Citizens National Bank Discover CNB Personal Business Investments/Insurance (Opens in a new Window) LOGIN Uniform Residential Loan Application *Indicates a Required Field Applicants should complete this form as "Borrower" or "Other/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 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. I. Type of Mortgage and Terms of Loan Mortgage applied for: * VA FHA Conventional USDA/Rural Housing Service Other Other mortgage If Other, please explain. Amount Requested * Interest Rate * Number of Months * Amortization Type Amortization Type: * Please select Fixed Rate Graduated Payment Mortgage (GPM) Adjustable Rate Mortgage (ARM) Other If ARM, which type? (Ex: One year, 5/5, Balloon, etc) Other ARM If Other, please explain. II. Property Information and Purpose of Loan Subject Property Street Address * Subject Property Address City * Subject Property Address State * Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Subject Property Address Zip * Legal Description of Subject Property * Year Built * Number of Units Purpose of Loan: * Purchase Refinance Construction Construction - Permanent Other Other Purpose of Loan If Other, please explain. Property will be: * Please select Primary Residence Secondary Residence Investment Complete the following if this is a construction or construction-permanent loan. Construction Loan Year Lot Acquired Construction Loan Original Cost Construction Loan Amount of Existing Liens (a) Present Value of Lot (b) Cost of Improvements Total (a) + (b) Complete the following if this is a refinance loan. Refinance Loan Year Lot Acquired Refinance Loan Original Cost Refinance Loan Amount of Existing Liens Purpose of Refinance Describe improvements Cost of improvements Improvements Made Improvements To Be Made Title will be held in name(s) * Manner in which title will be held * Estate will be held in: * Fee Simple Leasehold Leasehold expiration date Source of Down Payment, Settlement Charges, and/or Subordinate Financing (please explain) * III. Borrower Information Primary Borrower Information Primary Borrower Name * Primary Borrower Last 4 digits of SSN * Primary Borrower Home Phone (xxx-xxx-xxxx) * Primary Borrower Date of Birth (mmddyyyy) * Primary Borrower Years of School * Primary Borrower Number of dependents * Primary Borrower Age(s) of dependents, separated by commas Borrower Marital Status * Please select Married Separated Unmarried (including single, widowed, divorced) Own or Rent at Current Address? * Primary Borrower Own Rent Number of years renting: Primary Borrower Current Address Street * Primary Borrower Current Address City * Primary Borrower Current Address State * Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Primary Borrower Current Address Zip * Primary Borrower Mailing Address, if different from current address Primary Borrower Mailing Address City Primary Borrower Mailing Address State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Primary Borrower Mailing Address Zip If residing at current address for less than two years, please complete the following: Primary Borrower Former Address Street Primary Borrower Former Address City Primary Borrower Former Address State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Primary Borrower Former Address Zip Own or Rent at Former Address? Primary Borrower Own Rent Number of years renting: Other/Co-Borrower Information Other/Co-Borrower Name Other/Co-Borrower Last 4 digits of SSN Other/Co-Borrower Home Phone (xxx-xxx-xxxx) Other/Co-Borrower Date of Birth (mmddyyyy) Other/Co-Borrower Years of School Other/Co-Borrower Number of dependents Other/Co-Borrower Age(s) of dependents, separated by commas Co-Borrower Marital Status Please select Married Separated Unmarried (including single, widowed, divorced) Own or Rent at Current Address? Other/Co-Borrower Own Rent Number of years renting: Other/Co-Borrower Current Address Street Other/Co-Borrower Current Address City Other/Co-Borrower Current Address State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other/Co-Borrower Current Address Zip Other/Co-Borrower Mailing Address, if different from current address Other/Co-Borrower Mailing Address City Other/Co-Borrower Mailing Address State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other/Co-Borrower Mailing Address Zip If residing at current address for less than two years, please complete the following: Other/Co-Borrower Former Address Street Other/Co-Borrower Former Address City Other/Co-Borrower Former Address State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other/Co-Borrower Former Address Zip Own or Rent at this address? Other/Co-Borrower Own Rent Number of years renting: IV. Employment Information Primary Borrower Employment Information Primary Borrower Check here if currently Self-Employed Primary Borrower Name of Current Employer * Primary Borrower Current Employer Address Street * Primary Borrower Current Employee