Mortgage Application Checklist
The following documents may be required through the mortgage application process, but are not required to receive a
Loan Estimate.
Income
Past two years w-2’s & tax returns
Most recent paycheck stubs (30 day minimum)
Contact name & phone number to verbally verify employment
Verification of other income: social security, child support, retirement, etc.
If self-employed: past two years tax returns including all schedules and a profit and loss statement for
the current year signed by your accountant
Assets
Last two months statements for all bank and credit union accounts
Most recent retirement account statement if used for down payment or funds
Other Information Needed
Copy of driver's license for each borrower
Homeowner’s insurance agents name & phone number
Divorce decrees, if applicable, including property settlements, modifications, etc.
For Purchases Only
Contact name, phone number and address of all landlords for the past two years
Accepted purchase agreement and copy of listing sheet
Please note that any material changes in your employment, income, assets and/or credit must be reported
to us as soon as possible, as it may affect your financing. Also, you may provide computer print-outs of any
of the above documents, provided that they are dated and contain your full name, the institutions names, and
the full account number.
Universal Credit Application
(Consumer Real Estate)
Lender Use Only
HOMEBANK
Lender Case No./HMDA
ULI
HMDA
Reportable Census Tract
400
SOUTH
MAIN,
P O
BOX
311
PALMYRA
,
MO
63461
1.
Type
of
Application
Yes
No
(Check
only
!2!J!:.
of
the four checkboxes; and sign,
if
joint
credit. Use another application
if
more than
two
applicants.)
Individual Credit.
If
checked, this is
an
Application
for
Individual Credit - rel ing
m!!b!.
on
my
income and assets.
D Individual Credit with Another.
If
checked,
this
is
an
Application
for
Individual Credit - relying on
my
income and assets
ms!
on income and/or assets
of
another as a basis
for
loan qualification. (Complete
Applicant
and Co-Applicant sections.)
Individual Credit (Community Property State).
If
checked,
this
is
an
Application for Individual Credit - relying on
my
income or
assets. The income or assets
of
my
spouse (or other person),
who
has community property rights pursuant
to
state law,
will
not
be
used as a basis
for
loan qualification. However, his or her liabilities
must
be
considered because
my
spouse (or other
person) has community property rights pursuant
to
applicable law, and, as Applicant, I reside in a community property state,
the property
that
will
secure the loan is located in a community property state, or I am relying on other property located in a
community property state as a basis
for
repayment
of
the loan. (Complete Applicant and Co-Applicant sections.)
Joint Credit.
If
checked,
this
is
an
Application for
Joint
Credit. By signing below, the Applicant and Co-Applicant agree
that
each
of
us intend
to
apply
for
joint credit. (Complete Applicant and Co-Applicant sections.)
Applicant
for
Joint
Credit Co-Applicant
for
Joint
Credit
Subject Property Address (street, county or parish,
city
, state &
ZIP)
No.
of
Units
Legal Description
of
Subject Property (attach description
if
necessary) Year Built
Loan Purpose Property
will
be
:
Purchase
Construction-Initial
Home Improvement
Primary
Secondary
Investment
Refinance
Construction-Permanent
Residence Residence
Complete this line
if
construction
or
construction-permanent loan.
Year Lot Original Cost
Amount
Existing
(a)
Present Value
of
(b)
Cost
of
Improvements
$
Total
(a
+
b)
Acquired Liens Lot
$ $ $
$
Complete this line
if
this
is
a refinance loan.
Describe Improvements
Year Original Cost
Amount
Existing
Purpose
of
Refinance
made
to
be
made
Acquired Liens
$
$ Cost: $
Title
will
be
held in
what
Name(s) Manner in
which
Title
will
be
held Estate
will
be
held in:
__________________________
.._
_____________
--!
D
Fee
Simple
Source
of
Down
Payment, Settlement Charges, and/or Subordinate Financing (explain)
D Leasehold (show
expiration date)
4. Applicant Information
Applicant's Name
Social Security No.
IPrimary Phone
Cell
Date
of
Birth
ID
Type & No.
llssued By Issue Date
Exp. Date
E-mail Address
Married
Separated
Dependents
(not
li
sted by Co-Applicant)
Unmarried
No. Ages
(including si ngle, divorced, widowed)
I
Present Address
Own
Rent
No. Yrs.
--
--
Mailing Address,
if
different from Present Address
Former Address
Own
Rent No. Yrs.
--
--
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Co-Applicant's Name
Social Security No.
IPrimary Phone
Cell
Date
of
Birth
ID
Type & No.
llssued
Byl
Issue Date
Exp. Date
E-mail Address
Married
Separated
Dependents
(not
li
st ed by Applicant)
Unmarried
No. Ages
(including singl
e,
divorced, widowed)
I
Present Address D
Own
Rent
No. Yrs.
--
--
Mailing Address,
if
different from Present Address
Former Address
Own
Rent No. Yrs.
--
--
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Applicant
5. Employment Information
Co-Applicant
Name & Address
of
Employer D
Self
Employed
Yrs. on
this
job
Name & Address
of
Employer D
Self
Employed
Yrs. on
this
job
Yrs.
e
mploy
ed
in
this
line
of
work/profession
Yrs.
e
mploy
ed
in
this
line
of
work/profes
sion
Position/Title/Type
of
Business Business Phone Position/Title/Type
of
Business
Business Phone
If
em
lo
ed
in
current osition for
less
than
two
ears
or
if
current! em
lo
ed
in
more than
one
osition,
com
lete the followin
Name
& Address
of
Employer D
Self
Employed
Dates (from - to) Name & Address
of
Employer D
Self
Employ
ed Dates (from to)
Position/Title/Type
of
Business
Business Phone
$
Gross
Monthly
Position/Title/Type
of
Business
Income
Business Phone
$
Gross
Monthly
Income
Name
& Address
of
Employer D
Self
Employed
Dates (from - to) Name & Address
of
Employer D
Self
Employed
Dates (from - to)
Position/Title/Type
of
Business
Base Empl. Income*
$
Overtime
$ $
Bonuses
$ $
Commissions
$ $
Dividends/Interest
$ $
Net Rental Income
$ $
Other
$ $
(before
completing,
see
the
notice
in
"Describe
Oth
er
Incom
e,"
below)
Total
$
Business Phone
Gross
Monthly
Position/Title/Type
of
Business
Income
Rent
$
$
First Mortgage
(P&I)
$
$
Other Financing
(P&I
) $
$
Hazard Insurance
$
$
Real
Es
tate
Taxes
$
$
Mortgage Insurance
$
$
Homeowner Assn.
$
Dues
Other
$
$
Total
$
Business Phone
Gross
Monthly
Income
$
$
$
$
$
$
$
Self Employed Applicant(s) may be required to provide additional documentation
such
as
tax returns
and
financial statements.
A/C
Describe Other
Income
Notice: Alimony,
child
support,
or
separate maintenance
income need not
be
revealed
if
the Applicant (A)
or
Co-Applicant
(C)
does
not choose to have
it
considered for repaying this loan.
Monthly
Amount
$
$
$
7.
Assets and Liabilities
This Statement and any applicable supporting schedules may
be
completed
jointly
by
both married and unmarried Co-Applicants
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-Applicant section
was
completed about a
non-applicant spouse or other person, this Statement and supporting schedules
must
also
be
completed about
that
spouse or
other person. Completed
Jointly
Not
Jointly
Schedule
of
Real
Estate Owned. (If additional properties are owned, use continuation sheet.)
PropertS Address
Insurance
(enter
if
sold,
PS
if
pending sale,
R if rental
for
income or O
for
other)
...
Type
of
Property
Pre
s
ent
Market
Value
Amount
of
Mortgages
&
Liens
Gross
Rental
Income
Mortgage
Payments
Maintenan~e,
!raxes
& 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
Univers
al
Cr
edi
t Applic
at
ion
Re
al
Esta
te
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7.
Assets
and
Liabilities (Continued)
To:~/.
.
Assets (a) ·
··
Liabilities (b)
Assets Cash or Market
Description Value
Cash deposit
toward
purchase $
held
by
:
List checkin and savin s 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)
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.
Liabilities
Name and address
of
Company
Acct
. no.
Name and address
of
Company
Acct
. no.
Name and address
of
Company
Acct
. no.
Name and address
of
Company
Acct
. no.
Name and address
of
Company
Acct.
no.
Name and address
of
Company
cct. o.
$ Payment/ $
Months
D Revolvin
$ Payment/ $
Months
D Revolvin
$ Payment/ $
Months
D Revolvin
$ Payment/ $
Months
D Revolvin
$ Payment/
Months
Revolvin
$ Payment/
Months
D volvi
$
$
-------------+---------!
Name and address
of
Company
$ Payment/
Months
$
Vested interest in retirement $
fund
Net
worth
of
business(es) owned $
(attach financial statement)
Automobiles owned
(make and year)
Other Assets (itemize)
$
$
Acct
. no.
Alimony/Child Support/Separate
Maintenance Payments Owed to:
Job-Related Expense
(child care, union dues, etc.)
Total
Monthly
Payments
Other Liabilities
D Revolvin
$
$
. . . . i
II
1~·.
,----------,
111
(,.fr.om
continuatio_n_.p_a..,g,_e_,
_if_a_n
....
y
__
)
___
tl!!!i•t-.
Net
VVOrtn
(a - b) IJ
.
..
. ,
~-
..
Declarations
. . . .
a.
Are there any outstanding
judgments
against you?
b. Have you been declared bankrupt
within
the past
10
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?
f. Are you presently delinquent or in
default on any Federal debt or any
other loan, mortgage, financial
obligation, bond, or loan guarantee?
