Residential Application Form

Uniform Residential Loan Application

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 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 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.

II. PROPERTY INFORMATION AND PURPOSE OF LOAN

Borrower’s Name (include Jr. or Sr. if applicable)

Co-Borrower’s Name (include Jr. or Sr. if applicable)

Yrs. School Social Security Number Home Phone (incl. area code) DOB (MM/DD/YYYY)

Married SeparatedUnmarried (include single, divorced, widowed)Married SeparatedUnmarried (include single, divorced, widowed)Social Security Number Home Phone (incl. area code) DOB (MM/DD/YYYY)ages

Yrs. School Social Security Number Home Phone (incl. area code) DOB (MM/DD/YYYY)

Yrs. School

Married Separated

Unmarried (include single, divorced, widowed)

Dependents (not listed by Co-Borrower)

Married Separated

Unmarried (include single, divorced, widowed)

Dependents (not listed by Borrower)

no.

ages

Present Address (street, city, state, ZIP)

OwnRent

No. Yrs. Present Address (street, city, state, ZIP)

OwnRent

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)

OwnRent

Former Address (street, city, state, ZIP)

No. Yrs. Former Address (street, city, state, ZIP)

OwnRent

No. Yrs. Former Address (street, city, state, ZIP)

Rent

Name & Address of Employer

Self Employed Yrs. on this jobName & Address of Employer

Name & Address of Employer

Self Employed Yrs. on this job

Yrs. employed in this line of work/profession

Position/Title/Type of Business

If employed in current position for less than two years or if currently employed in more than one position, complete the following

Name & Address of Employer

Self Employed Dates (from – to)Name & Address of Employer

Name & Address of Employer

Self Employed Dates (from – to)

Date

Monthly Income

Position/Title/Type of Business

Business Phone (incl. area code)

Name & Address of Employer

Self Employed Dates (from – to)Name & Address of Employer

Self Employed Dates (from – to)

Name & Address of Employer

Self Employed Dates (from – to)

Date

Monthly Income

Position/Title/Type of Business

Business Phone (incl. area code) Position/Title/Type of Business

Business Phone (incl. area code)

V. M O N T H LY I N C O M E A N D C O M B I N E D HOUSING EXPENSE INFORMATION

Gross Monthly Income

	Borrower	Co-Borrower	Total
Overtime
Bonuses
Commissions
Dividends/Interest
Net Rental Income
Other (before completing, see the notice in “describe other income,” below)
Total

Borrower

Co-Borrower

Proposed

Rent

First Mortgage (P&I)

Other Financing (P&I)

Hazard Insurance

Real Estate Taxes

	-	-	-

Real Estate Taxes

	-	-	-

Real Estate Taxes

	-	-	-

Real Estate Taxes

Mortgage Insurance

	-	-	-

Mortgage Insurance

Homeowner Assn. Dues

	-	-	-

Homeowner Assn. Dues

Other

Total

Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements. Describe Other IncomeNotice: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.*

* Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements. Describe Other IncomeNotice: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.

	B/C	-	Monthly Amount

Monthly Amount

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

JointlyNot Jointly

ASSETS

Cash or Market Value

Cash deposit toward purchase held by:

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.

Monthly Payment & Months Left to Pay

List checking and savings accounts below

Name and address of Company

$ Payment/Months

Name and address of Bank, S&L, or Credit Union

Acct. no.

Name and address of Company

$ Payment/Months

Name and address of Bank, S&L, or Credit Union

Acct. no.

Name and address of Company

$ Payment/Months

Name and address of Bank, S&L, or Credit Union

Acct. no.

Name and address of Company

$ Payment/Months

Name and address of Bank, S&L, or Credit Union

Acct. no.

Name and address of Company

$ Payment/Months

Stocks & Bonds (Company name/number & description)

Acct. no.

Name and address of Company

$ Payment/Months

Life insurance net cash value

Face amount

Subtotal Liquid Assets

Real estate owned (enter market value from schedule of real estate owned)

Acct. no.

$ Payment/Months

Vested interest in retirement fund

Address

Name and address of Company

Street Address Line 2

Net worth of business(es) owned (attach financial statement)

Automobiles owned (make and year)

Acct. no.

Alimony/Child Support/Separate Maintenance Payments Owed to

Other Assets (itemize)

Job-Related Expense child care, union dues, etc

Total Assets a.

Net Worth (a minus b)

Total Liabilities b.

VI. ASSETS AND LIABILITIES cont

	Schedule of Real Estate Owned If additional properties are owned, use continuation sheet Property Address enter S if sold, PS if pending sale PresentAmount of Ty p e o f or R if rental being held for income Market ValueMortgages & Liens Property	-	-	-	Gross Rental Income	Mortgage Payments	Insurance, Maintenance, Ta x e s & M i s c .	Net Rental Income

Totals

List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s):

Alternate Name

Creditor Name

Account Number

b. Alterations, improvements, repairs

If you answer “Yes” to any questions a through i, please use continuation sheet for explanation.

	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 a 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 numbe r, if any, and rea son s for the action

c. Land (if acquired separately)

d. Refinance (incl. debts to be paid off)

h. Discount (if Borrower will pay)

i. Total costs (add items a through h)

j. Subordinate financing

k. Borrower’s closing costs paid by Seller

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 numbe r, if any, and rea son s 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.

m. Loan amount (exclude PMI, MIP, Funding Fee financed)

n. PMI, MIP, Funding Fee financed

k. Are you a permanent resident alien?

l. Do you intend to occupy the property as your primary residence?

If “Yes,” complete question m below.

	-	-	-	-
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?
j. Are you a U.S. citizen?
k. Are you a permanent resident alien?
l. Do you intend to occupy the property as your primary residence?
m. Have you had an ownership interest in a property in the last three years?

p. Cash from/to Borrower (subtract j, k, l & o from i)

(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)?

IX. ACKNOWLEDGMENT AND AGREEMENT

Each of the undersigned specifically represents to Lender and to Lender's actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors and assigns and agrees and acknowledges that: (1) the information provided in this application is true and correct as of the date set forth opposite my signature and that any intentional or negligent misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, but 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 trust on the property described herein; (3) the property will not be used for any illegal or prohibited purpose or use; (4) all statements made in this application are made for the purpose of obtaining a residential mortgage loan; (5) the property will be occupied as indicated herein; (6) any owner or servicer of the Loan may verify or reverify any information contained in the application from any source named in this application, and Lender, its successors or assigns may retain the original and/or an electronic record of this application, even if the Loan is not approved; (7) the Lender and its agents, brokers, insurers, servicers, successors and assigns may continuously rely on the information contained in the application, and I am obligated to amend and/or supplement the information 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 owner or servicer of the Loan may, in addition to any other rights and remedies that it may have relating to such delinquency, report my name and account information 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 representation or warranty, express or implied, to me regarding the property or the condition or value of the property; and (11) my transmission of this 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 fascimile 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.

Date

X. 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 mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may discriminate neither on the basis of this information, nor 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 or surname. 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 satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for

CO-BORROWER

I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of Title 18, United States Code, Section 1001, et seq.

Co-Borrower

Borrower

Combined Monthly Housing Expense

Present

LIABILITIES

Unpaid Balance

Total Monthly Payments

Borrower Co-Borrower

BORROWER

Ethnicity:

Race:

Sex: