFIELD, BY AND THROUGH HER POWER OF ATTORNEY, LISA CHAMBERLAND. MAY 16, 2024 MEMORANDUM OF LAW IN SUPPORT OF MOTION TO CITE IN PARTY DEFENDANT The Plaintiff, CONNECTICUT BAIL BONDS GROUP, LLC, has moved to cite in KATHLEEN E GOODFIELD, BY AND THROUGH HER POWER OF ATTORNEY, LISA CHAMBERLAND as party defendant in the Plaintiff's action pursuant to Connecticut Practice Book Section 10-69. KATHLEEN E GOODFIELD, BY AND THROUGH HER POWER OF ATTORNEY, LISA CHAMBERLAND has an interest in the pending action. PLAINTIF: = ORPORATE AMERICA FAMILY CREDIT UNION By: Melissa. Simonik, Its Attorney ‘The Law Office of Melissa L. Simonik, LLC 1001 Farmington Avenue, Suite 303 Bristol, CT 06010 Telephone: (860) 506-4409 CERTIFICATION This is to certify that a copy of the foregoing has been sent to all counsel and pro se patties of record, on April 25, 2024, to wit: Kathleen E Goodfield By and through her Conservator of Person and Estate, Lisa Chamberland 127 Butternut Lane Bristol, CT 06010 Kathleen E Goodfield By and through her Power of Attorney, Lisa Chamberland 127 Butternut Lane Bristol, CT 06010 Melissa L. Simonik Commissioner of the Superior Court men SUMMONS - CIVIL For information on STATE OF CONNECTICUT JD-CV-1 Rev. 2-22 ADA accommodations, SUPERIOR COURT | C.G.S. §§ 51-346, 51-347, 51-349, 51-350, 52-45a, 52-48, 52-259; P.B. §§ 3-1 through 3-21, 8-1, 10-13 contact a court clerk or www.jud.ct.gov o] go to: www.jud.ct.gov/ADA. Instructions are on page 2. CJ Select if amount, legal interest, or property in demand, not including interest and costs, is LESS than $2,500. [X] Select if amount, legal interest, or property in demand, not including interest and costs, is $2,500 or MORE. CJ Select if claiming other relief in addition to, or in place of, money or damages. TO: Any proper officer By authority of the State of Connecticut, you are hereby commanded to make due and legal service of this summons and attached complaint. ‘Address of court clerk (Number, street, town and zip code) Telephone number of clerk Return Date (Must be a Tuesday) 20 Franklin Square, New Britain, CT 06051 (860 ) 515 -5180 Judicial District GA ‘At (City/Town) Case type code (See list on page 2) 1 Housing Session CJ Number: New Britain Major: C Minor: 40 For the plaintiff(s) enter the appearance of: Name and address of atlorney, law firm or plaintiff f self-represented (Number, street, fown and zip code) Turis number (if alfomey or law firm) The Law Office of Melissa L. Simonik, LLC, 1001 Farmington Avenue, Suite 303, Bristol, CT 06010 433411 Telephone number Signature of plaintiff (if self-represented) (860 ) 506 - 4409 The attorney or law firm appearing for the plaintiff, or the plaintiff if E-mail address for delivery of papers under Section 10-13 of the Connecticut Practice Book (if agree self-represented, agrees to accept papers (service) electronically Ik] Yes [] No melissa@simoniklaw.com in this case under Section 10-13 of the Connecticut Practice Book. Parties Name (Last, First, Middle Initial) and address of each party (Number; street; P.O. Box; town; state; zip; country, if not USA) First Name: Corporate America Family Credit Union P-01 plaintiff Address: 501 Middle Street, Bristol, CT 06010 Additional Name: P-02 plaintiff Address: First Name: Kathleen E Goodfield, by and through her Power of Attorney, Lisa Chamberland D-01 defendant Address: 127 Butternut Lane, Bristol, CT 06010 Additional Name: D-02 defendant Address: Additional Name: D-03 defendant Address: Additional Name: D-04 defendant Address: Total number of plaintiffs: 1 Total number of defendants:1 (1 Form JD-CV-2 attached for additional parties Notice to each defendant 4 You are being sued. This is a summons in a lawsuit. The complaint attached states the claims the plaintiff is making against you. 2. To receive further notices, you or your attorney must file an Appearance (form JD-CL-12) with the clerk at the address above. Generally, it must be filed on or before the second day after the Return Date. The Return Date is not a hearing date. You do not have to come to court on the Return Date unless you receive a separate notice telling you to appear. If you or your attorney do not file an Appearance on time, a default judgment may be entered against you. You can get an Appearance form at the court address above, or on-line at https://jud.ct.gov/webforms/. If you believe that you have insu) iceth ay cover the claim being made against you in this lawsuit, you should immediately contact your insurance representative ther acti you may take are described in the Connecticut Practice Book, which may be found in a superior court law library or onjline at http: www.jud.ct.gov/pb.htm. If you have questions about the summons and complaint, you should talk to an attorney. The court staff is not allowed)to ive a ice on legal matters. Date Signed (Sign and Ky l [x] Commissioner of Superior Court Name of person signing 05/16/2024 oO Clerk Melissa L. Simonik If this summons is signed by Clerk: For Court Use Only File Date a. The signing has been done so that the plaintiff(s) will not be denied access to the courts. b. It is the responsibility of the plaintiff(s) to ensure that service is made in the manner provided by law. c. The court staff is not permitted to give any legal advice in connection with any lawsuit. d The Clerk signing this summons at the request of the plaintiff(s) is not responsible in any way for any errors or omissions in the summons, any allegations contained in the complaint, or the service of the summons or complaint. certify |have read and | Slaned (Sefr-represented plainti Date Docket Number understand the above: Page 1 of 2 Instructions Type or print legibly. If you are a self-represented party, this summons must be signed by a clerk of the court. If there is more than one defendant, make a copy of the summons for each additional defendant. Each defendant must receive a copy of this summons. Each copy of the summons must show who signed the summons and when it was signed. If there are more than two plaintiffs or more than four defendants, complete the Civil Summons Continuation of Parties (form JD-CV-2) and attach it to the original and all copies of the summons. Attach the summons to the complaint, and attach a copy of the summons to each copy of the complaint. Include a copy of the Civil Summons Continuation of Parties form, if applicable. After service has been made by a proper officer, file the original papers and the officer's return of service with the clerk of the court. Use this summons for the case type codes shown below. Do not use this summons for the following actions: (a) Family matters (for example divorce, child support, (e) Administrative appeals custody, parentage, and visitation matters) (f) Proceedings pertaining to arbitration (b) Any actions or proceedings in which an attachment, (g) Summary Process (Eviction) actions garnishment or replevy is sought (h) Entry and Detainer proceedings (c) Applications for change of name (i) Housing Code Enforcement actions (d) Probate appeals Case Type Codes MAJOR CODE | MAJOR CODE Major! | MINOR DESCRIPTION Major MINOR DESCRIPTION DESCRIPTION DESCRIPTION