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8. Declarations (Continued)
Applicant Co-Applicant Applicant Co-Applicant
Yes
No
Yes
No
m. Have you had an ownership interest
Yes
No
Yes
No
g.
Are
you obligated
to
pay alimony, child
in a property in the last three years?
support, or separate maintenance?
(1)
What
type
of
property did ~ou
h.
Is any part
of
the
down
payment
own
--
principal residence
R),
borrowed?
second home (SH),
or
i.
Are
~ou a co-maker or endorser on a
investment property
(IP)?
note.
(2)
How
did you hold
title
to
the
j.
Are
you a U.S. citizen?
home
--
solely
by
yourself (S),
k.
Are
you a permanent resident alien?
jointly
with
your
spouse
(SPlc'
or
I.
Do you intend
to
occupy the property
jointly
with
another person
O)?
as
your primary residence?
n. Are there an~ other equity loans on
the property.
9.
Continuation
and
Additional
Information
Instructions. Use
this
section
if
you need more space
to
complete
the
Universal Credit Application.
Mark
"A"
for
Applicant
and
"C"
for
Co-Applicant. Use
this
space
if
ou answered
"Yes"
to
an
of
the questions in Section 8.
10. Federal
Notices
Important Information to Applicant(s). To help
the
government
fight
the funding
of
terrorism and money laundering
activities, federal
law
requires all financial institutions
to
obtain, verify, and record information
that
identifies each person
who
applies
for
a loan or opens an account.
What this means for you. When you apply
for
a loan or open an account,
we
will
ask
for
your name, address, date
of
birth,
and other information
that
will
allow
us
to
identify
you. We may also ask
to
see your driver's license and/or other identifying
documents. In some instances,
we
may
use outside sources
to
confirm
the
information. The information you provide is
protected
by
our privacy policy and federal law.
False Statements. By signing below,
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.
11.
State
Notices
California Residents.
Each
applicant,
if
married,
may
apply
for
a separate account.
Massachusetts Residents. Under Massachusetts statute, Mass. Gen.
L.
ch.
184,
Section 17B,
you, the Applicant (and Co-Applicant) are entitled
to
know
the following:
1. The responsibility
of
the
attorney
for
the Mortgagee is
to
protect the interest
of
the
Mortgagee.
2. Mortgagors may,
at
their
own
expense, engage an attorney
of
their
own
selection
to
represent their interests in
the
transaction.
For Home Equity Line
of
Credit. The current annual percentage rate
for
finance charges and,
if
the rate
may
vary, a
statement
to
that
effect
and
of
the circumstances under
which
the rate
may
increase and
whether
there are any limitations on any such increase, as
well
as the
effects
of
any such increase; the conditions under
which
a finance charge
may
be
imposed,
including
the
time
period
within
which
any credit extended
may
be
repaid
without
incurring a
finance charge;
whether
any annual fee is charged and the amount
of
any such fee; and
whether
any other charges or fees
may
be
assessed,
the
purposes
for
which
they
are
assessed, and the amounts
of
any such charges or fees.
New
York Residents. A consumer report
may
be
ordered in connection
with
your application. Upon your request,
we
will
inform
you
whether
or
not
a report
was
ordered.
If
a report
was
ordered,
we
will
tell you
the
name and address
of
the
consumer
reporting agency
that
provided
the
report. Subsequent reports
may
be
ordered or utilized in connection
with
an
update, renewal
or extension
of
credit
for
which
you have applied.
Ohio Residents. The Ohio
laws
against discrimination require all creditors make credit equally available
to
all
creditworthy
customers, and
that
credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil
Rights Commission administers compliance
with
this
law.
Any
person
who,
with
intent
to
defraud
or
knowing
that
he is facilitating a fraud against an insurer, submits an application
or
files a claim containing a false
or
deceptive statement is
guilty
of
insurance fraud.
Texas Residents. The
owner
of
the homestead is
not
required
to
apply
the
proceeds
of
the
extension
of
credit
to
repay another
debt except debt secured
by
the
homestead or
debt
to
another lender.
Wisconsin Residents. Notice
to
Married Applicants. No provision
of
any marital property agreement, unilateral statement under
Wisc. Statutes
§766.59
or a court decree under Wisc. Statutes
§766.
70
adversely
affects
the interest
of
the lender unless
the
lender, prior
to
the
time
the
credit is granted, is furnished a
copy
of
the
agreement, statement or decree or has actual
knowledge
of
the adverse provision
when
the
obligation
to
the lender is incurred.
For married Wisconsin Residents. The credit being applied for,
if
granted,
will
be
incurred in the interest
of
my
marriage
or
family.
I understand the creditor
may
be
required
by
law
to
give notice
of
this
transaction
to
my
spouse.
12.
Acknowledgment
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
dama_ges,
to
any
person
who
may
suffer
any loss due
to
reliance upon any misrepresentation
that
I have made on
this
application, and/or in
criminal8enalties including,
but
not
limited
to,
fine or imprisonment or both under
the
provisions
of
Titre
18,
United States Code,
Sec.
