I. Type of mortgage and terms of loan

This application is designed to be completed by the applicant(s) with the lender's assistance. Applicants should complete this form as "Borrower" or "Co-Borrower" as applicable. Co-Borrower information must also be provided (and the appropriate box checked) when:

Yes    No   Will the income or assets of a person other than the "Borrower" (including the Borrower's spouse) will be used as a basis for loan qualification or:

Yes    No   the income or assets of the Borrower's spouse will not be used as a basis for loan qualification, but his or her liabilities must be considered because the Borrower resides in a community property state, the security property is located in a community property state, or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan.
I. TYPE OF MORTGAGE AND TERMS OF LOAN
    
Mortgage Applied For: 
If Other:  

Agency Case Number:

Lender Case Number:

Amount
$

Interest Rate
%

No. of Months
Program Type
if other then explain:     
if ARM then what type:
II. PROPERTY INFORMATION AND PURPOSE OF LOAN
Subject Property Address (Street):
 
(City):                                (State):
   
(Zip):

No. of Units
Legal Description of Subject Property:

Year Built
 Purpose of Loan:  Property will be:
   Investment
if other fill this out   Primary Residence
  Secondary Residence
Complete this area if construction or construction-permanent loan:

Year Lot Acquired
(eg. 1993)

Original Cost
$

Amount
Existing Liens
$

(a)Present Value
of Lot
$

(b)Cost of
Improvements
$

Complete this area if this is a refinance loan:

Year Lot Acquired
(eg. 1993)

Original Cost
$

Amount
Existing Liens
$

Purpose of Refinance: Change in Rate/Term
Cash Home Improvement
Debt Consolidation
      Refinance		 Change in Loan Type
   
Describe Improvements: made to be made        Cost $
Title will be held in what Name(s):
(separated by a ; )
 Manner in which Title will be held:
Amount of Down Payment
$

Source of Down Payment, Settlement Charges and/or Subordinate Financing:
Explanation of Down Payment
Estate will be held in:
Fee Simple
Leasehold
Expiration Date:
CCYYMMDD
BORROWER
III. BORROWER INFORMATION
CO-BORROWER
    
Borrower's Name
(First, Middle, Last, Suffix)
Social Security Number
 Home Phone
(incl. area code)
 Age
 Yrs.School 
Married
Separated
Unmarried
(single, divorced, widowed)
Dependents
    (not listed by Co-Borrower)

no.

ages (1,5,etc)
Present Address
Own Rent Years/Months
/
(street):
(City):                                  (State):

(Zip):
Co-Borrower's Name
(First, Middle, Last, Suffix)
Social Security Number
 Home Phone
(incl. area code)
 Age
 Yrs. School 
Married
Separated
Unmarried
(single, divorced, widowed)
 
Present Address
Own Rent Years/Months
/
(Street):
(City):                                  (State):

(Zip):
 
If residing at present address for less than two years, complete the following:
Former Address
Own Rent Years/Months
/
(street):
(City):                                  (State):
(Zip):
Former Address
Own Rent Years/Months
/
(street):
(City):                                  (State):
(Zip):
Former Address
Own Rent Years/Months
/
(Street):
(City):                                  (State):

(Zip):
Former Address
Own Rent Years/Months
/
(Street):
(City):                                  (State):

(Zip):
BORROWER
IV. EMPLOYMENT INFORMATION
CO-BORROWER
    
Current Employer

Self Employed Yes    No  
(Name):
(Address):
(City):                              (State):

(Zip):

Years/Months
/

Yrs. employed
in this line of
work/profession
Position/Title &
Type of Business
 Business Phone
(incl. area code)
Current Employer

Self Employed Yes    No  
(Name):
(Address):
(City):                              (State):

(Zip):

Years/Months
/

Yrs. employed
in this line of
work/profession
Position/Title &
Type of Business
 Business Phone
(incl. area code)
If employed in current position for less than two years or if currently employed in more than one position, complete the following:
Previous Employer

Self Employed Yes    No  
(Name):
(Address):
(City):                              (State):

