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About

Financial Statement

Borrower Name: *
Borrower's Mailing Address: *
Borrower's Social Security #: *
E-mail Address: *
Co-Borrower's Name: *
Co-Borrower's Mailing Address: *
Co-Borrower's Social Security #: *
Address of Subject Property: *
Mortgage Servicer: *
Account Number: *
Type of Loan: *
Mortgage Servicer #2: *
Account Number: *
Type of Loan: *
Additional Leins on Property?: *	Yes No
Is this Property in Foreclosure?: *	Yes No
Have you ever filed Bankruptcy?: *	Yes No
If so, when and what Chapter?:
How much $$ do you have at this time to put towards your delinquency?: *
What is your monthly combined NET income?: *
Assets: Cash in hand: *
Assets: Checking and Savings: *
Assets: Certificate of Deposit (COD's): *
Assets: Stocks, Bonds, Mutual Funds: *
All Retirement Assets: (401(k), IRA's, etc.): *
Other:
Estimated Home Value: P/R: *
Estimated Home Value: Additional Homes: *
Value: Automobile 1: *
Value: Automobile 2: *
Value: Automobile 3:
Cash Value of Life Insurance: *
Value: Boat: *
Value: Trailer: *
Net Monthly Income - 1st person: *
Net Monthly Income - 2nd person: *
Bonuses - both Total: *
Child Support - Receive: *
Child Support - Pay: *
Rental Property Income: Total: *
Disability / Social Security / Retirement: *
Room Rental:
Monthly Mortgage Payment: 1: *
Monthly Mortgage Payment: 2: *
Automobile Payment: 1: *
Automobile Payment: 2: *
Student Loan Payments: total monthly: *
CC Payments: total: *
Gas / Electric: *
Water/Trash/Sewer: *
Phone/Cable/Internet: *
Cellular: *
Property Tax: if not included in payment: *
Property Insurance: if not included in payment: *
HOA Dues: *
Auto Insurance: total: *
Household Expenses: monthly (groceries, lunches, child care, education, tuition, animal care): *
Car: maintenance:
Car: gasoline: *
TOTAL MONTHLY EXPENSES:: *
COMBINED MONTHLY NET INCOME:: *
Notes and Additional Information::
Enter Code Shown:*

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