Proof of Claim: Official Form 410
Proof of Claim: Official Form 410
Proof of Claim: Official Form 410
---------------------------------
Fill in this information to identify the case:
Debtor 2
(Spouse, if filing)
Read the instructions before filling out this form. This form is for making a claim for payment in a bankruptcy case. Do not use this form to
make a request for payment of an administrative expense. Make such a request according to 11 U.S.C. § 503.
Filers must leave out or redact information that is entitled to privacy on this form or on any attached documents . Attach redacted copies of any
documents that support the claim , such as promissory notes , purchase orders, invoices, itemized statements of running accounts , contracts, judgments,
mortgages, and security agreements. Do not send original documents; they may be destroyed after scanning. If the documents are not available,
explain in an attachment.
A person who files a fraudulent claim could be fined up to $500,000 , imprisoned for up to 5 years, or both . 18 U.S.C. §§ 152, 157, and 3571.
Fill in all the information about the claim as of the date the case was filed. That date is on the notice of bankruptcy (Form 309) that you received.
3. Where should notices Where should notices to the creditor be sent? Where should payments to the creditor be sent? (if
and payments to the different)
creditor be sent?
Bank of America , NA Bank of America , NA
Federal Rule of Name Name
Bankruptcy Procedure
(FRBP) 2002(g) PO BOX31785 PO Box 15312
Number Street Number Street
Uniform claim identifier for electronic payments in chapter 13 (if you use one):
------------------------
• :.r. • w...- Give Information About the Claim as of the Date the Case Was Filed
7. How much is the claim? $_ _ _ _ _ _ _ _ _ _ 3 . Does this amount include interest or other charges?
59_,2_8_8_.9_
Q No
la Yes. Attach statement itemizing interest, fees , expenses , or other
charges required by Bankruptcy Rule 3001(c)(2)(A).
8. What is the basis of the Examples: Goods sold , money loaned , lease, services performed , personal injury or wrongful death , or credit card .
claim?
Attach redacted copies of any documents supporting the claim required by Bankruptcy Rule 3001 (c).
Limit disclosing information that is entitled to privacy, such as health care information .
Money Loaned
Nature of property:
IQ Real estate. If the claim is secured by the debtor's principal residence , file a Mortgage Proof of Claim
Attachment (Official Form 410-A) with this Proof of Claim.
Iii Motor vehicle
[QI Other. Describe:
Attach redacted copies of documents, if any, that show evidence of perfection of a security interest (for
example , a mortgage , lien , certificate of title , financing statement, or other document that shows the lien has
been filed or recorded.)
Value of property: $_ _ _ _ _ _ _ _
Amount of the claim that is unsecured: $_ _ _ _ _ _ _ _ (The sum of the secured and unsecured
amounts should match the amount in line 7.)
Ill Fixed
[QI Variable
A claim may be partly [g Domestic support obligations (including alimony and child support) under
$_ _ _ _ _ _ __
priority and partly 11 U.S.C. § 507(a)(1 )(A) or (a)(1 )(B).
nonpriority. For example,
in some categories , the IQ] Up to $3,025* of deposits toward purchase , lease, or rental of property or services for
personal, family, or household use. 11 U.S.C. § 507(a)(7). $_ _ _ _ _ _ _ _ _
law limits the amount
entitled to priority.
[g Wages, salaries, or commissions (up to $13,650*) earned within 180 days before the
bankruptcy petition is filed or the debtor's business ends, whichever is earlier. $_ _ _ _ _ _ _ _ _
11 U.S.C. § 507(a)(4).
* Amounts are subject to adjustment on 4/01 /22 and every 3 years after that for cases begun on or after the date of adjustment.
Sign Below
Print the name of the person who is completing and signing this claim:
Addison , TX 75001
City State ZIP Code
USED 201 B
Ml:,FICEDES-BENZ
813 NIA
□ . .. . .
Personal, "41'1\ily; qr househQI~ unless
.,....,ness
other,vise ln(!lcated'.betov,,
. .
