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 information must also be provided (and the appropriate box checked) when the income or assets 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 or other person who has community property rights pursuant to state law will not be used as a basis for loan qualification, but his or her liabilities must be considered because the spouse or other person has community property rights pursuant to applicable law and 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.

If this is an application for joint credit, Borrower and Co-Borrower each agree that we intend to apply for joint credit (sign below):

_________________________________________ _________________________________________

Borrower Co-Borrower

I. TYPE OF MORTGAGE AND TERMS OF LOAN
Mortgage Applied for: VA Conventional Other (explain): FHA USDA/Rural Housing Service

Agency Case Number: ______________ Lender Case Number: ______________
Amount:$_____________ Interest Rate: ___________% No. of Months: ______
Amortization Type: Fixed Rate GPM Other (explain): ARM (type):

II. PROPERTY INFORMATION AND PURPOSE OF LOAN
Subject Property Address (street, city, state & ZIP) No. of Units: ____

Legal Description of Subject Property (attach description if necessary) Year Built: _______

Purpose of Loan Purchase Construction Other (explain): Refinance Construction-Permanent

Property will be: 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
$____________
Total (a + b)
$_____________

Title will be held in what Name(s)

Manner in which Title will be held

Source of Down Payment, Settlement Charges, and/or Subordinate Financing (explain)
Estate will be held in: Fee Simple Leasehold (show expiration date: _____________)

Borrower III. BORROWER INFORMATION Co-Borrower

Borrower"s Name (include Jr. or Sr. if applicable)

Social Security Number: ________________
Home Phone (incl. area code): ______________
DOB (mm/dd/yyyy): ____________
Yrs. School: ______
Married Unmarried Separated single, divorced, widowed)
Dependents (not listed by Co-Borrower) no.____ ages __________
Present Address (street, city, state, ZIP) Own Rent ____No. Yrs.
Mailing Address, if different from Present Address
If residing at present address for less than two years, complete the following:
Former Address (street, city, state, ZIP) Own Rent ____No. Yrs.
Co-Borrower"s Name (include Jr. or Sr. if applicable)

Social Security Number: ________________
Home Phone (incl. area code): ______________
DOB (mm/dd/yyyy): ____________
Yrs. School: ______
Married Unmarried Separated single, divorced, widowed)
Dependents (not listed by Borrower) no.____ ages __________
Present Address (street, city, state, ZIP) Own Rent ____No. Yrs.
Mailing Address, if different from Present Address
If residing at present address for less than two years, complete the following:
Former Address (street, city, state, ZIP) Own Rent ____No. Yrs.

Borrower IV. EMPLOYMENT INFORMATION Co-Borrower

Name & Address of Employer Self Employed
Yrs. on this job: ______
Yrs. employed in this line of work/profession: ____
Position/Title/Type of Business:
Business Phone (incl. area code): __________________ Name & Address of Employer Self Employed
Yrs. on this job: ______
Yrs. employed in this line of work/profession: ____
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 __________)
Monthly Income: $_____________
Position/Title/Type of Business

Business Phone (incl. area code): ______________

Name & Address of Employer Self Employed

Dates (from _________ to __________)
Monthly Income: $_____________
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
Dividends/Interest				Real Estate Taxes
Net Rental Income				Mortgage Insurance
Other (before completing, see the notice in "describe other income," below)				Other:
Total	$_________	$_________	$_________	Total	$_________	$_________

* 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) or Co-Borrower (C) does not choose to have it considered for repaying this loan.

B/C 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 non-applicant spouse or other person, this Statement and supporting schedules must be completed about that spouse or other person also.

Completed Jointly Not Jointly

Assets Cash or Market
Value

Description

Cash deposit
toward purchase
held by: $________

List checking and savings accounts below
Name and address of Bank, S&L, or Credit Union

Acct. no. ______ $__________
Name and address of Bank, S&L, or Credit Union

Acct. no. ______ $__________
Name and address of Bank, S&L, or Credit Union

Acct. no. ______ $__________
Name and address of Bank, S&L, or Credit Union

Acct. no. ______ $__________

Stocks & Bonds (Company
name/ number & description)

$__________

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
and year) $__________

Other Assets (itemize)

$__________

Total Assets a. $__________

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.

LIABILITIES Monthly Payment &
Months Left to Pay Unpaid Balance

Name and address of Company

Acct. no. $ Payment/Mon. $

Name and address of Company

Acct. no. $ Payment/Mon. $

Name and address of Company

Acct. no. $ Payment/Mon. $

Name and address of Company

Acct. no. $ Payment/Mon. $

Name and address of Company

Acct. no. $ Payment/Mon. $

Name and address of Company

Acct. no. $ Payment/Mon. $

Alimony/Child Support/Separate
Maintenance Payments Owed to:

$

Job-Related Expense (child care, union dues, etc.)

