af9TmtKvly8XTNSFcabzNqQTclk=K3IreFN79scP4ABiSnCSatsviQfzYIpzfVP9Y0/38euXvaSGm6oqXCrt2eDqUb1u t7EMDaNsyYuVkn/d/FN3l4alG2iV93rqDcsJEt1Brtsyk3SDKmu8dIj2NEEYmmXw nSfajleYAJdZXEs8FKsN+gfVznz20xIBoZasDwiUTRU= MIIGjzCCBfigAwIBAgICEMQwDQYJKoZIhvcNAQEFBQAwggE1MRQwEgYDVQQDEws2 MDIgcm9vdCBDQTELMAkGA1UEBhMCU0sxRTBDBgNVBAcePABLAHIAdQBwAGkAbgBz AGsA4QAgADQALAAgADgANQAxACAAMAAxACAAQgByAGEAdABpAHMAbABhAHYAYTEY MBYGA1UECBMPU2xvdmFrIFJlcHVibGljMSUwIwYDVQQKExxTb2Z0d2FyZTYwMiBT bG92ZW5za28gcy5yLm8uMW0wawYDVQQLHmQAQwBlAHIAdABpAGYAaQBrAGEBDQBu AOEAIABhAHUAdABvAHIAaQB0AGEAIABTAG8AZgB0AHcAYQByAGUANgAwADIAIABT AGwAbwB2AGUAbgBzAGsAbwAgAHMALgByAC4AbwAuMRkwFwYJKoZIhvcNAQkBFgph Y2FANjAyLnNrMB4XDTA2MDIyNDEwNTM1NloXDTA3MDIyNDEwNTM1NlowgcQxGTAX BgkqhkiG9w0BCQITCkNaNjMwNzgyMzYxGDAWBgNVBAgTD0Nlc2thIHJlcHVibGlr YTELMAkGA1UEBhMCQ1oxIDAeBgNVBA0TFzYwMlhNTCBMaWNlbnNlIEtleSAyLjAw MRkwFwYDVQQLExBTb2Z0d2FyZTYwMiBhLnMuMRkwFwYDVQQKExBTb2Z0d2FyZTYw MiBhLnMuMRkwFwYDVQQDExBTb2Z0d2FyZTYwMiBhLnMuMQ0wCwYDVQQFEwQ0Mjky MIGfMA0GCSqGSIb3DQEBAQUAA4GNADCBiQKBgQDJS5b3oxaFC3KPh/bEjjoEc9Dk AOvVCvqBAtZEABPSvajJ+euBD1L7fnzcadUqJhtpWGBsQW84s9TUPOUAALQYgeET TnFj2Ex4u51zuNuJlEt0FZ8dkF5Ei27BqoN/4Sf9Tb4olcAe6lJjaEkgHf/v4roC iU0EsEz0Idj3YykLcQIDAQABo4IDGjCCAxYwCQYDVR0TBAIwADBGBgNVHSAEPzA9 MAYGBCoDAwQwBgYEKgMDBTArBgQqAwMGMCMwIQYIKwYBBQUHAgEWFWh0dHBzOi8v Y2EuNjAyLnNrL2NwczARBglghkgBhvhCAQEEBAMCBaAwCwYDVR0PBAQDAgXgMCkG A1UdJQQiMCAGCCsGAQUFBwMCBggrBgEFBQcDBAYKKwYBBAGCNxQCAjAjBglghkgB hvhCAQ0EFhYUVXNlciBDZXJ0aWZpY2F0ZSBvZiAwHQYDVR0OBBYEFEsCNjzHjudk f2XwJI9DNwJGnubtMIIBZwYDVR0jBIIBXjCCAVqAFKPffndhg/Uvs8Kl0rsKzjs4 Z4X6oYIBPaSCATkwggE1MRQwEgYDVQQDEws2MDIgcm9vdCBDQTELMAkGA1UEBhMC U0sxRTBDBgNVBAcePABLAHIAdQBwAGkAbgBzAGsA4QAgADQALAAgADgANQAxACAA MAAxACAAQgByAGEAdABpAHMAbABhAHYAYTEYMBYGA1UECBMPU2xvdmFrIFJlcHVi bGljMSUwIwYDVQQKExxTb2Z0d2FyZTYwMiBTbG92ZW5za28gcy5yLm8uMW0wawYD VQQLHmQAQwBlAHIAdABpAGYAaQBrAGEBDQBuAOEAIABhAHUAdABvAHIAaQB0AGEA IABTAG8AZgB0AHcAYQByAGUANgAwADIAIABTAGwAbwB2AGUAbgBzAGsAbwAgAHMA LgByAC4AbwAuMRkwFwYJKoZIhvcNAQkBFgphY2FANjAyLnNrggEBMBUGA1UdEQQO MAyBCnhtbEA2MDIuY3owFQYDVR0SBA4wDIEKYWNhQDYwMi5zazAxBglghkgBhvhC AQQEJBYiaHR0cDovL2NhLjYwMi5zay9wdWIvY3JsL2NhY3JsLmNybDAxBglghkgB hvhCAQMEJBYiaHR0cDovL2NhLjYwMi5zay9wdWIvY3JsL2NhY3JsLmNybDAzBgNV HR8ELDAqMCigJqAkhiJodHRwOi8vY2EuNjAyLnNrL3B1Yi9jcmwvY2FjcmwuY3Js MA0GCSqGSIb3DQEBBQUAA4GBAJ/pFPy9L8aFkJ2AvUifOVwe+n5xG5a6hrJonCiZ iPDvaClMdPwry6AIRmGZaaQWnfZaR3XvA7Wpg1n4g+I810eBLbKkG4hzxiXAriM9 iQa+lNWsYCUhhsOE2VLlrvwUGImso/OqFuqMD5czSA1CpQiPbFxq99tGwTB9uBeg xuwP Freddie Mac Form 65A/7/05PagePage of 3Fannie Mae Form 1003A/7/05Statement of Assets and Liabilities(Supplement to Residential Loan Application)NameThe following information is provided to complete and become a part of the application for a mortgage in the amount of $ with interest at %, for a term of months and to be secured by property known as: Subject Property Address (street, city, state, & ZIP)Legal Description of Subject Property (attach description if necessary)ASSETS AND LIABILITIESThis 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 meaningfully 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.Completed Jointly Not JointlyASSETS DescriptionCash orMarket ValueLiabilities 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. Use continuation sheet, if necessary. Indicate by (*) those liabilities, which will be satisfied upon sale of real estate owned or upon refinancing of the subject property. Cash deposit toward purchase held by: $ LIABILITIES Monthly Payment & Months Left to Pay Unpaid BalanceList checking and savings accounts below Name and address of Company$ Payment/Months $ Name and address of Bank, S&L, or CreditUnion Acct. no. Acct. no. $ Name and address of Company$ Payment/Months $ Name and address of Bank, S&L, or CreditUnion Acct. no. Acct. no.$ Name and address of Company$ Payment/Months $ Name and address of Bank, S&L, or CreditUnion Acct. no. Acct. no. $ Name and address of Company$ Payment/Months $ Name and address of Bank, S&L, or CreditUnion Acct. no. Acct. no. $ Name and address of Company$ Payment/Months $ ASSETS AND LIABILITIES (cont’d)Stocks & Bonds (Company name/number & description)$ Acct. no. Life insurance net cash value $ Name and address of Company $ Payment/Months$Face amount: $Subtotal Liquid Assets $ Acct. no. Real estate owned(enter market value from schedule of real estate owned$ Alimony/Child Support/SeparateMaintenance Payments Owed to:$ Vested interest in retirement fund$ Net worth of business(es) owned (attach financial statement) $ Job-Related Expense (child care, union dues, etc.)$ Automobiles owned (make and year)$ Other Assets (itemize) $ Total Monthly Payments$ Total Assets a.$ Net Worth (a minus b) $ Total Liabilities b. $ Schedule of Real Estate Owned (if additional properties are owned, use continuation sheet)Property Address (enter S if sold, PS ifpending sale or R is rental being held for incomeType ofPropertyPresentMarketValueAmount of Mortgagesand LiensGrossRentalIncomeMortgagePaymentsInsurance,Maintenance,Taxes & MiscNetRentalIncome$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ Totals$ $ $ $ $ $ List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s):Alternate NameCreditor NameAccount NumberACKNOWLEDGEMENT AND AGREEMENTEach 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.Acknowledgement. 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 agencyBorrowers SignatureDateCo-Borrowers SignatureDateXXTO BE COMPLETED BY INTERVIEWERThis application was Interviewer’s Name (print or type)Name and Address of Interviewer’staken by:EmployerFace-to-face interviewInterviewer’s Signature DateMailTelephoneInterviewer’s Phone Number (incl. area code)Internet