WDDUQ7JB4GA233265
D .agnou,tu~I O ...Nl=A~.....- - -
You agree that we advised you whether, based on seller's knowledge, ttie :vehicte was titled, registered, or used.as a.taxicab, police vefilcle,.shott terrn rental
a vehicle that Is rebuilt or assembled from parts, -a kit car, ·a replica, a flood vehicle, or a manufacturer buy back.
or is
FEDERAL TRUTH-IN~LENDING ·DISCLOSURES WARRAtfflES·SELLER DISCLAIMS
ANNUAL FINANCE Amount Total of Total Sale un·1ess the Seller makes a w,1tten warranty, or
PERCENTAGE CHARGE Financed Payments Price
RATE The dollar The amount of The amount yqu The total cost·of enters Into a service ;contract within 90 days
The cost of amount the credit provided will have paid.after your·pu.rchase on from the·date ofthls ~ontract, the·SeUer makes
your credit as credit Will to you or you have made all oritcllt, Including· ;no warranties, express or lmpll~, on ~e
a yearly rate. oost you. on your behalf. payments as your down vehicle, 111d t!ttre wlll be .no .lmplled warranties
scheduled, payment of
'$ _ 9800~00 18
of merchantabllltj or of fitness for. a par11cular
6.31 · % $ 14602.00 $ 86588~60 $ 101190.60 $; 110990,60
purpose.
This provision does not aff~t any warranties
Your Payment Schedule WIii Be: (e)means an esitmatl3 oovenng the vehicle toat the vehicle manufacturer
Number of Amount of When Payments may-provide.
Pavments Pavments Are Due
Monthly beginning 1Relumad Payment a.gt.,~mtdledl qrolher,paymentl_nstrumentyou
60 1686.51 glite iii !s ·dlshanarad or any tllidronlc payment ·you make Is returned
1
HOW THI_S CONTRACT CAN B~ CHANGED. This oontracl oontains ~-;:~..,,.:._/t belween;you and.us rela~ng lo 11his·oontrac1. Any change to !hii,oontract 111U$l beJn·.wrjm,g and we
· must sign It. No oral changes are binding. Buyer Slgns'A ~ .' Co-Buyer Signs ,,.,,X,..._____Nl:..:::.::.A.___ _ _ __
If any part of this contractls not valid, all.olh&r parts stay valid. We may delay or refrain from enforclng:ariy'Of our rights Linder !his oontract wllhoµt l,OSing 'them. For example, we may
extend the time for making some. payments without extending the time for making others. · ··- . ·
See the.restoUbls contract for other Important agreements.
/
Buyer Signs~~.:.--=·==,c_--'_ _ _ _ _ Co-Buyer SignsX _ _ _N/_·___ :02/1412019, 04:2' pm
A_____ LAW 553-FL-AR&,eps '5/14 )it Page 1 of 6
Case 20-22398-MAM Claim 1-1 Part 2 Filed 11/17/20 Page 2 of 8
ITEMIZATION OF AMOUNT FINANCED Used Car Buyers Guide, The infor0
1 C8sh Prlce (Including $ NIA sales ta,) $ 95829.00 11 I matlon you see on the window form for-
2 Total llowr!>ayment • this vehicle Is part of this contract.
Gross Tmde-ln Alowance $ 185000.00 Information on the window fotm
Less Pay Off Made By S~ler (e) s 176200.00 overrides any contrary provisions in the
contract of sale.
Equals Net Tmde In $ 8800.00 Spanish Translation: Gui, para
+Cash $ 1000.00 compradoras de vehlculos uaados. La
+Oll1er NIA $ WA lnformacl6n que ve en el formulario de
(If lotal down~yment 19 negative, enter "O" and sae 4J below) $ 9800.00 (2) la ventanllla para este vehlcu lo form a
3 Unpaid Balance of cash Price (1 minus 2) $ 86029.00 (3) parte del presente contrato. La
4 Other Charges Including Amounts Pold to Others on YOLK Bohall lnformacl6n del formularlo de la
(Soller may keep pan of !hose amounts):
ventanllla. · deja sin efecto toda
dlsposlcl6n en contr11rio contenlda en
- A Cost of Optional Credit Insurance Paid to Insurance el contrato de venta.
Company or Companies.
