Fillable Form 65 - Uniform Residential Loan Application (Page 3 of 4) in pdf

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VI. ASSETS AND LIABILITIES (cont.)

Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet.)

Insurance,

Property Address (enter S if sold, PS if pending sale

Present

Amount of

Gross

Mortgage

Maintenance,

Net

Type of

or R if rental being held for income)

Market Value

Mortgages & Liens

Rental Income

Payments

Taxes & Misc.

Rental Income

Property

Totals $

List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s):

Alternate Name

Creditor Name

Account Number

VII. DETAILS OF TRANSACTION

VIII. DECLARATIONS

a. Purchase price

If you answer “Yes” to any questions a through i, please use continuation

Borrower Co-Borrower

sheet for explanation.

b. Alterations, improvements, repairs

Yes

❑

c. Land (if acquired separately)

a. Are there any outstanding judgments against you?

❑

d. Refinance (incl. debts to be paid off)

b. Have you been declared bankrupt within the past 7 years?

❑

e. Estimated prepaid items

c. Have you had property foreclosed upon or given title or deed in lieu thereof

in the last 7 years?

f. Estimated closing costs

❑

g. PMI, MIP, Funding Fee

d. Are you a party to a lawsuit?

❑

h. Discount (if Borrower will pay)

e. Have you directly or indirectly been obligated on any loan which resulted in

foreclosure, transfer of title in lieu of foreclosure, or judgment?

i. Total costs (add items a through h)

(This would include such loans as home mortgage loans, SBA loans, home improvement loans,

j. Subordinate financing

educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond,

or loan guarantee. If “Yes,” provide details, including date, name and address of Lender, FHA or

k. Borrower’s closing costs paid by Seller

VA case number, if any, and reasons for the action.)

❑

l. Other Credits (explain)

f. Are you presently delinquent or in default on any Federal debt or any other

loan, mortgage, financial obligation, bond, or loan guarantee?

If “Yes,” give details as described in the preceding question.

❑

g. Are you obligated to pay alimony, child support, or separate maintenance?

❑

m. Loan amount

h. Is any part of the down payment borrowed?

❑

(exclude PMI, MIP, Funding Fee financed)

i. Are you a co-maker or endorser on a note?

❑

n. PMI, MIP, Funding Fee financed

j. Are you a U.S. citizen?

❑

k. Are you a permanent resident alien?

❑

o. Loan amount (add m & n)

l. Do you intend to occupy the property as your primary residence?

If “Yes,” complete question m below.

❑

m. Have you had an ownership interest in a property in the last three years?

p. Cash from/to Borrower

(1) What type of property did you own—principal residence (PR),

(subtract j, k, l & o from i)

second home (SH), or investment property (IP)?

__________ __________

(2) How did you hold title to the home—solely by yourself (S),

jointly with your spouse (SP), or jointly with another person (O)?

__________ __________

IX. ACKNOWLEDGMENT AND AGREEMENT

ach of the undersigned specifically represents to Lender and to Lender's actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors and assigns

and agrees and acknowledges that: (1) the information provided in this application is true and correct as of the date set forth opposite my signature and that any intentional or

negligent misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to

reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, but not limited to, fine or imprisonment or both under the provisions

of Title 18, United States Code, Sec. 1001, et seq.; (2) the loan requested pursuant to this application (the "Loan") will be secured by a mortgage or deed of trust on the property

described herein; (3) the property will not be used for any illegal or prohibited purpose or use; (4) all statements made in this application are made for the purpose of obtaining a

residential mortgage loan; (5) the property will be occupied as indicated herein; (6) any owner or servicer of the Loan may verify or reverify any information contained in the

application from any source named in this application, and Lender, its successors or assigns may retain the original and/or an electronic record of this application, even if the Loan

is not approved; (7) the Lender and its agents, brokers, insurers, servicers, successors and assigns may continuously rely on the information contained in the application, and I am

obligated to amend and/or supplement the information provided in this application if any of the material facts that I have represented herein should change prior to closing of the

Loan; (8) in the event that my payments on the Loan become delinquent, the owner or servicer of the Loan may, in addition to any other rights and remedies that it may have

relating to such delinquency, report my name and account information to one or more consumer credit reporting agencies; (9) ownership of the Loan and/or administration of the

Loan account may be transferred with such notice as may be required by law; (10) neither Lender nor its agents, brokers, insurers, servicers, successors or assigns has made any

representation or warranty, express or implied, to me regarding the property or the condition or value of the property; and (11) my transmission of this application as an "electronic

record" containing my "electronic signature," as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or my facsimile

transmission of this application containing a fascimile of my signature, shall be as effective, enforceable and valid as if a paper version of this application were delivered containing

my original written signature.

Borrower’s Signature

Date

Co-Borrower’s Signature

Date

X. INFORMATION FOR GOVERNMENT MONITORING PURPOSES

The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lender's compliance with equal credit

opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may

discriminate neither on the basis of this information, nor on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you

may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual

observation or surname. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy

all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)

❑

BORROWER

I do not wish to furnish this information.

CO-BORROWER

I do not wish to furnish this information.

❑

Ethnicity:

Hispanic or Latino

Not Hispanic or Latino

Ethnicity:

Hispanic or Latino

Not Hispanic or Latino

❑

Race:

American Indian or

Asian

Black or

Race:

American Indian or

Asian

Black or

Alaska Native

African American

Alaska Native

African American

❑

Native Hawaiian or

White

Native Hawaiian or

White

Other Pacific Islander

❑

Sex:

Female

Male

Sex:

Female

Male

To be Completed by Interviewer

Interviewer’s Name (print or type)

Name and Address of Interviewer’s Employer

This application was taken by:

❑

Face-to-face interview

Interviewer’s Signature

Date

❑

Mail

❑

Telephone

❑

Interviewer’s Phone Number (incl. area code)

Internet

Freddie Mac Form 65

01/04

Page 3 of 4

Fannie Mae Form 1003

01/04

Form 65 - Uniform Residential Loan Application Page 3

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