Mortgage Application

* Required Field

This application is designed to be completed by the applicants 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 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.
 

TYPE OF MORTGAGE AND TERMS OF LOAN

Mortgages
Applied For: *
VA Conventional Other
FHA USDA / Rural Housing Svc.
Agency Case Number
Lender Case Number
 
Amount *
$
Interest Rate
%
No. of Months *
Amortization: Fixed Rate Other (Explain):
GPM ARM (Type):
 
Subject Property Address (street, city, state, ZIP)
No. of Units
Legal Description of Subject Property (Tax Township/Lot/Block)
Year Built
 
Purpose of Loan: * Purchase Property will be: * Primary Residence
  Refinance   Secondary Residence
  Construction   Investment
  Construction-Permanent  
  Other (Explain):  

Complete this row 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 Loans
Purpose of Refinance
Describe Improvements: made
to be made Cost
 
 
 
Title is Held in What Name(s) *
Manner in Which Title is Held
  (Individual/Joint/Joint-Survivorship)
Estate is Held in
Fee Simple
Leasehold (show Expiration Date)
 
Source of Down Payment, Settlement Charges and/or Subordinate Financing (explain):

 

BORROWER INFORMATION

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 Separated Unmarried
  (Include Single, Divorced, Widowed)
 
Dependents (not listed by Co-Borrower)
 
Number
Ages
Present Address (Street, City, State, ZIP) *
Own Rent *   No Yrs. *
Mailing Address, if different from Present Address
 

Co-Borrower

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 Separated Unmarried
  (Include Single, Divorced, Widowed)
 
Dependents (not listed by Borrower)
 
Number
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:
Own Rent   No Yrs.
Former Address (street, city, state, ZIP)
 
Own Rent   No Yrs.
Former Address (street, city, state, ZIP)

 

EMPLOYMENT INFORMATION

Borrower

Name & Address of Employer *
Self Employed

Position/Title/Type of Business *
Yrs. on this job *

Yrs. employed in this
  line of work/profession *


Business Phone
  (incl. area code) *

 

Co-Borrower

Name & Address of Employer
Self Employed

Position/Title/Type of Business
Yrs. on this job

Yrs. employed in this
  line of work/profession


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

Position/Title/Type of Business
Dates (from - to)

Gross Monthly Income
$
Business Phone
(incl. area code)

 
Name & Address of Employer
Self Employed

Position/Title/Type of Business
Dates (from - to)

Gross Monthly Income
$
Business Phone
(incl. area code)

 
Name & Address of Employer
Self Employed

Position/Title/Type of Business
Dates (from - to)

Gross Monthly Income
$
Business Phone
(incl. area code)

 
Name & Address of Employer
Self Employed

Position/Title/Type of Business
Dates (from - to)

Gross Monthly Income
$
Business Phone
(incl. area code)

 

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 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   Gross Monthly Amount
$
$
$

 

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 a completed about that spouse also.
 
Completed: Jointly Not Jointly
 
ASSETS 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
Acct. no. $ Payment / Months 
 
$
Name and address of Company
Acct. no. $ Payment / Months 
 
$
Name and address of Company
Acct. no. $ Payment / Months 
 
$
Name and address of Company
Acct. no. $ Payment / Months 
 
$
Name and address of Company
Acct. no. $ Payment / Months 
 
$
Name and address of Company
Acct. no. $ Payment / Months 
 
$
Name and address of Company
Acct. no. $ Payment / Months 
 
$
Alimony/Child Support/
Separate Maintenance
Payments Owed to:
$  
Job-Related Expenses
(child care, union dues, etc.)
$  
 
Total Monthly Payments $  
Total Liabilities b. $
Net Worth (a minus b) $

 

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 &
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

 

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)
 

DECLARATIONS

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? *
b. Have you been declared bankrupt within the past 7 years? *
c. Have you had property foreclosed upon or given title or deed in lien 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? *
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)?

 

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 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 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.
 