Life f N/A OPTIONAL SERVICE CONTRACTS
Dlsablll!x I N/A $ NIA You are not required to buy a service
B Vendor's Single lntarest 1.;.,mnce Paid to lnsumnce Com!!!!~ NIA contract to obtain credit. Your choice of
$
C Other Ootlonel lnsumnce·Pald to Insurance Coml!!!n~ or Co!!!!!!!nles service contract providers for anh service
$ NIA contracts you buy will not a eel our
D Qm!!!nal ~ Conlracl $ NIA decision to sell or extend credit to you.
E Official Fees Paid to Government Agendes $ NIA
F Govenvnent Documen!!!): Sta!!);! Taxes $ 303.10 REJECTION OR REVOCATION
a Government Taxes Not Included In Cash Prloe $ NIA If you are permitted under Florida's
H Government Llcensa andlor Reglslrallon Fees Uniform Commercial Code to reject or
TIRE FEE I 5.00 BAJI EEE I 1.50 LIC REG I 250,00 256,50 revoke acceptance of the vehicle and you
$ claim a security interest in the vehicle
I Government Cer!lflcattiof Tl1le Fees $ WA because of this, you must either: (a) post a
J Other Charges (~ler must Identify who 19 paid end bond in the amount of the disputed
descrlbe l}:UrDOS8) balance; or {b) deposit all Installment
ION/A for Pmr Credft or Lease Balance l•I $ WA payments as they become due into the
fi>NTA lor NIA $ NIA registry of a court of competentjurisdiction.
l)N/A for NIA $ NIA
for !flt,
SERVICING AND COLLECTION CONTACTS
ION/A $ WA You agree that we may try to contact you
totttA for !!IA $ l'.llA in writing, by e-mail, or using pre-
toN/A for NIA $ NIA recorded/artificial voice messages, text
lOtflA for ti/A $' ~IA messages, and automatic telephone dialing .
IO!!£A for'N/A $ WA systems, as the law allows. You also agree
toutA for !flt, that we may try to contact you in these and
$ ~IA other ways at any address or telephone
ION/A lor !!/A $ NIA
number you provide us, even if the
Tol!I Other Chames and Amounts Pold to Olhe[! on Yo11 Behall $ 559.60 (4) telephone number is a cell phone number
5 ,Loan Prooesslng.Fee Paid to Seller (Prepaid Finance Charge) $ o.oo (5) or the contact results in a charge to you.
6 .Amount Financed 13 ~us 4l $ 86588:60 (6)
APPLICABLE LAW
OPTION: D You pay no finance charge ff the Amount Financed, Item 6, Is paid In full on or before Federal law and the law of the state of our
address shown on page 1 of this contract
NIA 1 Year, NIA • SELLER'$ INITIALS NIA apply to this contract.
OPTIONAL GAi' CONTRACT, A gap contract (debt cancellation contract) Is nol'requlred to obtain credit and wlll not be provided unless you sign below and agree
to pay the extra charge. If you choose to buy a gap contract, the charge le ehown In Item 4D of the Itemization of Amount FlnBl'lced ..See your gap contract for
details on the tenns and conditions It provides. It Is a part of this contract. •- ·
Agreement to A r b ~ l n g below, you agree that, pursuant to the Arbitration Provision on page 6 of-this contract, you or we may elect to resolve any
dispute by~~ , ~~n and not by a court action. See the Arbitration Provision for additional information concerning the agreement to arbilrate.
Buyer Sign
- --- -
Buyer Signs)<
· ·
-...;:-
Co-Buyer Signs X
required by this contract (see 2.d.) during any extension. If you do not payment as shown on page 1 cl this contract. Acceptance of a late
have this insurance, we may buy It and charge you for it as this contract payment or late charge ·does, n.ot excuse your ilate paynienl'ormean
says. You may extend the term of any optional insurance you bought that you may keep making late payments.
with this contract to cover the extension if the insurance company or tt;yourpay late, we,may ai!!(I take the,steps described below.
your insurance contract permits it, and you pay the charge for b. You may have .IQ pay all yo11 owe ai once. If you break your
extending this Insurance. promises (default), we.may demand:thal you,pa:y·all·.you owe on this
If you get a payment extension, you will pay additionalflnance charges contract at once;,,"Default,means:
at the Base Rate on the amount extended during the extension. You will You•c!o:not,pay anfpayment.on time;
also pay any, addltional Insurance charges resulting from'lhe extension, , You.give f!ll$e, Incomplete, or misleading lhformatton on a credit
and the $15 extension fee If we charge you this fee. app!cattonr
You start a proceeding In liahkl'IJptcy or one Is starte.d against
0
□ WA · Type of Insurance
WA
Tonn
Premium$ NIA
Insurance Company-NBiTie &-Address ·
WA
□ WA
Type of lneurence
WA.
