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
		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

Complete this line if construction or construction-permanent loan.

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

Gross Monthly Income

Borrower

Co-Borrower

Total

Combined Monthly Housing Expense

Present

Proposed

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

Total

Total

*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 joinly 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 basisotherwise 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 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. Monthly Payment & Months Left to Pay Unpaid Balance LIABILITIES  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.)    Total Monthly Payments    Net Worth (a minus b)   Total Liabilities b.

	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

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   b. Alterations, improvements, repairs   c. Land (if acquired separately)   d. Refinance (incl. debts to be paid off)   e. Estimated prepaid items   f. Estimated closing costs   g. PMI, MIP, Funding Fee   h. Discount (if Borrower will pay)   i. Total costs (add items a through h)   j. Subordinate financing   k. Borrower's closing costs paid by Seller   l. Other Credits (explain)   m. Loan amount     (exlude PMI, MIP, Funding Fee financed)   n. PMI, MIP, Funding Fee financed   o. Loan amount (add m & n)   p. Cash from/to Borrower     (subtract j, k, l & o from i)

If you answer "yes" to any questions a through i, please  Borrower  Co-Borrower  use continuation sheet for explanation. Yes No Yes No  a. Are there any outstanding judgments against you?  b. Have you been declared bankrupt within the past 7 years?  c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?  d. Are you a party to a lawsuit?  e. Have you directly or indirectly been obligated on any loan 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.)  f. Are you presently delinquent or in 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.  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?  k. Are you a permanent resident alien?  l. Do you intend to occupy the property as your primary residence? If "Yes," complete question m below.  m. Have you had an ownership interest in a property in the last three years?   (1)  What type of property did you own-principal residence (PR), second home (SH), or investment property (IP)?   (2)  How did you hold title to the home-solely by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?

	IX. ACKNOWLEDGEMENT AGREEMENT

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            I do not wish to furnish this information		CO-BORROWER      I do not wish to furnish this information
Ethnicity:                Hispanic              Not Hispanic		Ethnicity:               Hispanic              Not Hispanic
Race/National Origin: American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Sex: Female Male		Race/National Origin: American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White Sex: Female Male

To be Completed by Interviewer This application was taken by:   Face-to-face interview   Mail   Telephone   Internet			Interviewer's Name (print or type)			Name and Address of Interviewer's Employer
			Interviewer's Signature	Date
			Interviewer's Phone Number (incl. area code)

	Continuation Sheet/Residential Loan Application

Use this continuation sheet if you need more space to complete the Residential Loan Application. Mark B for Borrower or C for Co-Borrower.		Borrower:		Agency Case Number:
		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						Fannie Mae Form 1003