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Uniform Residential Loan Application
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 D 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 Dthe income or assets of the Borrower's spouse or other person who has community
property rights pursuant to state law will not be used as a basis for loan qualification, but his or her liabilities must be considered because the spouse or other person
has community property rights pursuant to applicable law and 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.
If this is an application for joint credit, Borrower and Co-Borrower each agree that we intend to apply for joint credit (sign below):
Borrower Co-Borrower
Year Built
Legal Description of Subject Property (attach description if necessary)
Purposeof Loan [Y] Purchase D Construction D Other(explain): Property will be:
D Refinance D Construction-Permanent [Y] Primary Resi~ence DSecondary Residence Dlnvestment
Complete this line if construction or construction-permanent loan.
Year Lot I OriginalCost I AmountExistingLiens I (a) PresentValueof Lot Total (a+b)
Acquired
$ $ $ $
Complete this line if this is a refinance loan.
Year I OriginalCost I AmountExistingLiens Purpose of Refinance D made D to be made
Acquired
$ $
Title will be held in what Name(s) Estate will be held in:
[Y] Fee Simple
D Leasehold (show
date)
expiration
Source of Down Payment, Settlement Charges and/or Subordinate Financing (explain)
Social Security Number! Home Phone (incl. area code)! DOB (mm/dd/yyyy)!Yrs. School! Social Security Numberl Home Phone (incl. area code)! DOB (mm/dd/yyyy)! Yrs. School
DMarried DUnmarried (include single, D Married D Unmarried (include single,
DSeparated divorced, widowed) D Separated divorced, widowed)
Present Address (street, city, state, ZIP) _No. Yrs.! Present Address (street, city, state, ZIP) No. Yrs.
Mailing Address, if different from Present Address Mailing Address, if different from Present Address
If residing at present address for less than two years, complete the following:
FormerAddress(street,city,state,ZIP) DOwn D Rent - No.Yrs.1FormerAddress(street,city,state,ZIP) DOwn DRent _No. Yrs.
Former Address (street, city, state, ZIP) DOwn D Rent - No. Yrs.1 Former Address (street, city, state, ZIP) DOwn DRent _No. Yrs.
Fannie Mae Form 100~ 07/05 Freddie Mac Form 65 07/05
Borrower
CALYX Form Loanapp1.frm 09/05 Page 1 of 5
Co-Borrower
0 Self Employed Yrs. on this job
Yrs. employed in this Yrs. employed in this
line of work/profession line of work/profession
PositionlTitielType of Business Business Phone (inc!. area code) PositionlTitielType of Business Business Phone (inc!. 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& Addressof Employer 0 Self Employed IDates(from-to) I Name& Addressof Employer 0 Self Employed I Dates(from-to)
Monthly Income Monthly Income
$ $
PositionlTitlelType of Business Business Phone (inc!. area code) PositionlTitielType of Business Business Phone (inc!. area code)
Name & Address of Employer 0 Self Employed Dates (from-to) Name & Address of Employer 0 Self Employed Dates (from-to)
Monthly Income Monthly Income
$ $
I I
PositionlTitlelType of Business Business Phone (inc!. area code) PositionlTitielType of Business Business Phone (inc!. area code)
Name & Address of Employer 0 Self Employed Dates (from-to) Name & Address of Employer 0 Self Employed Dates (from-to)
Monthly Income Monthly Income
$ $
I I
PositionlTitielType of Business Business Phone (inc!. area code) PositionlTitielType of Business Business Phone (incl. area code)
Name & Address of Employer 0 Self Employed Dates (from-to) Name & Address of Employer 0 Self Employed Dates (from-to)
Monthly Income Monthly Income
$ $
I I
PositionlTitlelType of Business Business Phone (incl. area code) PositionlTitielType of Business Business Phone (incl. area code)
Gross Combined Monthly
Monthly Income Borrower Co-Borrower Total Housing Expense Present I Proposed
BaseEmp!.Income* $ $ $ Rent $
Overtime First Mortgage(P&I) 1$
Bonuses OtherFinancing(P&I)
Commissions HazardInsurance
Dividendsllnterest Real EstateTaxes
Net RentalIncome MortgageInsurance
Other (beforecompleting, HomeownerAssn. Dues
seethenoticein"describe
otherincome," elow)
b Other:
Total $ $ $ Total T$
. Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.
T$
Describe Other Income Notice: Alimony,child support, or separate maintenance income need not be revealed ifthe
Borrower (B) or Co-Borrower (C) does not choose to have it considered for repaying this loan.
~
Fannie Mae Form 1003 07/05
CALYX Form Loanapp2.frm 09/05 Page 2 of 5
Borrower
~ Moolhly
Freddie Mac Form 65
Amoool
07/05
Co-Borrower
-- . -,
List checking and savings accounts below Name and address of Company $ Payment/Months $
Name and address of Bank, S&L, or Credit Union
Acc!. no.