Term
Premium$ WA
Insurance Company Name & Address
l.1/A
□ WA :rype of lneurence
NIA
Term
Premium$ WA
Insurance Company Name & Address
WA
Other optional lnsurenos ls.riot required to obtain crsdlt. Your aeolslon lo buy or not buy olhor optional lnsursnce wiH not be a factor In the crsdil approval process. ii will not be provided unlsss you sign
and ai,ee to pay theeXlra cost. · " ·
!·want the Insurance checked above.
X~ ~ X -~ ~
Buyer Signature Date Co-Buyer Signature Dela
LIABILITY INSURANCE COVERAGE FOR BODILY INJURY AND PROPERTY DAMAGE CAUSED TO OTHERS IS NOT INCLUDED IN THIS CONmACT.
□ VENDOR'S SINGLE INTEREST INSURANCE (VSI Insurance): If the preceding box Is checked, the Creditor requires VSI Insurance for the Initial term of the contract to
protect the,Credltor for loss or damage-to lhevehicle (collision, fire, theft). VSI Insurance Is for the Creditor's sole protection. This Insurance does not protect your Interest in the
vehicle. You may cha- the Insurance company through which the VSI Insurance Is obtained. tt. you elect to purchase VSI Insurance through lhe Creditor, the cast al
this Insurance Is $ NIA and Is also shown In item 4B of the llemlzatton ol Amount Financed. The coverage Is for the Initial term of the contract.
You authorize us to purchase Vendor's or Lendefs Sing le Interest Insurance,
02/1412019, 04:25 pm
BuyerSlgnsC-S Co-Buyer Signs X _ _ __,W=A::.....___ LAW 553-FL-ARB-sps 5/14 vi Page 3 of 6
Case 20-22398-MAM Claim 1-1 Part 2 Filed 11/17/20 Page 5 of 8
d. We may take the vehicle from you. If you defauli we may take We will apply the money from the sale, less aDowed expenses, to the .
(repossess) the vehicle from you tt we do so peacefully and the law amount you owe, Allowed expenses are eJ!P811S8s we pay as a direct
allows it. If your vehicle has an electronic tracking device, you agree that · result oi taking the•vehlck!: holding It, preparing it for sale, and selling it
· we may use the de.vice to find the vehicle. If we take the vehicle, any Attotney fees and court costs the law pernilis are also ailowed expenses.
aocessories, equipme~ and replacement parts will stay with the If any money is left (surplus), we will pay itto you unlessthe.law requires
vehicle. Hany personal items are in the vehicle, we may store them for us to pay it to som'10rle,else,,H money from the sale is not enough to pay
you at your expense. Jf you do not ask for these Items back, we may •. the amount you owe, you must pay the rest to us. If you do not pay this
dispose of them as .the law.altows. amount when we ask, we may charge you Interest at·a raie not exceeding
e. How you can get the vehicle back If we take H. If we repossess the lhe highest lawful tale until YO\l,pay,
vehicle, you may pay to get it back (redeem). We will tell you how much. g, What we may do about optlonal1 lnaurence, maintenance, service, or
to pay to redeem. Your right to redeem ends when we sell the vehicle. other contracts. This contract may contain charges for 'optional
f. Wewlll sellthevehlcle If you do notgetHback. lfyoudo not redeem, Insurance, maintenance, service, .or other contracts. tt we demand that
we will sell the vehicle. We will send you a written notice of sale before you pay all you owe at once orwe repossess•the vehicle, we may claim
semng the vehicle. benefits under these contracts and cancel them to obtain refunds of
unearned charges to recjuce what _you owe or repair·the vehicle. If the
vehicle is a total'loss because i\:ls confiscated, damaged, or.stolen, we
may claim benefits under these contracts and cancel them. to obtain
refunds:of unearned charges to reduce what you owe.
