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     Please complete each section on this form. In an area which requires a dollar amount, please enter "4000" instead of $4,000.00, "100000" instead of "$100,000.00" (no dollar sign, comma or period). Also, please note that placing any other characters in a dollar amount space, such as "about 1500 per month," will make your work unusable on our end. If you are entering a monthly amount, you must enter the exact monthly amount. If you spend $400 per year on homeowner's insurance, you'll have to put "33.33" in the box. The conversion program will stall if you enter "about 400 per year." It can't calculate. It can't convert letters to numbers.
     Remember that you are submitting a mortgage loan application, and that the mortgage company will rely on the statements that you make here, as well as on credit report, job verification and similar information.
     It is important to complete this work thoroughly and accurately. You may find it best to review this rather lengthy form now, check what kinds of information you are required to submit, like bank and credit card company names and addresses, account numbers and account balances, and return to this form later, when you have all of this information assembled.

This application is designed to be completed by the applicant(s) 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 either:     1. The income or assets of a person other than the "Borrower" (including the Borrower's spouse) will be used as a basis for loan qualification or;     2. 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.

Co-Borrower Assets Used?	Yes No
Community Property Assets Used?	Yes No

You will probably find that you will want to speak with a loan officer or mortgage broker to have that person's assistance with some of the questions on this application. The brokers listed here will all give you courteous and professional assistance, and you may find that you would like to have your application forwarded to one of them.

This application will be sent to:

My first name
My last name
My e-mail address (this will permit us to speed confirmation of receipt and processing)
Co-Borrower's ("Co's") first name
Co's last name
My SS#
My home phone
My age
My years of schooling
My significant other status is	Single Partner Relationship Married Separated Widowed Divorce
No. of my dependents
Ages of my dependents
My street address is
My city, state and zip are:
At this residence, I	Own Rent
No. of years at this residence
At my former address,
I	Owned Rented
For this number of years:
At my next former address,
I	Owned Rented
For this number of years:
I am	Employed Self-employed
If employed by another, that name is
My employer's address
I've worked here this many years
I've worked in this field this many years
My title or position is
My business phone, with area code, is
If employed here fewer than 2 years, I was previously	Employed Self-employed
That address was
I worked there from MM/YY to MM/YY
My monthly income was
My title or position was
My business phone number was
Co's SS#
Co's home phone
Co's age
Co's years of schooling
Co's significant other status is	Single Partner Relationship Married Separated Widowed Divorce
No. of Co's dependents
Ages of Co's dependents
Co's street address is
Co's city, state and zip are:
At this residence, Co	Owns Rents
Co's no. of years at this residence
At Co's former address,
Co	Owned Rented
For this number of years:
At Co's next former address,
Co	Owned Rented
For this number of years:
Co is	Employed Self-employed
If employed by another, that name is
Co's employer's address
Co's worked here this many years
Co's worked in this field this many years
Co's title or position is
Co's business phone, with area code, is
If employed here fewer than 2 years, Co was previously	Employed Self-employed
That address was
Co worked there from MM/YY to MM/YY
Co's monthly income was
Co's title or position was
Co's business phone number was
The type of mortgage loan being applied for is	VA no FHA no Conventional no FmHA no Other no n/a, don't know no
Amount applied for
Interest rate applied for
No. of months
The type of mortgage loan interest rate being applied for is	Fixed Rate no GPM no ARM no Other, uncertain no
Subject property address
Number of units
Year property built
Legal description (book & page if known)
This loan is to be used for	Purchase Refinance Construction Construction-Permanent Other NA
This property will be	Primary residence Secondary residence Investment property
Complete these questions for construction loans:
Year that the lot was acquired
Original lot cost
Amount of existing liens on the lot
Present value of lot
Cost of improvements
Complete these questions for refinance loans:
Year property acquired
Original cost
Amount of existing liens
Purpose of refinance
Improvements	have been made are to be made
Description of improvements
Cost of improvements
Complete these questions for all loans:
Name(s) of person(s) who own or lease, or will own or lease the property
The way the property will be owned will be as	Sole tenant Tenants in common Joint tenants Husband and wife, tenants by entirety Other
The property will be	Owned Leased
The source of down payment, settlement charges and/or subordinate financing will be
These questions are for employment information and other income information
My base monthly income
My monthly overtime
My monthly bonuses
My monthly commissions
My monthly interest/dividends
My monthly NET rental income
My total other monthly income
Co's base monthly income
Co's monthly overtime
Co's monthly bonuses
Co's monthly commissions
Co's monthly interest/dividends
Co's monthly NET rental income
Co's total other monthly income
The following description is of other income of the	Borrower Co-Borrower
Description of income source
Monthly amount
The following description is of other income of the	Borrower Co-Borrower
Description of income source
Monthly amount
These questions are about your present and proposed (post-loan) housing expenses.
What is your present rent (enter "0" if not applicable)?
Proposed rent (enter "0" if not applicable)?
Present first mortgage principal and interest?
Proposed principal and interest?
Present other financing principal and interest?
Proposed other principal and interest?
Present homeowner's/hazard insurance?
Proposed homeowner's/hazard insurance?
Present real estate taxes?
Proposed real estate taxes?
Present mortgage insurance?
Proposed mortgage insurance?
Present homeowner association dues (enter "0" if not applicable)?
Proposed homeowner association dues (enter "0" if not applicable)?
Describe other present housing expenses.
Describe other proposed housing expenses.
These questions ask for information about your assets
If you have made a deposit on the property, name of person or agency who holds the deposit
Dollar amount of deposit being held

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 spoust, this Statement and supporting schedules must be completed about that spouse also.

