Uniform Residential Loan Mortgage Application
Please print out, complete, and fax to 608-829-0518.


This application is designed to be completed by the applicant(s) with the lender's assistance. Applicants should complete this form as "Borrower" or "Co-Borrower", as applicable. Co-Borrower information must also be provided (and the appropriate box checked when the income or assets of a person other than the "Borrower" (including the Borrower's spouse) will be used as a basis for loan qualification or the income or assets of the Borrower's 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, 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:            
Agency Case Number
 		 Lender Case Number
 		 Amount
$		 Interest Rate
 		 No. of Months
 
Amortization Type:
Fixed Rate    GPM    Other (explain):                               ARM (type):   
II. PROPERTY INFORMATION AND PURPOSE OF LOAN
Subject Property Address (street, city, state, & zip code)
 
 		 No. of Units
 
 
Legal Description of Subject Property (attach description if necessary)
 
 		 Year Built
 
 
Purpose of Loan Purchase
Refinance 		Construction
Construction-Permanent
Other (explain):
 
Property will be:
Primary Residence
Secondary Residence
Investment
Complete these two lines if construction or construction-permanent loan.
Year Lot Acquired Original Cost
$		 Amount Existing Liens
$
(a) Present Value of Lot
$		 (b) Cost of Improvements
$		 Total (a + b)
$
Complete these two lines if this is a refinance loan.
Year Acquired
 		 Original Cost
$		 Amount Existing Liens
$
Purpose of Refinance
 		 Describe Improvements
made   to be made
Cost: $
Title will be held in what Name(s)
 		 Manner in which Title will be held
 		 Estate will be held in:
Fee Simple
Leashold
(show expiration date)
 
Source of Down Payment, Settlement Charges and/or Subordinate Financing (explain)
 
III. BORROWER INFORMATION
Borrower
Borrower's Name (include Jr. or Sr. if applicable)
 
Social Security Number
 		 Home Phone (incl. area code)
 		 Age
 		 Yrs. School
 
Married
Separated
Unmarried (include single, divorced, widowed) 		Dependents (not listed by Co-Borrower)
no.       ages
 
Present Address (street, city, state, zip code)     Own    Rent    ______No. Yrs.
 
 
If residing at present address for less than two years, complete the following:
Former Address (street, city, state, zip code)     Own    Rent    ______No. Yrs.
 
 
Former Address (street, city, state, zip code)     Own    Rent    ______No. Yrs.
 
 
Co-Borrower
Co-Borrower's Name (include Jr. or Sr. if applicable)
 
Social Security Number
 		 Home Phone (incl. area code)
 		 Age
 		 Yrs. School
 
Married
Separated
Unmarried (include single, divorced, widowed) 		Dependents (not listed by Co-Borrower)
no.       ages
 
Present Address (street, city, state, zip code)     Own    Rent    ______No. Yrs.
 
 
If residing at present address for less than two years, complete the following:
Former Address (street, city, state, zip code)     Own    Rent    ______No. Yrs.
 
 
Former Address (street, city, state, zip code)     Own    Rent    ______No. Yrs.
 
 
IV. EMPLOYMENT INFORMATION
Borrower
Name & Address of Employer
Self Employed
  		Yrs. on this job
 
Yrs. employed in this line of work/profession
 
Position/Title/Type of Business
 		 Business Phone (incl. area code)
 
If employed in current position for less than two years or if currently employed in more than one position, complete the following:
Name & Address of Employer
Self Employed
  		Dates (from-to)
 
Monthly Income
$
Position/Title/Type of Business
 		 Business Phone (incl. area code)
 
Name & Address of Employer
Self Employed
  		Dates (from-to)
 
Monthly Income
$
Position/Title/Type of Business
 		 Business Phone (incl. area code)
 
Co-Borrower
Name & Address of Employer
Self Employed
  		Yrs. on this job
 
Yrs. employed in this line of work/profession
 
Position/Title/Type of Business
 		 Business Phone (incl. area code)
 
If employed in current position for less than two years or if currently employed in more than one position, complete the following:
Name & Address of Employer
Self Employed
  		Dates (from-to)
 
