Uniform Residential Loan Application

____________________________________________________________________________________________
This application is designed to be completed by the applicant(s) with the Lender’s assistance. Applicants should
complete this form as “Borrower” or “Co-Borrower,” as applicable. Co-Borrower information must also be provided
(and the appropriate box checked) when the income or assets of a person other than the Borrower (including the
Borrower’s spouse) will be used as a basis for loan qualification or the income or assets of the Borrower’s
spouse or other person who has community property or similar rights pursuant to applicable state law will not be
used as a basis for loan qualification, but his or her liabilities must be considered because the spouse or other
person who has community property or similar rights and the Borrower resides in a community property state, the
security property is located in a community property state, or the Borrower is relying on other property located in a
community property state as a basis for repayment of the loan.

If this is an application for joint credit, Borrower and Co-Borrower each agree that we intend to apply for joint credit
(sign below):

_____________________________________ __________________________________________
Borrower Co-Borrower

I. TYPE OF MORTGAGE AND TERMS OF LOAN

Mortgage VA USDA/Rural Housing Service Agency Case Number Lender Case Number
Applied for: FHA Conventional Other (explain):

Amount Interest Rate No. of Months Amortization Fixed Rate Other (explain):
$ % Type: GPM ARM (type):
II. PROPERTY INFORMATION AND PURPOSE OF LOAN
Subject Property Address (street, city, state & ZIP) No. of Units

Legal Description of Subject Property (attach description if necessary) Year Built

Purpose of Loan Purchase Refinance Construction Property will be:

Construction-Permanent Other (explain): Primary Residence
Secondary Residence
Investment
Complete this line if construction or construction-permanent loan.
Year Lot Original Cost Amount Existing (a) Present Value of (b) Cost of Total (a + b)
Acquired Liens Lot Improvements

$ $ $ $ $
Complete this line if this is a refinance loan.
Year Original Cost Amount Existing Purpose of Describe made to be made
Acquired Liens Refinance Improvements

$ $
Title will be held in what Name(s) Manner in which Title will be held Estate will be held in:
Fee Simple
Leasehold
(show expiration date)

Source of Down Payment, Settlement Charges, and/or Subordinate Financing (explain)

Freddie Mac Form 65 7/05 Page 1 of 8 Fannie Mae Form 1003 7/05
 Borrower III. BORROWER INFORMATION Co-Borrower
Borrower’s Name (include Jr. or Sr. if applicable) Co-Borrower’s Name (include Jr. or Sr. if applicable)

Social Security Home Phone DOB Yrs. Social Security Home Phone DOB Yrs.
Number (incl. Area code) (mm/dd/yyyy) School Number (incl. Area code) (mm/dd/yyyy) School

Dependents Dependents
Married Separated (not listed by Co-Borrower) Married Separated (not listed by Borrower)
Unmarried no. ages Unmarried no. ages
(include single, divorced, widowed) (include single, divorced, widowed)

Present Address Own Rent __No. Yrs. Present Address Own Rent __No. Yrs.
(street, city, state, ZIP) (street, city, state, ZIP)

Mailing Address, if different from Present Address Mailing Address, if different from Present Address

If residing at present address for less than two years, complete the following:
Former Address Own Rent __No. Yrs. Former Address Own Rent __No. Yrs.
(street, city, state, ZIP) (street, city, state, ZIP)

Borrower IV. EMPLOYMENT INFORMATION Co-Borrower

Name & Address Self Employed Yrs. on this job Name & Address Self Employed Yrs. on this job
of Employer of Employer
Yrs. employed Yrs. employed
in this line of in this line of
work/profession work/profession

Position/Title/Type of Business Business Phone Position/Title/Type of Business Business Phone

(incl. area code) (incl. area code)

If employed in current position for less than two years or if currently employed in more than one position, complete
the following:
Name & Address Self Employed Dates Name & Address Self Employed Dates
of Employer (from – to) of Employer (from – to)

Monthly Income Monthly Income

$ $
Position/Title/Type of Business Business Phone Position/Title/Type of Business Business Phone
(incl. area code) (incl. area code)

Name & Address Self Employed Dates Name & Address Self Employed Dates
of Employer (from – to) of Employer (from – to)

Monthly Income Monthly Income

$ $
Position/Title/Type of Business Business Phone Position/Title/Type of Business Business Phone
(incl. area code) (incl. area code)

Freddie Mac Form 65 7/05 Page 2 of 8 Fannie Mae Form 1003 7/05
 V. 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

Freddie Mac Form 65 7/05 Page 3 of 8 Fannie Mae Form 1003 7/05
 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.
Cash deposit toward $ LIABILITIES Monthly Payment & Unpaid
purchase held by: Months Left to Pay Balance
List checking and savings accounts below Name and address of Company $ Payment/Months $
Name and address of Bank, S&L, or Credit Union

Acct. no.
Acct. no. $ Name and address of Company $ Payment/Months $

Name and address of Bank, S&L, or Credit Union Acct. no.

