Information Disclosure Authorization Page 4
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6VI. ASSETS AND LIABILITIES (cont’d)
Name and address of Bank, S&L, or Credit Union
Name and address of Company
$ Payment/Months
$
Acct. no.
$
Acct. no.
Stocks & Bonds (Company name/
$
Name and address of Company
$ Payment/Months
$
number & description)
Acct. no.
$
Name and address of Company
$
$ Payment/Months
Life insurance net cash value
Face amount: $
$
Subtotal Liquid Assets
Real estate owned (enter market value
$
from schedule of real estate owned)
Vested interest in retirement fund
$
Net worth of business(es) owned
$
(attach financial statement)
Acct. no.
Alimony/Child Support/Separate
Automobiles owned (make
$
$
Maintenance Payments Owed to:
and year)
Other Assets (itemize)
$
Job-Related Expense (child care, union dues, etc.)
$
Total Monthly Payments
$
Total Assets a.
$
Total Liabilities b.
$
$
Net Worth
►
(a minus b)
Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet.)
Amount
Insurance,
Property Address (enter S if sold, PS if pending sale or R
Type of
Present
Gross
Mortgage
Net Rental
Maintenance,
if rental being held for income)
of Mortgages
Property
Payments
Income
Market Value
Rental Income
Taxes & Misc.
▼
& Liens
$
$
$
$
$
$
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
If you answer “Yes” to any questions a through i,
Borrower
Co-Borrower
a.
Purchase price
$
please use continuation sheet for explanation.
Yes No
Yes No
b.
Alterations, improvements, repairs
a. Are there any outstanding judgments against you?
c.
Land (if acquired separately)
b. Have you been declared bankrupt within the past 7 years?
c. Have you had property foreclosed upon or given title
d.
Refinance (incl. debts to be paid off)
or deed in lieu thereof in the last 7 years?
e.
Estimated prepaid items
d. Are you a party to a lawsuit?
f.
Estimated closing costs
e. Have you directly or indirectly been obligated on any
loan which resulted in foreclosure, transfer of title
g.
PMI, MIP, Funding Fee
in lieu of foreclosure, or judgment?
(This would include such loans as home mortgage loans, SBA loans, home
h.
Discount (if Borrower will pay)
improvement loans, educational loans, manufactured (mobile) home loans, any
mortgage, financial obligation, bond, or loan guarantee. If “Yes,” provide
i.
Total costs (add items a through h)
details, including date, name, and address of Lender, FHA or VA case number,
if any, and reasons for the action.)
Uniform Residential Loan Application
Freddie Mac Form 65 7/05 (rev.6/09)
Page 3 of 5
Fannie Mae Form 1003 7/05 (rev.6/09)
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