Financial Statement

PERSONAL FINANCIAL STATEMENT

Date Prepared:_____________ Loan Number:______________

Borrower’s Name:

_____________________________________________

Borrower’s Employer:

_____________________________________________

Co-Borrower’s Name:

_____________________________________________

Co-Borrower’s Employer:

_____________________________________________

Daytime Phone Number:

_____________________________________________

Number of Dependents:

_____________________________________________

Property Address:

Mailing Address (if different)

____________________________________

MONTHLY INCOME:

Borrower’s monthly NET income:

$_____________________

Co-Borrower’s monthly NET income:

$_____________________

Other Income: Please circle below

$_____________________

(Child support, Alimony, Rental, Other___________________)

DOWN PAYMENT TOWARDS DELINQUENCY $_______________

MONTHLY EXPENSES:

Monthly Payments:

Monthly Payment Balance Owed:

Mortgage Payment:	$______________
Child Care:	$______________
Alimony/Child Support	$______________
Telephone:	$______________
Cell Phone/Pager:	$______________
Gas/Oil:	$______________
Electricity:	$______________
Trash/Sewer:	$______________
Food:	$______________
Water:	$______________
Auto Insurance:	$______________
Transportation/Gas	$______________
Life Insurance:	$______________
Cable/Satellite:	$______________
Clothing:	$______________
Prescriptions:	$______________

2nd Mortgage:	$______________ $______________
Other Mortgage:	$______________ $______________
Rent Paid:	$______________ $______________
Doctor Bills:	$______________ $______________
Hospital Bills:	$______________ $______________
Auto Loan Pmt:	$______________ $______________
Auto Loan Pmt:	$______________ $______________
*Homeowner Ins:	$______________ $______________
*Property Taxes:	$______________ $______________


*If not included in Mortgage Payment

OTHER MONTHLY EXPENSES (Example: Credit Cards, Department Store Cards, IRS Lien):

Paid To: Balance:	Monthly Payment:
1.____________________$_________________	$__________________________
2.____________________$_________________	$__________________________
3.____________________$_________________	$__________________________
If more space is necessary, please continue list on additional paper.

The information submitted in this personal financial statement is true, correct and complete in all material respects.
The information and documentation provided does not omit any material fact or matter that makes the information
or documentation presented misleading.

_____________________________________________________________________________________________
Borrower Signature Date Co-Borrower Signature Date

revised 4/17/08

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