Uniform Residential Loan Application

Borrower:

Co-Borrower:

I. Type of Mortgage and Terms of Loan

Mortgage Applied for: Mortgage Type VA Conventional FHA USDA/Rural Housing Service Other	If Other Explain:	Agency Case Number:
Lender Case Number:	Amount: $	No. of Months
Amortization Type:
Fixed Rate  Other (explain):	GPM   ARM (type):	Interest Rate: %

II. Property Information and Purpose of Loan

Subject Property Address: (street, city, state, & zip)

No. of Units: Year Built:

Legal Description of Subject Property (attach description if necessary)

Purpose of Loan: Property will be: Purchase Refinance Construction Construction-Permanent Primary Residence Investment Secondary Residence

Complete this line if this is a 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: $

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Title will be held in what Name(s):

Manner in which Title will be held:

Estate will be held in: Fee Simple Leasehold

Source of Down Payment, Settlement Charges and/or Subordinate Financing (explain):

III. Borrower Information

Borrower

Co-Borrower

Borrower's Name (include Jr. or Sr. if applicable): Email Address Home Phone (incl. area code): Cell Phone: Social Security Number: Date of Birth: (MM/DD/YYYY) Years of School Marital Status: Married Separated Unmarried (include single, divorced, widowed) Dependents (not listed by Co-Borrower): No. of dependents: Ages: (Separate with comma) Present Address:(street, city, state, ZIP) Own Rent Number of Years Mailing Address if different from above: If residing at present address for less than two years, complete the following: Former Address:(street, city, state, ZIP) Own Rent Number of Years

Borrower's Name (include Jr. or Sr. if applicable): Email Address Home Phone (incl. area code): Cell Phone: Social Security Number: Date of Birth: (MM/DD/YYYY) Years of School Marital Status: Married Separated Unmarried (include single, divorced, widowed) Dependents (not listed by Co-Borrower): No. of dependents: Ages: (Separate with comma) Present Address:(street, city, state, ZIP) Own Rent Number of Years Mailing Address if different from above: If residing at present address for less than two years, complete the following: Former Address:(street, city, state, ZIP) Own Rent Number of Years

IV. Employment Information

Borrower

Co-Borrower

Name & Address of Employer: Self Employed Yrs. on this Job: Yrs. employed in this line of work/profession 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 & Address of Employer: Self Employed Dates (from-to): Monthly Income: $ Position/Title/Type of Business: Business Phone: (incl. area code) Name & Address of Employer: Self Employed Dates (from-to): Monthly Income: $ Position/Title/Type of Business: Business Phone: (incl. area code)

Name & Address of Employer: Self Employed Yrs. on this Job: Yrs. employed in this line of work/profession 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 & Address of Employer: Self Employed Dates (from-to): Monthly Income: $ Position/Title/Type of Business: Business Phone: (incl. area code) Name & Address of Employer: Self Employed Dates (from-to): Monthly Income: $ 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
Base Empl. Income*	$	$	$
Overtime
Bonuses
Commissions
Dividends/Interest
Net Rental Income
Other: (before completing, see the notice in "describe other income," below)
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
			$
Combined Monthly Housing Expense	Present	Proposed
Rent	$	$
First Mortgage (P&I)
Other Financing (P&I)
Hazard Insurance
Real Estate Taxes
Mortgage Insurance
Homeowner Assn. Dues
Other
Total	$	$

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 this 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

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

ASSETS		LIABILITIES
Cash Deposit toward purchase held by:	Cash or Market Value $	Name and address of Company
		Acct. No.	$ Payment/Months	$ Unpaid Balance

List checking and savings accounts below

Account Number 1

ASSETS		LIABILITIES
Name and address of Bank, S&L or Credit Union		Name and address of Company
Acct. No.	Cash or Market Value $	Acct. No.	$ Payment/Months	$ Unpaid Balance

Account Number 2

Name and address of Bank, S&L or Credit Union		Name and address of Company
Acct. No.	Cash or Market Value $	Acct. No.	$ Payment/Months	$ Unpaid Balance

Account Number 3

Name and address of Bank, S&L or Credit Union		Name and address of Company
Acct. No.	Cash or Market Value $	Acct. No.	$ Payment/Months	$ Unpaid Balance

Account Number 4

Name and address of Bank, S&L or Credit Union		Name and address of Company
Acct. No.	Cash or Market Value $	Acct. No.	$ Payment/Months	$ Unpaid Balance

