Borrower
Co-Borrower

I.  TYPE OF MORTGAGE AND TERMS OF LOAN
Mortgage Applied For VA       Conventional
FHA    USDA/Rural Housing Service
Agency Case Number
Lender Case Number
Amortization Type Fixed Rate    Other*
GPM               ARM*        Explain
Amount
Interest Rate
Number of Months

II.  PROPERTY INFORMATION AND PURPOSE OF LOAN
Subject Property Address
(Street, City, State, Zip)
Legal Description of Subject Property
No. of Units
Year Built
Purpose of Loan Purchase      Construction       Other, Explain      
Refinance     Construction Permanent                      Explain
Property Will Be Primary Residence      Investment
Secondary Residence

Complete This Section If Construction or Construction-Permanent Loan
Year Lot Acquired
Original Cost
Amount Existing Loan
(a) Present Value of Lot
(b) Cost of Improvements
Total (a+b)

Complete This Section If This Is A Refinancing Loan
Year Acquired
Original Cost
Amount Existing Loan
Purpose of Refinance
Describe Improvements Made To     Will Be Made
Describe    Cost
Title Will Be Held in What Name(s)
Manner In Which Title Will Be Held
Source of Down Payment, Settlement Changes and/or subordinate financing
Estate Will Be Held In Fee Simple  Leasehold (Show Expiration Date)  Expiration Date

III.  BORROWER INFORMATION
Borrower's Name
Social Security Number
Home Phone (xxx) xxx-xxxx
Date of Birth  (MM/DD/YYYY)
Years in School
Status Married  Seperated  Unmarried (Single, Divorced, Widowed)
Dependents How Many Ages
Present Address
(Street, City, State, Zip)
Mailing Address
(Street, City, State, Zip)

If Residing At Present Address For Less Than 2 Years, Complete The Following
Former Address
(Street, City, State, Zip)
Former Address
(Street, City, State, Zip)
Co-Borrowers Name
Social Security Number
Home Phone (xxx) xxx-xxxx
Date of Birth  (MM/DD/YYYY)
Years in School
Status Married  Seperated  Unmarried (Single, Divorced, Widowed)
Dependents How Many Ages
Present Address
(Street, City, State, Zip)
Mailing Address
(Street, City, State, Zip)

If Residing At Present Address For Less Than 2 Years, Complete The Following
Former Address
(Street, City, State, Zip)
Former Address
(Street, City, State, Zip)

IV.  MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION
Gross Monthly Income Borrower Co-Borrower Total Combined Monthly Household Expenses Present Proposed
Base Empl. Income*   Rent
Overtime First Mortgage (P&I)
Bonuses Other Financing (P&I)
Commissions Hazard Insurance
Dividends/Interest Real Estate Taxes
Net Rental Income Mortgage Insurance
Other Homeowner Assn. Dues
        Other
TOTAL TOTAL
*Describe Other Income  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 the loan.
B/C                                     Income Source                                                                                                                                                                                  Monthly Amount
   
   
   

V.  EMPLOYMENT INFORMATION
Borrower's Company Self Employed
Address of Employer
Years At The Job
Years Emp. At This Profession
Position/Type of Business

If Employed In Current Position for less than 2 years or if currently employed in more than 1 position, complete the following
Name of Company Self Employed
Address Of Employer
Dates (from -to)
Monthly Income
Name of Company Self Employed
Address Of Employer
Dates (from-to)
Monthly Income
Name of Company Self Employed
Address Of Employer
Dates (from-to)
Monthly Income
Name of Company Self Employed
Address Of Employer
Dates (from -to)
Monthly Income
Co-Borrower's Company Self Employed
Address Of Employer
Years At The Job
Years Emp. At This Profession
Position/Type of Business

If Employed In Current Position for less than 2 years or if currently employed in more than 1 position, complete the following
Name of Company Self Employed
Address Of Employer
Dates (From-To)
Monthly Income
Name of Company Self Employed
Address Of Employer
Dates (From-To)
Monthly Income
Name of Company Self Employed
Address Of Employer
Dates (From-To)
Monthly Income
Name of Company Self Employed
Address Of Employer
Dates (From-To)
Monthly Income

