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EL-11-1772Inspection Worksheet Miami Shores Village 10050 N.E. 2nd Avenue Miami Shores, FL Phone: (305)795 -2204 Fax: (305)756 -8972 Inspection Number: INSP - 166547 Scheduled Inspection Date: November 14, 2011 Inspector: Devaney, Michael Owner: WALLACE, JOHN Job Address: 518 NE 106 Street Miami Shores, FL 33138 -2046 Project: <NONE> Contractor: ADT SECURITY SERVICES, INC Permit Number: EL -9 -11 -1772 Permit Type: Electrical - Residential Inspection Type: Final Work Classification: Alarm Phone Number Parcel Number 1122310140211 Phone: (786)331 -3967 Building Department Comments burglar alarm Passed Failed Correction Needed Re- Inspection Fee No Additional Inspections can be scheduled until re- inspection fee is paid. Inspector Comm r,j P/L //i/ //// /( November 10, 2011 For Inspections please call: (305)762 -4949 Page 31 of 34 Y /WO Miami Shores Village Building Department 10050 N.E.2nd Avenue, Miami Shores, Florida 33138 Tel: (305) 795.2204 Fax: (305) 756.8972 INSPECTION'S PHONE NUMBER: (305). 762.4949 BUILDING PERMIT APPLICATION FBC 20 Permit Type: ELECTRICAL SEP 7 2011 I B Y: _m....... Permit Not Master Permit No. Owner's Name (Fee Simple Titleholder),„ Y t V' Phone # o f 7 32 m6 d * fL Owner's Address 51 City )T 5 -fougS Tenant/Lessee Name Email State Zip 31 '18 Phone # Job Address (where the work is being done) 54 kb- 166 1 A€_ City Miami Shores Villa a County Miami -Dade FOLIO / PARCEL # // c:a..7 3/ - C7 /c( - eoVO Is Building Historically Designated YES NO Contractor's Company Name " % Zip 0 3i 38' Contractor's Address /5 7Y' City a) re 74r- QualifierName et ,Ysci State Certificate or Registration No Contact Phone 4rh 64.'ai State Ft i44.p d Phone # Flood Zone Architect/Engineer's Name (if applicable) E -mail Zip Phone # 61534- Certificate of Competency No. Phone # Value of Work For this Permit Type of Work: Describe. Work: ['Addition EAlteration Square / Linear Footage Of Work: ['New ❑ Repair/Replace . Q Demolition /2-t ******** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** Fees * * * * * * * * * * * * * * * * * * * * * * * * * * ** Submittal Fee $ Permit Fee $ 4i6' Notary $ Training/Education Fee $ Scanning $ Radon $ DPBR $ Double Fee $ Violation date: Structural Review. $ Total Fee Now Due $ * * * * * * * * * * * * ** CCF $ CO /CC $ Technology Fee $ Bond $ See Reverse side -* Bonding Company's Name (if applicable) Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a re- inspection fee will be charged. Signatur Signature 4.7 Owner or Agent //y�� Contractor The forego ,;s a strument was acknowledged before me this d-d- The foregoing instrument was acknowledged before me this day of '.` , . , 20 II , by , day of , 20 _, by who is personally known to me or who has produced who is personally known to me or who has produced Sign: Print: Ptc My Commission Expires: as identification and who did take an oath. Sign: Print: My Commission Expires: ***************************************************************************** * * * * * * * * * * * * * * * * * * * * * * * * * * * * * ** APPROVED BY P/2-- .z) y' 9 t // Plans Examiner Zoning Engineer Clerk checked (Revised 07 /10 /07)(Revised 06/10/2009) Bonding Company',s Name (if applicable) • Bonding Company's Address City State Zip Mortgage Lender's Name (if applicable) Mortgage Lender's Address City State