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Borrower Information

First Name

Middle Name

Last Name

Email Address

Phone Number

SSN

Date of Birth

Citizenship

Marital Status

Dependents (Count & Ages)

Housing Status

Monthly Housing Expense ($)

Type	Institution	Value ($)

Type	Company	Unpaid Balance ($)	Monthly Payment ($)

List all properties you currently own.

Address	Status (Sold/Pending/Retained)	Value ($)	Mtg Balance ($)

Loan Amount ($)

Loan Purpose

Subject Property Address

Property Value ($)

Occupancy

Yes No

Ethnicity

Sex

Race

American Indian or Alaska Native Asian Black or African American Native Hawaiian or Other Pacific Islander White I do not wish to provide