Name and address of Company $ Payment/Months $
Acc!. no. I$
Name and address of Bank, S&L, or Credit Union
Acc!' no.
Name and address of Company $ Payment/Months $
Acc!. no. I$
Name and address of Bank, S&L, or Credit Union
Acc!. no.
Name and address of Company $ Payment/Months $
Acc!. no. $
Stocks & Bonds (Company $
name/number description)
Acc!. no.
Name and address of Company $ Payment/Months $
Life insurance net cash value $
Face amount: $
Subtotal Liquid Assets $
ompany
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) Acc!. no.
Automobiles owned (make and year) "$ Alimony/Child Support/Separate $
Maintenance Payments Owed to:
Other Assets (itemize) $ Job-Related Expense (child care, union dues, etc.) I$
Total Monthly Payments $
$ Total Liabilities b.
Total Assets a. $
Schedule of Real Estate Owned (if additional properties are owned, use continuation sheet) Insurance,
Type of Present Amount of Gross Mortgage Maintenance, Net
Property Address (enter S if sold, PS if pending
sale or R if rental being held for income) Property Market Value Mortgages & Liens Rental Income Payments Taxes & Misc. Rentallncome
$ $ $ $ $ $
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
Fannie Mae Form 1003 07/05 Borrower Freddie Mac Form 65 07/05
CALYX Form Loanapp3.frm 09/05 Page 3 of 5 Co-Borrower
, VII. DETAILS OF TRANSACTION VIII. DECLARATIONS
$ If you answer "Yes" to any questions a through i, Borrower Co-Borrower
a. Purchase price
please use continuation sheet for explanation. Yes No Yes No
b. Alterations, improvements, repairs
c. Land (if acquired separately)
a. Arethere any outstandingjudgments against you? D D D D
d. Refinance (incl. debts to be paid off)
b. Have you been declared bankrupt within the past 7 years? D D D D
e. Estimated prepaid items
c. Have you had property foreclosed upon or given title or deed in lieu thereof D D D D
in the last 7 years?
f. Estimated closing costs
g. PMI, MIP, Funding Fee
d. Are you a party to a lawsuit? D D D D
h. Discount (if Borrower will pay)
e. Have you directly or indirectly been obligated on any loan which resulted in D D D D
foreclosure, transfer of title in lieu of foreclosure, or judgment?
i. Total costs (add items a through h) (Thiswouldinclude such loans as home mortgage loans, SBAloans, home improvement
j. Subordinate financing (
loans,educationalloans,manufacturedmobile)homeloans,any mortgage, financial
obligation,bond, or loan guarantee. If "Yes,"providedetails, includingdate, name and
k. Borrower's closing costs paid by Seller of F i
address Lender, HAorVA casenumber,f any,andreasons theaction.) for
I. Other Credits (explain)
f. Are you presently delinquent or in default on any Federal debt or any other D D D D
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? D D 0 D
h. Is any part of the down payment borrowed? D D D D
i. Are you a co-maker or endorser on a note?
--------- ------------------------------------- ------ -------- D D D D
j. Are you a U. S. citizen? D D D D
m. Loan amount (exclude PMI, MIP, k. Are you a permanent resident alien? D D D D
FundingFeefinanced) I. Doyou intendto occupythe propertyas your primaryresidence? D D D D
n. PMI, MIP, Funding Fee financed question below.
If "Yes,"complete m
m. Have you had an ownership interest in a property in the last three years? D D D D
o. Loan amount (add m & n) (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),
p. Cash from/to Borrower (subtract j, k, I &
0 from i) jointly with your spouse (SP), or jointly with another person (O)? - -
I lAW 1/I.lI.Nn il
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, andlor 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 andlor an
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, successorsor assigns has made any representationor warranty, express or implied, to me regardingthe 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, enfonceable and valid as if a paper version of this
application were delivered containing my original written signature.
Acknowledaement. 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 purpose through any source, including a source named in this application or a consumer
reporting agency.
Borrower's Signature Date I Co-Borrower'sSignature Date
X X
Xi: INFioRI\IA TloN..FioR<SOVERNJIJIENT JIJIONlrORINGPORPOSES
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
matenal to assure mat me OISClosures satIsfy all reQUIrements to wnlcn me lenoer IS sUP ect unDer applicaPle state law Tor me particular tYpe OTloan annliec1 for. \
BORROWER D I do not wish to furnish this information CO-BORROWER D I do not wish to furnish this information
Ethnfcity: D Hispanic or Latino D Not Hispanic or Latino Ethnicity: D Hispanic or Latino D Not Hispanic or Latino
Race: D American Indian or D Asian D Black or Race: D American Indian or D Asian D Black or
Alaska Native African American Alaska Native African American
D Native Hawaiian or
Other Pacific Islander
D White D Native Hawaiian or
Other Pacific Islander
DWhite
Sex: D Female D Male Sex: D Female DMaie
To be Completed by Interviewer Interviewer's Name (print or type) Name and Address of Interviewer's Employer
This application was taken by: Central Bank
D Face-to-face interview Interviewer's Signature Date 95 North University Ave
DMail Provo, UT 84601-
DTelephone Interviewer's Phone Number (incl. area code) (P) 801-373-3336
D Internet
IF)JL801)377-0963
Fannie Mae Form 1003 07/05 Freddie Mac Form 65 07/05
GALYX Form Loanapp4.frm 09/05 Page 4 of 5
FAST START LOAN REQUIREMENTS
CENTRAL BANK MORTGAGE LOAN DEPARTMENT
To accomplish a quick approval and meet conditions {or our investor, your help is needed for
the following items along with your application. .As applicable.
