Real Estate Loan Application

REAL ESTATE LOAN INFORMATION FORM

You may answer questions highlighted in green requiring a "Check Mark" before you print out the application for final completion and signature. Then simply call or stop by the Iberville Bank branch nearest you, to speak to one of our loan officers. For more information, call us at 1-800-299-2091, or email us.

This application is designed to be completed by the applicant(s) with the lender's assistance. Applicants should complete this form as "Borrower" or "Co-Borrower," as applicable. Co-Borrower information must also be provided (and the appropriate box checked when 1) the income assets of a person other than the "Borrower" (including the Borrower's spouse) will be used as a basis for loan application or 2) the income or assets of the Borrower's spouse will not be used as a basis for loan qualification, but his or her liabilities must be considered because the Borrower resides in a community property state, the security property is located in a community property state, or the Borrower is relying on the other property located in a community property state as a basis for repayment of the loan.

PLEASE READ OUR "USA PATRIOT ACT" NOTICE

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PLEASE READ OUR PRIVACY STATEMENT BEFORE COMPLETING THIS APPLICATION

I. TYPE OF MORTGAGE AND TERMS OF LOAN
Mortgage Applied for: VA Conventional FHA FmHA Other_________________
Amount: $_____________	Interest Rate: _____%	No. of Mos.	Lender Case No.	Agency Case No.
Amortization Type: Fixed Rate GPM Other:_________________ ARM (type):__________________

II. PROPERTY INFORMATION AND PURPOSE OF LOAN
Subject Property Address (street, city, state, ZIP code)
Legal Description of Subject Property (attach if necessary)					No. of Units
					Year Built
Purpose of Loan: Purchase Construction Refinance Construction-Permanent Other:_________________
Property will be: Primary Residence Secondary Residence Investment
*Complete next line if construction or construction-permanent loan.*
Yr. Acquired	Original Cost $	Existing Liens $	(a) Present Value $	(b) Improvements $	Total (a+b) $
*Complete next line if this is a refinance loan.*
Yr. Acquired	Original Cost $	Existing Liens $	Purpose of Refinance
Describe Improvements: made to be made Cost $:_______________________
Title will be held in what Name(s)			Manner in which Title will be held:
Source of Down Payment, Settlement Charges and/or Subordinate Financing
Estate will be held in: Fee Simple Leasehold (expiration date:________________ )

III. BORROWER INFORMATION
Name (include Jr. or Sr. if applicable)	Age	School Yrs.____
Social Security Number	Home Phone
Marital Status: Married Unmarried Separated	Dependents (other than listed by Co-Borrower): Number:_____ Ages:_____________
Present Address	Number of Years at this address: Years______ Own Rent
Former Address if less than 2 years at present address	Number of Years at this address: Years______ Own Rent

IIIa. CO-BORROWER INFORMATION
Name (include Jr. or Sr. if applicable)	Age	School Yrs.____
Social Security Number	Home Phone
Marital Status: Married Unmarried Separated	Dependents (other than listed by Co-Borrower): Number:_____ Ages:_____________
Present Address	Number of Years at this address: Years______ Own Rent
Former Address if less than 2 years at present address	Number of Years at this address: Years______ Own Rent

IV. BORROWER EMPLOYMENT INFORMATION
Name and Address of Employer	Years in this profession?_____ Years on this job? __________ Self-employed
Position/Title	Type of Business
If employed in current position for less than 2 years or if currently employed in more than one position, please complete the following:
Name and Address of Employer	Dates (from-to): ________________
	Monthly Income: $______________
	Self-employed
Position/Title/Type of Business	Business Phone
Name and Address of Employer	Dates (from-to): ________________
	Monthly Income: $______________
	Self-employed
Position/Title/Type of Business	Business Phone

IVa. CO-BORROWER EMPLOYMENT INFORMATION
Name and Address of Employer	Years in this profession?_____ Years on this job? __________ Self-employed
Position/Title	Type of Business
If employed in current position for less than 2 years or if currently employed in more than one position, please complete the following:
Name and Address of Employer	Dates (from-to): ________________
	Monthly Income: $______________
	Self-employed
Position/Title/Type of Business	Business Phone
Name and Address of Employer	Dates (from-to): ________________
	Monthly Income: $______________
	Self-employed
Position/Title/Type of Business	Business Phone

V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION
GROSS MONTHLY INCOME				MONTHLY HOUSING EXPENSE
Item	Borrower	Co-Borrower	Total	Item	Total
Base Income	$	$	$	Rent	$
Overtime				First Mortgage (P&L)
Bonuses				Other Financing
Commissions				Hazard Insurance
Dividends/Interest				Real Estate Taxes
Net Rental Income				Mortgage Insurance
Other* (See notice under Describe Other Income below)				Homeowner Assn. Dues
Other* (See notice under Describe Other Income below)
Total	$	$	$		$

DESCRIBE OTHER INCOME
*NOTICE: Alimony, child support, or separate maintenance income need not be revealed if the Borrower or Co-Borrower chooses not to have it considered as a basis for repaying this loan.
B/C	Item	Monthly Amount
		$

VI. ASSETS AND LIABILITIES
Assets	Cash or Market Value
List checking and savings accounts below
Name and address of Bank, S&L, or Credit Union
Acct. No.	$
Name and address of Bank, S&L, or Credit Union
Acct. No	$
Name and address of Bank, S&L, or Credit Union
Acct. No.	$
Name and address of Bank, S&L, or Credit Union
Acct. No.	$
Stocks & Bonds (Company name/number & description)	$
Life Insurance net cash value Face amount: $__________________	$
Subtotal Liquid Assets	$
Real Estate owned (enter market value from schedule of real estate owned)	$
Vested interest in retirement fund	$
Net worth of business(es) owned (attach financial statement)	$
Automobiles owned (make and year)	$
	$
	$
Other Assets (itemize)	$
Total Assets a.	$

Liabilities 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.