10
1,
et
seq.; (2)
the
loan requested pursuant
to
tllis
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
prohil)1ted
purPQse
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
an
electronic record
of
this
application,
whether
or
not
the
Loan is approved; (7)
the
Lender ana
its
agents, brokers, insurers,
servicers, successors and assigns may continuously rely on the information contained in
the
application, and I am obligated
to
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12.
Acknowledgment
and
Agreement
(Continued)
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
tliat
my
payments on
the
Loan become delinquent,
the
Lender,
its
servicers, successors or
assig_ns
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;
(1
0) 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
facsim~e 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
deITvered
containing
my
original
written
signature.
Consent. You authorize us
to
contact
you using any
of
the
telephone numbers listed on
this
Credit Application or
that
you
subsequently provide us in connection
with
your credit account - regardless
whether
the
number
we
use is assigned
to
a paging
service, cellular telephone service, specialized mobile radio service
or
other radio common carrier service or any other service
for
which
you may
be
charged
for
the call. You further authorize us
to
contact
you throu9h
the
use
of
voice,
text
and email and
through
the
use
of
pre-recorded/artificial voice messages or
an
automated dialing device.
Acknowledgment.
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.
X
X
Applicant's Signature
Date
Co-Applicant's Signature
Date
13.
Government
Monitoring
or
Demographic
Information
Lender only: Indicate whether a separate Regulation B (ECOA) Government Monitoring Information form,
or
a separate HMDA
Demographic Information form are applicable and incorporated
by
reference. Otherwise, indicate
Not
Applicable.
HMDA
Demographic Information
(if
HMDA reportable)
ECOA Government Monitoring
(if
not
HMDA reportable,
but
subject
to
Regulation
B's
12
C.F.R.
1002.
13
or
equivalent)
Not
applicable
For
Mortgage
Loan
Originator
This information
Mail or Fax
E-mail or Internet
was
provided through:
Telephone Interview
Face-To-Face
Interview
(includes Electronic Media
with
Video Component)
Loan Originator's Signature
Date
Loan Originator's Phone Number
X
Loan Originator's
Name
Loan Originator Identifier Loan Origination Company's Address
Loan Origination Company's Name Loan Origination Company Identifier
Transaction Worksheet - Optional
a.
Purchase rice aid b Seller $
b.
Alterations, improvements, repairs
$
c. Land
(if
acquired separate! )
Lender's Initial Lien Position
First Lien
Second Lien
Subordinate Lien
Date
Application Received
Decision
Approved
Interest Rate
Fixed/Index:
Margin
Refinancing
Yes
Denied
points
Cash
Out
Universal Credit Application-Real Estate
:r~:~
~~;'~ina~~r
Services
2012
*%1814%03162018*
Loan No.
Received
By
Decision
Date
Amount
Approved
Rescindable
Yes
m. Loan amount (exclude PMI, MIP,
Funding
Fee
financed)
n. PMI, MIP, Fundin
Fee
financed
o. Loan amount (add m
&
n)
p.
Cash
from/to
Applicant
(subtractj,
k, I & o from
i)
Loan No.
Amount
Requested
Decision By
$
$
$
$
Initial Advance
(if
applicable) Funding
Date
Early Disclosures Given
Yes, on
High
Cost Mortgage
Hi h Priced
Mort
a e
Yes
Yes
VMPC149R
(1701),00
UCA-RE-WOGM
1/1/2017
Page 5
af
5
Erin Otten NMLS #897590
Joni Bock NMLS #470066
Mike Smith NMLS #466086
Mary Smith NMLS #1043541
Thomas Nelson NMLS #1678652
Taylor Warbritton NMLS #1799344
HOMEBANK
Halie Meyer NMLS #1634032
Devin Perry NMLS #469894
Brady Frericks NMLS #1431728
Angie Poppe NMLS #470114
Clinton Stewart NMLS #469688
Rebecca Schuefele NMLS #1791609
450000
Curt Meany NMLS #902080
Nicole Brinkman NMLS #1514965
Marcia Hardin NMLS #1580496
Joshua Wilson NMLS #1681670
Mary Dickey NMLS #1605734
Larraleigh Hetzler NMLS #1751740
(573)-769-2001
400 South Main, PO Box 311,
Palmyra MO 63461
Continuation Sheet For Loan Application
Use this continuation Borrower: Agency Case Number:
sheet
if
you need more
space
to
complete
the
Loan Application. Mark Co-Borrower:
Lender Case Number:
B
for
Borrower or C
for
Co-Borrower.
Additional Assets and Liabilities
Additional Schedule
of
Real
Estate Owned
...