Setler's,Rlght to cancel . . ,.
a. Seller agrees to deliver the vehicle to you on the date this contract Is signed by Seller and you. You . .
urideratand that.ft mayt$8·a few days
for Seller to verify your credit, locate flrianclng for you on the exact terms·show'n on page 1 of this contract,
and assign this Contract to a
flnanclel lnsUtutlon. You agree that Seller has the number of,~• Slated on page 1 of this contract to:asstgn
this contract. You.agree that
II Seller Is unable to aaalgn this contract within this time period to any one of the flhanclal lnBllbJtlons
with whom .Seller regularly does •
business under an assignment acceptable to Seller, Seller may cancel. this contract. .Seller's right ,to
cancel this contract ends upon
assignment of this contract. ·
b. If Seller elects to cancel per Paragraph a above, Seller will give you written notice (or In any other manner
In .which actual notice ·is given
to you). In that event, you may have the option or negotiating a.nd signing a new Contract with different
financing ierms (!or-example,. a
larger down payment, a higher annual percentage rate, a requited cosigner, etc.) or you may pay wHh alternate
c. Upon receipt of the notice of cancellation, you mUBI return the vehlcle to Seller within 48 hours In the funds arranged by you.
same. condition ,as when SOid other
than reasonable wear for the Ume you had It Except as descr.lbed below, Seller must give .you back all conskleraU
from you In connection with this contract. on Seller has.received
d. II you do not return the vehicle within 48 hours alter receipt of the notice of cancellitlon, you.agree
that Seller may use:any lawful means
to take II back (Including repossession II done peacefully) and you will be llable fQf·tll expenses Incurred
by Seller In taking .the vehicle
from you, Including reasonable attorney's f"'- II you fall to return the vehlcle wHhln 48 hour11aftei' recelptof
the riotlca·of.cancellatlon,
you agree to pay Seller the charge shown In the Sellar's Right to,cancel provision on page to! this contract
the vehicle altar receipt of the notice of cencellatlon. for each day you do not return
e. Whlle the vehicle Is In your posse1Slon, all terms of this Contract; Including those-relating to use.of
the vehicle
vehicle, are In full force and you aaaume all risk of loss or damage tq the vehicle•. You must pay all reasonalile .and lnsu11111ce for the
damage done to the vehicle Vlhllethe vehicle ls In your possession. Seller may deduct from any considera , costs for repair of any
tion due to you under paragraph
c. above Seller's reasonable costs to repair the vehicle and any dally chaiges you Incur lfiyou fall to re)urn
tile
receipt of the notice or cancellatlon. If Seller cancels this contract, the terms of this Seller's Right to cancel. vehl~i•.IY!thln 48 hours after
page 1 of this contract) rernaln In effect even after you no longer have possession of the vehlcle. provision ~l'icludlng those on
Buyer S i g n ~ ~
02/1412019, 04:25 pm
Co-Buyer Signs X _ _ _Nl~A ~--- LAW 553'FL-Alil8-eps 5/1il·v1 Page 5 of 6
Case 20-22398-MAM Claim 1-1 Part 2 Filed 11/17/20 Page 6 of 8
ARBITRATION PROVISION
PLEASE REVIEW - IMPORTANT• AFFECTS YOUR LEGAL RIGHTS
1. EITHER YOU ORWE MAY CHOOSE TO HAVE ANY DISPUTE BETWEEN US DECIDED BY ARBITRATION AND NOT IN COURT OR BY JURYTRIAL
2. IF A DISPUTE IS ARBITRATED, YOU WILL GIVE UP YOUR RIGHTTO PARTICIPATE AS A CLASS REPRESENTATIVE OR CLASS MEMBER ON ANY Cl.ASS CLAIM
YOU.MAY HAVE.AGAINST US INCLUDING ANY RIGHT TO CLASS ARBITRATION OR ANY CONSOLIDATION OF INDIVIDUAL ARBITRATIONS. '
3. DISCOVERY AND RIGHTS TO APPEAL IN ARBITRATION ARE GENERALLY MORE LIMITED THAN IN ALAWSUIT,ANDOTHER RIGHTSTHATYOU AND WE WOULD
HAVE IN COURT MAY NOT BE AVAILABLE IN ARBITRATION.
