Universal Credit Application - The First National Bank of Edgewood

Universal Credit Application
lConsumer Real Estatel
lCheck only ggt
t, if joint credit. Use another application if more than two app
Individual Cradit, lf
for lndividual Credit - relvinq solelv on my income and assets.
Individual Credit with Another, lf checked, 'thls is an Apptication for lndividual Credi r - relying on my income and assets aId
on income and/or assets of another as a basis for loan qualification. (Complete Applicant bnd Co-Afplicant sections.)
Individuaf Crsdit fcommunity Propsrty State), lf checked, this is an Application for lndividual Crcdlt - retying on my income or
assels. lhe Income or assets of my spouse {or other person), who has community property rights pursuant to state law, will
nol be used as a basis for loan qualification. However, his or her liabilities must be considered because my spouse (or other
person) has community property rights pursuant to applicable law, and. as Applicant, I reside in a community property state,
the property that will secure the loan is located in a community property state, or I am relying on other property located in a
community property state as a basis for repayment of the loan. (Complete Applicant and Co-Applicant sections.)
D
Joint Credit, lf checked, thisis an Application for Joint Oedit. By signing below, the Applicant and Co-Applicanl agree thar
each of us intend to apply for jqi4gE!!!. (Complete Applicant and Co-Applicant sections,)
E
Home Purchase or Refinancing
E
n
Home Equity Loan
Home Equity Line of Credit
!
Fixed
tr ARM fl
(street, cr1y, state
Property (attach description if necessary)
Year Built
Purpose of Loan
I
D
Purchase
Refinance
Property will be:
U Construction
!
n Construction-Permanent
Year Lot lOriginal Cost
Acquired
I Primary E
Other:
Residence
Amount Existing
(a) Present Value of
(b) Cost of
Liens
Lot
lmprovements
$
I
E
Secondary
Investment
Residence
Total (a
+
b)
$
Describe lmprgvements
Original Cost
Year
Amount Existing
Acquired
E made E
Purpose of Refinance
Liens
Cost:
to be made
$
Manner in which Title will be held
Name(s)
Estate will be held in:
!
n
Source of Down Payment. Settlement Charges. and/or Subordinate Financing (explain)
Fee Simple
Leasehold (show
expiration date)
l0 Typs
l0 Typs & No.
&
Exp. Date
o.
E-mail Address
!
0 Married
las dofin€d by sta$ law;
E
E
El Married
dsfinsd by rtar€ law;
Separated
incl. domestic pannerhip, civil union)
D
Unmarried
{including sinsle, divorcod, widow€d)
Present
Address ! Own fl Rent !
No. Yrs.
fl own I
Rent
!
lnot list€d by Applicani)
Unmarried
No, Ages
incl. domestic p.rtnorchip, civil unionl
(in.luding single, divotc.d, widowed)
Present Address
E Own D Rent !
No. Yrs.
Former Address
I Own E Rent !
Woh.6 Kluw.r
.jEEi.l S.rvicB
@
No. Yrs.
VMPC148F {1211),00
P:9.
2009, 2012
The First National Bank of Edgewood
NMLS# 405337
No, Yrs.
uca-RE 11/1/2012
Uhiv.r6.l Cr.dit AlDlic.tiohR..l E.lat
vN|P@ B.nt€G stli.msTM
Dependents
Address, if different from Present
Mailing Address, if different from Present Address
Former Address
Separated
las
Mark Alan Pickens
NMLSf 408364
1 oJ 5
Name & Address of Employer
i
se|t
Name & Address of Employer
I
Sar
this lahe of
work/profession
Positionffittefyp- oi
BiliiEi
Position/Title/Type of Business
lor less than two
Name & Address of Employer
D
ser
Posirion/Title/Type ot BuiinEs!
