1003 Page 3 08/05 ~ Encompass
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from Ellie Mae ~ www.elliemae.com
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 if 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
(exclude 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 use
continuation sheet for explanation.
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 thereo
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)?
Borrower
Yes No
Co-Borrower
Yes No
IX. ACKNOWLEDGEMENT AND AGREEMENT
Each of the undersigned specifically represents to Lender and to Lender’s actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors and
assigns and agrees and acknowledges, that: (1) the information provided in this application is true and correct as of the date set forth opposite my signature and that any
intentional or negligent misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to any person who may suffer
any loss due to reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, but not limited to, fine or imprisonment or both
under the provisions of Title 18, United States Code, Sec. 1001, et seq.; (2) the loan requested pursuant to this application (the “Loan”) will be secured by a mortgage or deed
of trust on the property described in this application; (3) the property will not be used for any illegal or prohibited purpose or use; (4) all statements made in this application are
made for the purpose of obtaining a residential mortgage loan; (5) the property will be occupied as indicated in this application; (6) the Lender, its servicers, successors or
assigns may retain the original and/or electronic record of this application, whether or not the Loan is approved; (7) the Lender and its agents, brokers, insurers, servicers,
successors and assigns may continuously rely on the information contained in the application, and I am obligated to amend and/or supplement the information provided in this
application if any of the material facts that I have represented herein should change prior to closing of the Loan; (8) in the event that my payments on the Loan become
delinquent, the Lender, its servicers, successors or assigns may, in addition to any other rights and remedies that it may have relating to such delinquency, report my name
and account information to one or more consumer reporting agencies; (9) ownership of the Loan and/or administration of the Loan account may be transferred with such notice
as may be required by law; (10) neither Lender nor its agents, brokers, insurers, servicers, successors or assigns has made any representation or warranty, express or
implied, to me regarding the property or the condition or value of the property; and (11) my transmission of this application as an “electronic record” containing my “electronic
signature,” as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or my facsimile transmission of this application containing
a facsimile of my signature, shall be as effective, enforceable and valid as if a paper version of this application were delivered containing my original written signature.
Acknowledgement:
Each of the undersigned hereby acknowledges that any owner of the Loan, its servicers, successors and assigns, may verify or reverify any information
contained in this application or obtain any information or data relating to the Loan, for any legitimate business purpose through any source, including a source named in this
application or a consumer reporting agency.
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
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.)
BORROWER I do not wish to furnish this information. CO-BORROWER I do not wish to furnish this information.
Ethnicity: Hispanic or Latino Not Hispanic or Latino Ethnicity: Hispanic or Latino Not Hispanic or Latino
Race: American Indian or Asian Black or
Alaska native African American
Native Hawaiian or White
Other Pacific Islander
Race: American Indian or Asian Black or
Alaska native African American
Native Hawaiian or White
Other Pacific Islander
Sex: Female Male Sex: Female Male
Interviewer’s Name (print or type)
Interviewer’s Signature Date
To be Completed by Interviewer
This application was taken by:
Face-to-face interview
Mail
Telephone
Internet
Interviewer’s Phone Number (incl. area code)
Name and Address of Interviewer’s Employer
Freddie Mac 65 07/05 Page 3 of 4 Fannie Mae Form 1003 07/05