STATEMENT OF ASSETS AND LIABILITIES
(Supplement to Residential Loan Application)
___________________________________________________________________________________________________________________
Name
___________________________________________________________________________________________________________________
The following information is provided to complete and become a part of the application for a mortgage in the amount of $ __________________________________________________________________
with interest at ___%, for a term of ________ months and to be secured by property known as: _______________________________________________________________________________________
___________________________________________________________________________________________________________________
Subject Property Address (street, city, state, & ZIP)
___________________________________________________________________________________________________________________
Legal Description of Subject Property (attach description if necessary)
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 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
Liabilities and Pledged Assets. List the creditor’s name, address, and account number for all outstanding debts, including
Market Value
automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges, etc. Use continuation
Description
sheet, if necessary. Indicate by (*) those liabilities, which will be satisfied upon sale of real estate owned or upon
Cash deposit toward purchase held by:
$
refinancing of the subject property.
LIABILITIES
Monthly Payment &
Unpaid Balance
Months Left to Pay
Name and address of Company
$ Payment/Months
$
List checking and savings accounts below
Name and address of Bank, S&L, or Credit Union
Acct. no.
Acct. no.
$
Name and address of Company
$ Payment/Months
$
Name and address of Bank, S&L, or Credit Union
Acct. no.
Acct. no.
$
Name and address of Company
$ Payment/Months
$
Name and address of Bank, S&L, or Credit Union
Acct. no.
Acct. no.
$
Name and address of Company
$ Payment/Months
$
Name and address of Bank, S&L, or Credit Union
Acct. no.
Acct. no.
$
Name and address of Company
$ Payment/Months
$
Stocks & Bonds (Company
$
name/number description)
Acct. no.
$
Name and address of Company
$
$ Payment/Months
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
$
Freddie Mac Form 65A/Rev. 7/05
Page 1 of 2
Fannie Mae Form 1003A/Rev. 7/05