Property
Addr
ess (enter S
if
sold,
PS
if
pending
sa
le
or
R
if
rental being held
for
income)
'f
Type
of
Property
Present
Market
Value
Amount
of
Mortgages &
liens
Gross
Rental Income
Mortgage
Payments
Insurance,
Maintenance,
Taxes & Misc,
Net
Rental
Income
$
$
$ $
$ $
Totals $
$ $ $ $ $
List checking and savings accounts below
Name and address
of
Bank, S&L, or Credit Union
Name and address
of
Company
Acct
. no.
Monthly
Payment &
$
Months
Left
to
Pay
Unpaid Balance
$
I
Acct
. no.
$
Name and address
of
Bank, S&L, or Credit Union
Name and address
of
Company
Acct.
no.
Monthly
Payment &
$
Months
Left
to
Pay
Unpaid Balance
$
I
Acct
. no.
$
Name and address
of
Bank, S&L, or Credit Union
Name and address
of
Company
Acct.
no.
Monthly
Payment &
$
Months
Left
to
Pay
Unpaid Balance
$
I
Acct
. no. $
Name and address
of
Bank, S&L, or Credit Union
Name and address
of
Company
Acct.
no.
Monthly
Payment &
$
Months
Left
to
Pay
Unpaid Balance
$
I
Acct
. no. $
Stocks & Bonds (Company
name/number & description)
$
Name and address
of
Company
Acct
. no.
Monthly
Payment &
$
Months
Left
to
Pay
Unpaid Balance
$
I
Life Insurance net cash value
Face amount:
$
$
Subtotal Liquid Assets $
Name and address
of
Company
Acct
. no.
Monthly
Payment &
$
Months
Left
to
Pay
Unpaid Balance
I
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) $
Name and address
of
Company
Acct
. no.
Monthly
Payment &
Months
Left
to
Pay
Unpaid Balance
Other Assets (itemize)
Total Additional Assets
Continuation
Sheet
For
Loan Application CONSHEET-APP
11/1/2011
:;::~
~fu~e;1~inancial Services 201 0,
20
1 1 Page 1
of2
*%1814%03162018*
Continuation
Sheet
For
Loan A
lication
Additional
Liabilities
Name and address
of
Company Name and address
of
Company
Acct.
no.
Acct.
no.
Monthly Payment
&
$ I
Monthly Payment &
$ I
Months Left
to
Pay Months Left
to
Pay
Unpaid Balance
$ Unpaid Balance $
Name and address
of
Company Name and address
of
Company
Acct.
no.
Acct.
no.
Monthly Payment &
$
I
Monthly Payment &
$
I
Months Left
to
Pay Months Left
to
Pay
Unpaid Balance
$ Unpaid Balance $
Name and address
of
Company Name and address
of
Company
Acct.
no.
Acct.
no.
Monthly Payment
&
$
I
Monthly Payment &
$
I
Months Left
to
Pay Months Left
to
Pay
Unpaid Balance $ Unpaid Balance $
Name and address
of
Company Name and address
of
Company
Acct.
no.
Acct.
no.
Monthly Payment
&
$ I
Monthly Payment &
$ I
Months Left
to
Pay Months Left
to
Pay
Unpaid Balance $ Unpaid Balance $
Name and address
of
Company Name and address
of
Company
Acct.
no.
Acct.
no.
Monthly Payment
&
$
I
Monthly Payment &
$
I
Months Left
to
Pay Months Left
to
Pay
Unpaid Balance
$ Unpaid Balance $
Name and address
of
Company Name and address
of
Company
Acct.
no.
Acct.
no.
Monthly Payment
&
$
I
Monthly Payment &
$
I
Months Left
to
Pay Months Left
to
Pay
Unpaid Balance
$ Unpaid Balance $
Name and address
of
Company Name and address
of
Company
Acct.
no.
Acct.
no.
Monthly Payment
&
$ I
Monthly Payment &
$ I
Months Left
to
Pay Months Left
to
Pay
Unpaid Balance
$
Unpaid Balance
$
Name and address
of
Company Name and address
of
Company
Acct.
no.
Acct.
no.
Monthly Payment
& Monthly Payment &
Months Left
to
Pay Months Left
to
Pay
Unpaid Balance Unpaid Balance
Total Additional Monthly Payments
I
Total Additional Liabilities
I
..
I/We
fully
understand
that
1t
1s
a Federal cnme pumshableby fine or 1mpnsonment,
or
both,
to
knowingly make any false statements
concernin an
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
Continuation Sheet For Loan Application
~~:~
~~;1~inancial
Services 201
0,
2011
*%1814%03162018*
CONSHEET-APP
11/1/2011
Page 2
af
2
H8
ME
BANK
strength and service continues
___________________________________
___________________________________
____________________________________
_______________________________
_______________________________
______________________________
Credit Application and Borrower’s Certification
Type of Credit Requested-Check the appropriate boxes below and complete the applicable section.
secured individual credit relying solely on my income or assets
unsecured individual credit relying on my income or assets as well as
income or assets from other sources
joint credit we intend to apply for joint credit
entity owners the undersigned understand they may be asked
to co-sign or guarantee the loan being requested as they are the
owners, officers or control parties for the entity.
