| If Yes, do you have documentation of the hardship? |
Yes
No |
| Are you currently in Bankruptcy? |
Yes
No
Chapter 7
Chapter 13
When Filed:
|
| Is there a discharge or dismissal coming up? |
|
| Other judgments or liens? |
|
Mortgage Information |
| How much do you owe on your house? |
|
| First Mortgage |
|
| Balance of first mortgage |
|
| Who is it with? |
|
| Monthly Payments |
|
| Does this include Taxes? |
Yes
No |
| Does this include Insurance? |
Yes
No |
| Second Mortgages or leans |
|
| Amount of second mortgage |
|
| Who is it with? |
|
| Monthly Payments |
|
| The total monthly payment is |
|
| Homeowners Association Dues, if any: Specify
per year |
|
| Are House Payments Current? |
Yes
No |
| If not, how far behind? |
|
| Is your house in Foreclosure? |
Yes
No |
| If so, enter date of Trustees Sale |
|
| Is the house attached to a bankruptcy? |
Yes
No |
| Will you sell your house for what you owe on
it? |
Yes
No |
| Property Information |
| How many bedrooms? |
|
| How many bathrooms? |
|
| Does your house have a garage or carport? |
Garage
Carport |
| How many cars? |
|
| Type of Construction: |
Brick
Block
Wood
Frame
Stucco Finish |
| Do you have central heat/air? |
Yes
No |
| How many units? |
|
| Sub Flooring |
Concrete
Slab
Wood Floor
w/Crawlspace
Basement
|
| Does your house need repairs? |
Yes
No |
| If so, what kind? |
|
| When was the house built? |
|
| How long have you owned your house? |
|
| What did you pay for the house? |
|
| What did you put down on the home? (% or amount) |
|
| At what subdivision or crossroads is your home? |
|
| Is the Home Listed for Sale? |
Yes
No |
Employment Information |
Is everyone on the mortgage currently employed?
please add any comments about work situation |
Yes
No
Comments:
|
| Total take home pay for household each month? |
Him:
Her:
Other:
|
| How much do you currently have in... |
Checking:
Savings:
|
| Any other liquid cash available? |
Yes
No |
| Anyone that you could borrow from if needed? |
Yes
No |
| Lets pretend you are current on your mortgage and all the back payments are gone, would you be able to pay the mortgage and all other expenses including other bills and still have a little money left over every month? |
Yes
No
Don't Know |
| Any other question or comment? |
|
