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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 Borrowers 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, or 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. 
Mortgage
Applied for:
{$laf_va}
V.A.
{$laf_conv}
Conventional
{$laf_other}
Other (explain):{$laf_other_explain} Agency Case Number Lender Case Number
{$laf_fha}
FHA
{$laf_fmha}
FmHA      
Amount
$ {$loan_amount}
Interest Rate
{$interest_rate}%
No. of Months
{$number_of_months}
 Amortization
 Type:
{$fixed}
 Fixed Rate
{$amort_gpm}
 GPM
{$amort_other}
 Other (explain): {$amort_explain}
{$amort_arm}
 ARM (type): {$arm_type}
Subject Property Address  (street, city, state, ZIP)
{$subj_prop_street}, {$subj_prop_city} {$subj_prop_state} {$subj_prop_zip}
No. of Units
{$num_units}
Legal Description of Subject Property (attach description, if necessary)
{$leg_descr}
Year Built
{$year_built}
Purpose of Loan
{$purch}
 Purchase
{$purp_refi}
 Refinance
{$constr}
 Construction
{$const_perm}
 Construction-permanent
{$purp_other}
Other (explain): {$purp_explain}
 Property will be:
{$prime_res}
 Primary
 Residence
{$second_res}
 Secondary
 Residence
{$invest}
 Investment
Title will be held in what Name(s)
{$title_held_in}
 Manner in which Title will be held
 {$title_held_manner}
Source of Down Payment, Settlement Charges and/or Subordinate Financing (explain)
 Estate will be held in:
Fee Simple
Leasehold
(show expiration date)
Borrower's Name (include Jr. or Sr. if applicable)
{$b_first_name} {$b_mi_name} {$b_last_name}
 Co-Borrower's Name (include Jr. or Sr. if applicable)
  {$cb_first_name} {$cb_mi_name} {$cb_last_name}
Social Security Number
{$b_soc_sec}
 Home Phone (incl. area code)
 {$b_phone}
Age
{$b_age}
Yrs. School
{$b_school}
 Social Security Number
 {$cb_soc_sec}
 Home Phone (incl. area code)
 {$cb_phone}
Age
{$cb_age}
Yrs. School
{$cb_school}
{$b_married}
 Married
{$b_separated}
 Separated
{$b_unmarried}
 Unmarried (include single,
 divorced, widowed)
 Dependents (not listed by Co-Borrower)
 no.  ages
{$cb_married}
 Married
{$cb_separated}
 Separated
{$cb_unmarried}
 Unmarried (include single,
 divorced, widowed)
 Dependents (not listed by Borrower)
 no.  ages
Present Address (street, city, state, ZIP)
{$b_own_home}
 Own
{$b_rent_home}
 Rent
{$b_yrs_at_res}
No. Yrs.
{$b_res_street}
{$b_res_city}, {$b_res_state} {$b_res_zip}
 Present Address (street, city, state, ZIP)
{$cb_own_home}
 Own
{$cb_rent_home}
 Rent
{$cb_yrs_at_res}
No. Yrs.
 {$cb_res_street}
 {$cb_res_city}, {$cb_res_state} {$cb_res_zip}
Name & Address of Employer
{$b_self_employed}
 Self Employed
{$b_employer_name}
{$b_employer_street}
{$b_employer_city}, {$b_employer_state} {$b_employer_zip}
Yrs. on this job
{$b_yrs_on_job}
Yrs. employed in this line
of work/profession
{$b_yrs_in_prof}
Name & Address of Employer
{$cb_self_employed}
 Self Employed
{$cb_employer_name}
{$cb_employer_street}
{$cb_employer_city}, {$cb_employer_state} {$cb_employer_zip}
Yrs. on this job
{$cb_yrs_on_job}
Yrs. employed in this line
of work/profession
{$cb_yrs_in_prof}
Position/Title/Type of Business
{$b_employer_position}, {$b_employer_bus_type}
Business Phone (include area code)
{$b_employer_phone}
 Position/Title/Type of Business
  {$cb_employer_position}, {$cb_employer_bus_type}
Business Phone (include area code)
{$cb_employer_phone}
Gross Monthly Income
Borrower
Co-Borrower
Total
 Combined Monthly
 Housing Expense
Present
Proposed
Base Empl. Income*
 $  {$b_base_income}
 $  {$cb_base_income}
 $  {$total_base_income}
  Rent
 $  {$housing_expense_rent}
Overtime
{$b_overtime_income} 
{$cb_overtime_income} 
{$total_overtime_income} 
  First Mortgage (P&I)
{$current_pi} 
 $  {$proposed_pi}
Bonuses
{$b_bonus_income} 
{$cb_bonus_income} 
{$total_bonus_income} 
  Other Financing (P&I)
{$current_other_financing} 
{$proposed_other_financing} 
Commissions
{$b_commission_income} 
{$cb_commission_income} 
{$total_commission_income} 
  Hazard Insurance
{$current_hazard_insurance} 
{$proposed_hazard_insurance} 
Dividends/Interest
{$b_dividend_income} 
{$cb_dividend_income} 
{$total_dividend_income} 
  Real Estate Taxes
{$current_re_taxes} 
{$proposed_re_taxes} 
Net Rental Income
{$b_rental_income} 
{$cb_rental_income} 
{$total_rental_income} 
  Mortgage Insurance
{$current_mi} 
{$proposed_mi} 
Other (see "Describe Other
Income Notice" below)
{$b_other_income} 
{$cb_other_income} 
{$total_other_income} 
  Homeowner Assn. Dues
{$current_hoa_dues} 
{$proposed_hoa_dues} 
 Other:
{$current_other_expenses} 
{$proposed_other_expenses} 
Total
 $  {$b_total_income}
 $  {$cb_total_income}
 $  {$total_total_income}
  Total
 $  {$current_total_expenses}
 $  {$proposed_total_expenses}
* Self employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.
Describe Other Income   Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower (B)
B/C
or Co-Borrower (C) does not choose to have it considered for repaying this loan.
Monthly Amount
 
