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AGENCY CASE NO:                          
VI. ASSETS AND LIABILITIES (cont.)
Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet.)
Property address (enter S if sold, PS if pending
sale or P 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   $   If you answer "yes" to any questions a through i, please
  use continuation sheet for explanation.
Borrower Co-Borrow
b. Alterations, improvements, repairs   $    Yes No Yes No
c. Land (if acquired separately)   $   a. Are there any outstanding judgments 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 a party to a lawsuit?
g. PMI, MIP, Funding Fee   $   e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure,transfer
      title in lieu of foreclusure, or judgement? (This would include such loans as home mortgage
h. Discount (if Borrower will pay)   $       loans SBA loans, home inprovement loans, educational loans, mamufactured(mobile)home
      loans, any mortgage, financial obligation, bond, or loan guarantee. If "Yes"
i. Total costs (add items a through h)   $       provide details, including date, name and address of Lender,
      FHA or V.A. case number, if any, and reasons for the action.)
j. Subordinate financing   $   f. Are you presently delinquent or in default on any Federal
      debt or any other loan, mortgage, financial obligation, bond
k. Borrower's closing costs paid by Seller   $       or loan guarantee? if "Yes," give details as described in the
l. Other Credits (explain)          preceding question
  $   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 permenent resident alien?
m. Loan amount
    (exclude PMI, MIP, Funding Fee financed)
  $   I. Do you intend to occupy the property as your primary
      residence?
      If "Yes," complete question m below.
n. PMI, MIP, Funding Fee financed   $   m. 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 (SH), 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. ACKNOWLEDGMENT 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 assignsand 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 herein; (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 herein; (6) any owner or servicer of the Loan may verify or reverify any information contained in the application from any source named in this application, and Lender, its successors or assigns may retain the original and/or an electronic record of this application, even if the Loan is not 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 owner or servicer of the Loan 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 credit reporting agencies; (9) ownership of the Loan and/or administration of the Loan account may be transferred with such notice as may be required by law; (10) neither Lender nor its 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 fascimile 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.
 
 
Borrower's Signature:   Date   Co-Borrower's Signature:   Date
           
X    X   
X. INFORMATION FOR GOVERNMENT MONITORING PURPOSES

 
The following information Is requested by the Federal Government for certain types of loans releted 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 it, under Federal regulations this Lender is required to note race and sex on the 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 aII requirements to which the Lender is subject under appliceble state law for the particular type of loan appled for.)
 
BORROWER: I do not wish to furnish this information Asian or Pacific Islander CO-BORROWER: I do not wish to furnish this information Asian or Pacific Islander
Race/National American Indian or Alaskan Native Hispanic Race/National American Indian or Alaskan Native Hispanic
Origin: Black, not of Hispanic orgin White, not of Hispanic orgin Origin: Black, not of Hispanic orgin White, not of Hispanic orgin
  Other (specify)      Other (specify)   
Sex: Female     Male   Sex: Female     Male  
To be Completed by Interviewer   Interviewer's Name (print or type)
This application was taken by:   
face-to-face interview   Interviewer's Signature Date    
by mail      
by telephone   Interviewer's Phone Number (incl. area code)
by internet   
  Name and Address of Interviewer's Employer
  Smartforms
  Street
  City,   State   Zip Code
  Phone:  ###-###-####
  Fax:  ###-###-####