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 Contact Information

BORROWER

CO-BORROWER

Name: (First, MI, Last)
Soc. Sec. #:
Date of Birth:
(mm/dd/yyyy)
MM/DD/YYYY
MUST be in the numeric format MONTH DAY YEAR
MM/DD/YYYY
MUST be in the numeric format MONTH DAY YEAR
Years School:
Marital Status: married single Separated married single Separated
# Dependents:
Ages:

Contact Information

Phone (H):
Phone (W):
Phone (Cell):
E-Mail:
Primary contact:

Alternate number:

Address History (2 year history required)

BORROWER

CO-BORROWER

  Own     Rent    No Years   Own     Rent    No Years

Previous Address (Only if less than 2 years at present address)

BORROWER CO-BORROWER
  Own     Rent    No Years Own     Rent    No Years

Employment Information (2 year history required)

BORROWER

CO-BORROWER

Self Employed    Yrs on this job Self Employed    Yrs on this job

Previous Employer if less than 2 years in current position or if employed in more than one position.

Self Employed   Dates from - to Self Employed    Dates from - to
 
 

 

Self Employed   Dates from - to Self Employed    Dates from - to
 
 

Monthly Income and Combined Housing Expense Information


Gross Monthly Income
Borrower
Co-Borrower
  Base Employment Income:  $ $  
  Overtime:  $ $  
  Bonuses:  $ $  
  Commissions:  $ $  
  Dividends/Interest: $ $  
  Net Rental Income:  $ $  

Combined Monthly Housing Expense
Present
Proposed
  Rent:  $
  First Mortgage (P&I):  $ $
  Other Financing (P&I):  $ $
  Hazard Insurance:  $ $
  Real Estate Taxes:  $ $
  Mortgage Insurance:  $ $
  Homeowner Association Dues: $ $
  Other Expenses:  $ $

Other Income (Child Support, SS, Pension...)

B/CB
Description
Monthly Amt

Assets and Liabilities

 

Assets Description
Cash or Market Value
   
List checking and savings accounts below





     
  Life Insurance net cash value
  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)
   

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.  Check the "Paid off" box indicating those liabilities which will be satisfied upon sale of real estate owned or upon refinancing of the subject property.  Do not list normal household bills such as electricity, water, garbage, cable, phone, etc.

Liabilities
Monthly Payment & Months Left to Pay
Unpaid Balance












Allimony/Child Support/Seperate Maintenance

 
Job-Related Expense (Child care, union dues)
 


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

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

P
R
S
|
V
Type of
Property
Present
Market Value
Amt Mrtg
& Liens
Gross
Rental
Income
Mortgage
Payments
Insurance
Maint &
Taxes
 
 
 
 

List any additional names under which credit has previously been recieved and indicate appropriate creditor name(s) and account number(s)
Alternate Name
Creditor Name
Account Number

Legal

 

                 BORROWER

CO-BORROWER

Are there any outstanding judgments against you?

  Yes No   Yes No  

 

Have you been declared bankrupt within the last 7 years?

  Yes No   Yes No  

 

Have you had property foreclosed upon in the last 7 years?

                 Yes     No      Yes   No  

 

Are you a party to a lawsuit?

      Yes     No      Yes   No  

 

Have you directly or indirectly been obligated on any loan which resulted in foreclosure?

      Yes     No      Yes   No  

 

Are you presently delinquent or in default on any Federal debt or any other loan?

      Yes     No      Yes   No  

 

Are you obligated to pay child support, maintenance or alimony?

  Yes No   Yes No  

 

Is any part of your down payment borrowed?

  Yes No   Yes No  

 

Are you a co-maker or endorser on a note?

  Yes No   Yes No  

 

Are you a U.S. citizen?  

  Yes No   Yes No  

 

Are you a permanent resident alien?

  Yes No   Yes No  

 

Do you intend to occupy the property as your primary residence?

      Yes     No      Yes    No  

 

Have you had and ownership interest in a property within the last 3 years?       Yes      No      Yes   No  

 

If yes then what type of property did you own?

  

 

How did you hold title to this property?


Credit Report Authorization

I/We hereby authorize David J. Schultz and/or assigns, for verification purposes, to obtain information concerning Employment history, mortgage loan rating, (opening date, high credit, payment amount, loan balance and payment record), banking and savings accounts of record or any information deemed necessary in connection with a consumer credit report for a real estate transaction. This information is for the confidential use of this lender in compiling a mortgage loan credit report.

 
I / We Agree (Yes) 

I / We Disagree (No)


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.  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 disclosures satisfy all requirements to which the Lender is subject under applicable state law for the particular type of loan applied for.)

You are not required to furnish this information, but are encouraged to do so.

 

 Borrower

Co-Borrower

Sex:

  Female Male  

   Female Male 

Ethnicity

Hispanic Not Hispanic or Latino

Hispanic Not Hispanic or Latino

Race
American Indian or Alaskan Native
Asian
Black or African American
Native Hawiian or Other Pacific Islander
White
American Indian or Alaskan Native
Asian
Black or African American
Native Hawiian or Other Pacific Islander
White

 


David J. Schultz - David Schultz - 2670 commerce blvd Suite103 - Mound, MN 55364
Phone: 612-366-3832   Email: david@davidjschultz.com

Copyright © 2016 DAVID J. SCHULTZ, All Rights Reserved.


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