 
 
 
 
 
 
 
This Statement and any applicable supporting schedules may be completed jointly by both married 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.
Completed 
 Jointly 
 Not Jointly
ASSETS
Description
Cash or Market
Value
Cash deposit toward purchase held by:
 $   
List checking and savings accounts below
Name and address of Bank, S&L, or Credit Union
{$bnk1_name}
Acct no. {$bank_account_number_one}
  {$bank_amount_one}
Name and address of Bank, S&L, or Credit Union
{$bnk2_name}
Acct no. {$bank_account_number_two}
  {$bank_amount_two}
Name and address of Bank, S&L, or Credit Union
{$bnk3_name}
Acct no. {$bank_account_number_three}
  {$bank_amount_three}
Name and address of Bank, S&L, or Credit Union
{$bnk4_name}
Acct no. {$bank_account_number_four}
  {$bank_amount_four}
Stocks & Bonds (Company name/number & description)
{$stk1_name} / {$stk1_num}
{$stk2_name} / {$stk2_num}
  {$stock_value_one}
  {$stock_value_two}
Life Insurance net cash value
Face amount: $
  
Subtotal Liquid Assets
 $   
Real estate owned (enter market value from schedule of real estate owned)
  
Vested interest in retirement fund
  
Net worth of business(es) owned (attach financial statement)
  
Automobiles owned (make & year)
 
  
  
  
Other Assets (itemize)
 
  
  
  
Total Assets a. 
 $ {$total_all_assets}  
Liabilities and Pledged Assets. List the creditor's name 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.
LIABILITIES
Monthly Payt. &
Mos. Left to Pay
Unpaid
Balance
 Name and address of Company
 
 
  {$liab1_name}
 Acct. no. {$liability_acct_number_one}
 $ Payt./Mos.
$ {$monthly_pymt_one}
mo.
  {$unpaid_balance_one}$
 Name and address of Company
 
 
  {$liab2_name}
 Acct. no. {$liability_acct_number_two}
 $ Payt./Mos.
$ {$monthly_pymt_two}
mo.
  {$unpaid_balance_two}$
 Name and address of Company
 
 
  {$liab3_name}
 Acct. no. {$liability_acct_number_three}
 $ Payt./Mos.
$ {$monthly_pymt_three}
mo.
  {$unpaid_balance_three}$
 Name and address of Company
 
 
  {$liab4_name}
 Acct. no. {$liability_acct_number_four}
 $ Payt./Mos.
$ {$monthly_pymt_four}
mo.
  {$unpaid_balance_four}$
 Name and address of Company
 
 
  {$liab5_name}
 Acct. no. {$liability_acct_number_five}
 $ Payt./Mos.
$ {$monthly_pymt_five}
mo.
  {$unpaid_balance_five}$
 Name and address of Company
 
 
  {$liab6_name}
 Acct. no. {$liability_acct_number_six}
 $ Payt./Mos.
$ {$monthly_pymt_six}
mo.
  {$unpaid_balance_six}$
 Name and address of Company
 
 
  {$liab7_name}
 Acct. no. {$liability_acct_number_seven}
 $ Payt./Mos.
$ {$monthly_pymt_seven}
mo.
  {$unpaid_balance_seven}$
 Alimony/Child Support/separate maintenance  Payments owed to:
 
