There is NO fee for mortgage assistance counseling.

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1 Supporting Document Checklist Mortgage Assistance Counseling NOTE: If you have an impairment, disability, language barrier, or otherwise require an alternative means of completing this form or accessing information about housing counseling, please talk to your housing counselor about arranging alternative accommodations. PLEASE READ ALL INSTRUCTIONS, AND ALL FORMS. All forms must be completed signed and dated. The Document Checklist on Page 2 contains a list of what is required. Please use this checklist to verify your packet is complete prior to sending it in. COPIES of your personal documentation must be provided, we cannot accept originals. If you need copies made of any of your documents, there is a charge of 10 cents per page (just like any copy or print center). ALL of the completed forms and copies of your personal documents requested on the checklist following this page must be sent in to our office a MINIMUM OF 48 HOURS PRIOR TO YOUR APPOINTMENT OR IT WILL BE RESCHEDULED. You can send the documents the following ways: choose one method only & call to verify your package was received. - BY FAX: (efax number) - BY MAIL: Partners In Charity, 86 N. Williams St. Crystal Lake IL Attn: Housing Counseling Intake Coordinator - BY - DROP OFF: between the hours of 9:30 and 5:00 pm Monday through Friday PLEASE CALL OUR OFFICE IF YOU HAVE ANY QUESTIONS: Ask for the Intake Coordinator or a Housing Counselor. Housing Counselors: Irene Magdaleno-Baez ext. 101 Anna Hill ext. 113 Chris Samuels ext. 110 There is NO fee for mortgage assistance counseling. Page 1 of 13

2 DOCUMENTATION CHECKLIST HOUSING COUNSELING MORTGAGE ASSISTANCE PLEASE NOTE: If the forms are incomplete, if you are missing a majority of the personal documentation, or if the forms are not in our office a MINIMUM of 48 hours prior to your scheduled appointment it will be rescheduled for another date. Completed Intake Packet includes the following forms: Mortgage Delinquency/Foreclosure Assistance Counseling Intake form (complete all pages, sign and date) Detailed Budget: Monthly: ALL monthly expenses to be included including credit cards, installment loans, mortgages, utilities, insurance, and all household expenses such as gasoline, cell phones, internet, cable, groceries. Even if you are not paying a certain bill please include the minimum monthly payment that is required. Certification & Authorization form Foreclosure Mitigation Counseling Agreement Partners In Charity Disclosure Statement Client/Counselor Contract Partners In Charity Counseling and No Steering Agreement Loan Modification Scam Identification & Loan Scam Reporting Form (3 pages) Personal Bank Statements for last 2 months mbusiness bank statements and P&L statement for last 6 months if self employed Signed tax returns for last 2 years, including W-2s If self employed, provide Business tax returns for last 2 years Most Recent Paycheck Stubs (for last 30 days) OR proof of income covering last 30 days - from Unemployment, SSI, other sources Provide copies of ALL most recent statements (for last month) for any debts you pay monthly including utilities: Credit Card, Installment Loan Statements, Payment Books, utility bills, cell phone, cable, internet, auto insurance, life insurance, homeowner s insurance OR bring credit report fee: $16.00 per person Photo ID: Divorce Decree (if applicable) Bankruptcy Documentation (if applicable) Alimony and Child Support Documentation (if applicable) Proof of other household income (if applicable) Most recent Mortgage Statement(s), Tax Bill and copy of Homeowners Insurance Bill Current copies of ALL monthly bills you are paying (this includes utilities, phone, cable, cell phone, auto insurance, life insurance, etc.) state issued drivers license or photo id / US passport ALL correspondence from mortgage company, attorneys Page 2 of 13