Name & Address of Employer
y6;;;;E
in more
th!!
one poiiti"n, c"mpto-tc tfrg
Name & Address of Employer
!
gsx
Dates {from - to)
Position/Title/Type of Business
I
Gross Monthly
lncome
$
s€t,
Name & Address ot employei plu11
Dates (from - to)
Business
Position,.f itleff vpe oiEusinEG
Position/Title/Type
;f
Bu"jness
Income
Base
Gross
Income
Proposed
Income*
Overtime
Bonuses
Commissions
Dividends/lnterest
Net Rental Income
Other
(before completing. see
the notice in'Describe
Other Income," below)
Total
r
Sell Employcd AtDticlnt(3}
Describc Otlrcr
Income
A/C
."y
b
lrlotica: Alimony, chlld support, ot soplr.te maintsnanca
income necd noi bc r.v""i.d il tr Aiplicent tAi or Co-Applicant lCl
doe3 not choolo to havc it consider6dior repaying this loan.
lny
number(sl:
and account
Alternate Name
Creditor Name
Univ.r..l Cr.dn ApDtic.riocR4l E6r.r.
VMP(a B.nl.rr syn.n6r,
woh.6 (luw.r Fh.nciet S6ivic.s @2009,
20
Monthly Amount
i2
Account Number
ucA-nE 1l/l/2012
vMPCt4gF I l2l l).OO
P.g. 2 ol5
7. Assets and Liabitities
Liabilities and Pledged Ass.ts. Lt"r rh"
nl-",
account number for all outstanding debrs, including
"r"ditol"auromoUite
"=JI[Cno
loins.
revorvtng charge accounts, real estate loans, alimony, child support,
stock
pledges, etc. Use continuation sheet, if necessary. tnai"at"
UV i.l ino"u
yllt -ill be satisfied upon sate of reai estare o*;;i ;r.';;;n
l:.l,ll,--:
refinancing of the subject property.
Cash deposit toward purchase
h€ld byi
List
Unpaid Balance
Name and address of
S&1, or Credit Union
Name and address of Cornpany
or Credit Union
Name and address of Company
Name and address of Bank, S&L, or Credit Union
Name and address of Company
Name and address
Name and address of Company
Name
address of Bank,
or Credit
Acct. no.
Stocks & Bonds (Company
Name and address of Company
name/number & description)
Insurance net cash value
Name and address of Company
Face amount: $
Real estate owned
(enter market value from
schedule of real estate owned)
Vest
interest in
fund
Net worth of businessles)
(attach f inancial statement)
owneo
(make and year)
lvlaintenance Payments Owed to:
Job-Related Expense
(child care, union dues, etc,)
Other Assets (itemize)
conltnuatton
8. Declarations
a. Are.there any outstanding judgments
agatnsr you /
b, Have you been declared bankruor
within the past 10 yearsz
c.
Have you had property foreclosed
upon or given title or deed in lieu
thereof in the last 7 years?
d. Are you a party to a lawsuit?
Untv.El Cr.dn Appneriofri.at En.b
VMP@ E€nr.rs
Wolr.6 Kluwd
svd.n3rM
Fi;ei.l Srvic.s
@
2009, 2Oi2
tr
!
!
D
res
tr tr
! tr
trtr !tr
!tr
ID
Have you directly or indireclly been
obligated on any loan which resulted
in foreclosure, transfer of title in lie_
of foreclosure, or judgment?
f. Are you presently delinquent ot in
default on anv Federal debt or anv
other loan. mortgage, financial
obligation, bond, or loan guarantee?
Itr
Dtr
tr!
n!
ucA-RE 11/t/20r2
vMPCt4aR 11211),OO
8. Declarations (Continued)
g. Are you obligated to pay alimony, child
trtr
trtr
trtr
!!
utr
trtr
support, or separate maintenance?
h. ls any part of the down payment
borrowedT
Are you a co-maker or endorser on a
noteT
i. Are you a U.S, citizen?
k. Are you a permanent resident alien?
l. Do you intend to occupy t{le ptoperty
a9 youl pdmary residence?
i.
n!
trt
tri
m, Have you had an ownership interest
in a property in the last three yearsT
(1) What type of property did you
own - principal residence {PR),
second home (SH), or
investment property (lP)?
(2) How did you hold title to the
home
-
solely by yourself (S),
jointly with your spouse (SP). or
jointly with another person (O)?
n, Are there any other equity loans on
the property?
9. Continuation and Additional lnformation
Inttluc$ons.
Use this section if you need more space to complete the Universal Credit Application. Mark
and "C" for Co-Applicant. Use this space if vou answered "Yes" to anv of the questions in Section 8,
"A" for Applicant
t lnfomation to Applicant{s}.
To help the government fight the funding of terrorism and money laundering
federal law requires all financial institutions to obtain. verify, and record information that identifies each person who
applies for a loan or opens an account.
What this meana fol you, When you apply for a loan or open an account, we will ask for your name, address, dale of birth,
and other information that will allow us to identify you. We may also ask to see your driver's license and/or other identifying
documents. In some instances, we may use outside sources to confirm the information, The information you provide is
protected by our privacy policy and federal law,
Fabe Staiements. By signing below, l/we fully understand that it is a federal crime punishable by fine or imprisonment, or
both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of Title 18.
United States Code, Section 1O01, etseq.
f
Calilornia
R.sidrnb.
f
.
State Notices
Each applicant, if married, may apply for a separate account.
Mascachusetts Residents. Under Massachusetts statute, Mass. Gen. L. ch. 184, Section 178,
you, the Applicant (and Co-Applicantl are entitled to know the following:
1. The responsibility of the attorney for the Mortgagee is to protect the interest of the
Mortgagee.
2. Mortgagors may, at their own expense, engage an attorney of their own selection to
represent their interests in the transaction.
For Home Equity Line of Credit. The current annual percentage rate for finance charges and, if
the rate may vary, a statement to that effect and of the circumstances under which the rate
may increase and whether there are any limitations on any such increase, as well as the
effects of any such increase; the conditions under which a finance charge may be imposed,
including the time period within which any credit extended may be repaid without incurring a
finance charge; whether any annual fee is charged and the amount of any such fee; and
whether any other charges or fees may be assessed, the purposes for which they are
assessed, and the amounts of any such charges or fees.
New Yolk Resid€nts, A consumer report may be ordered in connection with your application. Upon your roquest, we will inform
you whether or not a report was ordered. lf a report was ordered, we will tell you the name and address of the consumer
reporting agency that provided the report. Subsequent reports may be ordered or utilized in connection with an update. renewal
or extension of credit for which you have applied,
Ohio Residents, The Ohio laws against discrimination require all creditors make credit equally available to all creditworthy
customers, and that credit reporting agencies maintain separate credit histories on each individual upon request. The Ohio Civil
Rights Commission administers compliance with this law.
Any person who, with intent to defraud or knowing that he is facilitating a fraud against an insurer, submits an application or
files a claim containing a false or deceptive statement is guilty of insurance fraud.
T€xas Residents, The owner of the homestead is not required to apply the proceeds of the extension of credit to repay another
debt except debt secured by the homestead or debt to another lender.
llfisconsin R.3idents. Notice to Married Applicants. No provision of any marital property agreement, unil6teral statement under
Wisc, Statutes 5766,59 or a court decree under Wisc. Statutes 6766.70 adversely affects the interest of the lender unless the
lender. prior to the time the credit is granted. is furnished a copy of the agreement, statement or decree or has actual
knowledge of the adverse provision when the obligation to the lender is incurred.
For married Wisconsin Residents. The credit being applied for, if granted, will be incurred in the interest of my marriage or family.
I understand the creditor may be required by law to give nolice of this transaction to my spouse.
12.
Univ.rs.l Crsdh ADDlicarion-8..1 EBt.r.
vMP@ Bant.E sisi6m.rM
woh.B Kluw.r Fi*rcialS.rvic.s
@
2009, 2012
and
uca aE 1l/1/2012
VMPC148R t1211).00
P.go 4 ot 5
t2.