Zip Application is hereby made to obtain a permit to do the work and installations as indicated. I certify that no work or installation has commenced prior to the issuance of a permit and that all work will be performed to meet the standards of all laws regulating construction in this jurisdiction. I understand that a separate permit must be secured for ELECTRICAL WORK, PLUMBING, SIGNS, WELLS, POOLS, FURNACES, BOILERS, HEATERS, TANKS and AIR CONDITIONERS, ETC OWNER'S AFFIDAVIT: I certify that all the foregoing information is accurate and that all work will be done in compliance with all applicable laws regulating construction and zoning. "WARNING TO OWNER: YOUR FAILURE TO RECORD A NOTICE OF COMMENCEMENT MAY RESULT IN YOUR PAYING TWICE FOR IMPROVEMENTS TO YOUR PROPERTY. IF YOU INTEND TO OBTAIN FINANCING, CONSULT WITH YOUR LENDER OR AN ATTORNEY BEFORE RECORDING YOUR NOTICE OF COMMENCEMENT." Notice to Applicant: As a condition to the issuance of a building permit with an estimated value exceeding $2500, the applicant must promise in good faith that a copy of the notice of commencement and construction lien law brochure will be delivered to the person whose property is subject to attachment. Also, a certified copy of the recorded notice of commencement must be posted at the job site for the first inspection which occurs seven (7) days after the building permit is issued. In the absence of such posted notice, the inspection will not be approved and a re- inspection fee will be charged. Signatur Owner or Agent //��}} The forego , strument was acknowledged before me this d-d'- day of �' - , 20 , by John tai ( ct /w who is personally known to me or who has produced 1� take an oath. NOTARY P Sign: 11..-- c 1/14 Print: k/t (tEivaES My Commission Expires: APPROVED BY Signature Contractor nn The foregoing instrument was acknowledged before me this Off) I I, by 6. 1' 1 t 14e `1� or who has produced as i• entification and who did take an oath. day of who is personally Sign: Print: ins' My Commission Expires: Plans Examiner Zoning Engineer (Revised 07 /10 /07)(Revised 06/10/2009) Clerk checked Miami -Dade My Home My Home ea Show Me: 1Property Information Search By: [Select Item Text only Property Appraiser Tax Estimator Property Appraiser Tax Comparison Portability S.O.H. Calculator Summary Details: Folio No.: 11- 2231 - 014 -0211 Property: 518 NE 106 ST Mailing Address: PHILIP R CONSOLO 518 NE 106 ST MIAMI SHORES FL 33138- Property Information: Primary Zone: 1000 SINGLE FAMILY RESIDENCE CLUC: 0001 RESIDENTIAL - SINGLE FAMILY Beds /Baths: 3/1 Floors: 1 Living Units: 1 Adj Sq Footage: 1,658 Lot Size: 9,150 SQ FT Year Built: 1941 Legal Description: AMD PL MIAMI SHORES SEC 5 PB 10 -47 LOT 10 & E1/2 LOT 11 BLK 110 LOT SIZE 75.000 X 122 OR 27409 -2091 0810 01 Assessment Information: Year: 2011 2010 Land Value: $90,700 $101,024 Building Value: $25,119 $125,594 Market Value: $115,819 $226,618 Assessed Value: $115,819 $92,363 Exemption Information: Year: 2011 2010 Homestead: $25,000 $25,000 2nd Homestead: YES YES Taxable Value Information: ear: 2011 2010 axing Authority: Applied Exemption/ Taxable Applied Exemption/ Taxable Page 1 of 2 ACTIVE TOOL: SELECT Aerial Photography - 2009 0 113 ft My Home 1 Property Information 1 Property Taxes My Neighborhood Property Appraiser Home 1 Using Our Site 1 Phone Directory 1 Privacy 1 Disclaimer If you