UNIFORM RESIDENTIAL LOAN APPLICATION

This application is designed to be completed by the applicant(s) .Applicants should complete this form as "Borrower" or "Co-Borrower" as applicable. Co-borrower information must also be provided (and the appropriate box checked below) when:
the income or assets of a person other than the "Borrower" (including the Borrowers spouse) will be used as a basis for loan qualification or the income or assets of the Borrowers 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, or 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: VA FHA Conventional FmHA Other..
Loan Amount $	Interest Rate: %	No. of Months
Amortization Type:	Fixed Rate ARM	GPM Other...

II. PROPERTY INFORMATION AND PURPOSE OF LOAN
Subject Property Address: Street: Legal Description: No. of Units:	City: Year Built:	St.:	Zip code:
Purpose of Loan: Construction-Permanent Other (explain): Purchase Refinance Construction		Property will be: Investment Primary Residence Secondary

Complete this lines if this is a refinance loan.
Year Acquired:	Original Cost	Existing Liens	Purpose of Refinance	Describe Improvements: Made To be made

Title will be held in what name(s):	Manner in which title will be held:
Source of down payment, settlement charges and/or subordinate financing:	Estate will be held in: Fee Simple Leasehold (show exp. date)

III. BORROWER INFORMATION
Borrower		Co-Borrower
Name (include Jr. or Sr. if applicable) .		Name (include Jr. or Sr. if applicable) .
Social Sec. No. .	Home Phone .	Social Sec. No. .	Home Phone .
Age	Yrs. School	Age	Yrs. School
Marital Status Married Unmarried Separated	Dependents No.: Ages:	Marital Status Married Unmarried Separated	Addl. Dependents No.: Ages:
Present Address		Present Address
Street	City	Street	City
State	Zip	State	Zip
Own Rent	No. Yrs.	Own Rent	No. Yrs.
If at present address less than two years complete the following:
Former Address		Former Address
Street	City	Street	City
State	Zip	State	Zip
Own Rent	No. Yrs.	Own Rent	No. Yrs.

IV. EMPLOYMENT INFORMATION
Borrower		Co-Borrower
Name of Employer..... Self Employed		Name of Employer..... Self Employed
Address:		Address:
City:		City:
Position/Title		Position/Title
State:	Zip:	State:	Zip:
Yrs. on Job: .	Years in this line of profession: .	Yrs. on Job: .	Years in this line of profession: .
Business Phone:	(area code)	Business Phone:	(area code)

If employed in current position for less than two years or if currently employed in more than one position, complete the following:
Borrower		Co-Borrower
Name of Employer..... Self Employed		Name of Employer..... Self Employed
Address:		Address:
City:		City:
Position/Title		Position/Title
State:	Zip:	State:	Zip:
Yrs. on Job: .	Years in this line of profession: .	Yrs. on Job: .	Years in this line of profession: .
Business Phone:	(area code)	Business Phone:	(area code)

Borrower		Co-Borrower
Name of Employer..... Self Employed		Name of Employer..... Self Employed
Address:		Address:
City:		City:
Position/Title		Position/Title
State:	Zip:	State:	Zip:
Yrs. on Job: .	Years in this line of profession: .	Yrs. on Job: .	Years in this line of profession: .
Business Phone:	(area code)	Business Phone:	(area code)

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 the spouse also. Completed: Jointly Not Jointly
ASSETS	Cash or Market Value	Liability and Pledged assets. List the creditors name, address and account # for all outstanding debts, including auto 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 Purchase Held by:	$
List checking and savings accounts below, name & address of Bank S&L or Credit Union.		Liabilities	Mthly Payments
Name & Address: . Address:		Name: Address:	Pmt amount: $ Months remain:
Acct #	$	Acct#	unpaid balance: $
Name: . Address:		Name: Address:	Pmt amount: $ Months remain:
Acct #	$	Acct#	unpaid balance: $
Name: . Address:		Name: Address:	Pmt amount: $ Months remain:
Acct #	$	Acct#	unpaid balance: $
Name: . Address:		Name: Address:	Pmt amount: $ Months remain:
Acct #	$	Acct#	unpaid balance: $
Stocks & Bonds (Company name/number) Description		Name: Address:	Pmt amount: $ Months remain:
Acct #	$	Acct#	unpaid balance: $

VIII. DECLARATIONS
Items	Borrower	Co-Borrower
a. Are there any outstanding judgements against you?	Yes No	Yes No
b. Have you been declared bankrupt within the last 7 years?	Yes No	Yes No
c. Have you had property foreclosed upon 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 which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment?	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 the 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 3 years?	Yes No	Yes No

	Borrower	Co-Borrower
1. What type of property did you own?	Principal Residence Second Home Investment Property	Principal Residence Second Home Investment Property
2. How did you hold title to the home?	Solely by yourself Jointly with your spouse Jointly with another person	Solely by yourself Jointly with your spouse Jointly with another person

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 re-verification of any information contained in the application may be made at any time by the lender, it's agents, successors and assigns, either directly or through a credit reporting agent, 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, it's 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, it's 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, it's agents, successors and assigns make no representations or warranties, expressed 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 my 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, it's agents, successors and assigns, insurers and any other person who may suffer any loss due to the reliance upon any misrepresentation which I/we have made on this application.

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 is, 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 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. Race/National Origin: American Indian or Alaskan Native Black, not of Hispanic origin Asian or Pacific Islander Hispanic White, not of Hispanic origin Other: FEMALE MALE	I do not wish to furnish this information. Race/National Origin: American Indian or Alaskan Native Black, not of Hispanic origin Asian or Pacific Islander Hispanic White, not of Hispanic origin Other: FEMALE MALE

Continuation Sheet/Residential Loan Application