1003 - Page 2 application

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 the spouse also. Completed: Jointly Not Jointly
ASSETS	Cash or Market Value	Liability and Pledged assets. List the creditors name, address and account # for all outstanding debts, including auto loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges, etc. Use continuation sheet, if necessary. Indicate by (X) those liabilities which will be satisfied upon sale of real estate owned or upon refinancing of the subject property.
Cash Deposit Purchase Held by:	$
List checking and savings accounts below, name & address of Bank S&L or Credit Union.		Liabilities	Mthly Payments
Name: Address:		Name: Address:	Pmt amount: $ Months remain:
Acct #	$	Acct#	unpaid balance: $

Name: Address:		Name: Address:	Pmt amount: $ Months remain:
Acct #	$	Acct#	unpaid balance: $

Name: Address:		Name: Address:	Pmt amount: $ Months remain:
Acct #	$	Acct#	unpaid balance: $

Name: Address:		Name: Address:	Pmt amount: $ Months remain:
Acct #	$	Acct#	unpaid balance: $

Stocks & Bonds (Company name/number) Description		Name: Address:	Pmt amount: $ Months remain:
Acct #	$	Acct#	unpaid balance: $

Additional Assets	Value	Additional Liabilities	Monthly Payment
Life insurance net cash value Face amt.:	$	Name: Address:	Pmt amount: $ Months remain:
Subtotal Liquid Assets:	$	Acct#	unpaid balance: $
Real estate owned: (enter market value from schedule of real estate owned)	$	Name: Address:	Pmt amount: $ Months remain:
Vested interest in retirement fund:	$	Acct#	unpaid balance: $
Net worth of business (Est.) owned:	$	Alimony/Child Support/Separate maintenance pmts owed to:	$
Automobiles owned:	$	Job related expense (child care, union dues, etc.):	$
Other Assets:	$	Total Monthly Payments:	$
Total Assets (a.):	$	Total Liabilities (b.):	$
	Net Worth (a. minus b.)	$

Schedule of Real Estate Owned: (if additional properties are owned, use continuation sheet available at the end of this online application.)
Property Address	Type of Property	Present Market Value	Amount of Mtg. & Leans	Gross Rental Income	Mtg. Payments	Insurance, Maint, Misc..	Net Rental Income

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

VIII. DECLARATIONS

Items	Borrower	Co-Borrower
a. Are there any outstanding judgements against you?	Yes No	Yes No
b. Have you been declared bankrupt within the last 7 years?	Yes No	Yes No
c. Have you had property foreclosed upon 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?	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	Yes No
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?	Yes No	Yes No
i. Are you the 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	Yes No
m. Have you had an ownership interest in a property in the last 3 years?	Yes No	Yes No

	Borrower	Co-Borrower
1. What type of property did you own?
2. How did you hold title to the home?

IX. ACKNOWLEDGMENT 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 application are made for the purpose of obtaining the loan indicated herein; (4) occupation of the property will be as indicated above; (5) verification or re-verification of any information contained in the application may be made at any time by the lender, it's agents, successors and assigns, either directly or through a credit reporting agent, 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, it's 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, it's 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 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, it's agents, successors and assigns make no representations or warranties, expressed 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 provided 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 my intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalties 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, it's agents, successors and assigns, insurers and any other person who may suffer any loss due to the reliance upon any misrepresentation which I/we have made on this application.

Borrowers Name

Date

Co-Borrowers Name

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 neither discriminate on the basis of this information, nor on whether you choose to furnish it. However, if you choose not to furnish is, 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 type of loan applied for.)

Borrower	Co-Borrower
I do not wish to furnish this information Race/National Origin: Sex: Female Male	I do not wish to furnish this information Race/National Origin: Sex: Female Male

Borrower

Co-Borrower

I do not wish to furnish this information

Race/National Origin:

Sex: Female Male

I do not wish to furnish this information

Race/National Origin:

Sex: Female Male

Thank you for completing the Online Mortgage Application! If you need more space to add additional information, go to the Continuation sheet below. We will contact you very shortly regarding your request.

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:
	Co-Borrower:

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