Disbursement Checklist Page 4
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1
2
3
4
5ASSET CALCULATION:
1.
Purchase Price (Maximum price of $164,900)
$________________
2.
Closing Costs Including Prepaids to be paid by Borrower
$________________
a.) closing costs paid by allowable source (if applicable)
$________________
b.) credits or concessions from financial institution (if applicable)
$________________
3.
Total Closing Costs (Add a+b & subtract from closing costs, #2) $________________
4.
Total Acquisition Costs (#1 + #3)
$_________________
5.
PITI Payment Including Homeowners Association (HOA) FEE
$_________________
6.
1st Mortgage Amount
$_________________
7.
Cash Deposit Paid by Applicant
$_________________
8.
Additional Cash Required
$_________________
(3% of #1 or $1,000, whichever is less minus #7)
9.
Verified Available Assets per 1st Mortgage
$_________________
10.
Verified Available Assets per 1st Mortgage
less $5,000 reserves
(IF NEGATIVE NUMBER, INDICATE "0")
$_________________
11.
Second or Subordinated Mortgage Needed*
#4 - [#6 +#7 +#8+ #10]
(Maximum limit to borrower is $3,000)
$_________________
*If amount requested exceeds the $3,000 limit, please indicate
$_________________
the source of the additional money needed to close transaction
(i.e. applicants own funds, gift, or other)
Source:
NOTE: If line 8 exceeds line 9, borrower does not have required investment and is not eligible for second or subordinated
mortgage.
NOTE: First Mortgage Lender:
Show amount of Dauphin County Second or Subordinated Mortgage under other financing in details of transaction of
the first mortgage document.
Any false statement made knowingly and willfully may subject the signer to penalties under Section 1001 and 1010 of
Title 18 of the United States Code.
_______________________________________
________________
BORROWER
DATE
_______________________________________
________________
CO-BORROWER
DATE
_______________________________________
________________
APPLICATION PREPARER'S SIGNATURE
DATE
_______________________________________
________________
DAUPHIN COUNTY APPROVAL
DATE
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