Acct. no. $ Name and address of Company $ Payment/Months $

Name and address of Bank, S&L, or Credit Union

Acct. no.
Acct. no. $ Name and address of Company $ Payment/Months $
Name and address of Bank, S&L, or Credit Union

Acct. no.
Acct. no. $ Name and address of Company $ Payment/Months $
Stocks & Bonds (Company $
name/number & description)

Acct. no.
Life insurance net cash value $ Name and address of Company $ Payment/Months $

Face amount: $
Subtotal Liquid Assets $ Acct. no.
Real estate owned $ Alimony/Child Support/Separate $
(enter market value from Maintenance Payments Owed to:
schedule of real estate owned)
Vested interest in retirement fund $
Net worth of business(es) owned $ Job-Related Expense $
(attach financial statement) (child care, union dues, etc.)
Automobiles owned $
(make and year)

Other Assets (itemize) $

Total Monthly Payments $

Total Assets $ Net Worth $ Total Liabilities $
a. (a minus b) b.

Freddie Mac Form 65 7/05 Page 4 of 8 Fannie Mae Form 1003 7/05
Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet.)
Property Address Type of Present Amount Gross Mortgage Insurance, Net
(enter S if sold, PS if Property Market of Rental Payments Maintenance, Rental
pending sale or R if Value Mortgages Income Taxes & Income
rental being held for & Liens Misc.
income)
$ $ $ $ $ $

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 Borrower Co-
through i, please use continuation sheet Borrower
for explanation.
b. Alterations, Yes No Yes No
improvements, repairs
c. Land a. Are there any outstanding judgments
(if acquired separately) against you?
d. Refinance b. Have you been declared bankrupt
(incl. debts to be paid off) within the past 7 years?
e. Estimated prepaid c. Have you had property foreclosed
items upon or given title or deed in lieu
thereof in the last 7 years?
f. Estimated closing costs d. Are you a party to a lawsuit?
g. PMI, MIP, Funding Fee e. Have you directly or indirectly been
obligated on any loan of which
resulted in foreclosure, transfer of title
in lieu of foreclosure, or judgment?

(This would include such loans as home

mortgage loans, SBA loans, home improvement
loans, 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 VA case number, if any, and
reasons for the action.)
h. Discount f. Are you presently delinquent or in
(if Borrower will pay) 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.
i. Total costs g. Are you obligated to pay alimony,
(add items a through h) child support, or separate
maintenance?
j. Subordinate financing h. Is any part of the down payment
borrowed?

Freddie Mac Form 65 7/05 Page 5 of 8 Fannie Mae Form 1003 7/05
 VII. DETAILS OF TRANSACTION (cont’d) VIII. DECLARATIONS (cont’d)
k. Borrower’s closing i. Are you a co-maker or endorser on a
costs paid by Seller note?
l. Other Credits (explain) -------------------------------------------------------
j. Are you a U.S. citizen?

k. Are you a permanent resident alien?

m. Loan amount (exclude l. Do you intend to occupy the property

PMI, MIP, Funding Fee as your primary residence?
financed) If “Yes,” complete question m below.
n. PMI, MIP, Funding Fee m. Have you had an ownership interest
financed in a property in the last three years?
o. Loan amount (1) What type of property did you ___ ___ ___ ___
(add m & n) own—principal residence (PR), second
home (SH), or investment property
(IP)?
p. Cash from/to Borrower (2) How did you hold title to the ___ ___ ___ ___
(subtract j, k, l & o from i) home— by yourself (S), jointly
with your spouse or jointly with
another person (O)?
IX. ACKNOWLEDGMENT AND AGREEMENT
Each 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 in this application;
(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 in this application; (6) the Lender, its servicers, successors or assigns may retain the original and/or an
electronic record of this application, whether or not the Loan is 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 Lender, its servicers, successors or assigns 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 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 facsimile 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.

Acknowledgement. Each of the undersigned hereby acknowledges that any owner of the Loan, its servicers,
successors and assigns, may verify or reverify any information contained in this application or obtain any information
or data relating to the Loan, for any legitimate business purpose through any source, including a source named in
this application or a consumer reporting agency.

Borrower’s Signature Date Co-Borrower’s Signature Date

X X

Freddie Mac Form 65 7/05 Page 6 of 8 Fannie Mae Form 1003 7/05
 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 not discriminate either on the basis of this information, or 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 and surname if you have made this application in person. 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 CO-BORROWER
I do not wish to furnish this information 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 Alaska Native Race: American Indian or Alaska Native
Asian Asian
Black or African American Black or African American
Native Hawaiian or Other Pacific Islander Native Hawaiian or Other Pacific Islander
White White
Sex: Female Male Sex: Female Male
To be Completed by Interviewer Interviewer’s Name (print or type) Name and Address of Interviewer’s
This application was taken by: Employer
Face-to-face interview
Mail
Telephone
Internet

Interviewer’s Signature Date

Interviewer’s Phone Number

(incl. area code)

Freddie Mac Form 65 7/05 Page 7 of 8 Fannie Mae Form 1003 7/05
 CONTINUATION SHEET/RESIDENTIAL LOAN APPLICATION
Use this continuation sheet if Borrower: Agency Case Number:
you need more space to
complete the Residential Loan
Application. Mark B for
Borrower or C for Co-Borrower.

Co-Borrower: Lender Case Number:

____________________________________________________________________________________________
I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any
false statements concerning any of the above facts as applicable under the provisions of Title 18, United States
Code, Section 1001, et seq.
Borrower’s Signature Date Co-Borrower’s Signature Date
X X

Freddie Mac Form 65 7/05 Page 8 of 8 Fannie Mae Form 1003 7/05