PROPERTY OWNER(S) LIEN AFFIDAVIT

LENDERFirst Federal Savings Bank

OWNER(S)EDWARD F NIX; MARCIA A NIX

PROPERTY ADDRESS100 LANE 200 LAKE JAMES ANGOLA, IN 46703

1.The owner(s) listed above is (are) the sole owners(s) of property.YesNo

2.Title to this residence is held as:
Individual
Married couple or two or more related persons
Two or more unrelated persons
Trust
Land Contract
Life Estate
(Refer copy of the Trust, Land Contract, or Life Estate document to underwriting)

3.Residential Occupancy:

This residence is a one to four family dwelling, and occupied
as either a vacation home or a principal residence.		YesNo

4.The only liens against this residence are as follows:

Lender or Other Lien Holder
Balance
First Lien$
Second Lien$
Other Lien(s)$

5.   Please initial correct response below:
YES
NO
   All real estate taxes and assessments are paid in full.
   This Property is free of State and Federal tax liens.
   This Property is free of Judgements.
   Has owner filed bankruptcy in the past 90 days?
   Does this property have a reverse mortgage?

This Affidavit is given to induce First Federal Savings Bank (Lender) to make the loan. We (I) state that the above information is true and complete and understand that any intentional or negligent misrepresentation (s) of the information contained in this Affidavit may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section 1001, et seq. and liability for monetary damages to Lender, its agents, successors and assigns, insurers, and any other person who may suffer any loss in reliance upon any misrepresentations when made in this Affidavit.

Signatures:

Signature of Owner's Spouse if Not Owner:

Subscribed and sworn to before me thisday of
, 20
.
Notary Public
County of: State of:
    My commission expires:

Original for Loan File
Copy for Borrower





Borrower(s) EDWARD F NIX; MARCIA A NIX Financial InstitutionFirst Federal Savings Bank

Property Address100 LANE 200 LAKE JAMES Loan #650013532 Loan Amount$100,000

ANGOLA, IN 46703 Effective Date03/13/2017 Loan Term120 Months


POSSIBLE HOME EQUITY LIEN PROTECTOR (HELP) COVERAGE
IN LIEU OF TITLE SEARCH

This loan may qualify for the Home Equity Lien Protector coverage which protects the lender against losses due to impairments to the title on fixed term equity loans and equity lines of credit. Please refer to the Master Policy on file for all benefit or eligibility questions.

If this is a covered loan, the following items MUST be in the loan file at all times:

Copy of Credit Report

Original of Property Owner(s) Affidavit

Copy of Property Tax Bill or First Mortgage or Deed

NO COVERAGE WILL BE IN FORCE UNLESS THE PREMIUM IS PAID AND THE LOAN APPEARS ON THE MONTHLY REPORT SUBMITTED TO MIDWESTERN EQUITY TITLE INSURANCE COMPANY.

Form No. 01 (1/01)
Midwestern Equity Title Insurance Company
800-678-0329