Financial Worksheet For Loan Modification

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VTB MM Form # 10
VTB Form - MM # 10
12/16/11
11/14/2011
Financial Worksheet for Loan Modification
XXX-XX-
Borrower Name_______________________________________________Social Security
#_________________________________
XXX-XX-
Co-Borrower Name____________________________________________Social Security
#_________________________________
State
Property
Address___________________________________________City________________________Sate____Zip__________
State
MailingAddress_____________________________________________City________________________Sate____Zip__________
Home Phone__________________Work
Phone____________________Cell_____________________Fax___________________
Best time to
Call_________________________Email______________________________________________________________
Borrower
Employer_____________________________________
Full-Time
Part-Time Unemployed Self-Employed Retired
Occupant
Employer_____________________________________
Full-Time
Part-Time Unemployed Self-Employed Retired
Borrower Income Frequency
Weekly
Bi-Weekly
Semi Monthly
Monthly
Quarterly
Yearly
Additional Occupants Income Frequency
Weekly
Bi-Weekly
Semi Monthly
Monthly
Quarterly
Yearly
st
nd
Mortgage Company Name: 1
______________________________________2
______________________________________
st
nd
Loan Number
1
______________________________________
2
______________________________________
Income
Borrower Income
Occupant Income
Assets / Liabilities
Gross
Net
Gross
Net
Description
Value
Owe
Net
Income
Auto
Disability
Checking/Saving
Rental
IRA
Unemployment
401K
Child Support
Stocks/Bond/CDs
Other
Other
Total
Total
Household Liabilities and Expenses
Expenses
Payments
Balance Due
Expenses
Payments
Balance Due
Alimony Child Support
Clothing
Auto Expense(gas repairs)
Dry Cleaning
Child Care/Elder Care
Monthly Parking
Entertainment
Other Mortgages
Club or Union Dues
Education
School or Work Lunch Cost
/ condo dues
Medical
HOA Dues
Pets
Other
Food/groceries/meals
Spending Money
Dining Out
Debts
Ch 13 Plan pmt
Other Expenses
Auto Loan
Auto Insurance
Credit Cards
Health Insurance
Installment Loans
Life Insurance
Mortgage Payment
nd
Hospital
2
Loan Payment
Prescriptions
Property Tax & Insurance
Cable
Personal Loans
Electricity
Other Secured Debts
Gas
Other Unsecured Debts
Phone/Cell/Internet
Other
Water/Sewage
Total Expense / Debts
Debtor signature: ________________________
Co-Debtor signature:_______________________
Date signed: _____________
Date signed: _____________

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