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Mortgage Broker Number: MB 802616 UI 219001

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 (see   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 Cash or Market
Value
Liabilites 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 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.
Cash deposit toward purchase held by: $ LIABILITES Monthly Pmt. &
Mos. Left to Pay
Unpaid
Balance
List checking and savings accounts below
Name & Address of Bank, S&L, or Credit Union
 

Name & Address of Company
 

$ Pat/Mos.

$
-

Acct. no. $ Acct. no.
Name & Address of Bank, S&L, or Credit Union

Name & Address of Company
 

$ Payt./Mos.

$
-

Acct. no. $ Acct. no.
Name & Address of Bank, S&L, or Credit Union
 

Name & Address of Company
 

$ Payt./Mos.
 

$
 

Acct. no. $ Acct. no.
Name & Address of Bank, S&L, or Credit Union
 

Name & Address of Company
 

$ Payt./Mos.
 

$
-

Acct. no. $ Acct. no.
Stocks & Bonds(Company name/ number & description)
$
 

Name & Address of Company
 

$ Payt./Mos.
 

$
 

Acct. no. $ Acct. no.
Life insurance net cash value
 

. Name & Address of Company
 

$ Payt./Mos.
 

$
-

Face amount $ $ Acct. no.
Subtotal Liquid Assets $ Name & Address of Company

$ Payt./Mos.

$

Real Estate owned enter market value from schedule or real estate owned, (page 3.)
$ Acct. no.
Vested interest in retirement fund $ Name & Address of Company

$ Payt./Mos.

$

Net worth of business(es) owned (attach financial statement) $ Acct. no.
Automobiles owned (make and year) $ Alimony/Child Support/Separate Maintenance Payments $

.
Other Assets (itemize)
$
Job Related Expense (child care, union dues, etc. )
$

.
Total Monthly Payments $ .
Total Assets a. $ Net Worth (a-b) $ Total Liabilities b. $

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