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 must also be provided (and the appropriate box checked) when the income 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.

I. TYPE OF MORTGAGE AND TERMS OF LOAN
Mortgage
Applied for:		 VA Conventional Other: Agency Case Number Lender Case No.
FHA FmHA
Amount Interest
Rate		 No. of
Months		 Amortization Type: Fixed Rate Other(explain):
$ % GPM ARM(type):
II. PROPERTY INFORMATION AND PURPOSE OF LOAN
Subject Property Address (street, city, state & zip code) No. of Units
Legal Description of Subject Property (attach description if necessary) Year Built
Purpose of Loan Purchase Construction Other(explain): Property Will be:
Refinance Construction -Permanent Primary Residence Secondary Residence Investment
Complete this line if construction or construction-permanent loan.
Year Lot Acquired Original Cost Amount Existing Liens (a) Present Value of Lot (b) Cost of Improvements Total (a + b)
$ $ $ $ $
Complete this line if this is a refinance loan.
Year Acquired
Original Cost Amount Existing Liens Purpose of Refinance Describe Improvements made to be made
$ $ Cost:$
Title will be held in what Name(s) Manner in which Title will be held Estate will be held in:
Fee Simple Leasehold
Source of Down Payment, Settlement Charges and/or Subordinate Financing (explain): (show expiration date)
Borrower III. BORROWER INFORMATION Co-Borrower
Social Security Number Home Phone
(incl. area code)		 Age Yrs.
School		 Social Security Number Home Phone
(incl. area code)		 Age Yrs.
School
Married Unmarried (including single, divorced, widowed) Dependents
(not listed by Co-Borrower)		 Married Unmarried (including single, divorced, widowed) Dependents
(not listed by Co-Borrower)
Separated no.
ages 		Separated no.
ages
Present Address(street, city, state, zip code)
Own Rent No. Yrs.		 Present Address(street, city, state, zip code)
Own Rent No. Yrs.
If residing at present address for less than two years, complete the following.
Former Address(street, city, state, zip code)
Own Rent No. Yrs.		 Former Address(street, city, state, zip code)
Own Rent No. Yrs.
Former Address(street, city, state, zip code)
Own Rent No. Yrs.		 Former Address(street, city, state, zip code)
Own Rent No. Yrs.
 
Name & Address of Employer
Self Employed 		Yrs. on this job Name & Address of Employer
Self Employed 		Yrs. on this job
Yrs. in this line of work / profession Yrs. in this line of work / profession
Position/Title/Type of Business Business Phone
(incl. area code)		 Position/Title/Type of Business Business Phone
(incl. area code)
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
Self Employed 		Dates (from-to)
Monthly Income Monthly Income
Position/Title/Type of Business Business Phone
(incl. area code)		 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)
Monthly Income Monthly Income
Position/Title/Type of Business Business Phone
(incl. area code)		 Position/Title/Type of Business Business Phone
(incl. area code)
V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION
Gross Monthly Income Borrower Co-Borrower Total Combined Monthly Housing Expense Present Proposed
Base Empl. Income* $ $ $ Rent $
Overtime First Mortgage (P&I) $
Bonuses Other Financing (P&I)
Commissions Hazard Insurance
Dividends/Interest Real Estate Taxed
Net Rental Income Mortgage Insurance
Other (before completing, see the notice in "describe other income," below) Homeowner Assn. Dues
Other:
Total $ $ $ Total $ $
*Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.
B/C Describe Other Income (Notice: 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.) Monthly Amount
$
$
$
VI. ASSETS AND LIABILITIES
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: Jointly Not Jointly
ASSETS
Description
Cash or
Market Value
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.
Cash deposit toward purchase held by:
$
List checking and savings accounts below
LIABILITIES
Monthly Payt. & Mos. Left to Pay Unpaid Balance
Name and address of Bank, S&L or Credit Union Name and address of Company $ Payt./Mos. $
Acct. no. $ Acct. no.
Name and address of Bank, S&L or Credit Union Name and address of Company $ Payt./Mos. $
Acct. no. $ Acct. no.
Name and address of Bank, S&L or Credit Union Name and address of Company $ Payt./Mos. $
Acct. no. $ Acct. no.
Name and address of Bank, S&L or Credit Union Name and address of Company $ Payt./Mos. $
Acct. no. $ Acct. no.
Stocks & Bonds (Company name/number & description) Name and address of Company $ Payt./Mos. $
$ Acct. no.
Life Insurance net cash value
Face Amount: $ 		$ Name and address of Company $ Payt./Mos. $
Subtotal Liquid Assets $
Real Estate owned (enter market value from schedule of real estate owned) $ Name and address of Company $ Payt./Mos. $
Vested Interest in retirement fund $
Net worth of business(es) owned (attach financial statement) $ Alimony/Child Support/Separate Maintenance Payments Owed for $
Automobiles owned
(make & year) 		$ Job Related Expenses (child care, union dues, etc.) $
Other Assests (itemize) $ Total Monthly Payments $
Total
Assets a.		 $ Net Worth
(a minus b) $ 		$ Total
Liabilities b.		 $
Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet.)