Amount Requested Payment Due Desired Proceeds of Credit to be used for
$______________ __________________ ____________________________
Loan Number _______________ Date of Application ________________
Above references are for lender’s use only and do not limit the applicability of this document to any particular loan or item.
CERTIFICATION
The undersigned hereby certifies the accuracy of all financial statements provided in connection with
this credit application and indicates that our financial condition has not materially changed by
signing below.
-------------------------------------------- Fold to Copy --------------------------------------------
AUTHORIZATIONS
1) (I/We) authorize the bank to perform any credit investigation necessary to verify
information supplied to us by the following means:
By contacting banks or other credit sources disclosed to us to verify balance,
collateral and payment history.
By requesting and obtaining a credit report from a third party Credit Reporting
Agencies.
By contacting references provided.
2) (I/We) authorize the bank to report (my/our) names and information regarding this loan to
Credit Reporting Agencies.
3) (I/We) understand a copy of this authorization may be mailed or faxed to (my/our) creditors
as authorization to release information on (my/our) account directly to HOMEBANK and
any information received will be held strictly confidential and covered under the
HOMEBANK’s privacy policy.
4) In the event (my/our) loan is approved, (I/we) hereby authorize the HOMEBANK to request
payoff information directly from any creditor we intend to refinance with the proceeds.
Entity Name (if Applicable): _______________________________
Borrower
Borrower
Guarantor/Co-signer
Borrower
Borrower
Guarantor/Co-signer
Fees to be Collected: $_________ Interest $_________Other Fees = __________ Total to be Collected
Revised: 03/2015 als
NOTICE OF RIGHT TO RECEIVE COPY OF APPRAISAL/APPRAISAL EVALUATION
FROM:
HOMEBANK
400 SOUTH MAIN
P.O. BOX 311
PALMYRA, MO 63461
TO:
Loan Number: _________________
Property Address: ______________________________________________________________
Right to Receive Copy
We may order an appraisal to determine the property’s value and charge you for this appraisal. We will
promptly give you a copy of any appraisal/appraisal evaluation, even if your loan does not close.
You can pay for an additional appraisal for your own use at your own cost.
Acknowledgment
By signing below, you acknowledge you have received this Disclosure.
_____________________________________________________Date ____________________
_____________________________________________________Date ____________________
BORROWER'S CERTIFICATION & AUTHORIZATION
Certification
The
undersigned
certify
the
following:
1.
I/We
have
applied
for
a
mortgage
loan
from
HOMEBANK
(lender). In
applying
for
the
loan,
I/we
completed
a loan
application
containing
various
information
on
the
purpose
of
the
loan,
the
amount
and
source
of
the
downpayment,
employment
and
income
information,
and assets and liabilities.
I/We
certify
that
all
of
the
information
is
true
and
complete.
I/We
made
no
misrepresentations
in
the
loan
application
or
other
documents,
nor
did
I/we
omit
any
pertinent
information.
2.
I/We
understand
and agree
that
HOMEBANK
(lender) reserves
the
right
to
change
the
mortgage
loan
review
process
to
a
full
documentation
program.
This
may
include
verifying
the
information
provided
on
the
application
with
the
employer
and/or
the
financial
institution.
3.
I/We
fully
understand
that
it
is a Federal
crime
punishable
by
fine
or
imprisonment,
or
both,
to
knowingly
make
any
false
statements
when
applying
for
this
mortgage,
as applicable
under
the
provisions
of
Title
18,
United
States
Code,
Section
1014.
Authorization
to
Release Information
To
Whom
It
May
Concern:
1.
I/We
have
applied
for
a
mortgage
loan
from
HOMEBANK
(lender).
As
part
of
the
application
process,
HOMEBANK
(lender)
may
verify
information
contained
in
my/our
loan
application
and in
other
documents
required in
connection
with
the
loan,
either
before
the
loan is closed or as
part
of
its
quality
control
program.
2.
I/We
authorize
you
to
provide
to
HOMEBANK
(lender), and
to
any
investor
to
whom
HOMEBANK
(lender)
may
sell
my/our
mortgage,
any
and all
information
and
documentation
that
they
request.
Such
information
includes,
but
is
not
limited
to,
employment
history
and
income;
bank,
money
market,
and
similar
account
balances;
credit
history;
and copies
of
income
tax
returns.
3.
HOMEBANK
(lender)
or
any
investor
that
purchases
the
mortgage
may
address
this
authorization
to
any
party
named
in
the
loan
application
or
disclosed
by
any
consumer
credit
reporting
agency
or
similar
source.
4. A
copy
of
this
authorization
may
be
accepted
as an original.
5.
Your
prompt
reply
to
HOMEBANK
(lender), or
the
investor
that
purchased
the
mortgage
1s
appreciated.