Liabilities		Monthly Payment	Unpaid Balance
Name and address of Company		$	$
Acct. No.
Name and address of Company		$	$
Acct. No.
Name and address of Company		$	$
Acct. No.
Name and address of Company		$	$
Acct. No.
Name and address of Company		$	$
Acct. No.
Name and address of Company		$	$
Acct. No.
Alimony/Child Support/Separate Maintenance Payments Owed to:		$
Job Related Expense (child care, union dates, etc.)		$
Total Monthly Payments		$
Net Worth (a minus b)	$	Total Liabilities b.	$

List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s):
Alternate Name	Creditor Name	Account Number
__________________________________________________________________________
__________________________________________________________________________

VII. DETAILS OF TRANSACTION
a. Purchase Price	$
b. Alterations, improvements, repairs
c. Land (if acquired separately)
d. Refinance (incl. debts to be paid off)
e. Estimated prepaid items
f. Estimated closing costs
g. PMI, MIP, Funding Fee
h. Discount (if Borrower will pay)
i. Total Costs (add items a through h)	$
j. Subordinate Financing
k. Borrower's closing costs paid by Seller
l. Other Credits (explain)
m. Loan amount (exclude PMI, MIP, Funding Fee Financed
n. PMI,MIP, Funding Fee financed
o. Loan amount (add m&n)
p. Cash from/to Borrower (subtract j,k,l & o from i)

VIII. DECLARATIONS
If you answer "yes" to any questions a through i, please explain.	B Yes No		C Yes No
a. Are there any outstanding judgements against you?
b. Have you been declared bankrupt with the past 7 years?
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 law suit?
e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgement? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, education loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee. If "Yes," give details, including date, name and address of Lender, FHA or VA case number, if any, and reasons for the action.)
f. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? If "Yes," give details as described above.)
g. Are you obligated to pay alimony, child support, or separate maintenance?
h. Is any part of the down payment borrowed?
i. Are you a co-maker or endorser on a note?
j. Are you a U.S. citizen?
k. Are you a permanent resident alien?
l. Do you inted to occupy the property as your primary residence?
m. Have you had ownership interest in a property in the last 3 yrs.? (1) What type of property did you own? Prinicpal Residence (PR), Second Home (SH), or Investment Property (IP) (2) How did you hold title to the home? Solely (S), jointly with your spouse (SP), or jointly with another person (O)	__ __	__ __	__ __	__ __

IX. ACKNOWLEDGMENT AND AGREEMENT
The Undersigned specifically acknowledge(s) and agree(s) that: (1) the loan requested by this application will be secured by a first mortgage or deed of trust on the property described herein; (2) the property will not be used for any illegal or prohibited purpose or use; (3) all statements made in this application are made for the purpose of obtaining the loan indicated herein; (4) occupation of the property will be indicated as above; (5) verification or reverification of any information contained in the application may be made at any time by the Lender, its agents, successors and assigns, either directly or through a credit reporting agency, from any source named in this application, and the original copy of this application will be retained by the Lender, even if the loan is not approved; (6) the Lender, its agents, successors and assigns will rely on the information contained in the application and I/we have a continuing obligation to amend and/or supplement the information provided in this application if any of the material facts which I/we have represented herein should change prior to closing; (7) in the event my/our payments on the loan indicated in this application become delinquent, the Lender, its agents, successors and assigns, may, in addition to all their other rights and remedies, report my/our name(s) and account information to a credit reporting agency; (8) ownership of the loan may be transferred to successor or assign of the Lender without prior notice to me; (9) the Lender, its agents, successors and assigns make no representations or warranties, express or implied, to the Borrower(s) regarding the property, the condition of the property, or the value of the property. CERTIFICATION: I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature(s) on this application and acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section 1001, et seq. and liability for monetary damages to the Lender, its agents, successors and assigns, insurers and any other person who may suffer any loss due to reliance upon any misrepresentation which I/we have made on this application.
______________________________________________	________________
Borrower's Signature	Date

______________________________________________	________________
Co-Borrower's Signature	Date

X. INFORMATION FOR GOVERNMENT MONITORING PURPOSES

The following information is requested by the Federal Governemtn for certain types of loans related to a dwelling, in order to montior 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 that a Lender may neither discriminate on the basis of this information, nor on whether you choose to furnish it. However, if you choose not to furnish it, under Federal regulations this Lender is required to note race and sex on the basis of visual observation or surname. if you do not wish to furnish the above information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the Lender is subject under applicable state law for the particular type of loan applied for.)

Borrower	I do not wish to furnish this information.	Co-Borrower
Race/National Origin:	American Indian or Alaskan Native Asian or Pacific Islander Black, not of Hispanic Origin Hispanic White, not of Hispanic Origin Other (specify)___________________	Race/National Origin	American Indian or Alaskan Native Asian or Pacific Islander Black, not of Hispanic Origin Hispanic White, not of Hispanic Origin Other (specify)___________________
Sex	Male Female	Sex	Male Female

To be Completed by Interviewer
This application was taken by:
     face-to-face interview
     by mail
     by telephone

Interviewer's Name (print or type)

Name and Address of Interviewer's Employer

Interviewer's Signature

Interviewer's Phone Number
(incl. area code)

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