Please state whether this Statement of Assets and Liabilities is being completed

Jointly no Not Jointly no

In this section, please list any bank or credit union where you have money deposited, the address, the account number, and the account balance.

Bank Name

Address

Account Number

Account Balance

List the names, number of shares and type of all stocks and bonds
List the total value of all stocks and bonds
If you have a vested interest in a retirement fund, 401K, IRA, what is the dollar amount?
If you own a business, what is the net value?
Describe all other assets (not including real estate)?
Aggregate value of all other assets?

This is for liabilities. List the name and address of each creditor, the account number, the dollar amount of the monthly payment, and the dollar amout owed on the account. List all liabilities, including mortgage, credit cards, personal loans, car loans and other.

Name and address of creditor

Account number

Monthly payment

Unpaid balance

If you are required make alimony, separate support or similar payments, to whom do you make them?
What is the monthly amount of the payment(s)?
What is the monthly amount of any job-related expenses, like child care, union dues and so forth?

This section deals with real estate that you own
First Property address
First Property Status	Owned Sold Pending Sale Rental, being held for rental income
First Type of property	Single family, owner-occupied Single family, rental property Multi-family, owner-occupied Multi-family, non-owner-occupied Vacant land, to be used for home Vacant land, being held for investment Other
First property Present market value?
First property Amount of mortgages and liens
First property Gross rental income
First property Mortgage payments
First property Insurance, maintenance, taxes and misc. expenses
First Net rental income, or n/a
Second Property address
Second Status	Owned Sold Pending Sale Rental, being held for rental income
Second Type of property	Single family, owner-occupied Single family, rental property Multi-family, owner-occupied Multi-family, non-owner-occupied Vacant land, to be used for home Vacant land, being held for investment Other
Second Present market value?
Second Amount of mortgages and liens
Second Gross rental income
Second Mortgage payments
Second Insurance, maintenance, taxes and misc. expenses
Second Net rental income, or n/a
Information regarding credit extended under other name(s)
If you or co-borrower have had credit under another name, what was/were the name(s)?
List names of creditors who have given you credit under other names.
List account numbers of credit accounts under other names.
This information is for details of the proposed transaction, some of which you will know, and some of which you will need to obtain from your mortgage broker or lender
Purchase price
Alterations, improvements, repairs
Land (if purchased separately)
Refinance (include debts to be paid off)
PMI, MIP, Funding Fee
Discount (if Borrower will pay)
Borrowers' closing costs paid by Seller
Describe other credits
Amount of other credits
Loan amount (exclude PMI, MIP, Funding Fee Financed
PMI, MIP, Funding Fee Financed
Cash to or from Borrower:	To From
Amount of cash to or from borrower

This section contains "Declarations," which you make to induce the lender to loan you money. Please note that many of the remaining check-boxes have "Yes" and "No" boxes as well as "undo" boxes. If you select a "Yes" checkbox, please be sure to check the "Undo" checkbox for "No." Otherwise, the result will be both a "Yes" and "No" answer to that question. In this section, if you answer "yes" any of the questions marked with a "¤" sign, you MUST explain your answer in the "Continuation Sheet."