Address City * Primary Borrower Current Employee Address State * Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Primary Borrower Current Employee Address Zip * Primary Borrower Current Employment Type of Business * Primary Borrower Current Employment Position/Title * Primary Borrower Current Employment Business Phone Number (xxx-xxx-xxxx) * Primary Borrower Current Employment Years at this job * Primary Borrower Current Employment Years in this line of work or profession * Primary Borrower If employed in current position for less than two years or if currently employed in more than one position, please complete the following: Primary Borrower Name of Other/Previous Employer 1 Primary Borrower Other/Previous Employer One Address Street Primary Borrower Other/Previous Employee Address City Primary Borrower Other/Previous Employee Address State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Primary Borrower Other/Previous Employee Address Zip Primary Borrower Check here if you are/were Self-Employed in this position One Primary Borrower Other/Previous Employment One Beginning date (mmddyyyy) Primary Borrower Other/Previous Employment One End date (mmddyyyy) Primary Borrower Other/Previous Employment One Monthly Income Primary Borrower Other/Previous Employment Type of Business Primary Borrower Other/Previous Employment Position/Title Primary Borrower Previous Employment Business Phone Number (xxx-xxx-xxxx) Primary Borrower Previous Employment Years at this job Primary Borrower Previous Employment Years in this line of work or profession Primary Borrower Name of Previous Employer 2 Primary Borrower Previous Employer Two Address Street Primary Borrower Previous Employee Address City Primary Borrower Previous Employee Address State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Primary Borrower Previous Employee Address Zip Primary Borrower Employment 2 Check here if you are/were Self-Employed in this position Two Primary Borrower Other/Previous Employment Two Beginning date (mmddyyyy) Primary Borrower Other/Previous Employment Two End date (mmddyyyy) Primary Borrower Other/Previous Employment Two Monthly Income Primary Borrower Previous Employment Type of Business Primary Borrower Previous Employment Position/Title Primary Borrower Previous Employment Business Phone Number (xxx-xxx-xxxx) Primary Borrower Previous Employment Years at this job Primary Borrower Previous Employment Years in this line of work or profession Other/Co-Borrower Employment Information Co-Borrower Check here if currently Self-Employed Other/Co-Borrower Name of Current Employer Other/Co-Borrower Current Employer Address Street Other/Co-Borrower Current Employee Address City Other/Co-Borrower Current Employee Address State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other/Co-Borrower Current Employee Address Zip Other/Co-Borrower Current Employment Type of Business Other/Co-Borrower Current Employment Position/Title Other/Co-Borrower Current Employment Business Phone Number (xxx-xxx-xxxx) Other/Co-Borrower Current Employment Years at this job Other/Co-Borrower Current Employment Years in this line of work or profession Other/Co-Borrower If employed in current position for less than two years or if currently employed in more than one position, please complete the following: Other/Co-Borrower Name of Other/Previous Employer 1 Other/Co-Borrower Other/Previous Employer One Address Street Other/Co-Borrower Other/Previous Employee Address City Other/Co-Borrower Other/Previous Employee Address State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other/Co-Borrower Other/Previous Employee Address Zip Co-Borrower Check here if you are/were Self-Employed in this position One Other/Co-Borrower Other/Previous Employment One Beginning date (mmddyyyy) Other/Co-Borrower Other/Previous Employment One End date (mmddyyyy) Other/Co-Borrower Other/Previous Employment One Monthly Income Other/Co-Borrower Other/Previous Employment Type of Business Other/Co-Borrower Other/Previous Employment Position/Title Other/Co-Borrower Previous Employment Business Phone Number (xxx-xxx-xxxx) Other/Co-Borrower Previous Employment Years at this job Other/Co-Borrower Previous Employment Years in this line of work or profession Other/Co-Borrower Name of Previous Employer 2 Other/Co-Borrower Previous Employer Two Address Street Other/Co-Borrower Previous Employee Address City Other/Co-Borrower Previous Employee Address State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Other/Co-Borrower Previous Employee Address Zip Co-Borrower Check here if you are/were Self-Employed in this position Two Other/Co-Borrower Other/Previous Employment Two Beginning date (mmddyyyy) Other/Co-Borrower Other/Previous Employment Two End date (mmddyyyy) Other/Co-Borrower Other/Previous Employment Two Monthly Income Other/Co-Borrower Previous Employment Type of Business Other/Co-Borrower Previous Employment Position/Title Other/Co-Borrower