Uniform Residential Loan Application - 2009 Page 3
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16V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION
Gross
Borrower
Co-
Total
Combined
Present
Proposed
Monthly Income
Borrower
Monthly
Housing Expense
Base Empl.
$
$
$
Rent
$
Income*
Overtime
First Mortgage
$
(P&I)
Bonuses
Other Financing
(P&I)
Commissions
Hazard Insurance
Dividends/
Real Estate Taxes
Interest
Net Rental
Mortgage
Income
Insurance
Other
Homeowner Assn.
(before completing,
Dues
see the notice in
“describe other
income,” below)
Other:
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 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,
Market Value
and account number for all outstanding debts, including automobile
Description
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 satisfied upon sale of
real estate owned or upon refinancing of the subject property.
LIABILITIES
Monthly Payment &
Unpaid
Cash deposit toward
$
Months Left to Pay
Balance
purchase held by:
List checking and savings accounts below
Name and address of
$ Payment/
$
Months
Company
Name and address of Bank, S&L, or Credit
Union
Acct. no.
Acct. no.
$
Name and address of
$ Payment/
$
Months
Company
Uniform Residential Loan Application
Page 3 of 8
Freddie Mac Form 65 7/05 (rev.6 /09)
Fannie Mae Form 1003
7/05 (rev.6/09)
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