(Zip):
Dates (from-to)
CCYYMMDD
From
To
Monthly Income
$
Position/Title &
Type of Business
 Business Phone
(incl. area code)
Previous Employer

Self Employed Yes    No  
(Name):
(Address):
(City):                              (State):

(Zip):
Dates (from-to)
CCYYMMDD
From
To
Monthly Income
$
Position/Title &
Type of Business
 Business Phone
(incl. area code)
Previous Employer

Self Employed Yes    No  
(Name):
(Address):
(City):                              (State):

(Zip):
Dates (from-to)
CCYYMMDD
From
To
Monthly Income
$
Position/Title &
Type of Business
 Business Phone
(incl. area code)
Previous Employer

Self Employed Yes    No  
(Name):
(Address):
(City):                              (State):

(Zip):
Dates (from-to)
CCYYMMDD
From
To
Monthly Income
$
Position/Title &
Type of Business
 Business Phone
(incl. area code)
V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION
    
Gross Monthly Income Borrower Co-Borrower Combined Mo. Housing Expenses Present Proposed
Base Empl. Income*   $  $ Rent   $  $
Overtime   $  $ First Mortgage (P&I)   $  $
Bonuses   $  $ Other Finance (P&I)   $  $
Commissions   $  $ Hazard Insurance   $  $
Dividends/Interest   $  $ Real Estate Taxes   $  $
Net Rental Income   $  $ Mortgage Insurance   $  $
Other(before completing, see the notice in "describe other income," below)  $  $ Homeowner Assn. Dues   $  $
  Other   $  $
*Self Employed Borrower(s) may be required to provide additional documents such as tax returns and financial statements.
 
Describe Other Income     Notice:  Alimony, child support, or separate maintenance income need not be revealed if the Borrower(B) or Co-Borrower(C) does not choose to have it considered for repaying this loan.
Borrower
$
 
 $
 
$
 
 $
 
$
 
 $
 
VI. ASSETS AND LIABILITIES
    
This statement and any applicable supporting schedules may be completed jointly by both married and unmarried Co-borrowers if their assets and liabilities are sufficiently joined so that the statement can be meaningfully and fairly presented on a combined basis; otherwise separate Statements and Schedules are required. If the Co- Borrower section was completed about a spouse, this Statement and supporting schedules must be completed about that spouse also.
Completed Jointly Not Jointly
 
ASSETS Cash or Market Value
Cash Deposit toward purchase held by:
  $
List checking and savings accounts below
Name and Address of Bank S&L, or Credit Union
Acct. no.  $
Name and Address of Bank S&L, or Credit Union
Acct. no.  $
Name and Address of Bank S&L, or Credit Union
Acct. no.  $
Name and Address of Bank S&L, or Credit Union
Acct. no.  $
Stocks & Bonds
Company Name

number 
description
  $
Life insurance net cash value
Face amt $ 		 $
Vested interest in retirement fund  $
Net worth of business(es) owned (attach financial statement)  $
Automobiles owned
make/model         year

 $
 $
Liabilities and Pledged Assets. List the creditor's name, address and account number for all outstanding debts, including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges, etc. Use continuation sheet, if necessary. Indicate by (*) those liabilities which will be satisfied upon sale of real estate owned or upon refinancing of the subject property.
LIABILITIES Monthly Pyt. & Mos. Left to Pay Unpaid Balance
 Name and address of Company
 
 
  		 Payment
 $  Months to pay
  		 $
 Acct. no.
 Name and address of Company
 
 
  		 Payment
 $  Months to pay
  		 $
 Acct. no.
  Name and address of Company
 
 
  		 Payment
 $  Months to pay
  		 $
 Acct. no.
  Name and address of Company
 
 
  		 Payment
 $  Months to pay
  		 $
 Acct. no.
 Name and address of Company
 
 
  		 Payment
 $  Months to pay
  		 $
 Acct. no.
 Name and address of Company
 
 
  		 Payment
 $  Months to pay
  		 $
 Acct. no.
 Name and address of Company
 
 
  		 Payment
 $  Months to pay
  		 $
 Acct. no.
 Alimony/Child Support/Separate
 Maintenance Payments
 Owed to: 		   $
 Job related expenses
 (child care, union dues, etc.)
 description: 		   $
 
Schedule of Real Estate Owned (if additional properties are owned, use continuation sheet.)
Property Address (enter S if sold, PS if pending sale or R if rental being held for income) Type of Property Present Market Value Amount of Mortgages & Liens Gross Rental Income Mortgage Payments Insurance, Maintenance, Taxes & Misc.


