INCOME- TAKE HOME PAY
Primary Job
Part Time Job (net)
Retirement-Military
Retirement-Civil Serv.
Support/Alimony
Social Security
Room & Board/Rent
TOTAL Net Income:
EXPENSES
Home Mortgage
2nd Mortgage
Auto loan
Auto loan
Creditor
Creditor
Creditor
Creditor
Creditor
Creditor
Creditor
Student loan
Alimony/Support
Child Care
IRS
CH 13
Electricity
Heating fuel Oil or Natural Gas
Water& Sewer
Telephone
Cable TV
Auto Insurance
Health Insurance Paid directly (not by employer)
Life Insurance Paid directly (not by employer)
Medical/Dental Exp.
Homeowners Insurance Only list here if not in Mortgage Payment
Real Estate Tax Only list here if not in Mortgage Payment
Personal Property Tax Applies only in some States
Groceries
School Lunches
Transportation, Parking, TollsClothing
Dry cleaning/Laundry
Cell Phone
Internet service
Homeowners Assn. Dues
Recreation/Spending Money
Charitable donations
Other Expenses
TOTAL MONTHLY EXPENSES:
A. Total Monthly Income:
B. Total Monthly Expenses:
C. Residual Income:
Balance in 401K: Cash Value of Stocks:
Balance in IRA: Other Valuables to be sold:
Other Mics. Assets: Cash on Hand:
I/We have described my/our financial condition in the enclosed Financial Status Report and certify that allinformation, as well as all Attachments, is true, accurate and correct to the best of my/our knowledge. I/weunderstand that submission of this information in no way obligates my lender, servicer, Veterans Affairs, FHA/HUD, the investor, the Mortgage Insurers, (Agent) or (BROKERAGE) to provide assistance to me or stop theforeclosure process. I/We hereby authorize my/our lender, servicer, Veterans Affairs, FHA/HUD, the investor or the Mortgage Insurers to
1. Order a credit report from any credit reporting agency.
2. Order a title search from any title agency.
3. Verify the accuracy of the information contained in this Financial Status Report, including withoutlimitation, any current or previous employment information.
I/We agree that I/we will notify the AGENT and BROKERAGE mentioned above, my lender, Veterans Affairs, FHA/HUD, the investor, or the Mortgage Insurers immediately of any material change in the financial information thatI/We have provided herein. If I/we fail to do so, or if it is determined that the financial information providedherein has been misrepresented by me, and lender, servicer, Veterans Affairs, FHA/HUD, the investor or themortgage insurers makes decisions which would not have been made had the true facts been known, then (1) Ishall be liable for all costs (fees) incurred or damages suffered by lender , servicer, Veterans Affairs, FHA/HUD,the investor, the mortgage insurers or AGENT and BROKERAGE above and (2) lender, Servicer, Veterans Affairs,FHA/HUD, the investor, the mortgage insurers and/or AGENT shall have the right, in its sole discretion, toterminate any arrangement or agreement that has been extended to me based, in whole or in part, on theinaccurate or incomplete information that I/We have provided.
______________________ __________ _____________________ _________
Borrower Signature Date Co-Borrower Signature Date
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Print Seller's Name Print Seller's Name
© Distressed Property Institute, LLC 2008. All rights reserved. Any duplication without express written consent is prohibited. All CDPE forms are provided for informational purposes only. The Distressed Property Institute, LLC assumes no responsibility nor guarantees the accuracy of these forms. It is strongly recommended that agents investigate the specific items necessary to their situation and local and regional laws.