experience technical difficulties with the Property Information application, or wish to send us your comments, questions or suggestions please email us at Webmaster. Web Site © 2002 Miami -Dade County. All rights reserved. http:// gisims2. miamidade .gov /myhome /propmap.asp 9/26/2011 Miami -Dade My Home Page 2 of 2 Value: Value: Regional: $50,000/ $65,819 $50,000/ $42,363 County: $50,000/ $65,819 $50,000/ $42,363 City: $50,000/ $65,819 $50,000/ $42,363 School Board: $25,000/ $90,819 $25,000/ $67,363 Sale Information: Sale Date: 8/2010 Sale Amount: $120,000 Sale O/R: 27409 -2091 Sales Qualification Description: Sales qualified as a result of examination of the deed View Additional Sales Additional Information: Click here to see more information for this property: Community Development District Community Redevelopment Area Empowerment Zone Enterprise Zone Zoning Land Use Urban Development Boundary Zoning Non -Ad Valorem Assessments Environmental Considerations http://gisims2.miamidade.gov/myhome/propmap.asp 9/26/2011 HUD-1 A. Settlement Statement (HUD -1) OMB Approval No. 2502 -0265 B. Type of Loan Q 1. FHA Q 2. RHS Q 4. VA Q 5. Conv. Ins. ® 3. Conv. Unins. 6. File Number 11-61 7. Loan Number 5001854811 ID: 8. Mortg. Ins. Case Num. C. NOTE:This form is furnished to give you a statement of actual settlement costs. Amounts paid to and by the settlement agent are shown. Items marked "(p.o.c.)" were pate outside the closing; they are shown here for informational purposes and are not included in the totals. D. NAME OF BORROWER Address of Borrower. E. NAME OF SELLER Address of Seller F. NAME OF LENDER Address of Lender. G. PROPERTY LOCATION: H. SETTLEMENT AGENT: Place of Settlement I. SETTLEMENT DATE: John N. Wallace and Leslie Ann D. Wallace, husband and wife 1026 Kettletown Road, Southbury, Connecticut 06488 ['Thing' R. Consolo 518 NE 104th Street Alarm Shores, Florida 33138 TD Bank, N.A. 1 Portland Square, Portland, Maine 04101 518 NE 106 Street, Miami Shores, Florida 33138 Christopher P. Kelley, PA 11098 Biscayne Boulevard, Suite No. 205, Miami, Florida 33161 9/14/11 DISBURSEMENT DATE: 9/14/11 Phone: 305 - 8936004 J. Summary of borrower's transaction K. Summary of seller's transaction 400,000.00 100. Gross amount due from borrower: 101. Contract sales price 400,000.00 400. Gross amount due to seller: 401. Contract sales price 102. Personal property 402. Personal property 103. Settlement charges to borrower (Line 1400) 8,654.58 403. 104. 404. 105. 405. Adjustments for items paid by seller in advance.:. 106. City/town taxes {Adjustments for items paid by seller in advance: 406. City/town taxes 107. County taxes 407. County taxes 108. Assessments 408. Assessments 109. Waste from 09 /14/11 to 12/31/11: 210.69 409. Waste from 09/14/11 to 12/31/11 210.69 110. Stormwater from 09/14/11 to 09/30/11 2.10 410. Stormwater from 09/14/11 to 09/30/11 2.10 111. 411. 112. 412. 120. Gross amount due from borrower. 200. Amounts paid or in behalf of borrower: , 408,867.37 25,000.00 4.20. Gross amount due to seller. 1 500. Reductions in amount due to seller. 501. Excess deposit (see instructions) 400,212.79 201. Deposit or earnest money 202. Principal amount of new loan(s) 220,000.00 502. Settlement charges to seller (line 1400) 15,653.00 203. Existing loan(s) taken subject to : 503. Existing loan(s) taken subject to 204. Principal amount of second mortgage 504. Payoff of fast mortgage loan 205. Lender Paid Credits 8.45 505. Payoff of second mortgage loan 206. 