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Credit Summary
Historical Late Payments
Account Type Number of Accounts Open Accounts Accounts Currently Past Due Past Due Payment Balance Accounts 30 Days 60 Days 90+ Days
Mortgage 0 0 0 $0 $0 $0 0 0 0 0
Installment 5 0 0 $0 $0 $0 1 5 5 0
Revolving/Credit Line 28 26 0 $0 $449 $15,893 2 3 0 0
Totals 33 26 0 $0 $449 $15,893 3 8 5 0
Number of Public Records: 0 Available Credit: $87,595
Number of Collections/Charge-offs: 0 Revolving/Credit Line Used: 15%
Bankruptcy: No Number of Inquiries: 4
Number of Authorized User Accounts: 2
Late Payment History
1 Current 4 90-119 Days Late 8 Repossession
2 30-59 Days Late 5 120-149 Days Late 9 Charged Off / Collection
3 60-89 Days Late 6 150+ Days Late X No Data Available
Repository Files
Name Social Security Number Repository Score(s) Pulled File ID
Credit History
Summary
Number of Accounts Number of Open Accounts Number of Delinquent Accounts Credit Limit High Credit Past Due Payment Balance
33 26 0 $89,200 $74,682 $0 $449 $15,893
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
CHASE
201 N Walnut Street Individual 10/2013 12/2013 12/2013A $5,499
Mailstop D Account Type Collateral Terms Reported On Manner of Payment
Wilmington, DE Open EQX-A1, TUC-A1, Current (O01)
19801 EXP-A1
800-955-9900 Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late Past Due Payment Balance
1 0 Times 0 Times 0 Times $0 $107 $5,379
Account Number
5258313135432079 120-149 Days Late 150+ Days Late
0 Times 0 Times
Comment
CREDIT CARD
Merge(3) Page 2 of 8
Applicant Applicant's SSN Co-Applicant Co-Applicant's SSN Loan Number Report ID
Nickie Green 123-00-3333 71486
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
BOA MBNA
400 Christiana Rd Individual 12/2012 12/2013 12/2013A $6,000
Newark, DE 19713 Account Type Collateral Terms Reported On Manner of Payment
Revolving EQX-A1, TUC-A1, Current (R01)
EXP-A1
Account Number Past Due Payment Balance
Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late
4681 12 0 Times 0 Times 0 Times $0 $15 $2,969
120-149 Days Late 150+ Days Late
0 Times 0 Times
Comment
CREDIT CARD
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
BK OF AMER
P.O. Box 7047 Individual 02/2012 12/2013 12/2013A $11,000
Dover, DE 19903 Account Type Collateral Terms Reported On Manner of Payment
800-759-6262 Revolving EQX-A1, TUC-A1, Current (R01)
EXP-A1
Account Number Past Due Payment Balance
Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late
599971422963 21 0 Times 0 Times 0 Times $0 $25 $1,377
120-149 Days Late 150+ Days Late
0 Times 0 Times
Comment
CREDIT CARD
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
GEMB/WALM
P.O. Box 103027 Individual 12/2007 12/2013 12/2013A $3,600
Roswell, GA 30076 Account Type Collateral Terms Reported On Manner of Payment
Revolving EQX-A1, TUC-A1, Current (R01)
EXP-A1
Account Number Past Due Payment Balance
Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late
714331456132 72 0 Times 0 Times 0 Times $0 $35 $832
120-149 Days Late 150+ Days Late
0 Times 0 Times
Comment
CHARGE
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
CAP 1 BANK
PO Box 85015 Individual 03/2011 12/2013 12/2013A $1,049
Richmond, VA 23285 Account Type Collateral Terms Reported On Manner of Payment
Revolving EQX-A1, TUC-A1, Current (R01)
EXP-A1
Account Number Past Due Payment Balance
Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late
628916340666 33 0 Times 0 Times 0 Times $0 $15 $302
120-149 Days Late 150+ Days Late
0 Times 0 Times
Comment
CREDIT CARD
Merge(3) Page 3 of 8
Applicant Applicant's SSN Co-Applicant Co-Applicant's SSN Loan Number Report ID
Nickie Green 123-00-3333 71486
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
BOA MBNA
400 Christiana Rd Authorized 08/2006 11/2013 11/2013A $18,400
Newark, DE 19713 User
Account Type Collateral Terms Reported On Manner of Payment
Revolving EQX-A1, TUC-A1, Current (R01)
Account Number EXP-A1
7134 Past Due Payment Balance
Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late
29 0 Times 0 Times 0 Times $0 $0
120-149 Days Late 150+ Days Late
0 Times 0 Times
Comment
CREDIT CARD
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
CITI
P.O. Box 6500 Individual 04/2011 11/2013 12/2013A $9,900
Sioux Falls, SD Account Type Collateral Terms Reported On Manner of Payment
57117 Revolving EQX-A1, TUC-A1, Current (R01)
EXP-A1
Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late Past Due Payment Balance
Account Number
31 0 Times 0 Times 0 Times $0 $0
653529182340
120-149 Days Late 150+ Days Late
0 Times 0 Times
Comment
CREDIT CARD
ECOA Opened Last Activity Paid Reported Credit Limit High Credit
CONSECO
Individual 07/2007 08/2008 07/2008 08/2008A $9,000 $9,010
Account Type Collateral Terms Reported On Manner of Payment
Account Number Revolving Charge Account TUC-A1, EXP-A1 Current (R01)
818561121133 Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late
Past Due Payment Balance
13 0 Times 0 Times 0 Times
120-149 Days Late 150+ Days Late
$0 $0
0 Times 0 Times
Comment
CLOSED
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
FST USA BK B
3 Christiana Authorized 09/2004 11/2004 07/2006 11/2007A $9,000 $52
Wilmington, DE User
19801 Account Type Collateral Terms Reported On Manner of Payment
302-594-4000 Revolving Credit Card TUC-A1, EXP-A1 Current (R01)
Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late Past Due Payment Balance
Account Number
8 0 Times 0 Times 0 Times $0 $0
552823979950
120-149 Days Late 150+ Days Late
0 Times 0 Times
Comment
ACCOUNT CLOSED BY CREDIT GRANTOR
Merge(3) Page 4 of 8
Applicant Applicant's SSN Co-Applicant Co-Applicant's SSN Loan Number Report ID
Nickie Green 123-00-3333 71486
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
GEMB/BANAN
P O Box 103014 Individual 01/2008 12/2013A $400
Roswell, GA 30076 Account Type Collateral Terms Reported On Manner of Payment
Revolving EQX-A1, TUC-A1, Current (R01)
EXP-A1
Account Number Past Due Payment Balance
Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late
712960112351 2 0 Times 0 Times 0 Times $0 $0
120-149 Days Late 150+ Days Late
0 Times 0 Times
Comment
CHARGE
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
GEMB/GAP
Branch C10t Individual 01/2008 09/2009 12/2013A $750
Shawnee Mission, Account Type Collateral Terms Reported On Manner of Payment
KS 66201 Revolving EQX-A1, EXP-A1 Current (R01)
Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late
Past Due Payment Balance
25 0 Times 0 Times 0 Times
Account Number
120-149 Days Late 150+ Days Late
$0 $0
712960610132
0 Times 0 Times
Comment
CHARGE
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
GEMB/JCP
PO Box 27570 Individual 08/2006 05/2012 12/2013A $1,000
Albuquerque, NM Account Type Collateral Terms Reported On Manner of Payment
87125 Revolving EQX-A1, TUC-A1, Current (R01)
EXP-A1
Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late Past Due Payment Balance
Account Number
88 0 Times 0 Times 0 Times $0 $0
-204749
120-149 Days Late 150+ Days Late
0 Times 0 Times
Comment
CHARGE
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
GEMB/OLD
Branch C11a Individual 02/2008 08/2013 12/2013A $1,100
Shawnee Mission, Account Type Collateral Terms Reported On Manner of Payment
KS 66201 Revolving EQX-A1, TUC-A1, Current (R01)
EXP-A1
Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late Past Due Payment Balance
Account Number
70 0 Times 0 Times 0 Times $0 $0
712960710155
120-149 Days Late 150+ Days Late
0 Times 0 Times
Comment
CHARGE
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
HSBC/BSTBY
1405 Foulk Road Individual 07/2009 10/2013 11/2013A $1,600
Wilmington, DE Account Type Collateral Terms Reported On Manner of Payment
19808 Revolving EQX-A1, TUC-A1, Current (R01)
302-425-3500 EXP-A1
Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late Past Due Payment Balance
Account Number
52 0 Times 0 Times 0 Times $0 $0
270712-2226730350
120-149 Days Late 150+ Days Late
0 Times 0 Times