Previous Employment Business Phone Number (xxx-xxx-xxxx) Other/Co-Borrower Previous Employment Years at this job Other/Co-Borrower Previous Employment Years in this line of work or profession V. Monthly Income and Combined Housing Expense Information Gross Monthly Income Primary Borrower Other/Co-Borrower Total Base Employment Income * Self-Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements. Primary Borrower Base Employment Income Other/Co-Borrower Base Employment Income Total Base Employment Income Overtime Primary Borrower Overtime Income Other/Co-Borrower Overtime Income Total Overtime Income Bonuses Primary Borrower Bonuses Income Other/Co-Borrower Bonuses Income Total Bonuses Income Commissions Primary Borrower Commissions Income Other/Co-Borrower Commissions Income Total Commissions Income Dividends or Interest Primary Borrower Dividends or Interest Income Other/Co-Borrower Dividends or Interest Income Total Dividends or Interest Income Net Rental Primary Borrower Net Rental Income Other/Co-Borrower Net Rental Income Total Combined Net Rental Income Other Income Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower or Co-Borrower does not choose to have it considered for repaying this loan. Primary Borrower Other Income Other/Co-Borrower Other Income Total Other Income Total Monthly Income * Primary Borrower Total Monthly Income Other/Co-Borrower Total Monthly Income Total Monthly Income of Primary Borrower and Co-Borrower Combined Monthly Housing Expense Current Proposed Current Rent Current Rent Mortgage (P & I) Current First Mortgage (P & I) Proposed First Mortgage (P & I) Other Financing (P & I) Current Other Financing (P & I) Proposed Other Financing (P & I) Hazard Insurance Current Hazard Insurance Proposed Hazard Insurance Real Estate Taxes Current Real Estate Taxes Proposed Real Estate Taxes Mortgage Insurance Current Mortgage Insurance Proposed Mortgage Insurance HOA Dues Current HOA Dues Proposed HOA Dues Other Housing Expense Current Other Housing Expense Proposed Other Housing Expense Total Combined Monthly Housing Expenses * Total of Current Housing Expenses Total of Proposed Housing Expenses 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 meaningly and fairly presented on a combined basis; otherwise, separate Statements and Schedules are required. If the Co-Borrower section was completed about a non-applicant spouse or other person, this Statement and supporting schedules must be completed about that spouse or other person also. Application Completed: * Jointly Not Jointly Cash Deposit Toward Purchase Held By * Assets 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 ATTACH FINANCIAL STATEMENT Asset 1 Description Cash or Market Value Asset 2 Description Cash or Market Value Asset 3 Description Cash or Market Value Asset 4 Description Cash or Market Value Asset 5 Description Cash or Market Value List Checking and Savings Accounts Below. Checking or Savings Account 1 Name of Bank, S&L, or Credit Union Address of Bank, S&L, or Credit Union City State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Account Number Cash or Market Value of Account Checking or Savings Account 2 Name of Bank, S&L, or Credit Union Address of Bank, S&L, or Credit Union City State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Account Number Cash or Market Value of Account Checking or Savings Account 3 Name of Bank, S&L, or Credit Union Address of Bank, S&L, or Credit Union City State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Account Number Cash or Market Value of Account Checking or Savings Account 4 Name of Bank, S&L, or Credit Union Address of Bank, S&L, or Credit Union City State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Account Number Cash or Market Value of Account Stocks and Bonds Stocks/Bonds Company Name Stocks/Bonds Company Phone Number (xxx-xxx-xxxx) Description of Stocks/Bonds Cash Value of Stocks/Bonds Life Insurance Life Insurance Net Cash Value Life Insurance Face Value Automobiles Owned Automobile 1 Auto Owned 1 Year Auto Owned 1 Make and Model Auto Owned 1 Cash Value Automobile 2 Auto Owned 2 Year Auto Owned 2 Make and Model Auto Owned 2 Cash Value Automobile 3 Auto Owned 3 Year Auto Owned 3 Make and Model Auto Owned 3 Cash Value Automobile 4 Auto Owned 4 Year Auto Owned 4 Make and Model Auto Owned 4 Cash Value Automobile 5 Auto Owned 5 Year Auto Owned 5 Make and Model Auto Owned 5 Cash Value Other Assets: Itemize Other Asset 1 Description Cash or Market Value Other Asset 2 Description Cash or Market Value Other Asset 3 Description Cash or Market Value Other Asset 4 Description Cash or Market Value Other Asset 5 Description Cash or Market Value Total Assets * Liabilities Liabilities 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. Liability 1 Name of Company Account Number Company Address City State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Monthly Payment Months left to pay Unpaid Balance