Form 65 - Uniform Residential Loan Application Page 2
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4V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION
Combined Monthly
Gross Monthly Income
Borrower
Co-Borrower
Total
Housing Expense
Present
Proposed
Base Empl. Income*
$
$
$
Rent
$
Overtime
First Mortgage (P&I)
$
Bonuses
Other Financing (P&I)
Commissions
Hazard Insurance
Dividends/Interest
Real Estate Taxes
Net Rental Income
Mortgage Insurance
Other
Homeowner Assn. Dues
(before completing,
see the notice in “describe
Other:
other income,” below)
$
$
$
$
$
Total
Total
* Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.
Describe Other Income Notice: Alimony, child support, or separate maintenance income need not be revealed if the
Borrower (B) or Co-Borrower (C) does not choose to have it considered for repaying this loan.
B/C
Monthly Amount
$
VI. 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 spouse, this Statement and supporting schedules must be completed about that spouse also.
❑
❑
Completed
Jointly
Not Jointly
ASSETS
Cash or Market
Liabilities and Pledged Assets. List the creditor’s name, address and account number for all outstanding
Description
Value
debts, including automobile loans, revolving charge accounts, real estate loans, alimony, child support,
stock pledges, etc. Use continuation sheet, if necessary. Indicate by (*) those liabilities which will be
Cash deposit toward purchase held by:
$
satisfied upon sale of real estate owned or upon refinancing of the subject property.
Monthly Payment &
LIABILITIES
Months Left to Pay
Unpaid Balance
List checking and savings accounts below
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
$
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
$
Acct. no.
Real estate owned (enter market value
$
from schedule of real estate owned)
Name and address of Company
$ Payment/Months
$
Vested interest in retirement fund
$
Net worth of business(es) owned
$
(attach financial statement)
Automobiles owned (make and year)
$
Acct. no.
Alimony/Child Support/Separate Maintenance
$
Payments Owed to:
Other Assets (itemize)
$
Job-Related Expense (child care, union dues, etc.)
$
Total Monthly Payments
$
➧
Net Worth
Total Assets a.
$
$
Total Liabilities b.
$
(a minus b)
Freddie Mac Form 65
01/04
Page 2 of 4
Fannie Mae Form 1003
01/04
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