Comment
CHARGE
Merge(3) Page 5 of 8
Applicant Applicant's SSN Co-Applicant Co-Applicant's SSN Loan Number Report ID
Nickie Green 123-00-3333 71486
ECOA Opened Last Activity Paid Reported Credit Limit High Credit
HUDSON UNT
4716 Broadway Joint 06/2009 03/2011 03/2011 09/2012A $9,012
Union City, NJ 07087 Account Type Collateral Terms Reported On Manner of Payment
Installment EQX-A1, TUC-A1, Current (I01)
EXP-A1
Account Number Past Due Payment Balance
Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late
71447611112 38 0 Times 0 Times 0 Times $0 $226 $0
120-149 Days Late 150+ Days Late
0 Times 0 Times
Comment
PAID ACCOUNT/ZERO BALANCE / SECURED
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
KOHL/CHASE
N56 W17000 Individual 07/2007 11/2009 10/2011A $1,500
Ridgewood Dr Account Type Collateral Terms Reported On Manner of Payment
Menomonee Falls, Revolving EQX-A1, TUC-A1, Current (R01)
WI 53051 EXP-A1
516-673-2387 Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late Past Due Payment Balance
46 0 Times 0 Times 0 Times $0 $0
Account Number
41329149663 120-149 Days Late 150+ Days Late
0 Times 0 Times
Comment
CREDIT CARD
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
MACYS
Individual 03/2008 02/2013 02/2013A $1,500 $521
Account Type Collateral Terms Reported On Manner of Payment
Account Number Revolving Revolving EXP-A1 Current (R01)
521320409 Charge Account
Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late Past Due Payment Balance
1 0 Times 0 Times 0 Times $0 $0
120-149 Days Late 150+ Days Late
0 Times 0 Times
Comment
Curr Acct
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
MACYSDSNB
911 Duke Blvd Individual 11/2005 06/2013 12/2013A $1,750
Mason, OH 45040 Account Type Collateral Terms Reported On Manner of Payment
Past Due Payment Balance
Revolving EQX-A1, EXP-A1 Current (R01)
Comment
$0 $0
Account Number CHARGE
5231552697131
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
MACYSDSNB
911 Duke Blvd Individual 03/2008 09/2012 12/2013A $1,500
Mason, OH 45040 Account Type Collateral Terms Reported On Manner of Payment
Revolving EQX-A1, TUC-A1, Current (R01)
EXP-A1
Account Number Past Due Payment Balance
Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late
5213204094731 68 0 Times 0 Times 0 Times $0 $0
120-149 Days Late 150+ Days Late
0 Times 0 Times
Comment
CHARGE
Merge(3) Page 6 of 8
Applicant Applicant's SSN Co-Applicant Co-Applicant's SSN Loan Number Report ID
Nickie Green 123-00-3333 71486
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
PEOPLE CC
Joint 01/2005 06/2013 12/2013A $1,900
Account Type Collateral Terms Reported On Manner of Payment
Account Number Revolving EQX-A1, TUC-A1, Current (R01)
6656252114350494 EXP-A1
Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late Past Due Payment Balance
24 0 Times 0 Times 0 Times $0 $0
120-149 Days Late 150+ Days Late
0 Times 0 Times
Comment
CREDIT CARD
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
PEOPLES
Individual 01/2009 09/2009 09/2009 09/2009A $3,000
BANK
211 State St Account Type Collateral Terms Reported On Manner of Payment
Bridgeport, CT 06604 Installment Unsecured 24 Months TUC-A1, EXP-A1 Current (I01)
Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late
Past Due Payment Balance
9 0 Times 0 Times 0 Times
Account Number
120-149 Days Late 150+ Days Late
$0 $144 $0
251126750731112
0 Times 0 Times
Comment
CLOSED / IAM062402
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
PEOPLES
Individual 12/2004 09/2006 02/2007A $14,300
BANK
211 State St Account Type Collateral Terms Reported On Manner of Payment
Bridgeport, CT 06604 Installment Secured TUC-A1, EXP-A1 Current (I01) Past Due Payment Balance
Comment $0 $188 $0
CLOSED
Account Number
251122006721112
ECOA Opened Last Activity Paid Reported Credit Limit High Credit
PSB/PL
899 Main St Individual 02/2013 06/2013 06/2013 06/2013A $4,000
Bridgeport, CT 06604 Account Type Collateral Terms Reported On Manner of Payment
203-338-7171 Installment EQX-A1, TUC-A1, Current (I01)
