Fowler State Bank

Uniform Residential Loan Application

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: VA Conventional Other Applied For: FHA   USDA/Rural Housing Svc. Agency Case Number
Lender Case No.
 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 (attach description if necessary)
Year Built:
Purpose of Loan: Purchase Construction Other (Explain)
Refinance
Construction-Permanent
Property will be: Primary Residence Secondary Residence Investment

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 will 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 INFORMATION

Borrower

Co-Borrower

Borrowers Name (include Jr. or Sr. if applicable)
Co-Borrowers Name (include Jr. or Sr. if applicable)
Social Security Number
Home Phone (incl. area code)
DOB (MM/DD/YYYY)

Yrs. School

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)
Married  Separated   Unmarried (Include Single, Divorced, Widowed )  Dependents (not listed by
Co-Borrower)
No: Ages: No: Ages:
Present Address (street, city, state, ZIP) Own Rent  No Yrs.
Present Address (street, city, state, ZIP)
  Own Rent   No. Yrs.
Mailing Address, if different from Present Address
Mailing Address, if different from Present Address

If residing at present address for less than two years, complete the following:

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

EMPLOYMENT INFORMATION

Borrower Co-Borrower
Name & Address of Employer  Self Employed

Yrs. on this job
Name & Address of Employer  Self Employed

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
Gross Monthly Income

Business Phone (incl. area code)
Position/Title/Type of Business
Gross Monthly Income
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)
 Name & Address of Employer   Self Employed

Dates (from / to)
Gross Monthly Income
$
GrossMonthly Income
$
Position/Title/Type of Business
Business Phone (incl. area code)
 Position/Title/Type of Business
Business Phone (incl. area code)
Name & Address of Employer     Self Employed

Dates (from / to)
 Name & Address of Employer   Self Employed

Dates (from / to)
Gross Monthly Income
$
GrossMonthly Income
$
Position/Title/Type of Business
Business Phone (incl. area code)
Position/Title/Type of Business
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   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 or other person, this Statement and supporting schedules must be a completed about that spouse or other person also.

Completed: Jointly Not Jointly
ASSETS Description 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 Assts (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
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 Expense (child care, union dues, etc.)

$

Total Monthly Payments

$

Net Worth
(a minus b)
$ Total Liabilities 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

Join Credit before the signatures section

DETAILS OF TRANSACTION DECLARATIONS
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)
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 or 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?
Explanations
       
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 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 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. I do not wish to furnish this information.
Ethnicity: Hispanic or Latino Not Hispanic or Latino Ethnicity: Hispanic or Latino Not Hispanic or Latino
Race:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Race:
American Indian or Alaska Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Sex: Female Male Sex: Female Male

 

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.

NOTICE: JOINT CREDIT

We intend to apply for joint credit. Yes No
Borrower's Signature
Date
Co-Borrower's Signature
Date