3 Client ID: Partners In Charity MORTGAGE DELINQUENCY/FORECLOSURE ASSISTANCE COUNSELING INTAKE FORM (Borrower) FIRST NAME: MIDDLE: LAST: Date of Birth: / / Age: Are you the only borrower on the loan? YES NO If no, please state who else is on the loan: ADDRESS: (street) (city) (state) (zip) SOCIAL SECURITY - - HOME PHONE: CELL PHONE: RACE: White, not of Hispanic origin Hispanic American Indian/Alaskan Native Black, Not of Hispanic origin Asian/Pacific Islander Other MARITAL STATUS: Single Married Divorced Seperated Widowed GENDER: Male Female FAMILY HOUSEHOLD SIZE: NUMBER OF DEPENDENTS: AGES OF DEPENDENTS:,,,,,,,,, Are there any non dependents living in the home? YES NO Please list non dependent & relationship Relationship: Relationship: Age: Contributes income to household? YES NO Age: Contributes income to household? YES NO Education: Below High School Diploma High School Diploma or Equivalent Two Year College Bachelor s Degree Graduate Degree PLEASE ANSWER THE FOLLOWING QUESTIONS: Veteran of the U.S. Military? YES NO Disabled? YES NO Have a disabled dependent? YES NO Have you ever filed a bankruptcy? YES NO Which type? Chapter 7 Chapter 13 When did the bankruptcy begin? If a Chapter 7, when was it discharged? If a Chapter 13, when will it be completed/paid out? Amount of trustee payment: How were you referred to us? What is the annual (yearly) household income? Are you currently employed? YES NO If no, when did your employment end? Do you receive unemployment benefits? YES NO When did U/I benefits begin? If you are currently employed, please complete the current EMPLOYMENT INFORMATION : Primary Employer: Title: Hire Date: Address: Phone: Full Time Part Time MONTHLY Gross Income BEFORE taxes: Is this amount paid: Hourly Weekly Every two weeks Twice a month Montly Secondary Employer: Title: Hire Date: Full Time Part Time MONTHLY Gross Income BEFORE taxes: Is this amount paid: Hourly Weekly Every two weeks Twice a month Montly Page 3 of 13

4 Client ID: Partners In Charity MORTGAGE DELINQUENCY/FORECLOSURE ASSISTANCE COUNSELING INTAKE FORM (Co-Borrower) FIRST NAME: MIDDLE: LAST: Date of Birth: / / Age: ADDRESS: (street) (city) (state) (zip) SOCIAL SECURITY - - HOME PHONE: CELL PHONE: RACE: White, not of Hispanic origin Hispanic American Indian/Alaskan Native Black, Not of Hispanic origin Asian/Pacific Islander Other MARITAL STATUS: Single Married Divorced Seperated Widowed GENDER: Male Female FAMILY HOUSEHOLD SIZE: NUMBER OF DEPENDENTS: AGES OF DEPENDENTS: (not already listed by borrower),,,,,,,,, Your Education: Below High School Diploma High School Diploma or Equivalent Two Year College Bachelor s Degree Graduate Degree PLEASE ANSWER THE FOLLOWING QUESTIONS: Veteran of the U.S. Military? YES NO Disabled? YES NO Have a disabled dependent? YES NO Have you ever filed a bankruptcy? YES NO Which type? Chapter 7 Chapter 13 When did the bankruptcy begin? If a Chapter 7, when was it discharged? If a Chapter 13, when will it be completed/paid out? Amount of trustee payment: How were you referred to us? Are you currently employed? YES NO If no, when did your employment end? Do you receive unemployment benefits? YES NO When did U/I benefits begin? If you are currently employed, please complete the current EMPLOYMENT INFORMATION : Primary Employer: Title: Hire Date: Address: Phone: Full Time Part Time MONTHLY Gross Income BEFORE taxes: Is this amount paid: Hourly Weekly Every two weeks Twice a month Montly Secondary Employer: Title: Hire Date: Full Time Part Time MONTHLY Gross Income BEFORE taxes: Is this amount paid: Hourly Weekly Every two weeks Twice a month Montly What is the reason that caused you to fall behind in the mortgage? (Or if not already behind, please explain the hardship you are facing and why you think you may need assistance with the mortgage and/or may fall behind in the future. Additional room to explain on page 4) Page 4 of 13