Account Number 5

Stocks & Bonds (Company name/number & description)		Name and address of Company
	Cash or Market Value $	Acct. No.	$ Payment/Months	$ Unpaid Balance

Life Insurance net cash value - Face Amount $		Name and address of Company
	Cash or Market Value $	Acct. No.	$ Payment/Months	$ Unpaid Balance

Subtotal Liquid Assets

$

Real estate owned (enter market value from schedule of real estate owned)	Cash or Market Value $	Alimony / Child Support / Separate Maintenance Payments Owed to:	$ Payment/Months
Vested interest in Retirement Fund	Cash or Market Value $	Job Related Expense (child care, union dues etc.)	$ Payment/Months
Net worth of business(es) owned (attach financial statement)	Cash or Market Value $
Automobiles Owned (make and year)
	$	Total Monthly Payments	$
Other Assets (itemize)
	$
	Total Assets a. $	Total Liabilities b. $	Net Worth (a minus b): $

Schedule of Real Estate Owned (if additional properties are owned, use continuation sheet.)

Property Address	Type of Property	Present Market Value	Amount of Mortgages & Lines	Gross Rental Income	Mortgage Payments	Insurance Maintenance Taxes & Misc.	Net Rental Income
		$	$	$	$	$	$
[ Please enter:S if sold, PS if pending sale R if rental being held for income ]
		$	$	$	$	$	$
[ Please enter:S if sold, PS if pending sale R if rental being held for income ]
		$	$	$	$	$	$
[ Please enter:S if sold, PS if pending sale R if rental being held for 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, (end of form).	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 bankrupt within the past 7 years?
e.	Estimated prepaid items	$	c.	Have you ever 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)	$
i.	Total costs (add items a through h)	$
j.	Subordinate financing	$
k.	Borrower's closing costs paid by Seller	$	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 previous question.
l.	Other Credits (explain):		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?
	Amount	$	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 three 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--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 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 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 purpose of obtaining a residential mortgage loan; (5) the property will be occupied as indicated in this application; (6) the Lender, its servicers, successors or assigns may retain the original and/or an electronic record of this application, whether or not the Loan is approved; (7) the Lender and its agents, brokers, insurers, servicers, successors and assigns may continuously rely on the information contained in this 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 Lender, its servicers, successors or assigns 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.

Right to Receive Copy of Appraisal. I/We have the right to a copy of the appraisal report used in connection with this application for credit.  To obtain a copy, I/we must send Lender a written request at the mailing address Lender has provided.  Lender must hear from me/us no later than 90 days after Lender notifies me/us about the action taken on this application, or I/we withdraw this application.

Acknowledgment. Each of the undersigned hereby acknowledges that any owner of the Loan, its servicers, successors and assigns, may verify or reverify any information contained in this application or obtain any information or data relating to the Loan, for any legitimate business purpose through any source, including a source named in this application or a consumer reporting agency.

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 not discriminate either on the basis of this information, or 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 have made this application in person. 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	Co-Borrower
I do not wish to furnish this information Ethnicity: Hispanic or Latino Not Hispanic or Latino Race: American Indian or Alaskan Native Asian White Black or African American Native Hawaiian or other Pacific Islander Sex: Female    Male	I do not wish to furnish this information Ethnicity: Hispanic or Latino Not Hispanic or Latino Race: American Indian or Alaskan Native Asian White Black or African American Native Hawaiian or other Pacific Islander Sex: Female    Male

To be completed by Interviewer Only
Select Interview Type Face-to-Face Mail Telephone Internet Interviewer's Name (print or type) Interviewer's Signature Interviewer's Phone Number (incl. area code)	Name and Address of Interviewer's Employer

Continuation Section/Residential Loan Application

Use box below if you need more space to complete the Residential Loan Application. Mark B for Borrower or C for Co-Borrower

IMPORTANT INFORMATION ABOUT
PROCEDURES FOR OBTAINING CREDIT

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who obtains credit.

What this means for you: When you obtain credit, we will ask for your name, address, date of birth, and other information that will allow us to identify you.  We may also ask to see your driver's license or other identifying documents.

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NOTICE: We may report information about your account to credit bureaus.  Late payments, missed payments, or other defaults on your account may be reflected in your credit report.

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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.

Borrower's Signature	Date
Co-Borrower's Signature	Date

I certify the information above is correct and ready for submission.

Submit Application