Property Address (enter S if sold, PS if pending sale or R if rental being held for income)
Type
of
Property
Present Market Value
Amount of Mortgages and Liens
Gross Rental Income
Mortgage Payments
Insurance, Maintenance, Taxes & Misc.
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
VII. DETAILS OF TRANSACTION VIII. DECLARATION
a. Purchase Price $ If you answer "yes" to any questions a through l, please use continuation sheet for explanation.
Borrower
Co-Borrower
b. Alterations, improvements, repairs Yes No Yes No
c. Land (if acquired separately) a. Are there any outstanding judgements against you?
d. Refinance (incl. debts to be paid off) b. Have you been declared bankrupt within the past 7 years?
e. Estimated prepaid items c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
f. Estimated closing costs d. Are you party to a lawsuit?
g. PMI, MIP, Funding Fee e. Have you directed or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement? (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 adddress of Lender, FHA or VA case number, if any, and reasons for the action.)
h. Discount (if Borrower will pay)
i. Total costs (add items a through h)
j. Subordinate financing f. Are you presently deliquent or in default on any Federal debt or any other loan, mortgage, financial, financial obligation, bond, or loan guarantee? If "Yes", give details as described in the preceding question.
k. Borrower's closing costs paid by Seller g. Are you obligated to pay alimony, child support, or separate maintenance?
l. Other Credits
h. Are you a co-maker or endorser on a note?
i. Are you a U.S. citizen?
j. Are you a permanent resident alien?
m. Loan amount
(exclude PMI, MIP, Funding Fee financed)		 k. Do you intend to occupy the property as your primary residence? If "Yes", complete question below.
n. PMI, MIP, Funding Fee financed l. Have you had an ownership interest in a property in the last three years?
o. Loan amount (add m & n)    (1) What type of property did you own -- principal residence (PR), second home (SII), or investment property (IP)?
p. Cash from/to Borrower (subtract j, k, l & o from i)    (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. ACKNOWLEDGEMENT AND AGREEMENT
The undersigned specifically acknowledge(s) and agree(s) that: (1) the loan requested by this application will be secured by a first mortgage or deed of trust on the property described herein; (2) the property will not be used for any illegal or prohibited purpose or use; (3) all statements made in this appplication are made for the purpose of obtaining the loan indicated herein; (4) occupation of the property will be indicated as above; (5) verification or reverification of any information contained in the application may be made at any time by the Lender, its agents, successors and assigns, either directly or through a credit reporting agency, from any source named in this application, and the original copy of this application will be retained by the Lender, even if the loan is not approved; (6) the Lender, its agents, successors, and assigns will rely on the information contained in the application and I/we have a continuing obligation to amend and/or supplement the information provided in this application if any of the material facts which I/we have represented herein should change prior to closing; (7) in the event my/our payments on the loan indicated in this application become delinquent, the Lender, its agents, successors, and assigns, may, in addition to all their other rights and remedies, report my/our name(s) and account information to a credit reporting agency; (8) ownership of the loan may be transferred to the successor or assign of the Lender without notice to me and/or the administration of the loan account may be transferred to an agent, successor or assign of the Lender with prior notice to me; (9) the Lender, its agents, successors and assigns make no representations or warranties, express or implied, to the Borrower(s) regarding the property, the condition of the property, or the value of the property.
Certification: I/We certify that the information provide in this application is true and correct as of the date set forth opposite my/our signature(s) on this application and acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalities, including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section 1001, et. seq. and liability for monetary damages to the Lender, its agents, successors and assigns, insurers and any other person who may suffer any loss due to reliance upon any misrepresentation which I/we have made on this application.
Borrower's Signature Date Co-Borrower's Signature Date
X ___/___/___ X ___/___/___
X. INFORMATION FOR GOVERNMENT MONITORING PURPOSE
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 neither discriminate on the basis of this information, nor whether you choose to furnish it. However, if you choose not to furnish it, under Federal regulations this Lender is required to note race and sex on the basis of visual observation or surname. If you do not wish to furnish the above 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 of loan applied for.)
BORROWER I do not wish to furnish this information. CO-BORROWER I do not wish to furnish this information.
Race/
National
Origin
American Indian or Alaskan Native Asian or Pacific Islander White, not of Hispanic origin
Race/
National
Origin
American Indian or Alaskan Native Asian or Pacific Islander White, not of Hispanic origin
Black, not of Hispanic Origin Hispanic Black, not of Hispanic Origin Hispanic
Other (specify) Other (specify)
Sex: Female Male Sex: Female Male
Continuation Sheet/Residential Loan Application
Use this continuation sheet if you need more space to complete the Residential Loan Application. Mark B for Borrower or C for Co-Borrower.
Borrower: Agency Case Number:
Co-Borrower: Lender Case Number:
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 101, et seq.
Borrower's Signature:
Date
Co-Borrower's Signature:
Date
X ___/___/___ X ___/___/___
Freddie Mac Form 65/Rev. 10/92 Fannie Mae Form 1003/Rev. 10/92