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 V.A. Conventional Other:
Applied for: FHA FmHA 		Agency Case #
 Lender Case #
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)
 No. of Units
Legal Description of Subject Property (attach description if necessary)
 Year Built
Purpose of Loan: Purchase Construction
Refinance Construction-Permanent
Other (explain):
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
Cost $
Title to 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
Borrower's Email Address
 Co-Borrower's Email address
Social Security #
 Home Phone (incl. area code)
Age
 Yrs. School
 Social Security #
 Home Phone (incl. area code)
Age
 Yrs. School
Married
Unmarried (include single divorced, widowed)
Separated		 Dependents
(not listed by Co- Borrower)
no.
ages 		Married
Unmarried (include single divorced, widowed)
Separated		 Dependents
(not listed by Borrower)
no. ages
If residing at present address for less than two years, complete the following:
Previous Address (street, city, state, ZIP)
Own Rent No. Yrs.

 Previous Address (street, city, state, ZIP)
Own Rent No. Yrs.

Previous Address (street, city, state, ZIP)
Own Rent No. Yrs.

 Previous Address (street, city, state, ZIP)
Own Rent No. Yrs.

Borrower              IV. EMPLOYMENT INFORMATION              Co-Borrower
Name and Address of Employer Self Employed (check box)
Yrs. on this job
Name and Address of Employer Self Employed (check box)
 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 (incl. area code)
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 and Address of Employer Self Employed (check box)

 Dates(from-to)
 Name and Address of Employer Self Employed (check box)

Dates(from-to)
Monthly Income
$		 Monthly Income
$
Position/Title/Type of Business
 		Business Phone (incl. area code)

Position/Title/Type of Business
Business Phone (incl. area code)
Name and Address of Employer Self Employed (check box)

Dates(from-to)
 Name and Address of Employer Self Employed (check box)

 Dates(from-to)
Monthly Income
$		 Monthly Income
$
Position/Title/Type of Business
 Business Phone (incl. area code)
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 $ $ $ Hazard Insurance $ $
Dividends/Interest $ $ $ Real Estate Taxes $ $
Net Rental Income $ $ $ Mortgage Insurance $ $
Other (see Þ  below) $ $ $ Homeowner Assn. Dues $ $
$ $ $ Other: $ $
Total $ $ $ Total $ $
*Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.
Þ 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
ASSETS Cash or Market
Value		 Liabilites 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.
Cash deposit toward purchase held by: $ LIABILITES Monthly Pmt. &
Mos. Left to Pay		 Unpaid
Balance
List checking and savings accounts below
Name & Address of Bank, S&L, or Credit Union
 Name & Address of Company
 		$ Pat/Mos.
 		$
Acct. no. $ Acct. no.
Name & Address of Bank, S&L, or Credit Union
 		Name & Address of Company
 		$ Payt./Mos.
 		$
Acct. no. $ Acct. no.
Name & Address of Bank, S&L, or Credit Union
 		Name & Address of Company
 >		 $ Payt./Mos.
 		$

Acct. no. $ Acct. no.
Name & Address of Bank, S&L, or Credit Union
 		Name & Address of Company
 		$ Payt./Mos.
 		$
Acct. no. $ Acct. no.
Stocks & Bonds(Company name/ number & description)
 $ Name & Address of Company
 		$ Payt./Mos.
 $
Acct. no. $ Acct. no.
Life insurance net cash value $ Name & Address of Company
 		$ Payt./Mos.
 $
Face amount $ $ Acct. no.
Subtotal Liquid Assets $ Name & Address of Company
 		$ Payt./Mos.
$
Real Estate owned enter market value from schedule or real estate owned, (page 3.)
 $ Acct. no.
Vested interest in retirement fund $ Name & Address of Company
 		$ Payt./Mos.
 		$

Net worth of business(es) owned (attach financial statement) $ Acct. no.
Automobiles owned (make and year)
$ Alimony/Child Support/Separate Maintenance Payments
Made to: 		$  
Other Assets (itemize)
$
 Job Related Expense (child care, union dues, etc. )
 $

 
Total Monthly Payments $  
Total Assets a. $ Net Worth (a-b) $ Total Liabilities b. $

VI. ASSESTS AND LIABIILTES (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 Mortgage & 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-Borrower
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 bankruptcy 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 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 .)
h. Discount (if Borrower will pay) $ 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.
i. Total costs (add items a through h) $ g. Are you obligated to pay alimony, child support, or separate maintenance?
j. Subordinate financing $ h. Is any part of the down payment borrowed?
k. Borrower's closing costs paid by seller $ i. Are you a co-maker or endorser on a note?
l. Other Credits (explain)
 		$ j. Are you a U.S. citizen?
m. Loan amount (exclude PMI, MIP, Funding Fee financed ) $ k. Are you a permanent resident alien?
n. PMI, MIP, Funding Fee financed $ l. Do you intend to occupy the property as your primary residence?
If "Yes," complete question m below
o. Loan amount (add m & n) $ m. Have you had an ownership interest in a property in the last 3 years?
p. Cash from/to Borrower (subtract j, k, l & o from i) $ (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? Soley by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?

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 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) 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 representation 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 provide 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 may suffer any loss due to reliance upon any misrepresentation which I/we have made on this application.

This document will not be "signed" in the sense of a traditional paper document. To verify the contents of this form, the signatory must enter any combination of alpha/numeric characters that has been specifically adopted to serve the function of the signature, preceded and followed by the forward slash (/) symbol. Acceptable "signatures" could include: /john doe/; /jd/; and /123-4567/. For example: if your name is John Miller, you could type /John Miller/ below.
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 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 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 disclosure satisfy all requirements to which the Lender is subject under applicable state law for the particular type of loan applied for.
BORROWER CO-BORROWER
Race/National
Origin:		 I do not wish to furnish this information
American Indian or Alaskan Native
Asian or Pacific Islander
Black, not of Hispanic origin
Hispanic
White, not of Hispanic origin
Other (specify): 		Race/National
Origin:		 I do not wish to furnish this information
American Indian or Alaskan Native
Asian or Pacific Islander
Black, not of Hispanic origin
Hispanic
White, not of Hispanic origin
Other (specify):
Sex: Female Male Sex: Female Male
To be Completed by Interviewer
This application was taken by:
face-to-face interview
by mail
by telephone
by internet		 Interviewer's Name (print or type)

Interviewer's Signature / Date

Interviewer's Phone Number (incl. area code) 		Name and Address 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:


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.
This document will not be "signed" in the sense of a traditional paper document. To verify the contents of this form, the signatory must enter any combination of alpha/numeric characters that has been specifically adopted to serve the function of the signature, preceded and followed by the forward slash (/) symbol. Acceptable "signatures" could include: /john doe/; /jd/; and /123-4567/. For example: if your name is John Miller, you could type /John Miller/ below.
Borrower's Signature
 		Date
 Co-Borrower's Signature
 		Date