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 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, 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.
I. TYPE OF MORTGAGE AND TERMS OF LOAN
Mortgage       VA       Conventional  Other:
Applied for:    FHA     USDA/Rural Housing Service		 Agency Case No. Lender Case No.
Amount

$
Interest Rate

                      % 		No. of Months Amortization     Fixed Rate   Other (explain):
Type:                  GPM             ARM (type)

II. PROPERTY INFORMATION AND PURPOSE OF LOAN
Subject Property Address (street, city, state, & zip code)




 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          Secondary
Residence Residence    Investment
Complete next 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 next line if this is a refinance loan.
Year Acquired Original Cost


$ 		Amount Existing Liens


$ 		Purpose of
Refinance 		Describe Improvements made to be made

Cost: $
Title will be held in what Name(s)



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

 

Borrower           III. BORROWER INFORMATION           Co-Borrower
Borrower's Name (include Jr. or Sr. if applicable)

   Co-Borrower's Name (include Jr. or Sr. if applicable)
Social Security Number

 DOB
(MM/DD/YYYY)		 Yrs. School
 Social Security Number

 DOB
(MM/DD/YYYY)		 Yrs School
Home Phone (incl. area code)

 Home Phone (incl. area code)
Married
Separated
Unmarried (include single, divorced, widowed)		 Dependents
(not listed by Co-Borrower)
no.        |   ages		 Married
Separated
Unmarried (include single, divorced, widowed)		 Dependents
(not listed by Borrower)
no.        |   ages
Present Address (street, city, state, zip code)
Own     Rent _____ No. Yrs.


 Present Address (street, city, state, zip code)
Own     Rent _____ No. Yrs.
Mailing Address (street, city, state, zip code)
Own     Rent _____ No. Yrs.


   Mailing Address (street, city, state, zip code)
Own     Rent _____ No. Yrs.
If residing at present address for less than two years, complete the following:
Former Address (street, city, state, zip code)
Own     Rent _____ No. Yrs.


   Former Address (street, city, state, zip code)
Own     Rent _____ No. Yrs.

Borrower           IV. EMPLOYMENT INFORMATION           Co-Borrower
Name & Address of Employer
Self Employed
 Yrs. on this job

   Name & Address of Employer
Self Employed
 Yrs. on this job
Yrs. employed in this line of work/profession

 Yrs. employed in this line of work/profession

Position/Title/Type of Business

 Business Phone (inc. area code)


 Position/Title/Type of Business

 Business Phone (inc. 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)

   Name & Address of Employer
Self Employed		 Dates (from - to)
Monthly Income

$ 		Monthly Income

$
Position/Title/Type of Business
 Business Phone (inc. area code)

 Position/Title/Type of Business
 Business Phone (inc. area code)
Name & Address of Employer
Self Employed		 Dates (from - to)


 Name & Address of Employer
Self Employed		 Dates (from - to)
Monthly Income

$ 		Monthly Income

$
Position/Title/Type of Business
 Business Phone (inc. area code)


 Position/Title/Type of Business
 Business Phone (inc. 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       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 Borrowers(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 spouse, this Statement and supporting schedules must be completed about that spouse also.

Completed Jointly Not Jointly  
(continue on the next page)

 

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
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


 $ Payt./Mos. $
Acct. no.
Name and address of Company


 $ Payt./Mos. $
Acct. no.
Name and address of Company


 $ Payt./Mos. $
Acct. no.
Name and address of Company


 $ Payt./Mos. $
Acct. no.
Name and address of Company


 $ Payt./Mos. $
Acct. no.
Name and address of Company


 $ Payt./Mos. $
Acct. no.
Name and address of Company


 $ Payt./Mos. $
Acct. no.
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.		 $                  

 

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 R if rental being held for income)                   Type of
Property 		Present
Market
Value 		Amount of
Mortgages
and 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
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)  

 

VIII. DECLARATIONS
If you answer "yes" to any questions a through i, please use continuation sheet for explanation. Borrower

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 Co-Borrower
  Yes     No 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 law suit?          
e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclusure , 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 or 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? If "Yes," give details as described in the 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 permanent resident alien?          
l. Do you intend to occupy the property as your primary residence?
   If "yes," complete question m below.		          
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)?
________
________

 

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 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 misprepresentation 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 mortgagae 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 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.
Borrowers's Signature            

X

 Date              Co-Borrower's Signature        

X 		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 discriminate neither 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 ethnicity, 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: I do not wish to furnish this information CO-BORROWER: I do not wish to furnish this information
Ethnicity: Hispanic or Latino
Not Hispanic or Latino		 Ethnicity: Hispanic or Latino
Not Hispanic or Latino
Race: American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Asian
White
Black or African American 		Race: American Indian or Alaska Native
Native Hawaiian or Other Pacific Islander
Asian
White
Black or African American
Sex: Female        Male Sex: Female        Male
To be Completed by the Interviewer

This application was taken by:
   Face-to-face interview
   Mail
   Telephone
   Internet		 Interviewer's Name (print or type)

 Name and Address of Interviewer's Employer
Interviewer's Signature                Date
Interviewer's Phone Number (incl. area code)


 

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.
Borrowers's Signature            

X

 Date              Co-Borrower's Signature        

X 		Date             

Based on Freddie Mac Form 65/Rev. 01/04 Fannie Mae Form 1003/Rev. 01/04