 $ {$other_monthly_pymt}
 Job Related Expense (child care, union dues,  etc.):
 $ {$job_related_monthly_pymt}
 Total Monthly Payments
 $ {$liabilities_total_monthly_pymts}
 Net Worth (a minus b)
 $ {$total_net_worth}
Total Liabilities b.
 $ {$total_liabilities}
a. Purchase price
   {$details_purchase_price}
b. Alterations, Improvements, repairs
   {$details_improvements_value}
c. Land (if acquired separately)
{$details_land_only_value}    
d. Refinance (incl. debts to be paid off)
{$details_refinance_amount}    
e. Estimated prepaid items
{$details_estimated_prepaids}    
f. Estimated closing costs
{$details_estimated_closing_costs}    
g. PMI, MIP, Funding Fee
{$details_pmi_mip_funding_fee}    
h. Discount (if Borrower will pay)
{$details_discount_price}    
i. Total costs (add items a through h)
{$details_total_costs}    
j. Subordinate financing
{$details_subordinate_financing_amount}    
k. Borrower's closing costs paid by Seller
{$details_seller_paid_closing_costs}    
l.
Other Credits (explain)
{$details_other_costs_explain}    
m.
Loan amount (exclude PMI, MIP, 
Funding Fee financed)
   {$details_loan_amount_no_mi}
n. PMI, MIP, Funding Fee financed
{$details_pmi_mip_funding_fee_financed}    
0. Loan amount (add m & n)
{$details_loan_amount_m_plus_n}    
p.
Cash from/to Borrower
(subtract j, k, l, & o from i)
{$details_cash_from_to_borrower}    
 If you answer "Yes" to any questions a through i, please
 use continuation sheet for explanation.
Borrower
Co-Borrower
Yes
No
Yes
No
 a. Are there any outstanding judgments against you?
{$ba_yes}
{$ba_no}
{$cba_yes}
{$cba_no}
 b. Have you been declared bankrupt within the last 7 years?
{$bb_yes}
{$bb_no}
{$cbb_yes}
{$cbb_no}
 c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
{$bc_yes}
{$bc_no}
{$cbc_yes}
{$cbc_no}
 d. Are you a party to a lawsuit"
{$bd_yes}
{$bd_no}
{$cbd_yes}
{$cbd_no}
 e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, or loan guarantee.  If "Yes," provide details,
including details, including date, name and address of lender, FHA or V.A. case number if any, and reasons for the action.)
{$be_yes}
{$be_no}
{$cbe_yes}
{$cbe_no}
 f. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?  If "Yes", give details
as described in the preceding question
{$bf_yes}
{$bf_no}
{$cbf_yes}
{$cbf_no}
 g. Are you obligated to pay alimony, child support, or separate maintenance?
{$bg_yes}
{$bg_no}
{$cbg_yes}
{$cbg_no}
 h. Is any part of the down payment borrowed?
{$bh_yes}
{$bh_no}
{$cbh_yes}
{$cbh_no}
 i. Are you a co-maker or endorser on a note?
{$bi_yes}
{$bi_no}
{$cbi_yes}
{$cbi_no}
 j. Are you a U.S. citizen?
{$bj_yes}
{$bj_no}
{$cbj_yes}
{$cbj_no}
 k. Are you a permanent resident alien?
{$bk_yes}
{$bk_no}
{$cbk_yes}
{$cbk_no}
 l. Do you intend to occupy the property as your primary residence?  If "Yes," complete question m below.
{$bl_yes}
{$bl_no}
{$cbl_yes}
{$cbl_no}
 m. Have you had an ownership interest in a property in the last three years?
{$bm_yes}
{$bm_no}
{$cbm_yes}
{$cbm_no}
(1) What type of property did you own - - principal residence (PR), second home (SH), or investment property (IP)?
{$b_ownership_property_type}
{$cb_ownership_property_type}
(2) How did you hold title to the home - - solely by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?
{$b_ownership_title_held}
{$cb_ownership_title_held}
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 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 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 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 any 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, 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
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  Lender may neither discriminate 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 ethniciry, 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.)
BORROWER
{$b_private}
 I do not wish to furnish this information CO-BORROWER
{$cb_private}
I do not wish to furnish this information
Ethnicity:
{$b_hisp}
Hispanic or Latino
{$b_not_hisp}
Not Hispanic or Latino Ethnicity:
{$cb_hisp}
Hispanic or Latino
{$cb_not_hisp}
Not Hispanic or Latino
Race:
{$b_amer_indian}
American Indian or
Alaskan Native
{$b_api}
Asian
{$b_aa}
Black or
African American		 Race:
{$cb_amer_indian}
American Indian or
Alaskan Native
{$cb_api}
Asian
{$cb_aa}
Black or
African American
 
{$b_hawaiian}
Native Hawaiian or
Other Pacific Islander
{$b_white}
White
{$cb_hawaiian}
Native Hawaiian or
Other Pacific Islander
{$cb_white}
White
Sex:
{$b_female}
Female
{$b_male}
Male     Sex:
{$cb_female}
Female
{$cb_male}
Male    
To be Completed by Interviewer
This application was taken by:
{$ff_interview}
 Face-to-face interview
{$mail_interview}
 Mail
{$phone_interview}
 Telephone
{$internet_interview}
 Internet
 Interviewer's Name (print or type)
 
 Interviewer's Signature
Date
 Interviewer's Phone Number (incl. area code)
 Name and Address of Interviewer's Employer
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

 
 
 
 
Declarations Explanation:: 

 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
I/we 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.
Borrower's Signature Date  Co-Borrower's Signature  Date
X  X

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