$ $ $ $ $


$ $ $ $ $


$ $ $ $ $
List any additional names under which credit has been received
Alternate First Name Alternate Middle Name Alternate Last Name
VIII. DECLARATIONS
If you answer "yes" to any questions a through i, please use continuation sheet for explanation.
 Borrower  Co-Borrower
 Yes  No  Yes  No
 a. Are there any outstanding judgments against you?
 b. Have you been declared bankrupt within the past 7 years?
 c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
 d. Are you party to a lawsuit?
 e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee. If "Yes," provide details, including date, name and address of Lender, FHA or VA case number, if any, and reasons for the action .)
 f. Are you presently delinquent or in default on any federal debt or any other loan, mortgage, financial obligation bond, or loan guarantee? If "Yes," give details as described in the preceding question.
 g. Are you obligated to pay alimony, child support, or separate maintenance?
 h. Is any part of the down payment borrowed?
 i. Are you a co-maker or endorser on a note?
l. Do you intend to occupy the property as your primary residence? If "Yes," complete question m below
m. Have you had an ownership interest in a property in the last 3 years?
 
Are you a U.S. citizen? (Borrower)
Are you a U.S. citizen? (Co-Borrower)
The undersigned specifically acknowledge(s) and agree(s) that: (1) the loan requested by this application will be secured by a first mortgage or deed of trust on the property described herein; (2) the property will not be used for any illegal or prohibited purpose or use; (3) all statements made in this application are made for the purpose of obtaining the loan indicated herein; (4) occupation of the property will be as indicated above; (5) verification or re-verification of any information contained in the application may be made at any time by the Lender, its agents, successors and assigns, either directly or through a credit reporting agency, from any source named in this application, and the original copy of this application will be retained by the Lender, even if the loan is not approved; (6) the Lender, its agents, successors and assigns will rely on the information contained in the application and I/we have a continuing obligation to amend and/or supplement the information provided in this application if any of the material facts which I/we have represented herein should change prior to closing; (7) in the event my/our payments on the loan indicated in this application become delinquent, the Lender, its agents, successors and assigns, may in addition to all their other rights and remedies, report my/our name(s) and account information to a credit reporting agency; (8) be transferred to an agent, successor or assign of the Lender with prior notice to me; (9) the Lender, its agents, successors and assigns make no representation or warranties, express or implied, to the Borrower(s) regarding the property, the condition of the property, or the value of the property.
Certification: I/We certify that the information provide in this application is true and correct as of the date set forth opposite my/our signature(s) on this application and acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this application 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 the Lender, its agents, successors and assigns, insurers and any other person may suffer any loss due to reliance upon any misrepresentation which I/we have made on this application.
Borrower's Signature  Date(YYYYMMDD)  Co-Borrower's Signature  Date(YYYYMMDD)
X     X   
The following information is requested by the Federal Government for certain types of loans related to a dwelling. In order to monitor the lender's compliance with Equal Credit Opportunity, Fair Housing and Home Mortgage Disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may neither discriminate on the basis of this information, nor on whether you choose to furnish it. However, if you choose not to furnish it, under Federal regulations this Lender is required to note race and sex on the basis of visual observation or surname. If you do not wish to furnish the above information, please check the box below. Lender must review the above material to assure that the disclosure satisfy all requirements to which the Lender is subject under applicable state law for the particular type of loan applied for.
 
BORROWER CO-BORROWER
    I do not wish to furnish this information.