Minor. Minor Contracts C00 Construction - All other Property P00 Foreclosure C10 Construction - State and Local P40 Partition C20 Insurance Policy P20 Quiet Title/Discharge of Mortgage or Lien C30 Specific Performance P30 Asset Forfeiture C40 Collections P90 All other C50 Uninsured/Underinsured Motorist Coverage ceo Uniform Limited Liability Company Act - C.G.S. 34-243 C90 All other Torts (Other T02 Defective Premises - Private - Snow or Ice than Vehicular) T03 Defective Premises - Private - Other Eminent E00 State Highway Condemnation 1 Defective Premises - Public - Snow or Ice Domain E10 Redevelopment Condemnation T12 Defective Premises - Public - Other £20 Other State or Municipal Agencies T20 Products Liability - Other than Vehicular E30 Public Utilities & Gas Transmission Companies T28 Malpractice - Medical E90 All other T29 Malpractice - Legal T30 Malpractice - All other T40 Assault and Battery | Housing H10 Housing - Retum of Security Deposit T50 Defamation H12 Housing - Rent andlor Damages Tél Animals - Dog H 40 Housing - Housing - Audita Querela/Injunction Té6g Animals - Other H50 Housing - Administrative Appeal T70 False Arrest H60 Housing - Municipal Enforcement 7 Fire Damage H90 Housing - All Other T90 All other Miscellaneous M00 Injunction vot Motor Vehicles! - Driver and/or Passenger(s) vs. Driver(s) M10 Receivership Vehicular Torts Receivership for Abandoned/Blighted Property v04 Motor Vehicles’ - Pedestrian vs. Driver M15 vos Motor Vehicles* - Property Damage only M20 Mandamus vo6 Motor Vehicle’ - Products Liability Including Warranty M30 Habeas Corpus (extradition, release from Penal Institution) Motor Vehicle* - All other vog M40 Arbitration vi0 Boats M50 Declaratory Judgment v20 Airplanes M63 Bar Discipline v30 Railroads M66 Department of Labor Unemployment Compensation Snowmobiles Enforcement v40 Bar Discipline - Inactive Status v0 All other M68 *Motor Vehicles include cars, trucks, M70 Municipal Ordinance and Regulation Enforcement motorcycles, and motor scooters. M80 Foreign Civil Judgments - C.G.S. 52-604 & C.G.S. 502-30 M83 ‘Small Claims Transfer to Regular Docket Wills, Estates Wwi0 Construction of Wills and Trusts M84 Foreign Protective Order and Trusts ws0 All other M89 CHRO Action in the Public Interest - P.A. 19:93 M 90 All other Page 2 of 2 DOCKET NO.: HHB-CV-24-6084781-S SUPERIOR COURT CORPORATE AMERICA JUDICIAL DISTRICT OF FAMILY CREDIT UNION NEW BRITAIN ve. AT NEW BRITAIN KATHLEEN E GOODFIELD, BY AND THROUGH HER POWER OF ATTORNEY, LISA CHAMBERLAND MAY 16, 2024 AMENDED COMPLAINT 1 The Plaintiff, CORPORATE AMERICA FAMILY CREDIT UNION, is an Illinois credit union doing business at 501 Middle Street, Bristol, Connecticut. 2. The Defendant, KATHLEEN E GOODFIELD, is an individual residing at 127 Butternut Lane, Bristol, Connecticut 06010. 3 On or about February 8, 2010, the Defendant, KATHLEEN E GOODFIELD, applied for and received a Visa Card with a Five Thousand and 00/100 ($5,000.00) Dollars credit limit. 4 The Defendant, KATHLEEN E GOODFIELD, pursuant to the Visa Card agreement promised to pay the Plaintiff, CORPORATE AMERICA FAMILY CREDIT UNION, monthly installments of 2% of the unpaid balance with interest on the unpaid balance at the rate of 15.15% per annum until the balance is paid in full. 5 On October 27, 2022, Lisa Chamberland was appointed as Power of Attorney of Kathleen E Goodfield. 