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6. Explanation of Financial Hardship
Selling Paradise Realty Todd D. Lindgren – Broker Associate PH: 239-699-6091 Fax: 239-549-5008
Client Name_______________________________ Date:____________ Short Sale Property Address__________________________________
Please complete this form by checking the appropriate reason or reasons for your hardship, then providing a detailed explanation for each.
I am having problems making my monthly payment due to financial difficulties.
I believe my situation is: ________ Temporary _________ Permanent
My financial difficulties are the result of (check all that apply):
⌂ Unemployment (start date___________ end date ___________) Explain:_____________________________________________ ⌂ Excessive Financial Responsibilities Explain:_____________________________________________ ⌂ Illness (start date___________ end date ___________) Explain:_____________________________________________ ⌂ Reduction in income (start date________ end date ________) Explain:_____________________________________________ ⌂ Death (Date of death ___________) Explain:_____________________________________________ ⌂ Other Explain:_____________________________________________
If there is a third party that has information to support your claim, please provide their names below. Third-Party Disclosure I authorize the following individuals to release/ discuss information relating to my account. Name(s) of individual(s) ______________________________________ __________________________ ___________________ ____________ Borrower Printed Name Borrower Signature Date
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