506. 207. 507. Deposit is being disbursed as proceeds 208. Principal amt of mortgage held by seller 508. Principal amt of mortgage held by seller 209. 509. 2098. Adjustments for items unpaid by seller: 210. City/town taxes 5095. Adjustments for items unpaid by seller: 510. Clty/town taxes 211. County taxes from 01/01/11 to 09/14/11 936.50 511. County taxes from 01/01/11 to 09/14/11 936.50 212. Assessments 512. Assessments 213. 13. 214. 514. 215. 515. 216. 516. 217. 517. 218. 518. 219. 519. • 220. Total paid" by /for borrower 245,944.95 520. Total reductions In amount due seller 16,589.50 300. Cash at settlement from /to borrower: . 408,867.37 ' 600. Cash at settlement to /from seller: 601. Gross amount due to seller (line 420) 400,212.79 301. Gross amount due from borrower (line 120) 302. Less amount paid by/for the borrower (line 220) (245,944.95) 602. Less total reductions in amount due seller (line 520) (16,589.50) 303. Cash ( 0 From ❑ To ) Borrower: 162,922.42 603. Cash ( © 7o ❑ From ) Seller. 383,623.29 The Public Reporting Burden for this collection of information is estimated at 35 minutes per response for collecting, reviewing, and reportng the data. This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number. No confidentiality is ac -arced; this disclosure is mandatory. This is designed to provide the parties to a RESPA covered transaction with information during the settlement process. Borrower's Initial( s' Seller's Initial(s): DoubleTime® HUD-1 U.S. Department of Housing and Urban Development Pa 2 L. Settlement charges Paid from Borrower's Funds at Settlement Paid from Seller's Funds at Settlement 700. Total Real Estate Broker Fees 512,000.00 Division of commission (lira 700) as follows: 701. $ 12,000.00 to Kellogg Realty, Inc. 702. 5 to 703. Commission paid at settlement 12,000.00 704. 705. to 800. Items Payable in Connection with Loan 801. Our origination charge 5468.49 (from GFE #1) 802. Your credit or charge (points) forthe specific interest rate chosen (from GFE #2) 803. Your adjusted origination charges to TD Bank, NA (from GFE A) 468.45 804. Appraisal fee to Millenium Appraisals Inc Florid (from GFE #3) 400.00 805. Credit report to CBC Innovis (from GFE #3) 10.96 806. Tax service to CoreLogic Tax Services (from GFE #3) 58.00 807. Flood certfication to Corelogic Flood Services (from GFE #3) 5.00 808. to 809. to 810. Customer Auth Report to CBC Innovis 1.70 811. to 812. to 813. to 900. Items Required by Lender to Be Paid in Advance 901. Daly interest charges from 09114/11 to 0/01/11 (o) 21.0959 /day (from GFE #10) 358.63 902. Mortgage insurance premium for months to (from GFE#3) 903. Homeowner's insurance premium 1 years to Citizens (from GFE #11) 3619.00 POC (B)" 904. Flood insurance premium for years to 905. Real Property Taxes - ars to Miami -Dade County Tax Collector 2,08578 1000. Reserves Deoosited with Lender 1001. initial deposit for your escrow account (from GFE #9) 301.56 1002. Homeowner's insurance 4 months Ca) 5301.58 per month 51,206.32 1003. Mortgage insurance months a() per month 1004. Property taxes 1 months (a3 $173.82 per month 5173.82 1005. Flood insurance months (1, per month 1006. months A per month - 1007. months Caa per month 1008. months ( t per month 