1. Income information. if hourly or salaried. Your most recent two pay stubs showing
your year to date information.
2. ,If. m 10 ed conunis 'oned. or Jividen. please provide your most recent 2
years IRS tax returns Vfithfull schedules, including 1098, 1099, and W2. If you own
more than 25% of the business, please provide your most recent two years business tax
returns, and a year-to-date profit and loss statement.
3. Other income. derived from Social Se~urity, V.A. benefits, disability, etc. A copy of
your award letter, or benefit statement is very helpful.
4. 401kand. Retirement plans. please provide your most recent statement of accounts.
5. ~g and Savings accounts. please provide your most recent statements on all of
your checking and savings accounts.
6. Hazard. and Fire insurance. please provide us with the name of your agent who will
provide your fire and hazard insurance.
7. A signed, legible copy of your purchase agreement (~ with all pages and
addendums.
,
Reminder, if you are unable to provide current income documentation, we have programs
to do unverified income at competitive rates and terms.
Central Banl~, Mortgage Loan Dept.
phone 373-3336 Fax 377-0963
Central Bank
Mortgage Loan Department
Processing Fee Acknowledgment
Certain processing costs will be incurred in preparing your loan documentation:
* Appraisal $225.00- $300.00*
* Preliminary Title Policy $120.00
* Credit Report $18.00-$55.00
* Flood Certification $17.00
* Desktop Underwriting Fee $30.00
In many cases these costs can be added to the loan with the other closing costs,
providing we close the loan.
However, ifunforseen circumstancesprevent the loan from closing or change the loan,
(i.e.: appraisal, title problems, credit score, or you change your mind) I/we agree to pay
the costs incurred by Central Bank.
Borrower Borrower'
Date Date
j
*Investment Property and Duplexes have additional charges.
Upfmtfec39/99
---~-~ -- --~- ---
BORROWER'S SIGNATURE
AUTHORIZATION
95 North University Avenue
Central Bank Provo, Utah 848D1
Mortg.ge Loan Department (801 )375-1 DDO
TO WHOM IT MAY CONCERN:
I/WE HEREBY AUTHORIZE YOU TO RELEASE TO CENTRAL BANK AND/OR ITS ASSIGNS THE
INFORMA nON FOR THE PURPOSE OF VERIFICATION:
.
. Employment History. Dates. Title, Income. Hours. etc.
.
.
Bank and Savings Accounts of Record.
Mortgage Loan Rating(s) and/or Escrow Infonnation.
. Social Security. Pension or Retirement Income.
Any other infonnation deemed necessary in connection with a consumer credit report for transaction which
. involved Real Estate.
Child Support Accounts
THIS INFORMATION IS FOR TIlE CONFIDENTIAL USE IN COMPILING A MORTGAGE LOAN CREDIT
FILE. ...
A PHOTOGRAPHIC OR CARBON COpy OF THIS AUTHORIZATION (BEING A VALID COpy OF THE
SIGNATURE(S) OF THE UNDERSIGNED) MAY BE DEEMED TO BE TIlE EQUIVALENT OF THE
ORIGINAL AND MAYBE USED AS A DUPLICATE ORIGINAL.
YOUR PROMPT REPLY WILL HELP EXPEDITE MY REAL ESTATE TRANSACTION.
TItANK YOU.
BORROWERS SIGNATURE CO-BORROWERS SIGNA'lURE
SOCIAL SECURITY NUMBER SOCIAL SECURITY NUMBER
PRIVACY ACT NOTICE: lbis information is to be used by the agency collecting it in determining whether you qualifY as a prospective mortgagor
or bonower under its program. It will not be disclosed outside the agency without your consent except to your employer(s) for verification of
employment and as required and permitted by law. You do not have to give us this infOrmation, but if you do not, your application fur approval as a
prospective mortgagor or boROwermay be delayed or rejected. lbe infOrmationrequested in this fOrm is authorized by TIde 38, U.S.C., Chapter 37
(if VA); by 12 U.S.C., Section 1701etseq. (lfHUDIFHA); by 42 U.S.C., Section 142Sb (ifHUD/CPD); and by 42 U.S.C., Section 1471 elseq., or
7 U.S.C.,Section1921eI seq.(lfU.S.D.A.,FmHA).
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