6 The Defendant has been in default since October 12, 2024. Late fees and interest continue to accrue on the account and the principal balance owed to the Plaintiff as of this date is Nine Thousand Two Hundred Seven and 16/100 ($9,207.16) Dollars, which balance the Defendant has neglected and refused to pay on demand. Said agreement contains provisions for interest and attorney’s fees. 7 Despite demand, the Defendant has failed to pay the balance due. WHEREFORE, THE PLAINTIFF CLAIMS: 1 Fair, reasonable and adequate damages, which are within the jurisdiction of the Court; 2 Late fees, Interest, Costs, Attorney’s Fees; and 3 Such other and equitable relief as this Court deems it. Notice is hereby given to the Defendants that the Plaintiff intends to seek satisfaction of any judgment rendered in the Plaintiff's favor in this action from any debts accruing to the Defendants by reason of the Defendants’ personal services. Caitlin Gaughan, of Bristol, Connecticut is hereby recognized in the sum of $250.00 to prosecute, etc. Hereof fail not but of this writ with your doings thereon make due service and return according to law. Dated at Bristol, Connecticut, on May 16, 2024. PLAINTIFF — C PORATE AMERICA FAMILY CREDIT} UNION By Melissa’. Simonik The Law Office of Melissa L. Simonik, LLC 1001 Farmington Avenue, Suite 303 Bristol, CT 06010 Telephone: (860) 506-4409 Please enter the appeai afice of The Law Of e of Mel sa L. Simonik, LL) (43341 1)/for the Plaintiff. Melissa L. Simonik THIS IS A COMMUNICATION FROM A DEBT COLLECTOR. IT IS AN ATTEMPT TO COLLECT A DEBT AND ANY FURTHER INFORMATION WILL BE USED FOR THAT PURPOSE. DOCKET NO.: HHB-CV-24-6084781-S SUPERIOR COURT CORPORATE AMERICA JUDICIAL DISTRICT OF FAMILY CREDIT UNION NEW BRITAIN Vv. AT NEW BRITAIN KATHLEEN E GOODFIELD, BY AND THROUGH HER POWER OF ATTORNEY, LISA CHAMBERLAND MAY 16, 2024 AMOUNT IN DEMAND The amount in demand is more than Two Thousand Five Hundred and 00/100 ($2,500.00) Dollars exclusive of interest and costs. The amount in demand is based upon and express or impli¢d ise to pay a definite sum. Melissa L. Sisfonik, (433411) Commissioner of Superior Court EXHIBIT A LQANLINER. Married Applicants; May apply for a separate account. Application Individual Credit: You must complete the Applicant section about yourself and the Other section about 1. you live in or the property pledged as collateral is locate d in a community property state (AK, AZ, CA,yourID, spouse if: 2, your spouse will use the account, or . NM, NV, TX, WA, WI), 3. you are relying on your spouse's income as a basis for re| payment. If you are relying on income from alimony, child support, or separate maintenance, complete the Other section to the extent possible about tl he person on whose payments you are relying. Joint Credit: Each Applicant must individually complete the appropriate section below. If Co-Borrower is spouse of the Applicant, mark the Co-Applicant box. Guarantor: Complete the Other section if you are a guarantor on an account/loan. OU LOANLINER Account/Loan: 0 individual O Joint DY Credit Card Account: [] Individual Joint = (including ATM/Debit Card Access to the Account if Available) (See Disclosure Table or Agreement for Terms) Amount Requested $ 0.00 Credit Limit Requested $ 5,000.00 Purpose/Collateral: Other Repayment: C] Payroll Deduction C] Cash If Authorized User, Nari L1b0 O Military Allotment © Automatic Payment PAYMENT PROTECTION | "AYMENT PROTECTION | Are you interested in having your loan protected? []Yes If you answer "yes", then the credit union will disclose the cost of this voluntary payment protection to you. A separate election which discloses the terms and conditions must be signed for protection to be effective. APPLICANT OTHER | Bl co-appuicant [] spouse [1] otHer