Monthly Income Source
before completing, see the notice in "describe other income" below
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.
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.
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.
List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s)
Each of the undersigned specifically represent to Valley Bank of Nevada that: (1) the information provided in this application is true and correct as of the date of the application and that any intentional or negligent misrepresentation of the information contained in this application may result in civil liability including monetary damages due to reliance upon any misrepresentation under the provisions of Title 18, United States Code, Sec. 1001 et seq.; (2) the loan requested 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 purposes of obtaining a home equity loan or home equity line of credit; and (5) the property will be occupied as indicated in this application. By submitting this application as an "electronic record" containing my "electronic signature" as those terms are defined by applicable federal and state laws, shall be effective, enforceable, and valid as if a paper version of this application were delivered to Valley Bank of Nevada containing my original written signature.
Acknowledgement. Each of the undersigned hereby acknowledges that Valley Bank of NV, or any servicers or successors, may verify information contained in this application or obtain any information or data relating to this loan application through any source deemed necessary, including a consumer credit reporting agency.
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.