BORROWER INFORMATION Borrower Borrower's Name (include Jr. or Sr. if applicable)
Borrower's Email
Social Security Number
Home Phone (incl. area code)
DOB (mm/dd/yyyy)
Yrs. School
Married (includes registered domestic partners) Unmarried (includes single, divorced, widowed) Separated
Dependents (not listed byCo-Borrower)
No.
Ages
Present Address (street, city, state, ZIP/ country) Own Rent
No.Yrs.
Mailing Address, if different from Present Address
If residing at present address for less than two years, complete the following:
Former Address (street, city, state, ZIP) Own Rent No.Yrs.
Former Address (street, city, state, ZIP) Own Rent No.Yrs.
Co-Borrower Co-Borrower's Name (include Jr. or Sr. if applicable)
Co-Borrower's Email
Social Security Number
Home Phone (incl. area code)
DOB (mm/dd/yyyy)
Yrs. School
Married (includes registered domestic partners) Unmarried (includes single, divorced, widowed) Separated
Dependents (not listed byCo-Borrower)
No.
Ages
Present Address (street, city, state, ZIP/ country) Own Rent
No.Yrs.
Mailing Address, if different from Present Address
If residing at present address for less than two years, complete the following:
Former Address (street, city, state, ZIP) Own Rent No.Yrs.
Former Address (street, city, state, ZIP) Own Rent No.Yrs.
II. EMPLOYMENT INFORMATION MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION III. ASSETS AND LIABILITIES This Statement and any applicable supporting 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 non-applicant spouse or other person,this Statement and supporting schedules must be completed by that spouse or other person also.
ASSETS
Description
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.
$
Stocks & Bonds (Company name/number description)
$
Alimony/Child Support/Separate Maintenance Payments Owed to:
IV.DECLARATIONS If you answer "Yes" to any questions a through i, please use continuation sheet for explanation.
Borrower
Co-Borrower
a. Are there any outstanding judgments against you?
Yes No
Yes No
b. Have you been declared bankrupt within the past 7 years?
Yes No
Yes No
c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
Yes No
Yes No
d. Are you a party to lawsuit?
Yes No
Yes No
e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement?
Yes No
Yes No
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.
Yes No
Yes No
g. Are you obligated to pay alimony, child support, or separate maintenance?
Yes No
Yes No
h. Is any part of the down payment borrowed?
Yes No
Yes No
i. Are you a co-maker or endorser on a note?
Yes No
Yes No
j. Are you a U.S citizen?
Yes No
Yes No
k. Are you a permanent resident alien?
Yes No
Yes No
1. Do you intend to occupy the property as your primary residence?
Yes No
Yes No
m.Have you had an ownership interest in a property in the last three years?
Yes No
Yes No
(1)What type of property did you own-principal residence (PR), second home (SH), or investment property (IP)?
(2)How did you hold title to the home-solely by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?
V. ACKNOWLEDGEMENT AND AGREEMENT Each of the undersigned specifically represents to Lender and to Lenders actual or potential agents, brokers, processors, attorneys, insurers. servicers, successors and assigns and agrees and acknowledges thaw (1) the infomalion provided in this application is true and correct as of the date set forth opposite my signature and that any intentional or negligent mis- representation of this infomation contained in this application may result in civil liability, including monetary damages, to any person who may sutfer any loss due to reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, bul not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Sec. 1001, et seq.; (2) the loan requested pursuant to this application (the "Loan") will be secured by a mortgage or deed of tcisl on the propeny described in this application; (3) the property will not be used for any illegal or prohibited purpose or use; (4) all statements made in this application are made frx the purpose of obtaining a ‹esidential mortgage loan; (5) the property will be occupied as indicated in this application; (6) the Lender, its servicers, successors or assigns may retain the original and/or an electronic record of ihis application, whether or not the loan is approved; (7) the Lender and its egents, brokers, insurers, servicers, successors and assigns may continuously rely on the infomation contained in ihe application, and I am obligated to amend and/or supplement the infomation provided in this application if any of the material facts that I have represented herein should change prior to closing of the Loan; (8) in the event that my payments on the Loan become delinquent, the Lender, its servicers, successors, or assigns may, in addition to any other rights and remedies that il may have relating to such delinquency, report my name and account infomation to one or more consumer credit reporting agencies; (9) ownership of the Loan and/or administration of the Loan account may be transferred with such notice as may be required by law; (10) neither Lender nor its agents, brokers, insurers, servicers, successors or assigns has made any representa- tion or warranty, express or implied, to me regarding the property or the condition or value of the property; and (11) my transmission of ihis application as an "electronic record" containing my "electronic signature," as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or my facsimile transmission of this application containing a facsimile of my signature, shall be as effective, enforceable and valid as if a paper version of this application were delivered containing my original written signature.
Acknowledgement
INFORMATION FOR GOVERNMENT MONITORING PURPOSES 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 mongage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a Lender may not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation and surname if you have made this application in person. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satis all requirements to which the lender is subject under applicable state law for the particular pe of loan applied for.)
