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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 will not be used as a basis for loan qualification, but his or her liabilities must be considered because 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.

	I. TYPE OF MORTGAGE AND TERMS OF LOAN

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

Amount

Interest Rate

No. of Months

Amortization
Type:

Fixed Rate:

Other (explain):

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

Construction

Other (explain):

Property will be:

Refinance

Construction-Permanent

Primary Residence

Secondary Residence

Investment

Year Lot Acquired	Original Cost	Amount Existing Liens	(a) Present Value of Lot	(b) Cost of Improvements	Total (a+b)

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

Title will be held in what Name(s)	Manner in which Title will be held	Estate will be held in: Fee Simple

Source of Down Payment, Settlement Charge and/or Subordinate Financing (explain)		Leasehold (show expiration date)


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 Number

Home Phone (incl. area code)

DOB

Yrs. School

Social Security Number

Home Phone (incl. area code)

DOB

Yrs. School

Married

Unmarried (include single,
divorced, widowed)

Dependents (not listed
by Co-Borrower)

Married

Unmarried (include single,
divorced, widowed)

Dependents (not listed
by Borrower)

Separated

no.

ages

Separated

no.

ages

Present Address (street, city, state, ZIP)

Own

Rent

No. Yrs.

Present Address (street, city, state, ZIP)

Own

Rent

No. Yrs.


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 (street, city, state, ZIP)

Own

Rent

No. Yrs.

Former Address (street, city, state, ZIP)

Own

Rent

No. Yrs.

	Borrower	IV. EMPLOYMENT INFORMATION	Co-Borrower

Name & Address of Employer	Self Employed	Yrs. on this job	Name & Address of Employer	Self Employed	Yrs. on this job

		Yrs. employed in this line of work/profession			Yrs. employed in this line of work/profession

Position/Title/Type of Business	Business Phone (incl. area code)		Position/Title/Type of Business	Business Phone (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 of Employer	Self Employed	Dates (from-to)	Name & Address of Employer	Self Employed	Dates (from-to)

		Monthly Income			Monthly Income

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

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

		Monthly Income			Monthly Income

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


	V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION

Base Empl. Income*

Rent

Overtime

First Mortgage (P&I)

Bonuses

Other Financing (P&I)

Commissions

Hazard Insurance

Dividends/Interest

Real Estate Taxes

Net Rental Income

Mortgage Insurance

Other (before completing,
see the notice in "describe
other income," below)

Homeowner Assn. Dues

Other

*Self Employer 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 spouse, this Statement and supporting schedules must be completed about that spouse also.

Completed

Jointly

Not Jointly

ASSETS		Cash or Market Value
Description		Cash or Market Value

Cash deposit toward purchase held by:

List checking and savings accounts below

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

Acct. no.

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

Acct. no.

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

Acct. no.

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

Acct. no.

Stocks & Bonds (Company name/number & description)





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)

Automobiles owned (make and year)


Other Assets (itemize)


Total Assets a.

Liabilities and Pledged Assets. List the creditor's name, address and account number for all outstanding debts, including automobile 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.

Name and address of Company

Payment/Months

Acct. no.

Name and address of Company

Payment/Months

Acct. no.

Name and address of Company

Payment/Months

Acct. no.

Name and address of Company

Payment/Months

Acct. no.

Name and address of Company

Payment/Months

Acct. no.

Name and address of Company

Payment/Months

Acct. no.

Name and address of Company

Payment/Months

Acct. no.

Alimony/Child Support/Separate Maintenance Payments Owed to:

Job Related Expense (child care, union dues, etc.)


	VI. ASSETS AND LIABILITIES (cont.)

Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet.)

Property Address (enter S if sold, PS is pending sale or R if rental being held for income)

Type of Property

Present Market Value

Amount of Mortgages & Liens

Gross Rental Income

Mortgage Payments

Insurance, Maintenance, Taxes & Misc.

Net Rental Income