EXP-A1
Account Number Past Due Payment Balance
Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late
251104497391112 4 0 Times 0 Times 0 Times $0 $136 $0
120-149 Days Late 150+ Days Late
0 Times 0 Times
Comment
PAID ACCOUNT/ZERO BALANCE / UNSECURED
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
RBS NB CC
1000 Lafayette Blvd Joint 01/2005 06/2013 11/2013A $1,900
Bridgeport, CT 06604 Account Type Collateral Terms Reported On Manner of Payment
203-551-3548 Revolving EQX-A1 Current (R01)
Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late
Account Number Past Due Payment Balance
97 0 Times 0 Times 0 Times
549943121171 $0 $0
120-149 Days Late 150+ Days Late
0 Times 0 Times
Comment
CREDIT CARD
ECOA Opened Last Activity Paid Reported Credit Limit High Credit
SCA/AEROPST
Individual 08/2008 02/2009 02/2009 02/2009A $700 $60
L
1000 Macarthur Bv Account Type Collateral Terms Reported On Manner of Payment
Mahwah, NJ 07430 Revolving Charge Account TUC-A1, EXP-A1 Current (R01)
Past Due Payment Balance
201-818-4000 Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late
6 0 Times 0 Times 0 Times $0 $0
Account Number
120-149 Days Late 150+ Days Late
943112911196
0 Times 0 Times
Merge(3) Page 7 of 8
Applicant Applicant's SSN Co-Applicant Co-Applicant's SSN Loan Number Report ID
Nickie Green 123-00-3333 71486
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
WFNNB/EXP
220 W Schrock Rd
Westerville, OH
Individual
Account Type
01/2007
Collateral
10/2011
Terms Reported On
10/2011A
Maximum Manner of Payment
$680 *
43081 Delinquency
Revolving EQX-A1, Current (R01)
614-523-5017 TUC-A1, 07/2010,
EXP-A1 30-59
Account Number Days Late
Past Due Payment Balance
206624507894741 Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late
57 1 Time 0 Times 0 Times $0 $0
07/2010
120-149 Days Late 150+ Days Late
0 Times 0 Times
Comment
CHARGE
ECOA Opened Last Activity Closed Reported Credit Limit High Credit
WM FILENE
426 Washington St Individual 11/2005 05/2013 06/2013A $560
Boston, MA 02101 Account Type Collateral Terms Reported On Manner of Payment
617-357-2100 Revolving EQX-A1, TUC-A1, Current (R01)
EXP-A1
Account Number Past Due Payment Balance
Months Reviewed 30-59 Days Late 60-89 Days Late 90-119 Days Late
22800 90 0 Times 0 Times 0 Times $0 $0
120-149 Days Late 150+ Days Late
0 Times 0 Times
Comment
ACCOUNT TRANSFERRED OR SOLD / CHARGE
Public Records
THE REPORTING BUREAU CERTIFIES THAT: public records have been checked for judgements, foreclosures, bankruptcies, tax liens, and other legal actions involving the subject(s) were obtained directly through
the repositories used, or by direct searches, or a public records search firm other than the repository, or by all methods with the following results:
PUBLIC RECORDS LEARNED: NONE
Inquiries
Date Name Subscriber Code Reported On ECOA
File Summary
Historical Late Payments
Account Type Number of Accounts Open Accounts Accounts Currently Past Due Past Due Payment Balance Accounts 30 Days 60 Days 90+ Days
Mortgage 0 0 0 $0 $0 $0 0 0 0 0
Installment 5 0 0 $0 $0 $0 1 5 5 0
Revolving/Credit Line 28 26 0 $0 $449 $15,893 2 3 0 0
Totals 33 26 0 $0 $449 $15,893 3 8 5 0
Number of Public Records: 0 Available Credit: $87,595
Number of Collections/Charge-offs: 0 Revolving/Credit Line Used: 15%
Bankruptcy: No Number of Inquiries: 4
Number of Authorized User Accounts: 2
Repository Files Returned
File ID Name Current Address, Reported: 08/01/2009 Current Employer
TransUnion / TUC-A1 Nickie C. Green 100 Terrace St Centes Package Store, Reported:2005,
West Haven, CT 06516 Bridgeport, Ct
Social Security Number
Pulled
123-00-3333 Former Address, Reported: 09/01/2004
01/20/2014 45 Maple St
Age / DOB N Haven, CT 06511
Infile Date 07/24/1978
07/01/1997
This completed Credit Report includes all applicable Legislative Cost Recovery Fees from the respective credit repositories associated with the federal Fair and Accurate Credit Transactions Act of
2003 (FACT Act).