Borrower's Signature *
Date *
Co-Borrower's Signature
Date

 

INFORMATION FOR GOVERNMENT MONITORING PURPOSES

The purpose of collecting this information is to help ensure that all borrowers are treated fairly and that the housing needs of communities and neighborhoods are being fulfilled. For residential mortgage lending, Federal law requires that we ask borrowers for their demographic information (ethnicity, race, and sex) in order to monitor our compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to provide this information, but are encouraged to do so. You may select one or more designations for "Ethnicity" and one or more designations for "Race". The law provides that we may not discriminate on the basis of this information, or on whether you choose to provide it. However, if you choose not to provide the information and you have made this application in person, Federal regulations require us to note your ethnicity, race, and sex on the basis of visual observation or surname. The law also provides that we may not discriminate on the basis of age or marital status information you provide in this application. If you do not wish to provide some or all of this information, please check below.
 
BORROWER
 
Ethnicity: Check one or more

Hispanic or Latino
Mexican
Puerto Rican
Cuban
Other Hispanic or Latino - Print origin, for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on:

Not Hispanic or Latino
I do not wish to provide this information
 
Race: Check one or more

American Indian or Alaskan Native - Print name of enrolled or principal tribe:

Asian:
Asian Indian
Chinese
Filipino
Korean
Vietnamese
Other Asian - Print race, for example, Hmong, Laottan, Thai, Pakistani, Cambodian, and so on:

Black or African American
Native Hawaiian or Other Pacific Islander
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander - Print race, for example, Fijian, Tongan, and so on:

White
I do not wish to provide this information
 
Sex:

Female
Male
I do not wish to provide this information
 
To Be Completed by Financial Institution (for an application taken in person):

Was the ethnicity of the borrower collected on the basis of visual observation or surname?
Yes
No
Was the race of the borrower collected on the basis of visual observation or surname?
Yes
No
Was the sex of the borrower collected on the basis of visual observation or surname?
Yes
No
 
CO-BORROWER
 
Ethnicity: Check one or more

Hispanic or Latino
Mexican
Puerto Rican
Cuban
Other Hispanic or Latino - Print origin, for example, Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on:

Not Hispanic or Latino
I do not wish to provide this information
 
Race: Check one or more

American Indian or Alaskan Native - Print name of enrolled or principal tribe:

Asian:
Asian Indian
Chinese
Filipino
Korean
Vietnamese
Other Asian - Print race, for example, Hmong, Laottan, Thai, Pakistani, Cambodian, and so on:

Black or African American
Native Hawaiian or Other Pacific Islander
Native Hawaiian
Guamanian or Chamorro
Samoan
Other Pacific Islander - Print race, for example, Fijian, Tongan, and so on:

White
I do not wish to provide this information
 
Sex:

Female
Male
I do not wish to provide this information
 
To Be Completed by Financial Institution (for an application taken in person):

Was the ethnicity of the co_borrower collected on the basis of visual observation or surname?
Yes
No
Was the race of the co_borrower collected on the basis of visual observation or surname?
Yes
No
Was the sex of the co_borrower collected on the basis of visual observation or surname?
Yes
No

 

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.
 
Type your name in the box below to represent your electronic signature.
 
Borrower's Signature
Date
Co-Borrower's Signature
Date



Appraisal Notice

We may order an appraisal to determine the property's value and charge you for this appraisal. We will promptly give you a copy of any appraisal, even if your loan does not close.

You can pay for an addtional appraisal for you own use at your own cost.

By signing below, you acknowledge receipt of this Appraisal Notice.

Insurance Disclosure

Purpose:
You have submitted an application for a loan. In connection with your loan application, Lender may be soliciting, offering to sell, or will sell you an insurance product or annuity. Federal law requires Lender to provide you with the following disclosures.

Credit Disclosures

  1. Lender, as a condition of granting you a loan, connot require that you purchase an insurance product or annuity from Lender or any of its affiliates.
  2. Lender, as a condition of granting you a loan, cannot require your agreement not to obtain or prohibit you from obtaining an insurance product or annuity from an unaffilated entity.

Acknowledgement
By signing below, I acknowledge that I have read, received and understsand this insurance disclosure.

 I agree to the above disclosures *


Submission of this form authorizes First National Bank in Carlyle to verify information provided herein,
including but not limited to employment credit history.