1009. Aggregate accounting adjustment (51,078.58) 1100. Title Charges - - 1101. Tate services and lender's title insurance (from GFE #4) - 1,155.00 1102. Settlement or dosing fee to Christopher P. Kelley, PA 5895.00 1103. Owner's title insurer= to Oid Republic Nat Ttle/Christopher P. Kelley (from GFE #5) OF6- 2075.00 2,075.00 1104. Lender's title insurance to Old Republic Nat Title/Christopher P. Kelley 5260.00 MF6- 25.00;8.1 25;F9- 210.00 1105. Lender's title policy riunit 5220,000.00 1106. Owner's title policy limit $400,000.00 1107. Agent's portion of the total title insurance premium 51,634.50 to Christopher P. Kelley, P.A. 1108. Underwriter's portion of the total title insurance premium 5700.50 to Old Republic National Title Insurance Comp 155.00 1109. Abstract or title search to Christopher P. Kelley, PA. 1110. to 1111. to 1112. to 1113. to 1200. Government Recording and lTransfer Charaes 1201. Government recording charges (from GFE #7) 164.50 1202. Deed $18.50 Mortq_age(() $146.00 Releases 80.00 5164.50 1203. Transfer taxes (from GFE #8) 1204. City /County tax/stamps Deed: 50.00 Mortgage(s) $440.00 1,210.00' 1205. State tax/stamps Deed $2,400.00 mortgage(s) 5770.00 2,400.00 1206. 1207. Record Termination NOC to Clerk of Court Miami -Dade County 108.00 1208. 1300.! Additional Settlement Charges x•00 1301. Required services that you can shop for (from GFE #6) 1302. Survey to Nova Surveyors 5295.00 1303. Lien Search to Lightning Uen Letters 160.00 1304. Messenger /Courier / Copies/ Fe to Christopher P. Kelley, PA 1305. Attorney's fees to Alan J Marcus (S) 750.00 1306. Re- Occupancy Certificate to Village of Miami Shores 65.00 1307. Courier fee - to Alan J Marcus (S) 50.00 1308. Digital Storage - PageStream to Alan J Marcus (S) 30.00 1309. 1400 Total Settlement Charges 8,654.58. 15,653.00 ( Enter on lines 103, Section .1 and 502, Section K) * POC (3) = Paid outside of dosing by borrower * POC (S) = Paid outside of dosing by seller Borrower's () Seller's Initial(s): DoubieTime® SETTLEMENT CHARGES AND LOAN TERMS Page 3 Settlement dharges �. >°�.,�n •�rC .._.�k � * ' a7,�nQ?�`j ,'S & %+Gfr"�k�A"5,7 °, '11''k Jry ' f• ,. .?-,. .,..: C �,1 "' L'.74:!1':':.: Our origination charge # 801 $468.45 $468.45 Your credit or charge (points) :for the specific interest rate chosen # 802 8.00 $0.00 Your adjusted origination charges # 803 3468.45 $468.45 Transfer taxes # 1203 $3,610.00 $1,210.00 4l�•.,M'� • ar. �l'o n to q " /q,� a�. ' :u; fa '� .. ��C :S.e�fO��. ...9��� �'rr"•'kY�r,. -.ry 4A .•. �' )1 �Y �v`ti� aRUa � ``{.f i. ....,.9�L.vzL �' � Lh t .,J••1��5 Government recording charges # 1201 $251.00 $164.50 Appraisal fee # 804 $400.00 $400.00 Credit report *805 $10.96 $10.96 Tax service # 806 $58.00 858.00 Flood certification *807 $5.00 $5.00 CustomerAuth Report #810 $1.70 $1.70 e', ay {sr w` $' 444 t .?,,,V a' 4 e S F � 41 4 $726.66 $640.16 ti. t t _ it r°t f 1 " ,, ma MR >: w 69. S-86.50 or $- I1.900% F ., , •,..,'.1 C A 1 �' v k° S .f $g-lgi t ,2..... _ - p Initial depositfor your escrow account # 1001 $2,500.02 $301.56 Daily interest charges from . *901 $379.73 $358.83 Homeowner's insurance premium for # 903 - 5999.96 $3,619.00 Real Property Taxes *905 $.00 $2,085.78 Title services and lender's title insurance # 1101 $2,325.00 $1,155.00 Owner's title insurance # 1103 $2,225.00 32,075.00 Survey # 1302 $.00 $295.00 Loan Terms Your