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7. Borrower's Financial Statement
Selling Paradise Realty Todd D. Lindgren – Broker Associate PH: 239-699-6091 Fax: 239-549-5008
Client Name___________________________________ Date:____________ Short Sale Property Address______________________________________ BORROWER’S FINANCIAL STATEMENT
Borrowers Name_________________ Soocial Security No._____________ Is your home listed for sale? Yes__ No__ Agents Name______________ Date Listed?______ Listing Amount:______ Current Listing Price_______ Mailing Address_______________________________________________ Total number of persons living at this address:_________ Number of dependents at this address:____________ Home Phone:_________________ Work Phone:____________________ Co-Borrower Name:__________________________ Social Security Number:____________________ Home Phone:_____________ Monthly Income (Wages): $_____________ Have you contracted Credit Counseling Services? Yes______ No_______ Additional Income (not wages): $_____________________* Source:__________________________________ *Notice: Include Alimony, Child Support, Disability, Rental Income, Social Security, Welfare / Food Stamps. All requested information must be received before a short sale plan can be reviewed for approval.
ASSET TYPE: Estimated Value LIABILITY TYPE: Payment/Month Balance Due: Home ___________________ Alimony – Child Support _____________ _____________ Other Real Estate ___________________ Dependent Care / Child Care _____________ ______________ Checking Accounts ___________________ Cable / Cell Phone _____________ ______________ Savings – Money Market ___________________ Other Mortgage(s) – Rent _____________ ______________ IRA / Keogh Accounts ___________________ Personal Loan(s) – Credit Cards_____________ ______________ 401K / ESOP Accounts ___________________ Medical Expenses _____________ ______________ Stocks, Bonds, CD’S ___________________ HOA Fees / Taxes / Hazard Ins._____________ ______________ Rental Property ___________________ Automobile(s) _____________ ______________ Auto 1, Auto 2, Boat ___________________ Tax Liens & Homeowners Ins. _____________ ______________ Water, gas, electric, phone ______________ ______________ Food ________________ _____________ Other Investments ________________ Auto Expenses (gas, maintenance)____________ _____________
Reasons for delinquency (dates of hardship): ___________________________________________________________ ___________________________________________________________ ___________________________________________________________
I (we) agree that the financial information provided is an accurate statement of my (our) financial status. I (we) understand and acknowledge that any action taken by the lender of my (our) mortgage loan on my (our) behalf will be made in strict reliance on the financial information provided. My (our) signature(s) below grants the holder of my (our) mortgage the authority to confirm the information I (we) have disclosed in this financial statement, to verify that it is accurate by ordering a credit report, and to contact my real estate agent and / or credit counseling service representative (if applicable).
Submitted this ___________ day of ___________________ 20________
By:_____________________________________ Date: _____________ Signature of Borrower
By:_____________________________________ Date: _____________ Signature of Borrower
Before mailing, make sure you have signed and dated the form and attached a copy of your most recent pay stub and bank statements of your checking and / or savings account. If you are self-employed, attach a copy of your most recent Federal tax returns with schedules.
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