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Th�rd Pa Authorizotion and reement to Releose <br /> THIS FORM IS REQUIRED IF YOU WAN'T LfS TO ANYONE OTHER THAN YOURSEEF R�GARDING YOUR ACCOUNT THIS INCLUDES <br /> SPOUSES NOT ON THE MOR7GAGE NOi'E,CONTRqCTpRS,qpJUS7ERS QR ADJUSTING COMPANY OR LAWyER FIRM RELATED TQ <br /> YOUR fNSURANCE CLqIM PAYMENT, <br /> LOAN NUMBER: oo�160 9 2 �6-- '�i� <br /> Name �11'(�C� ' �f��_ �C3��t 1�°L�� <br /> SOCIAL SECUftITY#: �. <br /> PROPEItTY ADDRESS: � � � �1� �` � r <br /> � �J�f 2 <br /> For the purpose of insurance claim payment inforn,atron and any other inforrnatior���n,���o hereby authorize <br /> �, . � (my lender mo <br /> � r�a8e servicer)to release or otherwise provide to <br /> IRISI.�Yp!GqN1EZ from Ca�ro Cnnser„�n and[�)oament.INC. <br /> 813 885-48�'1 <br /> Name CornPan'V Name(if applirabF� <br /> � Phone Nurnber <br /> Public and non-public persona�finax;a� ir�{�r�ation contained in my loan aaount which may include, but is not limited <br /> to:loan balances,final payaff statements,loan status,insurance informat;cn,claim payment inforniat;on and/or property <br /> information. <br /> We the iender/mortgage sen,;cer� v,,;��take rea�nable steps to�ver;fy the ident�ty of the 3'" <br /> wiN have no responsibility or i'�ability to verify the true idenY�ty of t�e requestor when he/she as�k discuss my account or <br /> seeks mfonnation about my account. No shatl we, the lendec/mo <br /> what the requestor may do w;th the;nfvrmat;on he/she obtains co cern ng my���urn any responsibility or liability for - <br /> I do hereby indemnify and for�.wer hoid harmless the lender/mo <br /> suits, claims, attorneys fees, derr,ands again the ienders mo �e �N���' frQ'n afi actions and causes of actions, <br /> from the lender/mortgage servicer discussing my �oa� account an%ri providing anytl/�rm t on conceman resulting <br /> account to the above named requestor of person identifying themsehres td be that requestor, g mY ��n <br /> If you agree to this Authorization and the terms of the Release as stated above,please si�n and date below and <br /> include it with your completed fin�ncial form. <br /> Note: No information conceming you�actount can or will be provided until we have received this executed <br /> document.A!1������e mort000e must sina. <br /> � G'� a��.�A l��►i�7 � � � �►�.�z 0 /2 <br /> Printed Customer Name � <br /> Customer Signature Date <br /> Printed Customer Name <br /> tustomer Signature Da#e <br />