Third Party Borrower Authorization

Third Party Borrower Authorization
Mortgage Servicer Name
Customer Service/Loss Mitigation Phone Number
Borrower(s) name(s)
Property address
Mortgage loan account number(1)
Mortgage loan account number(2)
Third Party Information (all applicable fields must be completed)
Name of Entity, Agency, Firm HomeOwnershipOC Phone Number 714.204.2314

Name(s) of authorized person(s) Connie Der Torossian / Angie Coronel / Ghada Allous / Helen Tran, counselors at HomeOwnership OC

Mailing address 801 W. Civic Center #200, Santa Ana CA 92701

Office address

Email ctd@conniedt.com Website URL www.HomeOwnershipOC.org

Tax ID# 90580 HUD ID
State license # (if required)
Issuing state
HUD Approved Counseling Agency?
For non-profit agencies only*

HUD Approved Counseling Agency?

Yes: X No:

Approval valid until (date): 12/2024

HUD HCS#: 90580

*Attach National Foreclosure Mitigation Counseling form if needed
Approved Counselors
Approval valid until (date)
Do you represent the above named Borrower for a workout arrangement with the named Servicer?

YesNo
Firm Name
Individual Attorney name(s)
All states where licensed
** Attorney who represents Borrower must sign below
Third Party Acknowledgement
The undersigned, on behalf of the Third Party, represents that: (i) it is in compliance with Regulation o (Mortgage Assistance Relief Services), if applicable, and all other applicable laws and regulations; and (ii) the Third-Party information provided above is true and correct. The undersigned acknowledges that a misrepresentation or omission of fact made in connection with a government program such as Making Home Affordable may result in civil/criminal prosecution.
Connie Der Torossian

Signature of Third Party Printed Name
Date

MonthDayYear
Date
Title HUD Housing Counselor
Borrowers Initials
BORROWER AUTHORIZATION OF THIRD PARTY
Borrower Authorization (please initial all items)
Third Party you are authorizing (from first page)
I (Borrowers listed below) authorize the above named Third Party to discuss, assist with, or, if applicable, negotiate a workout arrangement on my mortgage(s) with the above named Mortgage Servicer (its affiliates, agents, employees, and successors). A workout arrangement could include a modification or other relief.
Borrowers initials
I authorize my Mortgage Servicer, and Third Party and Treasury (and its agents) to share with each other public and public information about my finances and my mortgage for the purpose of assisting me in obtaining a workout arrangement, including but not limited to: (i) my mortgage payment history, terms of my mortgage; and (ii) my social security number, credit score, income, debts and other information related to obtaining and servicing my mortgage.
I understand that my Mortgage Servicer may contact me directly except in limited situations, such as when I am represented by an attorney, and the Servicer and I must agree to any workout arrangement. I may still contact my Mortgage Servicer at any time.
I understand that this Third Party Authorization Form may not be accepted by my Mortgage Servicer and my Mortgage Servicer will notify me in writing if it is not accepted. Mortgage Loan Servicers have procedures designed to detect fraud or improper activity and must follow privacy laws to protect borrower information.
This Authorization expires one year from the date signed unless Borrower cancels it earlier by writing to the Servicer or by completing an Authorization of a different Third Party. Do not sign form until the form is fully completed. Keep a copy of form.
Signature of barrower

Clear
Printed name
Date

MonthDayYear
Date
Social Security Number
Phone
Email
example@example.com
Signature of co borrower

Clear
Printed name
Date

MonthDayYear
Social Security Number
Phone
Email
example@example.com
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Third Party Borrower Authorization

Third Party Acknowledgement

Connie Der Torossian