NAME NAME ALBERT GOODFIELD KATHLEEN E GOODFIELO OTHER'S MAIDEN NAME ee NUMBER MOTHER'S MAIDEN NAME [ACCOUNT NUMBER MARGARET DEWEY SOCIAL SECURITY NUMBER Toriver's TIGENSE WOWBERSTATE SOCIAL SECURITY NUMBER DRIVER'S TICENSE NUMBERISTATE cT cT AGES OF DEPENDENTS: EMAIL ADDRESS AGES OF DEPENDENTS EMAIL ADDRESS BIRTH DATE HOME PHONE BUSINESS PHONETEXT. BIRTH DATE HOME PHONE BUSINESS PHONEIEXT. (860) 585-8261 (860) 585-8261 860 673-0423 PRESENT ADDRESS (Street - City - State - Zip) PRESENT ADDRESS (Gireat City - State - Zp) 19 MATTHEWS ST Gtown [) rent 18 MATTHEWS ST [Baown Ly nent TERRYVILLE, CT 06786-5002 LENGTH AT RESIDENCE LENGTH AT RESIDENCE 7-2-2004 TERRWILLE, CT 06788-5002 PREVIOUS ADORESS (Strat - City - State - Zip) Clown CTrewt PREVIOUS ADDRESS (Street - City > State Zip) CE own T) rent LENGTH AT RESIDENCE LENGTH AT RESIDENCE o COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY COMPLETE FOR JOINT CREDIT, SECURED CREDIT OR IF YOU LIVE IN A COMMUNITY PROPERTY STAT! PROPERTY STATE: LOmarnico Ciseparateo [1] unmarnien (single - Divorced - Widoives) Lmarnieo Liserarateo [J UNMARRIED (Single - Divorced - widowed) EMPLOYMENT/INCOME EMPLOYMENT/INCOME, NAME AND. REYIRED FROM GM NAME AND CEWIS MILLS HIGH SCH. emacoven” ‘ADDRESS OF EMPLOYER 28 LYON RO BURLINGTON cr 206013 TITLEIGRADE START DATE HOURS AT WORK THTLEIGRADE START DATE HOURS AT WORK 6-1-2000 0 FOOD SERVICE 9 2005 20 SUPERVISOR'S NAME IF SELF EMPLOYED, TYPE OF BUSINESS SUPERVISOR'S NAME IF SELF EMPLOYED, TYPE OF BUSINESS DOLORES NOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEEO NOT BE INOTICE: ALIMONY, CHILD SUPPORT, OR SEPARATE MAINTENANCE INCOME NEED NOT Gé| REVEALED IF YOU D0 NOT CHOOSE TO HAVE IT CONSIDERED. IREVEALEO IF YOU DO NOT CHOOSE TO HAVE IT CONSIDERED. EMPLOYMENT INCOME OTHER INCOME PER MONTH EMPLOYMENT INCOME OTHER INCOME PER MONTH $,0.01 Per M $ 1780.00 s $9.49 Per H P $ D ver O cross $ 1183.57 IO ner © sross $ MILITARY: IS DUTY STATION TRANSFER EXPECTED DURING NEXT EAR? L] YES L] NO MILITARY: IS DUTY STATION TRANSFER EXPECTED DURING NEXT YEAR? Lives []no WHERE ENDING/SEPARATION DATE WHERE ENDING/SEPARATION DATE PRE IOUS EMPLOYER NAME AND ADDRESS IF EMPLOYED LESS THAN STARTING DATE Fino Peake OO ER NAME AND ADDRESS TF EMPLOVED LESS THAW ‘STARTING DATE ENDING DATE ENDING DATE REFERENCE RELATIONSHIP RECATIONSAIP REFERENCE Brother SON NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU NAME AND ADDRESS OF NEAREST RELATIVE NOT LIVING WITH YOU ANDRE GOODFIELO HOME PHONE ‘TROY ROBILLARD HOME PHONE 185 KENNEY ST (260}589-7864 185 REDSTONE HILL RO BRISTOL, CT 06030 BRITOL,CT 06010 (860)845-2189 © CUNA MUTUAL GROUP, 1980, 82, 84, 86, 89, 2000, 03, 04, 07, ALL RIGHTS RESERVED PAGE 1 DILDO2 (AXX129)-6 CREDITOR ‘wa, OTHER THAN THIS CREDIT UNION INTER EST PaONTHLY WHAT YOU OWE (Attach additional sheet(s) if necessary) ‘OWED BY E PRESENT BALANCE, YMENT APPLICANT] OTHER] Oo is) O Oo $ $ $ $ UST ANY NAMES UNDER WHICH YOUR CREDIT REFERENCES AND CREDIT HISTORY CAN BE CHECKED: TOTALS $ 0.00 $ 0.00 WHAT YOU OWN LIST LOCATION OF PROPERTY OR FINANCIAL INSTITUTION MARKET VALUE PLEOGED AS COLLATERAL ‘OWNED BY FOR ANOTHER LOAN APPLICANT] OTHER Yes NO Yes NO yes No yes NO YES NO yes No S$ yes NO $ Oo Yes No OTHER INFORMATION ABOUT YOU J] vou austen ves" Any GUESTION OTHER THAN 6, XPLAWON AN ATTACHED SHEET APPLICANT OTHER ARE YOU A U.S. CITIZEN OR PERMANENT RESIDENT ALIEN? DO YOU CURRENTLY HAVE ANY OUTSTANDING JUDGMENTS OR HAVE YOU EVER FILED FOR BANKRUPTCY, HAD A DEBT ADJUSTMENT PLAN Oo CT CONFIRMED UNDER CHAPTER 13, HAD PROPERTY FORECLOSED UPON OR REPOSSESSED IN THE LAST 7 YEARS, OR BEEN A PARTY IN A LAWSUIT? DO a 1S YOUR INCOME LIKELY TO DECLINE IN THE NEXT TWO YEARS? ‘ARE YOU A CO-MAKER, CO-SIGNER OR GUARANTOR ON ANY LOAN NOT LISTED ABOVE? 