-----------------------
Date
---------
1n
div
id u a
II
y
-----------------------
Date
---------
1n
div
id u a
II
y
Missouri
Borrower's
Certification & Authorization Initials
Wolters Kluwer Financial Services VMP®
Page 1
HOMEBANK
400
SOUTH
MAIN,
PO
BOX
311
PALMYRA,
MO
63461
MORTGAGE
FRAUD
IS
INVESTIGATED
BY
THE
FBI
Mortgage Fraud is investigated by the Federal Bureau
of
Investigation and is
punishable by up to 30 years in federal prison or $1,000,000 fine, or both. It is
illegal for a person to make any false statement regarding income, assets, debt, or
matters
of
identification, or to willfully overvalue any land or property, in a loan
and credit application for the purpose
of
influencing in any way the action
of
a
financial institution.
Some
of
the applicable Federal criminal statutes which
may
be charged
in
connection
with
Mortgage
Fraud include:
18
U.S.C. §
1001
- Statements or entries generally
18
U.S.C. § 1010 - HUD and Federal Housing Administration Transactions
18
U.S.C. § 1014 - Loan and credit applications generally
18
U.S.C. § 1028 - Fraud and related activity in connection with identification documents
18
U.S.C. §
1341
- Frauds and swindles
by
Mail
18
U.S.C. § 1342 - Fictitious name or address
18
U.S.C. § 1343 - Fraud by wire
18
U.S.C. § 1344 - Bank Fraud
42 U.S.C.
§ 408(a) - False Social Security Number
Unauthorized
use
of
the
FBI
seal,
name,
and initials
is
subject
to
prosecution
under
Sections
701,
709,
and
712
of
Title
18
of
the
United
States
Code.
771is
advisement
may
11ot
be
changed or altered
without
the
specific
written
co11se11t
of
the
Federal
Bureau
of
I11vestigatio11,
and
is
1101
an
endorsement
of
a11y
product or
service.
---•
--•-•-•K•••=-~-•-~---------------
Signature Date
Signature
Date
Wolters Kluwer Financial Services ©
2011
VMP554A (11031
____________________________________ _____________________________________
CRITICAL CLIENT INFORMATION REGARDING DEBT AND CREDIT
Thank you for allowing us to assist you with your home financing needs. Our top priority is to provide
our clients with outstanding, personalized service and a stress-free mortgage process. To help ensure
there are no surprises and your loan closes as expected, it is of critical importance that you are aware of
the following:
All existing and new debts must be considered for qualification purposes prior to funding your loan. This
means that your file could be subject to a pre-funding check to verify that:
You have not acquired any new debt or opened any new accounts/loans;
Your current loan balances have not increased (applies to loans, credit cards, lines of credit, etc.)
You do not have any new delinquencies on any existing account or any new public records
(judgments, bankruptcies, etc.)
Your credit score has not decreased.
These requirements apply to the borrower and any co-borrowers on the loan. If any of the above
changes are discovered through verification or obtaining of a new credit report, the file is subject to re-
qualification and/or re-underwriting.
If we must re-qualify and/or re-underwrite your loan, you must qualify with your updated debt and
credit profile. If you no longer qualify, we may not be able to fund your loan and any charges incurred
would be your responsibility.
If you suspect your credit or debt profile may have changed at any point between your approval and
loan funding, please notify your Loan Officer as soon as possible. This will help us stay “ahead of the
curve” and do everything we can to ensure your loan funds without any challenges.
Thank you for your cooperation! We look forward to serving you.
By signing below, I acknowledge I read and understood the information provided above.
Borrower Date Borrower Date
Affiliated Business Arrangement Disclosure Statement
Lender Borrower
HOMEBANK
400 S Main
P O Box 311
Palmyra, MO 63461
Date:
Loan Number:
Property:
This is to give you notice that HOMEBANK has a business relationship with Maine Street Title Services. The nature of
the relationship (and percentage of ownership interest) is:
Maine Street Title Services Subsidiary of Holding Corp, 100%
Because of this relationship, this referral may provide HOMEBANK a financial or other benefit.
x Set forth below is the estimated charge or range of charges for the settlement services listed. You are NOT required
to use the listed provider(s) as a condition for
l settlement of your loan on [or] x purchase, sale, or refinance of the
subject property.
THERE ARE FREQUENTLY OTHER SETTLEMENT
SERVICE PROVIDERS AVAILABLE WITH SIMILAR SERVICES.
YOU ARE FREE TO SHOP AROUND TO DETERMINE THAT
YOU ARE RECEIVING THE BEST SERVICES AND THE BEST
RATE FOR THESE SERVICES.