$

Total Monthly Payments
$

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
& 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. DECLARATIONS

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)

If you answer "Yes" to any questions a through i,
please use continuation sheet for explanation.

Borrower
Yes No

Co-Borrower
Yes No

a. Are there any outstanding judgments against you"

b. Have you been declared bankrupt within the past 7 years"

c. Have you had property foreclosed upon or given title
or deed in lieu thereof in the last 7 years"

d. Are you a party to a lawsuit"

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 VA case number, if any, and reasons for the action.)

f. Are you presently delinquent or in default on any Federal
debt or any other loan, mortgage, financial obligation, bond, or loan guarantee"

g. Are you obligated to pay alimony, child support, or
separate maintenance"

h. Is any part of the down payment borrowed"

i. Are you a co-maker or endorser on a note"

j. Are you a U.S. citizen"

k. Are you a permanent resident alien"

l. Do you intend to occupy the property as your
primary residence"

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" by yourself (S),
jointly with your spouse (SP), or jointly with another person (O)"

______

IX. ACKNOWLEDGEMENT AND AGREEMENT

Each of the undersigned specifically represents to Lender and to Lender's actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors and assigns and agrees and acknowledges that:
(1) the information provided in this application is true and correct as of the date set forth opposite my signature and that any intentional or negligent misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Sec. 1001, et seq.;
(2) the loan requested pursuant to this application (the "Loan") will be secured by a mortgage or deed of trust on the property described in this application;
(3) the property will not be used for any illegal or prohibited purpose or use;
(4) all statements made in this application are made for the purpose of obtaining a residential mortgage loan;
(5) the property will be occupied as indicated in this application;
(6) the Lender, its servicers, successors or assigns may retain the original and/or an electronic record of this application, whether or not the Loan is approved;
(7) the Lender and its agents, brokers, insurers, servicers, successors, and assigns may continuously rely on the information contained in the application, and I am obligated to amend and/or supplement the information provided in this application if any of the material facts that I have represented herein should change prior to closing of the Loan; (8) in the event that my payments on the Loan become delinquent, the Lender, its servicers, successors or assigns may, in addition to any other rights and remedies that it may have relating to such delinquency, report my name and account information to one or more consumer reporting agencies;
(9) ownership of the Loan and/or administration of the Loan account may be tra nsferred with such notice as m ay be require d by law;
(10) neither Lender nor i ts agents, brokers, insurers, servicers, successors or assigns has made any representation or warranty, express or implied, to me regarding the property or the condition or value of the property; and
(11) my transmission of this application as an "electronic record" containing my " electronic signature," as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or my facsimile transmission of this application containing a facsimile of my signature, shall be as effective, enforceable and valid as if a paper version of this application were delivered containing my original written signature.

Acknowledgement. Each of the undersigned hereby acknowledges that any owner of the Loan, its servicers, successors and assigns, may verify or reverify any information contained in this application or obtain any information or data relating to the Loan, for any legitimate business purpose through any source, including a source named in this application or a consumer reporting agency.
Borrower"s Signature

Date

Co-Borrower"s Signature

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 ho me mortgage disclosure laws . You are no t requ ired to furnish this in formation, bu t are en couraged to do so . Th e law p rovides t hat a le nder may not discriminate ei ther o n t he bas is of t his information, or on whether you choose to furnish it. If y ou furnish the information, please provide both ethnicity and race. Fo r race, you may check m ore than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation and surname if you have made this application in person. 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	I do not wish to furnish this information

Ethnicity:	Hispanic or Latino Not Hispanic or Latino

Race:	American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White

Sex:	Female Male

CO-BORROWER	I do not wish to furnish this information

Ethnicity:	Hispanic or Latino Not Hispanic or Latino

Race:	American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White

Sex:	Female Male

To be Completed by Loan Originator:
This information was provided:
In a face-to-face interview
In a telephone interview
By the applicant and submitted by fax or mail
By the applicant and submitted via e-mail or the Internet

Loan Originator"s Signature

Date

Loan Originator"s Name (print or type)	Loan Originator Identifier	Loan Originator"s Phone Number (including area code)
Loan Origination Company"s Name	Loan Origination Company Identifier	Loan Origination Company"s Address

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 1001, et seq.

Borrower"s Signature

Date

Co-Borrower"s Signature

Date

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 & Liens	Gross Rental Income	Mortgage Payments	Insurance, Maintenance, Taxes & Misc.	Net Rental Income
		$	$	$	$	$	$


	Totals	$	$	$	$	$	$