Financial Statement Form Page 3

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My opinion of the condition of my home is: ______________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
Describe what offers, if any, you as the Homeowner have made to your lender in
an effort to resolve the default of the loan: ________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________
If you are self-employed, you must complete the attached Profit and Loss
Statement for Self-Employed Homeowners.
Borrower Signature: _____________________________
Date: ___________________
Co-borrower Signature: ___________________________
Date: _____________________
This form was approved by the St. Louis County Counselor’s Office.
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