Fillable Va Form 26-6705b - Credit Statement Of Prospective Purchaser (Page 2 of 2) in pdf

CHECKING, SAVINGS AND INVESTMENT ACCOUNT INFORMATION

19A. BANK, CREDIT UNION OR OTHER DEPOSITORY NAMES AND MAILING ADDRESSES

19B. ACCOUNT NUMBERS AND PURPOSE

19C. BALANCE

COMBINED MONTHLY HOUSING & OTHER EXPENSES

MONTHLY INCOME

21A. COMBINED EXPENSES AND

20A. SOURCE OF INCOME AND

20B. APPLICANT

20C. SPOUSE

21B. PRESENT

21C. REQUESTED

GROSS MONTHLY AMOUNTS

BORROWER

CO-APPLICANT

HOME

LOAN

(1) BASE SALARY, WAGES

(1) RENT OR HOME LOAN PAYMENT

(2) OVERTIME, PART-TIME

(2) HAZARD INSURANCE

(3) BONUSES, COMMISSIONS

(3) REAL ESTATE TAXES

(4) INTEREST, DIVIDENDS

(4) HOMEOWNER ASSOCIATION DUES

(5) PENSION, COMPENSATION

(5) DEPENDENT CARE

(6) REAL ESTATE RENTAL

(6) OTHER

Disclose the following income only if needed to repay the loan. Send VA

SELF EMPLOYMENT: Send VA copies of latest tax returns and financial

copies of court documents and evidence of payments.

(profit/loss) statements for the last two years.

(7) ALIMONY, SEPARATE MAINTENANCE

RENTAL PROPERTY: Send VA copies of latest list of property addresses,

creditors, loan and rental amounts related to investment real estate owned.

(8) CHILD SUPPORT

LOANS AND OTHER CREDIT ACCOUNT INFORMATION

(List your charge card accounts, installment loans, and other debts you owe. Include present landlord(s) with other creditors and attach a separate sheet, if necessary, to

list and explain additional credit accounts, including any past due amounts, judgments, collections and foreclosures against you, deeds in lieu of foreclosure, bankruptcies

filed within the past seven years and court orders to pay separate maintenance, alimony or child support.)

22A. CREDITOR NAMES AND MAILING ADDRESSES (Include landlord(s)

22B. ACCOUNT NUMBERS AND PURPOSE

22C. BALANCE

22D. PAYMENT PER

MONTH

ACKNOWLEDGMENTS - I acknowledge that the Federal Government, its agents or assigns, are authorized by law to take any and all of the following

actions in the event that payments become delinquent on the loan described in this application: (1) Report my name and account information to a credit

bureau, (2) Charge penalty amounts and additional interest for the period of time that the loan is delinquent, (3) Charge additional amounts to cover

additional administrative costs of servicing the delinquent loan, (4) Offset other amounts owed to me under other Federal programs, (5) Refer my account to

a private attorney, collection agency or servicing agency to conduct computer matches, collect the amount due, foreclose the loan, sell the property and seek

judgement against me for a deficiency, (6) Refer my account to the Department of Justice for litigation in the courts, (7) If I am a current or retired Federal

employee, take action to offset my salary or retirement benefits, (8) Refer my debt to the Internal Revenue Service as my taxable income. These actions

may be used to recover any debt owed, when it is determined to be in the interest of the Federal Government, its agents or assigns, to do so. I understand

that Federal debts include grants, benefit overpayments, delinquent taxes and direct, guaranteed or insured loans for education, business or housing, and

that delinquencies are defined as follows: a grant is delinquent if a disallowed amount has not been repaid or resolved; a direct loan is delinquent if a

scheduled payment is more than 31 days past due; a guaranteed or insured loan is delinquent if the debt has been purchased by the Federal Government

because the loan agreement was breached by the borrower and is in default.

23. ARE YOU DELINQUENT ON ANY FEDERAL DEBT, OR HAVE YOU FILED BANKRUPTCY OR HAD A LOAN FORECLOSED WITHIN THE PAST SEVEN YEARS?

(If "Yes," explain in this box or attach a separate sheet)

YES

AGREEMENTS - Neither I, nor anyone authorized to act for me will restrict the sale or rental of the property covered by this application for credit to any

person because of race, color, religion, sex, handicap, familial status or national origin. I understand that such restriction is illegal. I understand that, if I

obtain a loan from VA to purchase a property acquired through VA Loan Guaranty operations, VA may either retain or sell the rights to collect the payments

and otherwise service the loan. I understand that VA may retain this application and any supporting documents, even if the loan is not approved. I agree to

notify VA if my income or expenses should change prior to closing.

CERTIFICATIONS - I certify that all information contained in this application for credit is true and complete to the best of my knowledge and that verification

may be obtained from any source named herein. I understand that if I give false information, I may be charged penalties or may be subject to criminal

prosecution.

24A. SIGNATURE OF APPLICANT

24B. DATE SIGNED

25A. SIGNATURE OF SPOUSE/CO-APPLICANT

25B. DATE SIGNED

FEDERAL LAW PROHIBITS A CREDITOR FROM DISCRIMINATING ON THE BASIS OF THE FOLLOWING FEDERAL GOVERNMENT MONITORING

INFORMATION, OR THE FACT THAT IT IS NOT FURNISHED. YOU ARE NOT REQUIRED, BUT ENCOURAGED, TO FURNISH THIS INFORMATION.

26. APPLICANT (If you do not wish to complete the

INITIALS

27. SPOUSE/CO-APPLICANT (If you do not wish to

INITIALS