Any claim or dispute, whether in. contract, tort, statute or otherwise (including the lnterpre.tation and scope of this Ar!Jlt.ration Provision, and the.arbitrabiilty of the
claim or dispute), between you and us or our employees, agents, successors or assigns, which arises out of or relates to your credit application, ,purchase or
condition of this vehicle, this contract or any resulting transaction or relationship (including any such relationship with third partias who do not sllJn this contract)
shall, at your or our election, ba resolved by neutral, binding arbitration and not by a court action. If federal law provides that a claim or dispute Is not subject to
binding arbitration, this Arbitration Provision shall not apply to such claim or dispute. Any claim or dispute is to be arbitrated by a single arbitrator on an lndMdual
·basis and not as a class action. You expressly waive anyrlgllt you may have to arbitrate a class action. You may choose the American .Arbitration Association,
1633 Broadway, 10th Floor, New York, New York 10019 ~-adr;0rg), or any other organization·to conduct Iha arbitration subject to our approval. You may get a
copy of the rules of. an a·rbttration organization by contacting the organization or visiting its website. ·
Arbitrators shall be attorneys or retired judges and shall ba selected pursuant lo,ihe applicable rules. The arbitrator shall apply governing substantive law and the
appllcablutatute of limitations. The aillitratlon hearing shall be conducted In the federal district in which you rsslde unless the Seller-Creditor is a party to Iha.
claim or dispute, In which case the hearing will be held in·lhe federal district where this contract was executed. We will pay your filing, administration, service or
case management fee and your arbitrator or hearlng,fee all up to a maximum of $5000, unless the law or the rules of the chosen arbitration organization require
us to pay more. The '¥!1ourt we pay may be reimbursed In whole or in part by decision of the arbitrator ff the arbitrator finds that any of your claims is frivolous
under applicable law. Each party shall ba responsible for Its own attorney, expert and other leas, unless awarded by the arbitrator under applicable law. If the
chosen arbltration·organization's rules conflict with this Arbitration Provision, than Iha provisions of this Arbitration Provision shall control. Any arbitration under
this Arbitration Provision shall be QOV&rned by Iha Federal Arbitration Act (9 U.S.C. § 1 at. seq.) and not by any state law concarnin9. arbitration. Any award by Iha
arbitrator shall be In writing and will be final and binding on all parties, subject to any limited.right to appeal under Iha Federal Arbitration Act.
You and we retain Iha right to seek.remedies in smaUclaims court for disputes or claims. within that court's Jurisdiction, unless such action Is transferred, removed
or appealed to a different court. Neither you nor we waive Iha right to arbitrate by using self-help remedies, such as repossession, or by filing an action to recover
Iha vehicle, to recover a deficiency balance, or for Individual injunctive relief. Any court having.Jurisdiction may enter Judgment on the arbltrato~s award. This
Arbitration Provision shall survive any tamiinatlon, payoff or transfer of this contract If any part of this Arbitration Provision, other than waivers of class action
rights, is deemed or found to be·unanforceabla for any reason, the remainder shall remain enforceable. If a waiver of class action rights is deemed or found to be
unenforceable for any reason In a case in which class action allegations have bean made, the remainder of·lhis Arbitration Provision shall be unenforceable.
Trade-In Vehk:lil Trade-In Vehicle
Vear 2015 Make FERRARI Year NIA Make..,Nl_,,,,A'-----------
M~ 45B ITALIA Model-:Nl7!=A'--------------,-------
VIN ZFF68NHAOF0206328 VIN,__,N"""'A'----~-----:-:-:-:---------
Gross Trade-In Allow-$ 185D00.00 GI088 Trade-In Allowance$ _ _ _ _ _ ___,N/=A'---------1
Payoll Made by Sel~r $ 17620D.00 (ej Payoll Made by Seller$ NIA (ej
Uenholder "''A ' Lienho~er NIA
You assign to SeUer all of your rights, tltfa and lnterast In such trade-In vehlcte(s~ ~cept as exp,-ty si8lad to Seller In wrtang, you represent that yaur trade-In vehlcle(s) has not
basn Involved In an·acctdsnt, hss not had any major body damage or raqullld any msjor engine rspsfr, and was not pravlously used as alBXlcsb, police vehicle, short tenn rantel or
Is avehicle that lnebulit or assembled tram psrts, a kit car;, areplica, aflood vehicle, or a manufacturer buy back.