End of Report
Credit Score Disclosure
AVANTUS LLC SAMPLE CUSTOMER Applicant Report ID Date
600 Saw Mill Rd Nickie Green 71486 03/25/2014
West Haven, CT 06516 100 Terrace Av Repositories Requested
West Haven, CT 06516 TransUnion, Experian, Equifax
The credit score is a computer generated summary calculated at the time of the request and based on information that a consumer reporting
agency or lender has on file. The scores are based on data about your credit history and payment patterns. Credit scores are important
because they are used to assist the lender in determining whether you will obtain a loan. They may also be used to determine what interest
rate you may be offered on the mortgage. Credit scores can change over time, depending on your conduct, how your credit history and
payment patterns change, and how credit scoring technologies change.
Because the score is based on information in your credit history, it is very important that you review the credit-related information that is being
furnished to make sure it is accurate. Credit records may vary from one company to another.
If you have questions about your credit score or the credit information that is furnished to you, contact the consumer reporting agency at the
address and telephone number provided with this notice, or contact the lender, if the lender developed or generated the credit score. The
consumer reporting agency plays no part in the decision to take any action on the loan application and is unable to provide you with specific
reasons for the decision on a loan application.
If you have any questions concerning the terms of the loan, contact the lender."
For information on FICO scores, please contact the developer, Fair Isaac Corporation, at www.myfico.com or 1-800-777-2066.
Questions regarding your credit report should be directed to TRANSUNION, EXPERIAN or EQUIFAX. You will find their contact
information below:
TransUnion Experian Equifax
P. O. Box 1000 P. O. Box 2002 P. O. Box 740241
Chester, PA 19022 Allen, TX 75013 Atlanta, GA 30374
800-888-4213 888-397-3742 800-685-1111
www.transunion.com www.experian.com www.equifax.com/fcra
Credit Score Information
Score Name Repository Model Developed By Range Calculated Reported On
Nickie C. Green Experian Fair Isaac (v2) Fair Isaac 300-850 01/20/2014 EXP-A1
Factors (18, 10, 08, 05)
732 • Number of accounts delinquent.
• Proportion of balance to high credit on bank revolving or all revolving accounts.
• Number of recent inquiries.
• Number of accounts with balances.
Score Name Repository Model Developed By Range Calculated Reported On
Nickie C. Green Equifax Beacon 5.0 Fair Isaac 300-850 01/20/2014 EQX-A1
Factors (30, 18, 23, 5)
734 • Time since most recent account opening is too short
• Number of accounts with delinquency
• Number of bank or national revolving accounts with balances
• Too many accounts with balances
• Score value was adversely affected by credit inquiries present in the credit file.
Score Name Repository Model Developed By Range Calculated Reported On
Nickie C. Green TransUnion FICO Risk Score, Classic (04) Fair Isaac 250-900 01/20/2014 TUC-A1
Factors (018, 030, 012, 010)
730 • Number of accounts with delinquency
• Time since most recent account opening is too short
• Length of time revolving accounts have been established
• Proportion of balances to credit limits is too high on bank revolving or other revolving accounts
• Score value was adversely affected by credit inquiries present in the credit file.
Your credit score can change, depending on how your credit history changes.