initial loan amount is $ 220,000.00 Your loan term is 15.0000 years Your initial interest rate is 3.5 % Your initial monthly amount owed for, principal, interest, and any mortgage insurance i§ $1,572.74 includes F Principal rV Interest r Mortgage Insurance . Can your interest rate rise? ® No Q Yes , ft can rise to a maximum of .00 %. The first change will be on and can change again every after . Every change date, your interest rate can increase or decrease by .00 %. Over the life of the loan, your interest rate is guaranteed to never be lower than .00% or higher than .00 %. Even if you make payments on time, can your loan balance rise? ® No Q Yes , it can rise to a maximum of $ .00 . Even if you make payments on time,, can your monthly amount owed for principal, interest, and mortgage insurance rise? • No 0 Yes , the first increase can be on and the monthly amount owed can rise to $ .00 The maximum it can ever rise to is $ .00 . Does your loan have a prepayment penalty? $ No Q Yes , your maximum prepayment penalty is $ .00 . Does your loan have a balloon' payment? et No 0 Yes , you have a balloon payment of $ .00 due in years on 00/00/0000 . Total monthly amount owed in?luding account payments escrow Q You do not have a monthly escrow payment for items, such as property taxes and homeowners insurance. You must pay these items directly yourself. ® You have an additional monthly escrow payment of $ 475.40 that results in a total initial monthly amount owed of 8 2,048.14 . This includes principal, interest, any mortgage insurance and any items checked below: Fr Property taxes {V Homeowner's insurance r Flood insurance r r r Note: If you have any questiofr Borrowers Irk ates } : about the Settlement Charges and Loan Terms listed on this form, please contact your lender. Seller's Initial (s): HUD=1 SETTLEMENT STATEMENT ADDENDUM File Number. 11.61 I have carefully reviewed the HUD -1 Settlement Statement and to the best of my knowledge and belief, it is a true and accurate statement of all receipts and disbursements made on my account or by me in this transaction. 1 further certify that I have received a copy of the HUD -1 Settlement Statement. Borrower(s) i ,, , )A. tkcl ..e'(d.�..A;�.t.'04,,, Wt AJ ,t <'�.t t,�.�1 t uct.� Q obn N. Wallace; Leslie Ann D. Wallace Philip R. Consolo Seller(s) Settlement Agent The HUD -1 Settlement Statement which I have prepared is a true and accurate account of this transaction. I have caused or will cause the funds to be disbursed in accordance with this statement Christopher P. & Illey, P.A. BY: Date: WARNING: It is a crime to knowingly make false statements to the United States on this or any other similar form. Penalties upon conviction can include a fine and imprisonment. For details see: Title 18 U.S. Code Section 1001 and Section 1010. DoubleTuneb RESIDENTIAL SERVICES CONTRACT CONTRACT DATE 1111 CUSTOMER ACCOUNT NO 111I11 11111I IN 11 IuII 5104UE12 0 3 JOB NO LEAD SOURCE ADT Security Services, Inc. ( "ADT ") Office Address Mt&v 1,07)1S ks 1/r/ N\ 1 i _ Z ,�� Thy s-- J (i).07:).N www.MyADT.com 1.800.ADT.ASAP® (1.800.238.2727) IF FAMILIARIZATION PERIOD IS REJECTED INITIAL HERE (see Paragraph 14 of the Terms and Conditions for explanation) Customer Name ( "Customer" or "I" or "me" or "my ") Address 5 1 w 1 6 State F ZIP Protected Premises' Telephone 3 8 City J E Tax Exempt No. 0 Traditional