¤ Are there any outstanding judgments against borrower?	Yes (undo) No (undo)
¤ Are there any outstanding judgments against co-borrower?	Yes (undo) No (undo)
¤ Has borrower been declared bankrupt within the past 7 years?	Yes (undo) No (undo)
¤ Has co-borrower been declared bankrupt within the past 7 years?	Yes (undo) No (undo)
¤ Has borrower had property foreclosed upon or given title or deed in lieu of foreclosure in the last 7 years?	Yes (undo) No (undo)
¤ Has co-borrower had property foreclosed upon or given title or deed in lieu of foreclosure in the last 7 years?	Yes (undo) No (undo)
¤ Is borrower a party to a lawsuit?	Yes (undo) No (undo)
¤ Is co-borrower a party to a lawsuit?	Yes (undo) No (undo)
¤ Has borrower 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 in following "continuation sheet."	Yes (undo) No (undo)
¤ Has co-borrower 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 in following "continuation sheet."	Yes (undo) No (undo)
¤ Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation or loan guarantee? If "Yes," provide details, as described in the proceeding question, on the "Continuation Sheet."	Yes (undo) No (undo)
¤ Is Co-Borrower in such a default?	Yes (undo) No (undo)
¤ Are you obligated to pay alimonry, child support, or separate maintenance?	Yes (undo) No (undo)
¤ Is co-borrower so obligated?	Yes (undo) No (undo)
¤ Did you borrow any part of the downpayment?	Yes (undo) No (undo)
¤ Did co-borrower borrower any part of the downpayment?	Yes (undo) No (undo)
¤ Are you a co-maker or endorser of any note?	Yes (undo) No (undo)
¤ Is co-borrower a co-maker or endorser of any note?	Yes (undo) No (undo)
Are you a U.S. citizen?	Yes (undo) No (undo)
Is co-borrower a U.S. citizen?	Yes (undo) No (undo)
Are you a permanent resident alien?	Yes (undo) No (undo)
Is co-borrower a permanent resident alien?	Yes (undo) No (undo)
Do you intend to occupy the property as your primary residence?	Yes (undo) No (undo)
Does co-borrower intend to occupy the property as their primary residence?	Yes (undo) No (undo)
Have you had an ownership interest in property in the last three years?	Yes (undo) No (undo)
Has co-borrower had an ownership interest in property in the last three years?	Yes (undo) No (undo)
What type of property did you own?	Principal residence Second home Investment property (undo)
How did you own the property?	By myself, alone Jointly, with spouse Jointly, with another person (undo)

By indicating "Yes" below, the borrower and co-borrower acknowledge and agree to the following:
" The undersigned specifically acknowledge(s) and agree(s) that : (1) the loan requested by this application will be secured by a first mortgage or deed of trust on the property described herein; (2) the property will not be used for any illegal or prohibited purpose or use; (3) all statements made in this application are made for the purpose of obtaining the loan indicated herein; (4) occupation of the property will be as indicated above; (5) verification or reverification of any information contained in the application may be made at any time by the Lender, its agents, successors and assigns, either directly or through a credit reporting agency, from any source named in this application, and the original copy of this application will be retained by the Lender, even if the loan is not approve; (6) the Lender, its agents, successors and assigns will rely on the information contained in the application and I/we have a continuing obligation to amend and/or supplement the information provided in this application, if any of the material facts which I/we have represented herein should change prior to closing; (7) in the event my/our payments on the loan indicated in this application become delinquent, the Lender, its agents, successors and assigns, may, in addition to all their other rights and remedies, report my/our name(s) and account information to a credit reporting agency; (8) ownership of the loan may be transferred to successor or assign of the Lender without notice to me and/or the administration of the loan account may be transferred to an agent, successor or assign of the Lender with prior notice to me; (9) the Lender, its agents, successors and assigns make no representations or warranties, express or implied, to the Borrower(s) regarding the property, the condition of the property, or the value of the property. 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. Certification : I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature(s) on this application, and acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section 1001, et seq., and liability for monetary damages to the Lender, its agents, successor and assigns, insurers and any other persons who may suffer any loss due to reliance upon any misrepresentation which I/we have made on this application. "
Is this correct ?	Yes No

" 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 neither discriminate on the basis of this information, nor on whether you choose to furnish it. However, if you choose not to furnish it, under Federal regulations this Lender is required to note race and sex on the basis of visual observation or surname. If you do not wish to furnish the above 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

Does not wish to furnish this information Does wish to furnish this information

Is American Indian or Alaskan Native (undo)

Is African-American (undo)

Is Asian or Pacific Islander (undo)

Is Hispanic (undo)

Is White (undo)

Is Male (undo)

Is Female (undo)

Co-Borrower

Does not wish to furnish this information Does wish to furnish this information

Is American Indian or Alaskan Native (undo)

Is African-American (undo)

Is Asian or Pacific Islander (undo)

Is Hispanic (undo)

Is White (undo)

Is Male (undo)

Is Female (undo)

" Information for Government Monitoring Purposes " was completed in the following manner:

By face-to-face interview By mail or e-mail By telephone

"Continuation Sheet:" Detail any explanations of entries you have made earlier in this form here.

We have time stamped this form and issued an order number as shown to the right. Please write this date and time down, it will identify your form for us, particularly if you do not include your name.

IMPORTANT!! CREDIT AUTHORIZATION!! I / We hearby authorize and instruct any person or consumer reporting agency to release any and all information that may be required for the purpose of a credit transaction.  The current information is requested for the use in connection with a bona fide "permissible purpose" as defined in Section 54 of Public Law 91-508. A photocopy of this authorization shall be equivalent of the original and may be used as such.

I'm sleeping, you'd better call me. Yes, you are authorized to obtain credit reports. I'm awake, but please call first before pulling a credit report (undo)

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©American Mortgage Debt Resolution, Inc. (1-800-351-3301), Mory Brenner, Esq. Last updated: 7/19/99 7:12:46 PM

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Please e-mail your comments or suggestions, and, to those who have given me advice and feedback on this page, "Thanks!," John P. Green

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