Freddie Mac Form 65 - Uniform Commercial Loan Application Page 3
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3VI. 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
Type of
Present
Amount of
Gross
Mortgage
Net
Maintenance,
sale or R if rental being held for income)
Property
Market Value
Mortgages & Liens
Rental Income
Payments
Rental Income
Taxes & Misc.
$
$
$
$
$
$
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
Borrower Co-Borrower
use continuation sheet for explanation.
b. Alterations, improvements, repairs
Yes
No
Yes No
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?
c. Have you had property foreclosed upon or given title or deed
e. Estimated prepaid items
in lieu thereof in the last 7 years?
f. Estimated closing costs
d. Are you a party to a lawsuit?
e. Have you directly or indirectly been obligated on any loan which resulted in
g. PMI, MIP, Funding Fee
foreclosure, transfer of title in lieu of foreclosure, or judgment?
(This would
h. Discount (if Borrower will pay)
include such loans as home mortgage loans, SBA loans, home improvement
loans, educational loans, manufactured (mobile) home loans, any
mortgage,
i. Total costs (add items a through h)
financial obligation, bond, or loan guarantee.
If "Yes," provide details, including
date, name and address of Lender, FHA or VA case number,
j. Subordinate financing
if any, and reasons for the action.)
k. Borrower's closing costs paid by Seller
f. Are you presently delinquent or in default on any Federal debt or any other loan,
mortgage, financial obligation bond, or loan guarantee?
if
l. Other Credits(explain)
"Yes," give details as described in the preceding question.
g. Are you obligated to pay alimony, child support, or separate
maintenance?
h. Is any part of the down payment borrowed?
i. Are you a co-maker or endorser on a note?
j. Are you a U. S. citizen?
m. Loan amount (exclude PMI, MIP,
k. Are you a permanent resident alien?
Funding Fee financed)
l. Do you intend to occupy the property as your primary residence?
If "Yes," complete question m below.
n. PMI, MIP, Funding Fee financed
m. Have you had an ownership interest in a property in the last
three years?
o. Loan amount (add m & n)
(1) What type of property did you own-principal residence (PR),
second home (SH), or investment property (IP)?
p. Cash from/to Borrower
(2) How did you hold title to the home-solely by yourself (S), jointly
with your spouse (SP), or jointly with another person (O)?
(subtract j, k, l & o from i)
IX. ACKNOWLEDGMENT AND AGREEMENT
The undersigned specifically acknowledge(s) and agree(s) that: (1) the loan requested by this application will be secured by a first mortgage or deed of trust
on the property described herein; (2) the property will not be used for any illegal or prohibited purpose or use; (3) all statements made in this application
are made for the purpose of obtaining the loan indicated herein; (4) occupation of the property will be as indicated above; (5) verification or reverification
of any information contained
in the
application may be made at any time by the Lender, its agents, successors and assigns, either directly or through a
credit reporting agency, from any source named in this application, and the original copy of this application will be retained by the Lender, even if the loan
is not approved; (6) the Lender,
its agents,
successors and assigns will rely on the information contained in the application and I/we have a continuing
obligation to amend and/or supplement the information provided in this application if any of the material facts
which I/we have represented herein should
change prior to closing;
(7) in the event my/our payments on the loan indicated in this application become delinquent, the Lender, its agents, successors
and assigns, may,
in addition
to all their other rights
and remedies,
report my/our name(s) and account information to a credit reporting agency; (8)
ownership of the loan may be transferred
to successor or assign of the Lender
without
notice to me
and/or the administration of the loan account may
be transferred to an agent,
successor
or assign
of
the
Lender
with prior notice
to me; (9) the Lender, its agents, successors and assigns make no
representations or warranties, express or implied, to the Borrower(s) regarding the property, the condition of the property, or the value of the property.
Certification: I/We certify that the information provided in this application is true and correct
as of the date set forth opposite my/our signature(s) on
this
application and acknowledge my/our understanding that any intentional or negligent misrepresentation(s)
of
the information contained in this
application
may result
in civil
liability
and/or
criminal
penalties including, but not limited to, fine or imprisonment or both under the provisions of
Title 18,
United
States Code, Section 1001, et seq. and liability
for monetary damages to the Lender,
its agents,
successors and assigns, insurers and any other person
who may suffer any loss due to reliance upon any misrepresentaion which I/we have made on this application.
Borrower's Signature
Date
Co-Borrower's Signature
Date
X
X
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 neither discriminate on the basis of this information, nor on whether you choose to furnish
it.
However, if you choose not to furnish it, under Federal regulations this Lender is required to note race and sex on the basis of visual observation
or surname.
If you do not wish to furnish the above information, please check the box below. (Lender must review the above material to assure that
the disclosure satisfy all requirements to which the Lender is subject under applicable state law for the particular type of loan applied for.)
BORROWER
CO-BORROWER
I do not wish to furnish this information
I do not wish to furnish this information
Race/National
Race/National
American Indian or Alaskan Native
Asian or Pacific Islander
American Indian or Alaskan Native
Asian or Pacific Islander
Origin:
Black,not of
White,not of
Origin:
Black,not of
White,not of
Hispanic
Hispanic
Hispanic origin
Hispanic origin
Hispanic origin
Hispanic origin
Other (specify)____________________
Other (specify)____________________
Sex:
Sex:
Female
Male
Female
Male
Interviewer's Name (print or type)
Name and Address Interviewer's Employer
To be Completed by Interviewer
Jeffrey Rosner
This application was taken by:
Seren Funding Corp.
Interviewer's Signature
Date
face-to-face interview
46
by mail
46 East Park Avenue
Interviewer's Phone Number (incl. area code)
by telephone
Long Beach NY 11561
516-889-8218
Freddie Mac Form 65
10/92
Page 3 of 4
Borrower
Fannie Mae Form 1003
10/92
CALYX Form 1003 Loanapp3.hp 2/95
Co-Borrower
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