Monthly Income
$
Position/Title/Type of Business
 		 Business Phone (incl. area code)
 
Name & Address of Employer
Self Employed
  		Dates (from-to)
 
Monthly Income
$
Position/Title/Type of Business
 		 Business Phone (incl. area code)
 
V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION
Gross Monthly Income Borrower Co-Borrower Total Combined Monthly Housing Expense Present Proposed
Base Empl. Income* $ $ $ Rent $  
Overtime       First Mortgage (P & I)   $
Bonuses       Other Financing (P & I)    
Commissions       Hazard Insurance    
Dividends/Interest       Real Estate Taxes    
Net Rental Income       Mortgage Insurance    
OTHER (before completing, see the notice in "describe other income," below)       Homeowner Assn. Dues    
      Other:    
Total $ $ $ Total $ $
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.
B/C   Monthly Amount
    $
     
     
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 that spouse also.
Completed Jointly Not Jointly
ASSETS

Description

Cash or Market Value
Cash deposit toward purchase held by:
 
 $
List checking and savings 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) $
Vested interest in retirement fund $
Net worth of business(es) owned (attach financial statement) $
Automobiles owned (make and year)
 
 
 $
Other Assets (itemize)
 
 
 $
Total Assets a. $
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 a 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 Monthly Payt. & Mos. Left to Pay Unpaid Balance
Name and address of Company
 
 
 $ Payt./Mos. $
Acct. No.
Name and address of Company
 
 
 $ Payt./Mos. $
Acct. No.
Name and address of Company
 
 
 $ Payt./Mos. $
Acct. No.
Name and address of Company
 
 
 $ Payt./Mos. $
Acct. No.
Name and address of Company
 
 
 $ Payt./Mos. $
Acct. No.
Name and address of Company
 
 
 $ Payt./Mos. $
Acct. No.
Name and address of Company
 
 
 $ Payt./Mos. $
Acct. No.
Alimony/Child Support/Separate Maintenance Payments Owed to:
 		 $  
Job Related Expense (child care, union dues, etc.):
 
 $  
Total Monthly Payments $  
Total Liabilities b. $
Net Worth (a minus b) $
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) S/PS/R 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
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)  
VIII. DECLARATIONS
If you answer "yes" to any questions a through i, please use a continuation sheet for explanation. Borrower Co-Borrower
a. Are there any outstanding judgements 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 which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement? (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? If "Yes," give details as described in the preceding. 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)? ______________ ______________
(2) How did you hold title to the home - solely by yourself (S), jointly with your spouse (SP), or jointly with another person (O)? ______________ ______________
IX. ACKNOWLEDGEMENT 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 reverification of any information contained in the application may be made at any time by the Lender, its agents, successors and assigns, either directly or through a credit reporting agency, 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, its 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, its 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, its agents, successors and assigns make no representations or warranties, express 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 any 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, its agents, successors and assigns, insurers and any other person who may suffer any loss due to reliance upon any misrepresentation which I/we have made on this application.
Borrower's Signature

X

Date

 

Co-Borrower's Signature

X

Date

 

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 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.)
Applicant
Co-Applicant
  I do not wish to furnish this information   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 Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White		 Race: American Indian or Alaskan Native
Asian
Black or African American
Native Hawaiian or Other Pacific Islander
White
Sex: Female    Male Sex: Female    Male
Use this continuation sheet if you need more space to complete the Residential Loan Application. Mark B for Borrower or C for Co-Borrower.
Borrower's Signature

X

Agency Case Number:

 

Co-Borrower's Signature

X

Agency Case Number:

 





































NOTICE TO RIGHT OF APPRAISAL COPY
You have the right to a copy of the appraisal report used in connection with your application for credit. If you wish a copy, please write us at the mailing address we have provided. We must hear from you no later than 90 days after we notify you about the action taken on your credit application or you withdraw your application. In your letter, give us the following information: Loan or application number (if known), date of application, name(s) of loan applicant(s), property address, and current mailing address.
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.
Borrower's Signature

X

Date

 

Co-Borrower's Signature

X

Date