VI.  ASSETS AND LIABILITIES

Assets
Description
Cash Deposit Toward Purchase Held By
Cash or Market Value
(Checking or Savings)
Bank Name
Bank Address
Account #
Balance
(Checking or Savings)
Bank Name
Bank Address
Account #
Balance
(Checking or Savings)
Bank Name
Bank Address
Account #
Balance
(Checking or Savings)
Bank Name
Bank Address
Account #
Balance
Stocks & Bonds
Life Insurance Net Cash Values
Subtotal Liquid Assets
Real Estate Owned
Enter Market Value From Schedule of Real Estate Owned)
Vested Interest in Retirement Fund
Net Worth of Businesses Owned
Attach Financial Statements
Automobiles Owned (Make and Year)
Other Assets (Itemize)
 
Total Assets

Liabilities
Name of Creditor
Address of Creditor
Account #
Monthly Payment
Unpaid Balance
Name of Creditor
Address of Creditor
Account #
Monthly Payment
Unpaid Balance
Name of Creditor
Address of Creditor
Account #
Monthly Payment
Unpaid Balance
Name of Creditor
Address of Creditor
Account #
Monthly Payment
Unpaid Balance
Name of Creditor
Address of Creditor
Account #
Monthly Payment
Unpaid Balance
Name of Creditor
Address of Creditor
Account #
Monthly Payment
Unpaid Balance
Alimony/Child Support
Job Related Expense
(Child Care, Union dues)
Total Payments
Net Worth (Total Assets - Liability  Unpaid Total)

Schedule Of Real Estate Owned
Enter S if Sold - PS If pending Sale - R if rental being held for Income
Property Address Status Type of Property Present Market Value Amount of Mortgage/Liens Gross Rental Income Mortgage Payments Insurance, Maint. & Taxes Net Rental Income
Totals
Alternative Name Which Credit Was Received
Creditor Name
Account Number
Alternative Name Which Credit Was Received
Creditor Name
Account Number

VII.  DETAILS OF TRANSACTION
a. Purchase Price
b. Alterations, Improvements, Repairs
c. Land (If Acquired Separately)
d. Refinance (Incl. Debts to be paid off)
e. Estimated Prepaid Items
f. Estimated Closing Costs
g. PMI, MIP, Funding Fee
h. Discount (If Borrower Will Pay)
i. Total Costs (add A through H)
j. Subordinate Financing
k. Borrowers Closing Costs Paid by Seller
L. Other Credits Explain
m.  Loan Amount (exclude PMI, MIP, Funding Fee Financed)
n. PMI, MIP, Funding Fee Financed
o.  Loan Amount (add M & N)
p. Cash From/To Borrower (Subtract J, K, L & O from I)

VIII.  DECLARATIONS
If you answer "Yes" to any questions a through l, 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 a lawsuit  Yes  No Yes  No
e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer a title in lieu of foreclosure or judgment?  Yes  No Yes  No
f. Are you presently delinquent or in default of any Federal debt or any other loan, mortgage, financial obligation, bond or loan guarantee  Yes  No Yes  No
g.  Are you obligated to pay alimony, child support, or separate maintenance  Yes  No Yes  No
h. Is there any part of the down payment borrowed  Yes  No Yes  No
i. Are you a comaker or endorser on a note  Yes  No Yes  No
j.  Are you a US Citizen  Yes  No Yes  No
k. Are you a permanent resident alien  Yes  No Yes  No
l. Do you plan to occupy the property as your primary residence?  If Yes complete questions below  Yes  No Yes  No
m. Have you had an ownership interest in a property in the last three years  Yes  No Yes  No
m1.  What type property did you own-principal residence (pr) second home (SH) Investment property (IP)
m2. How did you hold title to the home- solely by yourself (s) jointly with your spouse (sp) or jointly with another person.

IX. ACKNOWLEDGEMENT AND AGREEMENT

Borrowers Signature   Date
Co-Borrower Signature   Date

X. INFORMATION FOR GOVERNMENT MONITORING PURPOSES
Borrower   I Do Not Wish to Furnish This Information
Ethnicity
Race
Sex
Co-Borrower   I Do Not Wish to Furnish This Information
Ethnicity
Race
Sex