HELOC/Second Mortgage Application

I. TYPE OF MORTGAGE AND TERMS OF LOAN

Please select your preferred Citizens National Bank office  
 

Please select the loan type:*

Home Equity Line of Credit

Borrow what you need when you need it. Open a Home Equity Line of Credit based on the equity you have in your home. Once a line of credit is established, you can draw against the account by writing a check or through online transfer to your CNB checking account.

Second Mortgage

Perfect for one-time borrowing needs. Secure a loan with the equity you have invested in your home. A lump sum payment is made to you for the amount of the loan. Loan terms up to 120 months.

 
Term on Loan requested* Amount* $
 
Are you applying for joint credit?* Yes No    
 

II. PROPERTY INFORMATION AND PURPOSE OF LOAN

Subject Property Address (street, city, state, ZIP)*
No. of Units*
Legal Description of Subject Property (Tax Township/Lot/Block)*
Year Built*
Purpose of Loan*
 
Property will be:*
 
Primary Residence
  Secondary Residence
  Investment
 
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)
 

III. 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*
DL/State ID #*
State of Issuance*
Email Address*
Marital Status*
Married Separated Unmarried
  (Include Single, Divorced, Widowed)
 
Dependents (not listed by Co-Borrower)
 
Number*
Ages
Present Address (Street, City, State, ZIP)*
Housing Status*
Own Rent   No Yrs.*
Mailing Address, if different from Present Address
 

Co-Borrower

*required fields if applying for joint credit

Co-Borrower’s Name (include Jr. or Sr. if applicable)*
 
Social Security Number*
Home Phone*
(incl. area code)
DOB (MM/DD/YYYY)*
Yrs. School*
DL/State ID #*
State of Issuance*
Email Address*
Marital Status*
Married Separated Unmarried
  (Include Single, Divorced, Widowed)
 
Dependents (not listed by Borrower)
 
Number*
Ages
Present Address (Street, City, State, ZIP)*
Housing Status*
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)
 

IV. 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

*required fields if applying for joint credit

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)

Monthly Income

Business Phone
(incl. area code)

 
Name & Address of Employer
Self Employed

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

Monthly Income

Business Phone
(incl. area code)

 
Name & Address of Employer
Self Employed

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

Monthly Income

Business Phone
(incl. area code)

 
Name & Address of Employer
Self Employed

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

Monthly Income

Business Phone
(incl. area code)

 

V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION*

All fields are required as applicable.

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   Monthly Amount
$
$
$
 

VI. ASSETS AND LIABILITIES*

All fields are required as applicable.

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.
 
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* Unpaid Balance*

All fields are required as applicable.

Name and address of Company
Acct. no. $ $
Name and address of Company
Acct. no. $ $
Name and address of Company
Acct. no. $ $
Name and address of Company
Acct. no. $ $
Name and address of Company
Acct. no. $ $
Name and address of Company
Acct. no. $ $
Name and address of Company
Acct. no. $ $
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) $
 
 

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 that 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
Ethnicity:
Race:
Sex:
 

Co-Applicant

I do not wish to furnish this information
Ethnicity:
Race:
Sex:
 

Acknowledgement

*I/We have read the Electronic Records Consent and consent to the electronic delivery of required documents. The Electronic Records Consent will be sent to the email address entered in the borrower information section for authorization.

*I/We have read the Disclosures and agree to accept them in an electronic format: (Click the following links to view and/or save the Disclosures.)

Ohio laws against discrimination require that all creditors make credit equally available to all credit worthy customers, and that credit reporting agencies maintain seperate credit histories on each individual upon request. The Ohio Civil Rights commission administers compliance with this law.

I certify that everything stated in this application and on any attachements is correct. You may keep this application whether or not it is approved. By Submitting below, I authorize the Citizens National Bank to verify any of the above information and to answer questions others may ask about my credit record wth you. I understand additional information and documentation may be needed to complete this loan. I understand that I must update this credit information at your request and if my financial condition changes.

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

 

Member FDIC, Equal Housing Lender