Provider and settlement service
Charge or range of charges
Maine Street Title Services, Incoming/Outgoing
Wire Charges, if applicable
$25.00
Maine Street Title Services, Express Delivery
Fee per Package, if applicable
$20.00
Maine Street Title Services, Title Search Fee $75.00
Maine Street Title Services, Closing Fee $150.00
Maine Street Title Services, Closing Protection
Letter
$25.00
Maine Street Title Services, Curative Services
Fee, if applicable
$50.00
Maine Street Title Services, Title Insurance
Premium
$1.40 per Thousand to $0.24 per Thousand
l Set forth below is the estimated charge or range of charges for the settlement services of an attorney, credit reporting
agency or real estate appraiser that we, as your lender, will require you to use, as a condition of your loan on this property,
to represent our interests in the transaction.
Affiliated Business Arrangement Disclosure
Bankers Systems™ VMP® 12/2017
Wolters Kluwer Financial Services © 2014 18.1.0.1520-J20180209N Page 1 of 2
ACKNOWLEDGMENT
I/We have read this disclosure form, and understand that HOMEBANK is referring me/us to purchase the above-described
settlement service(s) and may receive a financial or other benefit as a result of this referral.
Borrower
Date Date
Affiliated Business Arrangement Disclosure
Bankers Systems™ VMP® 12/2017
Wolters Kluwer Financial Services © 2014 18.1.0.1520-J20180209N Page 2 of 2
FACTS
Rev 11/02/2015
WHAT DOES HOMEBANK DO
WITH YOUR PERSONAL INFORMATION?
Financial companies choose how they share your personal information. Federal law gives
consumers the right to limit some but not all sharing. Federal law also requires us to tell you
how we collect, share, and protect your personal information. Please read this notice carefully
to understand what we do.
The types of personal information we collect and share depend on the product or service you
have with us. This information can include:
Social Security number and income
Account balances and payment history
Credit history and credit scores
When you are no longer our customer, we continue to share your information as described in
this notice.
All financial companies need to share customerspersonal information to run their everyday
business. In the section below, we list the reasons financial companies can share their
customers’ personal information; the reasons HOMEBANK chooses to share; and whether
you can limit this sharing.
For our everyday business purposes
such as to process your transactions, maintain
your account(s), respond to court orders and legal
investigations, or report to credit bureaus
Yes No
For our marketing purposes
to offer our products and services to you
No No
For joint marketing with other financial companies
No No
For our affiliates’ everyday business purposes
information about your transactions and experiences
No No
For our affiliates’ everyday business purposes
information about your creditworthiness
No No
For our affiliates to market to you
No No
For non-affiliates to market to you
No No
Questions?
Call us at 573-769-2001 or Toll-Free at 1-855-577-2001 or
go to www.myhomebank.bank
Page 2
Who we are
Who is providing this notice? HOMEBANK
What we do
How does HOMEBANK protect my To protect your personal information from unauthorized access
personal information? and use, we use security measures that comply with federal law.
These measures include computer safeguards and secured files
and buildings.
How does HOMEBANK collect my
personal information?
Open an account or deposit money
Pay your bills or apply for a loan
Use your credit or debit card
We also collect your personal information from others, such as credit
Why can’t I limit all sharing?
sharing for affiliates’ everyday business purposesinformation
about your creditworthiness
affiliates from using your information to market to you
sharing for non-affiliates to market to you
State laws and individual companies may give you additional rights to
limit sharing.
Definitions
Affiliates Companies related by common ownership or control. They can be
financial and nonfinancial companies.
Our affiliates include companies with a common corporate identity of
HOMEBANK; financial companies such as Home Bank of C
alifornia,
Byron B. Webb, Inc., LaJolla Fund LLC, and others, such as The
Webb Co. LLC and Maine Street Services, LLC
Non-affiliates Companies not related by common ownership or control. They can be
financial and nonfinancial companies.
HOMEBANK does not share with non-affiliates so they can market
to you.
Joint marketing A formal agreement between nonaffiliated financial companies that
together market financial products or services to you.
HOMEBANK does not jointly market.
Other important information
HOMEBANK works diligently to safeguard the information you give to us. We do NOT share any information about you,
except as permitted by law. We restrict access to information about you to those employees who need to know that
information to provide products or services to you. We maintain physical electronic and procedural safeguards to
protect this information.
H.
ME
BANK
strength
and
service
continues
400 S. Main
P.O. Box 311
Palmyra, Missouri 63461
573-769-2001
Fax 573-769-2345
IMPORTANT INFORMATION ABOUT THE PROCEDURES FOR OPENING A
NEW ACCOUNT
To help the government fight the funding of Terrorism and money laundering
activities, Federal law requires all financial institutions to obtain, verify, and record
information that identifies each person who opens an account.
What that means for you: When you open an account, we will ask for your name,
address, date of birth, and other information that will allow us to identify you. We will
also ask to copy your driver's license
Identification is for verification of identity only and will in no way be used in the loan
credit process
***Payment made by you in person, by mail or electronically Monday through Friday,
prior to 5:00pm will be credited on the day we receive them
***Payments received on Friday after 5:00pm or Saturday will be credited on the next
business day.
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signature
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signature
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signature
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signature
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signature
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signature
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