Fill and Sign the Loan Application Checklist Tom Andolsen Midfirst Bank Form

CONSENT TO RELEASE OF FINANCIAL INFORMATION ______________________________ [City], __________________ [State] Dated: ____________ TO WHOM IT MAY CONCERN: This authorizes all banks, financial institutions, businesses, employers, credit reporting agencies and any other businesses to which I am indebted or have assets located, to provide information concerning my finances and assets, without liability, to : ______________________________________________________________________ (Name) _____________________________________________________________________ (Address). You are further requested not to disclose such information to any other person without written authority to do so. __________________________________ Signature Date Signed: ______________
(printed name) (printed address). Date received: (printed date) (printed signature) [city, state, zip code, email address or telephone number of bank, financial institution, employer, credit reporting agency or other business]: please contact me in writing (name and address) with any questions or to arrange a payment plan or for other assistance in locating or contacting me. The bank provides the report to the individual requesting it (see above), who is allowed to have copies of the documents on file. How do i sign a consent form? if the respondent does not recall signing this form, you should ask him or her to sign to confirm or deny the request. If the respondent does not remember and provides the following information, he or she should be given the opportunity to sign on the report: name (, "john doe"): address: date/time of birth: sex: date and place of birth: address: date of death, if known: race: state of residence at time of death: if other, other state/territory of residence: if deceased during past 5 years: name of person having custody of the deceased: name and date of birth of spouse: date of marriage: city, state, zip code of where deceased was born: if deceased during past year: if deceased during past month: if deceased at time of death, where at time of death: for each event listed (if applicable): (signature and date) i understand that this is a crime report, and that I am giving any information requested in this report, on a voluntary basis, voluntarily disclosed to my bank, financial institution, employer or credit reporting agency, without any legal obligation to do so. This consent is valid only for the specific event/event(s) to which it applies. By signing this release, I understand that any use, disclosure or release of this information is voluntary and not intended to waive the requirement of any legal or equitable right or remedy that might otherwise be available to me, my heirs, executors or assigns. The release provided here may be revoked at any time and for any reason by my consent. By consenting to the release of the information and by.