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 ihat my payments on the Loan become delinquent, the Lender, its
servicers, succi;ssors or assiqins mav, in addition to anv other riohis and remedies that it mav have relatino to such delinouencv.
report my
mv name ahd
ahd account
accouni information lo one or moie
mo;e consumer
consu;er regortinq
reoortino aqencies;
aoencies; (9) ownership
oivnershio of the
thl 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,
servicers, .successors
successors or
or- assigns has made any representation or warranty, express or implied,
implied. to me
regarding the property or the condition or value
va
of the-propertv; and (11)mv transmission of this application as an "electronic
record" containing
containino my "electronic
"electronic. signature.
sionature," as those terms
aDolicable federal and/or state laws {excludino
ns are defined in aoolicable
{excludino audio
and video
ano
vtoeo recordings),
recordrnqs), or mv
my tacstmtle
facsimiTe transmission
transn
of this application conrairiing
conrairiinq a facsimile of my
mV signature,
sionature, shall be as effective. enforceable and Valid as if a paper version of thisi applrcatron
bbDlication were delivered
clelrvered containino
contarnrng my
mvbriqinal
ongrnal wfltten
written srgnature.
sionature.
srgna
Conlont. You authorize us to contact you using any of the telephone numbers listed on this Credit Application or that you
su bsequenlly. provide. us in connection with your credit account.- regardless whether the number we use is assigned to a paging
selvice, cellular telephone service, specialized mobile radio service or other radio common carrier service or any other service for
which you may be charged for the call. You further aulhorize us to contact you through the use of voice, text and email and
through the use of pre{ecorded/artificial voice messages or an automated dialing device.
Acknowledgmont. Each of-the undersigned hereby. acknowledges.th at any owner of the Loan. its servicers, successors and
assigns,. may verify or. reverify any information contained in .lhis application or obtain any information or data relating to the Loan.
lor any legrlrmate bustness purpose through anv source. Includtng a source namecl In lhrs applrcatron or a consumer reportrng
agency,
x
x
Date
Applicant's Signature
Date
Co-Applicant's Signature
lnstruction to Lender: Cross out this entire section (or instruct the applicant to do so). if this information is not rcquired by law
for this type of ctedit.
The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to
monitor the Lender's compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not
required to furnish this information, but are encouraged to do so, The law provides thal a lender may not discriminate neither on
thd basis of this information, nor on whether you choose to furnish i1, lf you furnish the information, please provid_e both ethnicity
and race. For race, you may check more than one designation. lf you do not furnish ethnicity, race. or sex, under Federal
regulations, the Lender is required to note the information on the basis of visual observation or surname. lf you do not wish to
furnish the information, olease check the box below,
I
Race: !
Amsrican Indian or Alaska Native
E
Sex:
This information
was provided:
E
D
I
do noi wish to turnish rhis in{ormation
F6male
!
asian
D
Md.
n
Race: E
American Indian or Alaska
Sex:
In a face-to-face interview
By the applicant and submitted by fax or
!
E
mail I
do not wish 10 fumish this information
Nariv6
Femald
D
Asi.n
I
Mal6
!
In a telephone interview
By the applicant and submitted via e-mail or the lnternet
Loan Origination Company's Address
l.
d. Refinance (include debts to
Other Credits (explain)
be
m. Loan amount (6xclude PMl, MlP,
Funding Fee financed)
o, Loan amount (add m & n)
p. Cash from/to Applicant
(subtract j, k, l& o from i)
For Lender's Use
E
!
n
First Lien
Second Lien
Subordinate Lien
Cost Mortgag€
Univ.r*l Cr.dit
ADDlication-ao.l
vMP@ B.nk6.6 si6t€nsrM
En .
woft.E Kluw.r FrEtur.r S.rui@6
O 2009, 2012
E
Yes
lJca,RE 11/t/2012
VMPCl4aR (12t 1l,oo
P.g. 5 ot
5