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| Uniform Residential Loan Application |
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| Mortgage
Applied for
VA Conventional FHA FmHa Other: |
Identifying
Numbers
Agency Case No. Lender Case No. |
Financial
Details
Amount Interest Rate % No. of Months |
Amortization
Type
Fixed Rate GPM ARM : Other : |
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| Subject Property
Address (street, city, state, & ZIP)
Street City StateZip |
Legal Description (attach
description if necessary)
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| No. of Units | Year Built |
| Purpose of Loan
Purchase Refinance Construction Construction-Permanent Other (explain): |
Property will be:
Primary Residence Secondary Residence Investment
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| Complete this line if construction or construction-permanent loan. |
| Yr Lot Acquired
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Original Cost
$ |
Existing Liens
$ |
(a) Lot Present Value
$ |
(b) Improvement Cost
$ |
Total (a + b)
$ |
| Complete this line if this is a refinance loan. |
| Yr Acquired
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Original Cost
$ |
Amount Existing
Liens
$ |
Purpose of Refinance
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| Describe Improvements made
to be made
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Cost: $ |
| Title will be
held in what Name(s)
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Manner in which
Title will be held
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| Estate will be held in
Fee Simple Leasehold Expiration Date: |
Source of Down Payment,
Settlement, Subordinate Financing (explain)
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| BORROWER |
| Borrower's Name
(Jr. or Sr. if applicable)
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Social Security
No.
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Home Phone (w/area
code)
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Age
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Yrs. School
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| Marital Status
Married Separated Unmarried (include single, divorced, widowed) |
Dependents
(not listed by Co-Borrower) Number Dependants Ages |
Present Address (street,
city, state, ZIP)
Street City StateZip Own Rent No. Yrs |
| If residing at present address for less than two years, complete the following: |
| Former Address (street,
city, state, ZIP)
Street City StateZip Own Rent No. Yrs |
Former Address (street,
city, state, ZIP)
Street City StateZip Own Rent No. Yrs |
| CO-BORROWER |
| Co-Borrower's Name
(include Jr. or Sr. if applicable) |
Social Security
Number |
Home Phone
(incl. area code) |
Age |
Yrs. School |
| Marital Status
Married Separated Unmarried (include single, divorced, widowed) |
Dependents
(not listed by Borrower) No. Ages |
Present Address (street,
city, state, ZIP)
Street City StateZip OwnRent No. Yrs |
| If residing at present address for less than two years, complete the following: |
| Former Address (street,
city, state, ZIP)
Street City StateZip Own Rent No. Yrs |
Former Address (street,
city, state, ZIP)
Street CityStateZip Own Rent No. Yrs |
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| BORROWER |
| Name & Address
of Employer
Name Street City State Zip Self Employed |
Yrs. on this
job
Yrs. employed in this line of work/profession |
Postion/Title/Type
of Business
Business Phone (incl. area code) |
| If employed in current
for less than two years or if currently employed in more than one position,
complete the following: |
| Name & Address
of Employer
Name Street City State Zip Self Employed |
Dates (from
- to)
Monthly Income $ |
Postion/Title/Type
of Business
Business Phone (incl. area code) |
| Name & Address
of Employer
Name Street City State Zip Self Employed |
Dates (from
- to)
Monthly Income $ |
Postion/Title/Type
of Business
Business Phone (incl. area code) |
| CO-BORROWER |
| Name & Address
of Employer
Name Street City State Zip Self Employed |
Yrs. on this
job
Yrs. employed in this line of work/profession |
Postion/Title/Type
of Business
Business Phone (incl. area code) |
| If employed in current
for less than two years or if currently employed in more than one position,
complete the following: |
| Name & Address
of Employer
Name Street City State Zip Self Employed |
Dates (from
- to)
Monthly Income $ |
Postion/Title/Type
of Business
Business Phone (incl. area code) |
| Name & Address
of Employer
Name Street CityState Zip Self Employed |
Dates (from
- to)
Monthly Income $ |
Postion/Title/Type
of Business
Business Phone (incl. area code) |
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| 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 Taxes | $ | $ |
| 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 consideredfor repaying this loan. |
Monthly
Amount |
| $ | ||
| $ | ||
| $ |
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| 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 - Descriptions |
| Cash deposit
toward purchase held by (list entity)
Name Street City State Zip |
Cash or Market
Value
$ |
| List checking and savings
accounts (Bank, S&L, or Credit Union
Name Street City State Zip |
Acct. no.
