Bank & Financial Institution

Third Party Authorization & Release Form

I hereby authorize the Law Firm of Long, Marmero & Associates, James E. Schroeder, Esq., and
his assignees to request, obtain and verify any and all mortgage loan information, including but
not limited to, payoff, arrearage, and reinstatement amounts as well as financial history. The
information obtained is to be used for the purpose of facilitating the resolution of my foreclosure.
I authorize Mr. Schroeder to negotiate solutions and alternatives to foreclosure on my behalf.
This authorization will continue in effect until further notice.
Property Address: _____________________________________________________
Loan Number: ________________________
Loan Number: ________________________

________________________________
Borrower Signature
________________________________
Print Name

_________________
Date

Social Security Number: _________________________________

Date of Birth: _____________________

________________________________
Co-Borrower Signature
________________________________
Print Name

_________________
Date

Social Security Number: _________________________________

Date of Birth: _____________________

James E. Schroeder, Esq. Long, Marmero & Associates 407 Philadelphia Avenue Egg
Harbor City, NJ 08215