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					                                BORROWER'S INCOME STATEMENT
   NAME: ______________________________________________________________________________

                                                                                   NET MONTHLY
                                   Monthly Income Statement                           Income
Client #1
    Client #1 Currently Employed? If yes fill out employer information
                  Employer Name
                Employer Address
          Employer City, State, Zip
                  Employer Phone
            Length of Employment Enter years and months here.
NET MONTHLY Income From Salary and/or Commissions
               Employer #2 Name
             Employer #2 Address
       Employer #2 City, State, Zip
               Employer #2 Phone
            Length of Employment Enter years and months here.
NET MONTHLY Income From Salary and/or Commissions

Client #2
    Client #2 Currently Employed? If yes fill out employer information
                  Employer Name
                Employer Address
          Employer City, State, Zip
                  Employer Phone
            Length of Employment Enter years and months here.
NET MONTHLY Income From Salary and/or Commissions
               Employer #2 Name
             Employer #2 Address
       Employer #2 City, State, Zip
               Employer #2 Phone
            Length of Employment Enter years and months here.
NET MONTHLY Income From Salary and/or Commissions

Other Income Sources
                Unemployment
                      Disability
                       Pension
                Social Security
                       Alimony
                 Child Support
                 Other Income

Other Household Members
 Anyone else currently employed? If yes fill out employer information
                 Employer Name
               Employer Address
        Employer City, State, Zip
                 Employer Phone
           Length of Employment Enter years and months here.
NET MONTHLY Income From Salary and/or Commissions

     TOTAL MONTHLY INCOME                                                                    $0
I certify the above to be a true and correct accounting of my current income.

_______________________________________________________________________________________________
                                                                                 Date

_______________________________________________________________________________________________
                                                                                 Date
                        BORROWER'S MONTHLY EXPENSE STATEMENT
NAME: ____________________________________________________
____________________________________________________
                                            Amount Paid Per   # Months PAST DUE
                                            Month             Past Due Amount Owed      Current Balance
Liens & Mortgages:                                                              $0
                                                                      Sub-Total----->
                                           First Mortgage $0          $0    0
                                       Second Mortgage $0             $0    0
     Home Improvement Loan, LOC or Third Mortgage $0                  $0    0
  Property Taxes & Insurance (If NOT included in payt) $0             $0    0
                Home Owners Association and/or Other $0               $0    0
Utilities                                                                       $0
                                                                      Sub-Total----->
                                              Electric/Gas $0         $0    0
                All Telephones-Landline, Fax & Cellular $0            $0    0
                                           Cable/Internet $0          $0    0
                                    Water/Sewage/Trash $0             $0    0
                                                     Other $0         $0    0
Auto Expense                                                                    $0
                                                                      Sub-Total----->
                                                 Gasoline $0          $0    0
                                     Repair/Maintenance $0            $0    0
                                                Insurance $0          $0    0
                              Tolls/Parking/Mass Transit $0           $0    0
                                                     Other $0         $0    0
Household Expenses                                                              $0
                                                                      Sub-Total----->
                               Groceries/Food/Toiletries $0           $0    0
                                   School/Work Lunches $0             $0    0
                                                  Clothing $0         $0    0
                                 Repairs & Maintenance $0             $0    0
                               Hobbies/Spending Money $0              $0    0
                Entertainment (Dining out, Movies, etc.) $0           $0    0
                                                      Misc $0         $0    0
                                      Any other not listed $0         $0    0
Credit Cards: (Type/Write in Name)                                              $0
                                                                      Sub-Total----->
                                        VISA/Mastercard $0            $0    0
                                        VISA/Mastercard $0            $0    0
                                        VISA/Mastercard $0            $0    0
                                        VISA/Mastercard $0            $0    0
                                        VISA/Mastercard $0            $0    0
                                       Department Store $0            $0    0
                                                     Other $0         $0    0
Other Loans                                                                     $0
                                                                      Sub-Total----->
                                                      Auto $0         $0    0
                                                      Auto $0         $0    0
                                                 Personal $0          $0    0
                                  Credit Union/Signature $0           $0    0
                                                  Student $0          $0    0
                                       Finance Company $0             $0    0
                                                     Other $0         $0    0
Other Monthly Expenses                                                          $0
                                                                      Sub-Total----->
                                    Child Care/Day Care $0            $0    0
                        Child's Books, Tuition, Activities $0         $0    0
                                            Child Support $0          $0    0
                                                  Alimony $0          $0    0
                                     Doctor/Dentist/Clinic $0         $0    0
                                          Medicine/Drugs $0           $0    0
                 Life/Medical/Dental/Disability Insurance $0          $0    0
                                                     Other $0         $0    0
                        TOTAL MONTHLY EXPENSES $0                     $0        $0
I certify the above to be a true and correct accounting of my current expenses.
___________________________________________________________________________________
                                                                                Date
___________________________________________________________________________________
                                                                                Date
                                  BORROWER'S ASSET STATEMENT
    NAME: ______________________________________________________________________________


                                   ASSETS (Items that you own)
ITEM                            DESCRIPTION                                    PRESENT VALUE        AMOUNT OWED
Example                         Example                                        Example             Example
Automobile                      1998 Ford Taurus                                         $15,000             $10,000
Primary Residence
Vacation Home
Rental Property #1
Rental Property #2
Rental Property #3
Automobile #1
Automobile #2
Automobile #3
Recreational Vehicle
Motorcycle
Checking Account #1
Checking Account #2
Savings Account
Credit Union Account
IRA/Retirement Savings
Life Ins-$ Surrender Value
Stocks/Bonds/CDs
Jewelry/Furs
Other Investments
Furniture
Electronics
Cash on Hand
Any other assets
Any other assets
                                                                 Grand Total                  $0                  $0
                                Persons Living in This House
(self, spouse, son, daughter)                      Name                            AGE
Self
Spouse
Son
Son
Daughter
Daughter
Other
Other
I certify the above to be a true and correct accounting of my current assets.

_______________________________________________________________________________________________
                                                                                Date

_______________________________________________________________________________________________
                                                                                Date

				
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posted:4/30/2010
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