Application Page 1

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 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 V.A. Conventional Other: Applied for: FHA FmHA			Agency Case Number	Lender Case No.
Amount $	Interest Rate %	No. of Months	Amortization Fixed Rate Other (explain): Type: GPM ARM(type):

II. PROPERTY INFORMATION AND PURPOSE OF LOAN
Subject Property Address (street , city, state,&ZIP)							No. of Units
Legal Description of Subject Property (attach description if necessary)							Year Built
Purpose of Loan Purchase Construction Other (explain): Refinance Construction-Permanent				Property will be: Primary Residence Secondary Residence Investment
Complete this line 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 this line if this is a refinance loan.*
Year Acquired	Original Cost $	Amount Existing Liens $	Purpose of Refinance	Describe Improvements made to be made Cost $

Borrower IV. EMPLOYMENT INFORMATION Co-Borrower
Borrower's Name (include Jr. or Sr. if applicable)				Co-Borrower's Name (include Jr. or Sr. if applicable
Social Security #	Home Phone (incl. area code)	Age	Yrs. School	Social Security #	Home Phone (incl. area code)	Age	Yrs. School
Married Unmarried (include single divorced, widowed) Separated		Dependents (not listed by Co- Borrower) no.__ ages____		Married Unmarried (include single divorced, widowed) Separated		Dependents (not listed by Borrower) no.__ ages____
*If residing at present address for less than two years, complete the following:*
Former Address (street, city, state, ZIP) Own Rent ____No. Yrs.				Former Address (street, city, state, ZIP) Own Rent ____No. Yrs.
Former Address (street, city, state, ZIP) Own Rent ____No. Yrs.				Former Address (street, city, state, ZIP) Own Rent ____No. Yrs.

Borrower IV. EMPLOYMENT INFORMATION Co-Borrower
Name and Address of Employer Self Employed (check above box)		Yrs. on this job	Name and Address of Employer Self Employed (check above box)		Yrs. on this job
		Yrs. employed in this line of work/profession			Yrs. employed in this line of work/profession
Position/Title/Type of Business	Business Phone (incl. area code)		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 and Address of Employer Self Employed (check above box)		Dates(from-to)	Name and Address of Employer Self Employed (check above box)		Dates(from-to)
		Monthly Income $			Monthly Income $
Position/Title/Type of Business	Business Phone (incl. area code)		Position/Title/Type of Business	Business Phone (incl. area code)
Name and Address of Employer Self Employed (check above box)		Dates(from-to)	Name and Address of Employer Self Employed (check above box)		Dates(from-to)
		Monthly Income $			Monthly Income $
Position/Title/Type of Business .		Business Phone (incl. area code)	Position/Title/Type of Business		Business Phone (incl. area code)