Liability 2 Name of Company Account Number Company Address City State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Monthly Payment Months left to pay Unpaid Balance Liability 3 Name of Company Account Number Company Address City State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Monthly Payment Months left to pay Unpaid Balance Liability 4 Name of Company Account Number Company Address City State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Monthly Payment Months left to pay Unpaid Balance Liability 5 Name of Company Account Number Company Address City State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Monthly Payment Months left to pay Unpaid Balance Liability 6 Name of Company Account Number Company Address City State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Zip Monthly Payment Months left to pay Unpaid Balance Alimony/Child Support/Separate Maintenance Payments Notice: Alimony, child support, or separate maintenance income need not be revealed if the Borrower or Co-Borrower does not choose to have it considered for repaying this loan. Owed to: Payment Amount Months Job-Related Expenses (child care, union dues, etc.) Description Payment Amount Months Total Monthly Payments * Total Liabilities * Net Worth (Total Liabilities - Total Assets) * Schedule of Real Estate Owned Property 1 Property 1 Owned Status Please select Sold Pending Sale Rental Property 1 Owned Type of Property Property 1 Address Property 1 Owned City Property 1 Owned State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Property 1 Owned Zip Property 1 Owned Present Market Value Property 1 Owned Amount of Mortgages and Liens Property 1 Owned Gross Rental Income Property 1 Owned Mortgage Payments Property 1 Owned Insurance, Maintenance, Taxes, and Misc. Property 1 Owned Net Rental Income Property 2 Property 2 Owned Status Please select Sold Pending Sale Rental Property 2 Owned Type of Property Property 2 Address Property 2 Owned City Property 2 Owned State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Property 2 Owned Zip Property 2 Owned Present Market Value Property 2 Owned Amount of Mortgages and Liens Property 2 Owned Gross Rental Income Property 2 Owned Mortgage Payments Property 2 Owned Insurance, Maintenance, Taxes, and Misc. Property 2 Owned Net Rental Income Property 3 Property 3 Owned Status Please select Sold Pending Sale Rental Property 3 Owned Type of Property Property 3 Address Property 3 Owned City Property 3 Owned State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Property 3 Owned Zip Property 3 Owned Present Market Value Property 3 Owned Amount of Mortgages and Liens Property 3 Owned Gross Rental Income Property 3 Owned Mortgage Payments Property 3 Owned Insurance, Maintenance, Taxes, and Misc. Property 3 Owned Net Rental Income Property 4 Property 4 Owned Status Please select Sold Pending Sale Rental Property 4 Owned Type of Property Property 4 Address Property 4 Owned City Property 4 Owned State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Property 4 Owned Zip Property 4 Owned Present Market Value Property 4 Owned Amount of Mortgages and Liens Property 4 Owned Gross Rental Income Property 4 Owned Mortgage Payments Property 4 Owned Insurance, Maintenance, Taxes, and Misc. Property 4 Owned Net Rental Income Property 5 Property 5 Owned Status Please select Sold Pending Sale Rental Property 5 Owned Type of Property Property 5 Address Property 5 Owned City Property 5 Owned State Please select Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Property 5 Owned Zip Property 5 Owned Present Market Value Property 5 Owned Amount of Mortgages and Liens Property 5 Owned Gross Rental Income Property 5 Owned Mortgage Payments Property 5 Owned Insurance, Maintenance, Taxes, and Misc. Property 5 Owned Net Rental Income Property Totals Total Present Market Value Total Amount of Mortgages and Liens Total Gross Rental Income Total Mortgage Payments Total Insurance, Maintenance, Taxes, and Misc. Total Net Rental Income List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s): Additional Name 1 Alternate Name Creditor Name Account Number Additional Name 2 Alternate Name Creditor Name Account Number Additional Name 3 Alternate Name Creditor Name Account Number VII: Details of Transaction a. Purchase Price * b. Alterations, Improvements, Repairs * c. Land (if acquired separately) * d. Refinance (include debts to be paid off) * e. Estimated Prepaid Items * f. Estimated Closing Costs * g. PMI, MIP, Funding Fee * h. Discount (if borrower will pay) * i. Total Costs (add items a - h) * j. Subordinate Financing * k. Borrower's Closing Costs Paid By Seller * l. Other Credits Other Credits - Explain m. Loan Amount (exclude PMI, MIP, Funding Fee Financed * n. PMI, MIP, Funding Fee Financed * o. Loan Amount (add m + n) * Cash to and from borrower (subtract j, k, l, and o from i) * VIII: Declarations Borrower Declarations Are there any outstanding judgments against you? * Yes No If yes, please explain. Have you declared bankruptcy in the past seven years? * Primary Borrower Yes No If yes, please explain. Have you had property foreclosed upon or given title or deed in lieu thereof in the last seven years? * Primary Borrower Yes No If yes, please explain. Are you party to a lawsuit? * Primary Borrower Yes No If yes, please explain. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? * Primary Borrower Yes No If yes, please explain. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? * Primary Borrower Yes No If yes, please explain. Are you obligated to pay alimony, child support, or separate maintenance? * Primary Borrower Yes No If yes, please explain. Is any part of the down payment borrowed? * Primary Borrower Yes No If yes, please explain. Are you a co-maker or endorser on a note? * Primary Borrower Yes No If yes, please explain. Do you intend to occupy the the property as your primary residence? * Primary Borrower Yes No If yes, have you had an ownership interest in a property in the last three years? Primary Borrower Yes No Borrower What type of property did you own? Please select Principal Residence Second Home Investment Property Borrower How did you hold title to the home? Please select Yourself Jointly with your spouse Jointly with another person Are you a US Citizen? * Primary Borrower Yes No Are you a permanent resident alien? * Primary Borrower Yes No Other/Co-Borrower Declarations Are there any outstanding judgments against you? Yes No If yes, please explain. Have you declared bankruptcy in the past seven years? Co-Borrower Yes No If yes, please explain. Have you had property foreclosed upon or given title or deed in lieu thereof in the last seven years? Co-Borrower Yes No If yes, please explain. Are you party to a lawsuit? Co-Borrower Yes No If yes, please explain. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? Co-Borrower Yes No If yes, please explain. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? Co-Borrower Yes No If yes, please explain. Are you obligated to pay alimony, child support, or separate maintenance? Co-Borrower Yes No If yes, please explain. Is any part of the down payment borrowed? Co-Borrower Yes No If yes, please explain. Are you a co-maker or endorser on a note? Co-Borrower Yes No If yes, please explain. Do you intend to occupy the the property as your primary residence? Co-Borrower Yes No If yes, have you had an ownership interest in a property in the last three years? Co-Borrower Yes No Co-Borrower What type of property did you own? Please select Principal Residence Second Home Investment Property Co-Borrower How did you hold title to the home? Please select Yourself Jointly with your spouse Jointly with another person Are you a US Citizen? Co-Borrower Yes No Are you a permanent resident alien? Co-Borrower Yes No IX. Information For Government Monitoring Purposes 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 ho me mortgage disclosure laws. You are not required to furnish this in formation, 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 material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.) Borrower Optional Info Primary Borrower I do not wish to furnish this information. Ethnicity Primary Borrower Hispanic or Latino Not Hispanic or Latino Race Primary Borrower American Indian or Alaska Native Native Hawaiian or other Pacific Islander Asian White Black or African-American Borrower Gender Other/Co-Borrower Optional Info Co-Borrower I do not wish to furnish this information. Ethnicity Co-Borrower Hispanic or Latino Not Hispanic or Latino Race Co-Borrower American Indian or Alaska Native Native Hawaiian or other Pacific Islander Asian White Black or African-American Co-Borrower Gender X. Acknowledgement and Agreement By submitting this form, Borrower and Other/Co-Borrower (if applicable) acknowledge and agree to the following: I. If this is an application for joint credit, Borrower and Other/Co-Borrower each agree that we intend to apply for joint credit. II. 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, and/or 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 and/or 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, successors or assigns has made any representation or warranty, express or implied, to me regarding the 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, enforceable and valid as if a paper version of this application were delivered containing my original written signature. III. 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 business purpose through any source, including a source named in this application or a consumer reporting agency. IV. I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of Title 18, United States Code, Section 1001, et seq. SEND APPLICATION Routing#: 091202325 | Phone: 218-732-3393 Privacy Policy Terms of Use USA PATRIOT Act Fraud Contact Us ©2021 Citizens National Bank Created byProfitStars