Phone 0 Other (Qualified) 0 Other (Non - Qualified) Alternate Telephone 1 Alternate Telephone 2 EMAIL 3 6 3 0 3 6 Tax Expire Date 0 Home Cell 0 Work 0 Home Cell 0 Work 5 e. z) 0 Are Communications Authorization: I authorize ADT to provide me with information and updates about the security system and new ADT and third -party products and services to the contact information provided by me. I may unsubscribe or opt out by emailing donotcontact@ADT.com or by calling 888.DNC4ADT (888.362.4238). Initial here Confirmation of Appointments: I authorize ADT to call me using an automated calling device to deliver a pre- recorded message to set/confirm appointments and provide other information and notices about the alarm system at the telephone number(s) provided by me. Initial here Alarm System Ownership: 0 Customer -Owned ADT -Owned 1 ACKNOWLEDGE AND AGREE TO EACH OF THE FOLLOWING: (A) THIS CONTRACT CONSISTS OF SIX (6) PAGES. BEFORE SIGNING THIS CONTRACT, 1 HAVE READ, UNDERSTAND AND AGREE TO EACH AND EVERY TERM OF THIS CONTRACT, INCLUDING BUT NOT LIMITED TO PARAGRAPHS 5 AND 18 OF THE TERMS AND CONDITIONS. (B) THE INITIAL TERM OF THIS CONTRACT IS THREE (3) YEARS. (C) ADT IS NOT A SECURITY CONSULTANT AND CANNOT ADDRESS ALL OF MY POTENTIAL SECURITY NEEDS. ADT HAS EXPLAINED TO ME THE FULL RANGE OF EQUIPMENT AND SERVICES THAT ADT CAN PROVIDE ME. ADDITIONAL EQUIPMENT AND SERVICES OVER THOSE IDENTIFIED IN THIS CONTRACT ARE AVAILABLE AND MAY BE PURCHASED FROM ADT AT AN ADDITIONAL COST TO ME. I HAVE SELECTED AND PURCHASED ONLY THE EQUIPMENT AND SERVICES IDENTIFIED IN THIS CONTRACT. (D) NO ALARM SYSTEM CAN PROVIDE COMPLETE PROTECTION OR GUARANTEE PREVENTION OF LOSS OR INJURY. FIRES, FLOODS, BURGLARIES, ROBBERIES, MEDICAL PROBLEMS AND OTHER INCIDENTS ARE UNPREDICTABLE AND CANNOT ALWAYS BE DETECTED OR PREVENTED BY AN ALARM SYSTEM. HUMAN ERROR IS ALWAYS POSSIBLE, AND THE RESPONSE TIME OF POLICE, FIRE AND MEDICAL EMERGENCY PERSONNEL 15 OUTSIDE THE CONTROL OF ADT. ADT MAY NOT RECEIVE ALARM SIGNALS IF COMMUNICATIONS OR POWER 15 INTERRUPTED FOR ANY REASON. (E) ADT RECOMMENDS, THAT! MANUALLY TEST THE ALARM SYSTEM MONTHLY AND ANY TIME I CHANGE TELEPHONE SERVICE, BY CALLING 1.800.ADT.ASAP OR BY LOGGING IN TO WWW.MYADTCOM. (F) THIS CONTRACT REQUIRES FINAL APPROVAL BY AN ADT AUTHORIZED MANAGER BEFORE ADT MAY PROVIDE ANY EQUIPMENT OR SERVICES, AND IF APPROVAL IS DENIED, THEN THIS CONTRACT WILL BE TERMINATED, AND ADT'S ONLY OBLIGATION WILL BE TO NOTIFY ME OF SUCH TERMINATION AND REFUND ANY AMOUNTS 1 PAID IN ADVANCE. ADT Representative me /V)< ._ 1 RepsN. Cld✓��tr (If Required) ID No. -' Cust x Approval: Original Signature Required (Must match Customer Name in Section 1 above) NOTICE OF CANCELLATION I, THE STOMER, MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. I ACKNOWLEDGE BEING VERBALLY INFORMED OF MY RIGHT TO CANCEL AT THE TIME OF EXECUTION OF THIS CONTRACT AND RECEIPT OF THIS NOTICE. 