5 Client ID: Partners In Charity MORTGAGE & PROPERTY INFORMATION: Is mortgage for your primary residence? YES NO First Mortgage Company: What year did you get the mortgage? Loan number: Counselor to Complete: Fannie Mae? YES NO Freddie Mac? YES NO Type of Loan: FHA Conventional Fixed Rate Adjustable Rate Interest Only Option Arm What is the amount of the monthly payment? Does this include taxes and insurance? YES NO If no, what is the monthly amount for taxes and insurance? Are taxes current? YES NO Is there a Home Owners Association Fee? YES NO Amount of fee: HOA payments current? YES NO What is the AMOUNT past due on the mortgage? How many MONTHS past due? What year did you purchase this home? What is an estimate of its value today? Second Mortgage Company: Loan number: What is the amount of the monthly payment? Borrower Income: Gross Monthly Salary $ Alimony/Child Support $ Rental Income $ Pension Income $ Public Assistance $ Self Employment $ Unemployment $ Dependent SSI $ SSI $ Seasonal/ Other $ TOTAL $ Co - Borrower Income: Gross Monthly Salary $ Alimony/Child Support $ Rental Income $ Pension Income $ Public Assistance $ Self Employment $ Unemployment $ Dependent SSI $ SSI $ Seasonal/ Other $ TOTAL $ DEBTS/LIABILITIES Current Balance Monthly Payment Who's debt? Borrower or co-borrower? Borrower Signature: Date: Co - Borrower Signature: Date: Page 5 of 13

6 Client ID: Partners In Charity Hardship Explanation: Signature: Date: Signature: Date: Page 6 of 13

7 Detailed Budget: MONTHLY Borrower: Property: Loan# Housing -Primary Residence Monthly Pmt 1st Mortgage 2nd Mortgage H.O. Insurance included in payment? YES NO Property Taxes included in payment? YES NO Home Owners Association Loans/Credit Cards Monthly Pmt Housing - 2nd property Monthly Pmt Auto Loan 1 Address: Auto Loan 2 Loan Servicer: Installment Loan 1st Mortgage Installment Loan 2nd Mortgage Student Loan H.O. Insurance Student Loan Property Taxes Credit Card 1 Home Owners Association Credit Card 2 Are taxes and insurance included in payment? Y N Credit Card 3 Credit Card 4 Housing - 3rd Property Monthly Pmt Credit Card 5 Living Expenses Cable Address: Loan Servicer: 1st Mortgage 2nd Mortgage H.O. Insurance Property Taxes Home Owners Association Internet Are taxes and insurance included in payment? Y N Cell Phone Cell Phone Assets - 1 Phone - Land Line Checking Account 1 Groceries Checking Account 2 Trash Removal Savings Account/Money Market Water/Sewer CDs Electricity Cash on Hand Heat Other Real Estate Medical / Prescriptions TOTAL Gasoline Clothing Assets -2 Daycare Life & Health Insurance (OUT OF POCKET) Life Insurance Health Insurance TOTAL ALL EXPENSES Auto 1 - value Auto 2 - value TOTAL Signature: Date: Page 7 of 13

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13 Client/Counselor Contract Partners In Charity and its counselors agree to provide the following services: Development of an action plan based on the client s goal Analysis of the mortgage default, including the amount and cause of default Presentation and explanation of reasonable options available to the homeowner Assistance communicating with the mortgage servicer and other creditors Timely completion of promised action Explanation of the foreclosure process Identification of assistance resources & Referrals to needed resources Confidentiality, honesty, respect and professionalism in all services I/We, agree to the following terms of service: I/We will always provide honest and complete information to my/our counselor, whether verbally or in writing. I/We will provide all necessary documentation and follow-up information within the timeframe requested. I/We will be on time for appointments and understand that if we are late for an appointment, the appointment will still end at the scheduled time. I/We will call within 6 hours of a scheduled appointment if I/we will be unable to attend an appointment. I/We will contact the counselor about any changes in our situation immediately. I/We understand that breaking this agreement may cause the counseling organization to sever its service assistance to me/us. THIS INCLUDES NOT PROVIDING THE REQUESTED INFORMATION IN A TIMELY MANNER. I/We will understand that I must call to schedule an appointment if I need further assistance and that I understand Partners In Charity does not allow walk-ins. Name Date Name Date Counselor Date Page 13 of 13

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