OWNER OCCUPIED REHABILITATION LOAN APPLICATION Subject property street address City

							OWNER OCCUPIED REHABILITATION LOAN APPLICATION
Subject property street address City/State/Zip

Legal description of subject property (attach description if necessary) Title held in what name(s) Type of title document

Building type/age Book/Page/Date

Borrower
Full name Present address Age Full name Present address

Co-Borrower
Age

Previous address (if less than 2 years at present address) Marital Status: married separated unmarried Name and address of employer Years employed in this line of work or profession ______ years Years on this job _______ ___ Self-employed Position/title Type of business Social Security Number Item Base employment income Overtime Bonuses Commissions Dividend/Interest Net rental income Other-pensions, child support, etc. (see below) Total B/C Home Telephone ( ) Borrower $ $ Co-borrower $ Bus Telephone ( ) Total

Previous address (if less than 2 years at present address) Marital Status: married separated unmarried Name and address of employer Years employed in this line of work or profession _____ years Years on this job _______ ___ Self-employed Position/title Type of business Social Security Number Home Telephone ( ) Present First Mortgage (P & I) Other financing (P & I) Hazard Insurance Real Estate Taxes Mortgage insurance Other Total monthly payment Utilities Total $ $ Bus Telephone ( ) Proposed

Gross monthly household income

Monthly housing expense

$

$

$

$

$ Monthly amount

Describe other income
B-Borrower C-Co-Borrower NOTICE: Alimony, child support or separate maintenance income need not be revealed if the borrower or co-borrower does not choose to have it considered as a basis for repaying this loan.

$ $ Also report income being received by other members of the household and income from food stamps These questions apply to both borrower and co-borrower
If a “yes” answer is given to a question in this column, please explain on an attached sheet. Are there any outstanding judgments against you? Have you been declared bankrupt within the past 7 years? Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years? Are you a party to a lawsuit? Are you obligated to pay alimony, child support or Are you a co-maker or endorser on a note? Borrower yes/no ________ ________ Co-borrower yes/no __________ __________ Are you a U.S. Citizen? If “no” are you a resident alien? If “no” are you a nonresident alien? Borrower yes/no _________ _________ Co-Borrower yes/no __________ __________

________

__________

_________

__________

________ ________ ________

__________ __________ __________

Explain other financing or equity (if any) separate maintenance? __________________________________________________ __________________________________________________

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 City’s compliance with equal credit opportunity and fair housing 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 the above information, please check the box below. The City must review the above material to assure that the disclosures satisfy all requirements to which the City is subject under applicable state law for the particular type of loan applied for. Borrower: Race/national origin: __ American Indian __ Alaskan Native __ Asian, Pacific Islander __ Black __ Hispanic __ White Other (specify) _____________________ Sex __ Female __ Male __ Head of Household __ I do not wish to furnish this information Co-borrower: Race/national origin: __ American Indian __ Alaskan Native __ Asian, Pacific Islander __ Black __ Hispanic __ White Other (specify) _____________________ Sex __ Female __ Male __ Head of Household __ I do not wish to furnish this information

Front Side

Revised05/07/02

OWNER OCCUPIED REHABILITATION LOAN APPLICATION
Financial Assets
Include all liquid assets (cash or market value) and all non-liquid financial assets. Description Cash or market value Bank, S& L, or credit union

Financial Liabilities
Include real estate loans (owner or bank financed), revolving charge accounts, car loans student loans and unsecured personal loans. Unpaid Creditor’s names, addresses and account numbers Monthly balance payment/ months left Company Account # Address

$
Address City Account # Bank, S& L, or credit union

City Company Address City Company Address Account # Account #

$

/

$

$

/

$

$
Address City Account # Bank, S& L, or credit union

City Company Address City Company Address Account # Account #

$

/

$

$

/

$

$
Address City Account # Life insurance net cash value

City Company Address City Account #

$

/

$

$
Account #

/

$

$ $ $ $ $ $ $ $

Company Address City Company Address City Alimony, child support or separate maintenance payments owed to: _________________________

Subtotal liquid assets
Real estate owned (enter market value from schedule of real estate owned, below) Vested interest in retirement fund Net worth of business owned (attach financial statement) Automobiles owned (make/year) Furniture and personal property Other financial assets

$
Account #

/

$

$

/

$ $

/

Subtotal non-liquid assets

$
(A)

Total monthly installment payments

Total financial assets Address of property (indicate S if sold, PS if pending sale, or R is rental held for income)

$
Type of property

Net Worth (A minus B) $ Present market value Mortgages and liens Gross rental income Mortgage Payments

Total Liabilities Taxes, ins., maint., etc

(B)

$

Schedule of real estate owned (if additional properties are owned, attach separate schedule)
Net rental income

$

$

$

$

$

$

Totals B-Borrower C-Co-Borrower

$

$
Account Number

$

$
Purpose of Loan

$
Highest Balance

$
Date Paid

List previous credit references
Creditor’s name and address

AGREEMENT The undersigned applies for the loan indicated in this application to be secured by a _______ mortgage or deed of trust on the property described herein, and represents that the property will not be used for any illegal or restricted purposes, and that all statements made in this application are true and are made for the purpose of obtaining the loan. Verification may be obtained from any source named in this application. The original or a copy of this application will be retained by the City of Springfield, even if the loan is not granted. The undersigned __ intend __ do not intend to occupy the property as their primary residence. 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, U.S. Code, Section 1014.

________________________________________________ Borrower’s Signature Date

______________________________________________ Co-Borrower’s Signature Date

Reverse Side

Revised05/07/02