Buyer lnlllals Co-Buy~r lnlttals NIA
Trade-In Payoff Agraemsnt: Sel..- railed ?n.lnformatlon from you and/or lhe Ion holder or ossor ol your tra!le-ln vehlc~ to amve et the trade-In payoff amount shown above and In Item 2 of 1he Itemization
of Amount Financed.as the Pay Off Made by ~lier. You understand that the amount ql!()ted is an estimate.
Seller agrees to pay 1he """"ff amounl shown above and in Item 2 to 1he nenholder or lessor of lhe 1rade-ln ve,hlc~. or its deslgnee.)f the act~ payoff amount Is more than 1he amount shown above and in
Item 2 you must -' · ... - · the excess on demand. Hthe acJual payoff amount is ~ss lhen the amount shown above and In Hem 2 Seller win refund to you any overage Seller receives from yo" pr~,
llenholder or lessor~,•~the 'NOTICE" on page 5of lhls oontract, any assignee of this contract will not be obligated to pay lhe Pay Off.Made by i:.e:~!.
shown above and In Item 2 or any refund.
Buyer Slgnaturn- · · Co-lluyer Signature X.
The Annual Percentage Rate may be negotiable with the Seller. The Seller may ·assign this contract
and retain Its right to receive a part of the Finance Charge.
NOTICE TO THE BUYER: a) Do not sign this contract before you read It or If It contains any blank spaces. b) You are
entitled to an exact copy of the contract you sign. Keep It to protect your legal rights.
You agree to the terms of this contract You confirm that before you signed this contract, we gave it to you, and you were free to !eke It
and review I L ou~ge
~ . that you have read all pages of this contract,.lncludlng the arbitration provision above, before. signing
below. You c ou received a completely filled-In copy when you signed it. ·
Buyer Signs X: ·· Date 02/1412019 Co-Buyer Signs X NIA Date NIA
Co-Buyera and Other OWners - A co-buyer Is a psraon who Is responsible for psylng the entirs debt. An oiher owner Is a person whose name is on 1he tn~ to the veh~I• but
does not hsve to pay ths debt. The othsr owner agrees to ths sscurlty lntert6t In ths vehicle given to us ~ntraot.
Other owner signs here X NIA Addrass •' · NIA
S~lerSlgns MERCEDES-BENZ OF DELRAY Date 02/:1412019 By X ' / / '- TIiie NIA
Seifer assigns Its Interest ln_1hls contract to yg 81111111; IIA Yn1"1,'C:. ~ T'\W\.""\('\,Cf\. \_ -;,s;;signee) under lhe Jerms of Sellers agreemen~s) with Assignee.
D Assigned wilh recourse IJI Assigned wi/!!out recourse./ D Assigned wnh limited recourss
.
Seller MERCEDES-BENZ O~ l>ELRAY Bv ' I TIiie N/A
,. A1w· FORM NO. 553-FL-ARB-epa IREV 511() U.S. Rt,TENT NO. 0480,782
02/14/2019, 04:25 pm
...... Cla014 The Re1nold8 ancl Ral'f\llldB Company
THBA! ARE NO WARRANTIES, EXPRESS OR IMPLIED, AS TD CONreNT OR
mNB5S FOR PURPOSE OFTttl8 FORM. CONSULT'l'0UR OWN LEQAL COUNSEL LAW 553·FL·ARB-eps 5114 v1 Paga 6 of 6
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Case 20-22398-MAM Claim 1-1 Part 2 Filed 11/17/20 Page 7 of 8
App#49731483
ALS/ALI
Received On
2019-03-06 22:51:06.0 Add Record - Perfection of Lien
Vehicle Information
Title Information
State Information
Page: 1
Case 20-22398-MAM Claim 1-1 Part 3 Filed 11/17/20 Page 1 of 1
STATEMENT OF ACCOUNTS
DATE: 11/17/2020
BALANCE: 59 ,288.93