0 O FOR WHOM (Name of Others Obligated on Loan): TO WHOM (Name of Craditor): [zl | STATE LAW NOTICES OHIO RESIDENTS ONLY: The Ohio laws unless the Credit Union is furnished 2 copy of the agreement, statement or against discrimination require that all creditors decree, or has actual knowled: je of its terms, before ranted make credit equally available to all creditworthy customers, and that credit or the account is opened. (2) $ lease sign if you are not applyi the credit is ing applied for, fg ranted, for this) reporting agencies maintain separate credit stories on each individual account or loan with your spouse. The credit be upon request. The Ohio Civil Rights Commission administers compliance will be incurred inthe interest of the marriage or family of the with this law. undersigned WISCONSIN RESIDENTS ONLY: (1) No rovision of any marital property [xX 2-8-2010 agreement, unilateral statement under ection 766.59, or court decree under Section 766.70 will adversely affect the rights of the Credit Union SIGNATURE FOR WISCONSIN RESIDENTS ONLY DATE SIGN) JATURES 1, You promise that everything you have stated in this application is . If you are applying for a credit card, you understand that the use of] correct to the best of your knowledge and that the above information is a complete listing of what you owe. If there are any important changes you your Card will constitute acknowledgment of receipt and agreement to the| terms of the credit card agreement and disclosures. ou grant us a will notify us in writing immediately. You authorize the Credit Union to security interest in all individual and joint share and/or deposit accounts obtain credit reports in connection with this application for credit and for you have with us now and in the future to secure your credit card any update, increase, renewal, extension or collection of the credit account. When you are in default, you authorize us to apply the balance in received. You understand that the Credit Union will rely on the information ‘these accounts ‘to any amounts due. Shares and deposits in an Individual in this application and our credit report to make its decision, If you Retirement Account, and any other account that would lose special Tequest, the Credit Union will tell you the name and address of any credit treatment under state or federal law if given as security, are not subject taxto bureau from which it received a credit report on you, It is a federal crime the security interest you have given in your shares and deposits, to willfully and deliberately rovide incomplete or incorrect information on loan applications made to feederal credit unions or state chartered credit unions insured py NCUA. _4 XT VD APPLICANT'S SIGNATURE Ee LBERT GOODFIELD JN 2 iF cea oa | [LX DATE OTHER SIGNATURE Clad ig So KATHLEEN & GOODFIELD fis ; (SEA) DATE | FOR CREDIT UNION USE ONLY DATE APPROVED. LOAN APPROVED LIMITS: USR DEBT RATIO EMPERIGA TYPE 14 APPLICANT 798 2-8-2010 DENI 34.207 O (Adverse Action Notice Sent) \VRP1 Platinum Advantage Rewards $ 5,000.00 JOINT APPLICANT 790 i APPROVED Bu. eI 2515 em (0 pen "a ZL 2-8-2010 DATE Xx (imabely Vip t Y OTHER 2-8-2010 DATE PAGE 2 T DILDOZ (AXX129)-0 = Annual Percentage Other APR's Variable Rate Grace Method of Annual | Minimum] Transaction Rate (APR) for Purchases Information Period for Computing Fee Finance Fee for Purchases| the Balance Charge Purchases