PROPERTY INFORMATION AND PURPOSE OF LOAN

Subject Property Address:

		Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Street Address	City	State	Zip

No. of Units: 1 2 3 4

Legal Description of Subject Property: Chars. Left: 250


Purpose of Loan: Choose... Purchase Refinance Construction Construction-Permanent Other (explain):


Property Will Be: Choose... Primary Residence Secondary Residence Investment

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Title will be held in what Name(s) (one per line)


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

BORROWER INFORMATION

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Co-Borrower?

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MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION

Borrower's Gross Income: $ Co-Borrower's Gross Income: $

	Borrower $	Co-Borrower $	Total	Combined Monthly Housing Expense	Present $	Proposed $
Base Employment Income			0.00	Rent
Overtime			0.00	First Mortgage (P&I)
Bonuses			0.00	Other Financing (P&I)
Commissions			0.00	Hazard Insurance
Dividends/Interest			0.00	Real Estate Taxes
Net Rental Income			0.00	Mortgage Insurance
Other (before completing, see the notice in "describe other income," below)			0.00	Homeowner Assn. Dues
				Other:
Total	$ 0.00	$ 0.00	$ 0.00	Total	$ 0.00	$ 0.00

* 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.

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
Choose... Jointly Not Jointly

ASSETS

Description	Cash or Market Value	Cash deposit toward purchase held by
	$

List checking and savings accounts below

Name of Bank, S & L, or Credit Union	Address	City	State	Zip	Balance
			Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Stocks & Bonds (Company name/number & description)
$

Life insurance net cash value
$

Life insurance face amount
$

Subtotal Liquid Assets: $ 0.00

Vested interest in retirement fund
$

Net worth of business(es) owned (attach financial statement)
$

Automobiles owned (make and year)

Make	Model	Year	Value

Other Assets (itemize)

Asset	Value

a. Total Assets $ 0.00

LIABILITIES

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 of Company	Address	City	State	Zip	Monthly Payment & Months Left to Pay	Unpaid Balance
			Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
			Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
			Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
			Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
			Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
			Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

Alimony/Child Support/Separate Maintenance Payments Owned to*:
*Divorce decree will be required.

Monthly Payment	Balance

Job-Related Expense

Monthly Payment

Total Monthly Payments $ 0.00

b. Total Liabilities $ 0.00

Net Worth (a minus b) $ 0.00

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Do you own real estate?

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DECLARATIONS

If you answer "Yes" to any questions a - i, please use continuation sheet for explanation.

	Borrower	Co-Borrower
a. Are there any outstanding judgments against you?	Yes No	Yes No
b. Have you been declared bankrupt within the past 7 years?	Yes No	Yes No
c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?	Yes No	Yes No
d. Are you a party to a lawsuit?	Yes No	Yes No
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.)	Yes No	Yes No
f. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee?	Yes No	Yes No
g. Are you obligated to pay alimony, child support, or separate maintenance?	Yes No	Yes No
h. Is any part of the down payment borrowed?	Yes No	Yes No
i. Are you a co-maker or endorser on a note?	Yes No	Yes No
j. Are you a U.S. citizen?	Yes No	Yes No
k. Are you a permanent resident alien?	Yes No	Yes No
l. Do you intend to occupy the property as your primary residence? If "Yes" complete question m below.	Yes No	Yes No
m. Have you had an ownership interest in a property in the last three years?	Yes No	Yes No
(1) What type of property did you own-principal residence (PR), second home (SH), or investment property (IP)?	PR SH IP	PR SH IP
(2) How did you hold title to the home- by yourself (S), jointly with your spouse or jointly with another person (O)?	S O	S O

IX. 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.)

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I do not wish to provide this information

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