Southwestern Indiana 4-County Mortgage Foreclosure Prevention Education Outreach
(Vanderburgh/Gibson/Posey/Warrick)
Name
First Name
Last Name
Address
Street Address
City
State / Province
Postal / Zip Code
County
Name of the county of your home
Are you a Veteran
Please answer yes or no
Phone Number
Please enter a valid phone number.
Email Address
Email
Are you the primary owner?
Please answer yes or no
Have an authorized person?
If someone assisting with the application on your behalf? If yes, please provide the name.
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Co-Owner Name
First Name
Last Name
Received mortgage assistance?
If yes, what program
Hardest Hit Funds or Homeowner Assistance Funds or both?
Is there a Sheriff Sale scheduled?
Please type yes or no
If so, when is the sale date?
Are you in active Bankruptcy?
Please type yes or no
Which chapter of Bankruptcy (7 or 13)?
Please provide which type
Annual Income (Gross)
Please provide the amount for the year
Type of Income
(Wages/Social Security/Self Employed, etc.)
Who is your lender?
Please provide your lender's name
What is your mortgage loan #
Please provide your full loan number
What kind of mortgage do you have?
Please state if your loan is an FHA/USDA/VA/Conventional
What is your payment amount?
Please provide your monthly payment amount
Are you delinquent on your mortgage?
Please answer yes or no
How many months delinquent?
Please provide the number of missed payments
What caused you to fall behind on your mortgage payments
Please provide a brief explanation of your circumstances
Appointment
Submit
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