|
$ |
| Name
Street City State Zip |
$ | |
| Name
Street City State Zip |
$ | |
| Name
Street City State Zip |
$ | |
| Name
Street City State Zip |
$ |
| Stocks & Bonds (Company
name/number & description)
Name Street City State Zip |
$ | |
| Life insurance net cash
value:
$ |
Face amont:
$ |
Cash or Market Value:
$ |
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| Real estate
owned (enter market value from schedule of real estate owned)
$ |
$ |
Net worth of
business(es)
owned (attach financial statement) $ |
| Automobiles
owned (make and year)
$ |
Other Assets
(itemize)
$ |
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| 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, ect. 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. |
| LIABILITIES |
| Company Name and Address | Account
Number |
Monthly
Payment |
Months
to Pay |
Unpaid Balance |
| Name
Street City State Zip |
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| Name
Street City State Zip |
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| Name
Street City State Zip |
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| Name
Street City State Zip |
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| Name
Street City State Zip |
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| Name
Street City State Zip |
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| Name
Street City State Zip |
| Owed to | Liability Type | Monthly
Payment |
Months
to Pay |
| Name
Street City State Zip |
Alimony/Child Support/Separate Maintenance Payments | ||
| Job Related Expense
(child care, union dues, etc.) |
| XXXXXXXXXXXXXXXXXXXXXXX |
Total Monthly Payment $ |
| XXXXXXXXXXXXXXXXXXXXXXX |
Total Liabilities b. $ |
| Schedule of Real Estate Owned (if additional properties are owned, use continuation sheet) |
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| List any additional names under which credit has previously been received and indicate appropriate creditor name (s) and account number (s): |
| Alternate Name
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Creditor Name
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Account Number
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| Alternate Name
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Creditor Name
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Account Number
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| Alternate Name
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Creditor Name
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Account Number
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| 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 items a through h) | $ |
| j. Subordinate financing | $ |
| k. Borrower's 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) (do this math!!) |
$ |
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| If you answer "yes" to any questions a through i, please use continuation |
| a. Are there any outstanding judgments against you? | Borrower
yes No |
Co-Borrower
yes No |
| b. Have there any outstanding judgments against you? | 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
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 V.A. case number, if any, and reasons for the action.) |
yes No | yes No |
| f. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? | yes No | yesNo |
| g. Are you obligated to pay alimony, child support, or separate maintenance? | yes No | yes No |
| h. Is any part of the down payment borrowed? | yesNo | yes No |
| i. Are you a co-maker or endorser on a note? | yes No | yes No |
| j. Are you a U.S. citizen? | yes No | yes No |
| k. Are you a permanent resident alien? | yes No | yes No |
| l. Do you intend to occupy the property as your primary residence? If "Yes," complete question m below. | yes No | yesNo |
| m. Have you had an ownership
interest in a property in the last three years?
(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)?
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yes No
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yes No
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| The undersigned specifically
acknowledge(s) and agrees that: (1) though 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 application are made for
the purpose of obtaining the loan indicated-herein; (4) occupation of the
property will be a as indicated 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
of their rights and remedies, report and my /our name(s) and account information
to a credit reporting agency; (8)ownership of the loan may be transferred
to a 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 makes 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
certifies that the information provided in this application is true and
correct as of the date set forth the opposite my/our signature(s) on this
application and a knowledge my/our understanding that any intentional or
negligent representation(s) of the information contained in this application
may result in civil liability and/or criminal penalties including, but
not limited to, a 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.
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| Borrower's Signature
Date |
Co-Borrower's Signature
Date |
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| The following information is requested by the federal government for certain types of loans related to a dwelling, in order to monitor the lenders compliance with the 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 the lender may neither discriminate on the basis of disinformation, nor on whether you choose to furnish it. However, if you choose not to furnish it, under federal rent 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 disclosure satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.) |
| BORROWER
I do not wish to furnish this information Race/National Origin: American Indian or Alaskan Native Asian or Pacific Islander Black, not of Hispanic origin Hispanic White, not of Hispanic origin Other Sex: Female Male |
CO-BORROWER
I do not wish to furnish this information Race/National Origin: American Indian or Alaskan Native Asian or Pacific Islander Black, not of Hispanic origin Hispanic White, not of Hispanic origin Other Sex: Female Male |
