DEERFIELD VILLAGE
RESIDENT’S COSIGNER
INFORMATION and AGREEMENT
Deerfield Village Assisted Living Facility will keep all financial information strictly confidential.
Name of Resident (s): (1) (2)
Name of Cosigner:
Address of Cosigner (s) City: State:
Zip: Telephone: D.O.B. Cosigner:
Social Security Number of Cosigner:
FINANCIAL RESOURCES (use additional sheets if necessary)
Income:
Name of Income Source Amount Address Telephone Contact Person
(include relatives) (per month)
Assets:
Real Estate Address/Location Fair Market Value
Stocks/Bonds/Other Investments Held By (broker, deposit box, etc) Fair Market Value
Bank and Securities Accounts:
Name of Bank/Financial Institution Address Telephone Acct No. Value
Other personal property Fair Market Value
ADDITIONAL CREDIT REFERENCES
Name Address Telephone Acct No. Contact Person
Responsible Parties:
The undersigned responsible parties (if more than one, jointly and severally) hereby certifies that all of the information on this Application as it relates to the undersigned is true and correct and that the financial information accurately reflects the financial condition of the undersigned and is true and complete in all respects. Facility is hereby authorized to request credit reports from credit reporting agencies and to release information regarding the undersigned's account to others seeking such information. Facility is hereby authorized to request and obtain income verification from the undersigned's income sources and to request and obtain account verification from the undersigned's banks, credit unions, savings and loan association, broker or other financial institutions.
For a valuable consideration the undersigned cosigner(s)and each of them, hereinafter collectively called "Cosigner", jointly and severally and unconditionally guarantees and promises to pay to Deerfield Village Assisted Living Facility hereinafter called "Facility", its successors or assigns, on demand in lawful money of the United States of America, any and all indebtedness of the above named Resident(s), to Facility, as follows:
- "Indebtedness" defined. The word "indebtedness" is used herein in its most comprehensive sense and includes, but is not limited to, any and all advances, debts, obligations, and liabilities of Resident(s), or any one or more of them, including judgments against Resident(s), heretofore, now, or hereafter made, incurred, or created, whether voluntarily or involuntarily and however arising, whether due or not due, absolute or contingent, liquidated or unliquidated, determined or undetermined, and whether Resident(s) may be liable individually or jointly with others, or primarily or secondarily, or as guarantor, and whether recovery upon such indebtedness may be or hereafter may become barred by any statute of limitations, and whether such indebtedness may be or hereafter may become otherwise unenforceable, and whether such indebtedness arises from transactions which may be voidable on account of infancy, insanity, ultra vires, or otherwise.
- Nature of Cosigner(s)'s undertaking. The liability of Cosigner(s) hereunder shall be open and continuous for Indebtedness of Resident(s) to Facility now or hereafter arising. Cosigner(s) intend to guarantee at all times the performance of all obligations of Resident(s) to Facility. Thus, no payments made upon Resident(s)'s indebtedness shall be held to discharge or diminish the liability of Cosigner(s) for any and all remaining and succeeding indebtedness of Resident(s) to Facility. The liability of Cosigner(s) hereunder shall be enforceable against both the separate and community property of Cosigner(s)
- existing at the date of execution hereof or hereafter acquired.
- Facility's rights and obligations in dealing with Resident(s). Cosigner(s) authorizes Facility to deal with Resident(s) and Resident(s)'s sureties, endorsers, and other Cosigners, in any manner in which Facility sees fit in connection with any indebtedness of Resident(s) to Facility, now or hereafter created, without any further consent or authorization from Cosigner(s) being necessary. Specifically, but without limiting the powers of Facility, Facility may make secured or unsecured loans to Resident(s); Facility may extend the time for payment of any indebtedness of Resident(s); Facility may release any collateral given to Facility by Resident(s), with or without the substitution of new collateral; Facility may release or agree not to sue Resident(s)'s sureties, endorsers, or other Cosigners on any terms it chooses; Facility may sue or fail to sue Resident(s) upon any overdue indebtedness or may realize or neglect to realize upon any collateral held in connection therewith; all of the foregoing without the necessity of any notice to or consent from Cosigner(s) and all without affecting Cosigner(s)'s liability hereunder.
- Duration of guaranty. This guaranty shall take effect when received by Facility, without the necessity of any acceptance by Facility, and shall continue in full force until such time as Resident(s) no longer reside at the Facility. Any such termination of this guaranty shall be effective only as to advances made by Facility to Resident(s) after Resident(s) no longer reside at the Facility. This guaranty shall bind the Cosigner(s) for renewals and extensions granted after the termination hereof which pertain to debts guaranteed hereby. This guaranty shall bind the estate of Cosigner(s) as to indebtedness created both before and after the death or incapacity of Cosigner(s).
- Facility's rights against and obligations to Cosigner(s). Cosigner(s) hereby expressly waives presentment, protest, demand, or notice of any kind, including notice of nonpayment of any of Resident(s)'s indebtedness or of any collateral thereto and notice of any action or nonaction on the part of Resident(s), the Facility, or any other person. Upon any default of Resident(s) on any obligation to Facility, Facility may, at its option, then and there demand and be entitled payment from Cosigner(s) of the full amount or any part of the amount of Resident(s)'s indebtedness to Facility and if Cosigner(s) shall not pay the sum demanded to Facility, Facility may proceed directly and at once against Cosigner(s) to collect such sum without first proceeding against Resident(s), or any surety, endorser, or other Cosigner(s) and without foreclosing upon or selling or otherwise disposing of any collateral it may have as security for any of Resident(s)'s indebtedness. Failure of Facility to make such demand at such time or so to proceed shall not relieve Cosigner(s) of its obligations hereunder or in any sense constitute a waiver. Facility shall have the right to demand and collect from Cosigner(s) all or any portion of Resident(s)'s indebtedness and failure of Facility at any time to demand from Cosigner(s) or to proceed to collect from Cosigner(s) the full amount of Resident(s)'s indebtedness from Cosigner(s) shall not preclude Facility from later demanding or proceeding to collect from Cosigner(s) any remaining indebtedness of Resident(s) to Facility covered by this guaranty. In any action or suit against Cosigner(s) to enforce this guaranty, Facility shall be entitled to recover from Cosigner(s), in addition to costs and disbursements allowed by law, a reasonable amount for Facility's attorneys' fees in such action or suit or appeal therefrom. In any action or suit brought by Facility against Cosigner(s), Cosigner(s) will not assert as a defense any statute of limitations if at the time the action or suit is commenced there is outstanding any indebtedness of Resident(s) to Facility which is not barred by the statute of limitations of the State of Oregon. If payment is made by Resident(s) on a debt guaranteed hereby and thereafter the Facility is forced to remit the amount of that payment to the Resident(s)'s trustee in bankruptcy or similar person under any federal or state bankruptcy law or law for the relief of debtors, the Resident(s)'s debt shall be considered unpaid for the purpose of enforcement of this guaranty.
Cosigner Name: Cosigner Signature: Date: (Please print)
Cosigner Name: Cosigner Signature: Date:
(Please print)