How we use your Your credit score can affect whether you can get a loan and how much you will have to pay
credit score for that loan.
The range of Scores range from a low of 300 to a high of 850.
scores
Generally, the higher your score, the more likely you are to be offered better credit terms.
How your score Your credit score ranks higher than 53 percent of U.S. consumers.
compares to the
scores of other
consumers
By mail: Mail your completed Annual Credit Report Request Form (which
you can obtain from the Federal Trade Commission's web site at
http://www.ftc.gov/bcp/conline/include/requestformfinal.pdf) to:
Dear Consumer:
We have prepared a Mortgage Report at the request of your mortgage lender/broker listed below.
This report contains information obtained from one or more of the three major credit bureaus.
To proceed with the mortgage process, you must provide your mortgage lender/broker with a brief
written explanation concerning any current or prior late payments, collections, public record items,
inquiries and possible previous address(es).
If the item in question is an inquiry, this indicates a credit grantor has recently obtained a copy of
your credit report. Please explain the purpose of the inquiry. For example, if you have opened a
new account, if you attempted to open an account but credit was denied, or if the inquiry was for
employment purposes, please explain.
Space for your explanation is provided below each item. If additional space is needed, please
use the reverse side of this letter.
CREDIT ACCOUNT:
Credit Account: FUSA NA Type: Revolving
Account Number: 652822780931 Owner: Borrower
Balance: $0(as of 08-2011) Months reviewed: 68
Account Opened: 12-2005 Times 30 days late: 2
Current Status: CURRENT Times 60 days late: 0
Comment: Times 90+ days late: 0
PAID ACCOUNT/ZERO BALANCE Max Delinquent date: 07-2010
ACCOUNT CLOSED BY CREDIT GRANTOR
Account was 30-59 days late on: 03-2010, 02-2010, 01-2010, 11-2009,
09-2009
Account was 60-89 days late on: 05-2010, 04-2010, 12-2009, 10-2009,
08-2009
Explanation:
INQUIRIES:
Subscriber Date Explanation
CIBMS 01-02-2014
CBD 12-19-2013
CBOFDELMAR 12-19-2013
AVANTUS
600 SAW MILL RD., WEST HAVEN, CT 06516
Tel.: 203-931-2050
Applicant Date
Co-Applicant Date
Form Approved
Social Security Administration OMB No. 0960-0760
I want this information released because I am conducting the following business transaction:
I authorize the Social Security Administration to verity my name and SSN to the Company and/or the
Company's Agent, if applicable, for the purpose I identified.
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
City/State/Zip
Phone Number
Form SSA-89 (06-2013)
Privacy Act Statement
SSA is authorized to collect the information on this form under Sections 205 and 1106 of the Social
Security Act and the Privacy Act of 1974 (5 U.S.C. § 552a). We need this information to provide the
verification of your name and SSN to the Company and/or the Company's Agent named on this form.
Giving us this information is voluntary. However, we cannot honor your request to release this
information without your consent. SSA may also use the information we collect on this form for such
purposes authorized by law, including to ensure the Company and/or Company's Agent's appropriate
use of the SSN verification service.
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
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 "Order a Return or Account Transcript" 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. number, or employer identification number (see instructions)
Nickie Green 123-00-3333
2a If a joint return, enter spouse's name shown on tax return. 2b Second social security number or individual taxpayer
identification number if joint tax return
3 Current name, address (including apt., room, or suite no.), city, state, and ZIP code (see instructions)
100 Terrace Av, West Haven, CT 06516
4 Previous address shown on the last return filed if different from line 3 (see instructions)
5 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.
Avantus LLC, 600 Saw Mill Road, West Haven, CT 06516, 800-243-0120, ID=AvantusTRV
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 IRS transcript to the third party listed
on line 5, 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.
a Return Transcript, which includes most of the line items of a tax return as filed with the IRS. A tax return 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 1120A, Form 1120H, Form 1120L, 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
b Account Transcript, which contains information on the 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
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 spearately.
Check this box if you have notified the IRS or the IRS has notified you that one of the years for which you are requesting a transcript
involved identity thefton your federal tax return
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, partner, gardian, 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. For transcripts being sent to a third party, this form must be received within 120 days of the signature date.