11® 1111 FINANCIAL DISCLOSURE STATEMENT THERE IS NO FINANCE CHARGE OR COST OF CREDIT (0% APR) ASSOCIATED WITH THIS CONTRACT. A. NUMBER OF PAYMENTS FOR THE INITIAL TERM 15 36. B. AMOUNT OF EACH PAYMENT IS (TOTAL MONTHLY SERVICE CHARGE FROM BELOW) cr LATE CHARGE - PAYMENT IS DUE PURSUANT TO MY SELECTED BILLING FREQUENCY, PRIOR TO THE START OF SERVICE. MY FIRST BILUCHARGE WILL BE SENT /MADE SHORTLY AFTER MY SERVICE BEGINS. ADT MAY IMPOSE A ONE -TIME LATE CHARGE ON EACH PAYMENT THAT IS MORE THAN TEN (10) DAYS PAST DUE, UP TO THE MAXIMUM AMOUNT PERMITTED BY LAW, BUT IN NO EVENT WILL THIS AMOUNT EXCEED $5.00. TOTAL OF PAYMENTS FOR THE INITIAL TERM IS $ `"�) (A. TIMES B.) (EXCLUSIVE OF ANY APPLICABLE TAXES, FEES, FINES AND RATE INCREASES) PREPAYMENT - IF I PREPAY THE TOTAL OF PAYMENTS PRIOR TO THE END OF THE INITIAL TERM OF THIS CONTRACT, THERE IS NO PENALTY OR REFUND. SEE SECTIONS 2, 7, 15 AND 19 OF THIS CONTRACT FOR ADDITIONAL INFORMATION ABOUT NONPAYMENT, DEFAULT AND ACCELERATION. 1 of 6 Administrative Copy ©2011 ADT. All rights reserved. (04/11) RESIDENTIAL SERVICES CONTRACT CONTRACT DATE 2- CUSTOMER ACCOUNT NO 1111111 III IllI 5104UE12 IRO 0 JOB NO LEAD SOURCE ' • I - . . - . . - e ( . . - , ) Monthly Service Charge Standard Monthly Service, Burglary O Initial /Annual Recurring Municipal Fee billed separately (Subject to change based on local law) Initial /Annual Fee -', f { ` -1 Service includes: Customer Monitoring Center Signal Receiving and Notification Service for Burglary, i\, c.1 Manual Fire and Manual Police Emergency $ —..__ 0 Customer to obtain and pay for initial /annual municipal alarm use permit. Failure to obtain and provide ADT with the municipal alarm use permit registration number could result in no municipal fire /police response to an alarm from the premises and/or a fine. fa Standard Monthly Service, Fire /Smoke Detection Service includes: Customer Monitoring Center Signal 1 t Receiving and Notification Service for Fire, Manual Fire ' ,, and Manual Police Emergency Municipal Electrical Permit Fee 0 Customer to obtain electrical permit O Carbon Monoxide O Flood O Low Temp k $ O Medical Alert $ Installation Price Taxable Amount $ 1 1. ( 3 ft Safewatch Cellguard® I $ L IV L. Non - Taxable Amount $ O SecurityLink® j $ Connection Fee t Extended Limited Warranty /Quality Service Plan (QSP) I $ T. V t. Admin Fee O Guard Response Service Other I: L ��s �.. r -_�;) L- Sales Tax on Installation* Deposit Received 7-1 �''j l $ 3, ) Total Monthly Service Charge S1 .� Balance Due upon Installation* *If applicable sales tax not shown, it will d to the first invoice. be added ?, a`\ / S °c Seo , etie; a•F S '`Ee 1 . off. c\L e� ' cr °o, Sic tiC, Sys �` S� % \ec } 5 ° c� .\\ OQ`Sa�e.` °a¢\ Package Name: { ~# Includes: Famii om Office 1 f 1 % r 1 c >p. Z i~ _ Dining Room i r � Kitchen Laundry Room I ; Master Bedroom € j ! / l ^ Master Bath Bedroom 2 �r. j, i A .. t Bedroom 3 j Bath 2 Basement Garage j 4 j Totals > I I E = Existing Equipment Estimated Installation Start Dateii/J 111 INSTALLER NOTES (; } , 2 i `// d (d i-11 474 L..:/t _ Pi' \ // C Tf + o k' 1 2 of 6 ©2011 ADT. All rights reserved. (04/11) TRANSMISSION VERIFICATION REPORT TIME : 09/26/2011 05:25 NAME : ADT SECURITY SERVICE FAX : 9544287079 TEL : 9544362113 SER.# : 000E6J321165 DATE, TIME FAX NO. /NAME DURATION PAGE(S) RESULT MODE 09/26 05:21 93057568972 00:03:16 09 OK STANDARD ECM ADT SECURITY SERVICES, INC. ADT Always There® 10785 Marks Way Miramar, FL 33025 Office: 954-266-5069 Inspection Line: 954-266-5121 Fax: 954-266-5180 To: Fax Intrusion Detection Video Surveillance Electronic Access Control From: LAToIJ. R act rter, Permit Coordinator -7 ' i-- Phone: 954 -266 -5027 Phone: Date: 9/12/2011 Pages: Re: t + ftql2,0 Fax: 954.266.5180 Comments: Ri°\ e 7`v" ‘)c uP 0 - \ ‘() v)\ Li- e)%)1) \E-1\f k kvipA06Dvj