Foreign Born. Female Head of Household Female. Male. Native Hawiian/Pacific Islander Native American/Alaskan Native

Transcription

1 MORTGAGE DELINQUENCY INTAKE FORM Please fill out this application as completely as possible. If you have questions or need assistance, please call Windham & Windsor Housing Trust's Brattleboro office at (802) or the Springfield Office at (802) Please print neatly and be sure to sign the last page. Customer: Street Address: Town, State, Zip Mailing Address: (If different) Phone (w): Phone (h/c): Social Security: Birth Date: How did you hear about us? Co-Customer: Street Address: Town, State, Zip Mailing Address: (If different) Phone (w): Phone (h/c): Social Security: Birth Date: Government Monitoring Information: Customer: Co-Customer: Handicapped/Disabled Handicapped/Disabled Veteran Active Military Veteran Active Military Foreign Born Foreign Born Marital Status: Marital Status: Married Single Divorced Married Single Divorced Civil Union Widowed Separated Civil Union Widowed Separated Gender: Gender: Female Head of Household Female Head of Household Female Female Male Head of Household Male Head of Household Male Male Ethnicity: Ethnicity: Hispanic or Latino Not Hispanic or Latino Hispanic or Latino Not Hispanic or Latino Race: Race: White White Black/African American Black/African American Native Hawiian/Pacific Islander Native Hawiian/Pacific Islander Native American/Alaskan Native Native American/Alaskan Native Asian Asian Black/African American and White Black/African American and White American Indian/Alaskan Native and Black American Indian/Alaskan Native and Black Multi Racial Multi Racial I do not wish to provide this information I do not wish to provide this information

2 Government Monitoring Information (continued) Household Type: Two or More Unrelated Adults Single Adult Married with Children Married without Children Education (Customer): No High School Diploma High School Diploma or equivalent Two Year College Degree Bachelor s Degree Master s Degree Above Master s Degree Education (Co-Customer): No High School Diploma High School Diploma or equivalent Two Year College Degree Bachelor s Degree Master s Degree Above Master s Degree Family Composition and Current Income: How long have you lived at your current residence? Family/Household Size: How many dependents? What ages are they? Are there any non-dependents who will be living in the home? Yes No If yes, list below: Relationship Age Relationship Age Current Employment Information: Customer Primary Employer: Name of Firm: Address: Co-Customer Primary Employer: Name of Firm: Address: Phone: Hire Date: Title/Position: Income Information: Type of Income Salary Income (gross, before taxes) Self-employment Income (net) Unemployment Income Alimony/Child Support Income Public Assistance Income Seasonal Employment Rental Income Social Security Income Dependent SSI Income Disability Income Pension Income Customer Monthly Amount Phone: Hire Date: Title/Position: Total Monthly Income $ $ Co-Customer Monthly Amount License No NMLS No

3 Can you document your child support/alimony income? Yes No How long will it continue? If your child or a family member receives SSI, how many more years will the payments continue? If you receive disability income, is it for a permanent disability? Yes No Regarding seasonal employment, have you worked in this field for two years or more? Yes No If any adult household member is unemployed or has been employed for less than 2 years at current job, please provide the following information: Amount of Income Name Previous Employment/Position Dates Employed (before tax) Property Information: 911 address of property (if different from mailing) Names of all co-owners on the property Type of home: Single family home Duplex Multi-family (3+ units) Number of acres with the property? Mobile home on own land Are you living in the property now? Yes No What was the original purchase price? $ Estimate of current value? $ How long have you owned the home? Major repairs needed: Assets: Checking/savings accounts (both customer and co-customer) Mobile Home on leased land Name Name of Institution Type of Account Average Balance Assets: Real Estate, cars, stocks, bonds, CD's, Trust Funds, Retirement Accounts Inheritances, Lump Sum Payments or any asset worth more than $5,000. Name Asset Estimated Value License No NMLS No

4 Monthly Expenses Worksheet (Please fill out this form completely) Housing Education Mortgage Tuition Heating (gas or oil) Books, papers, and supplies Electricity Newspapers and magazines Water or sewage Lessons (sports, dance, music) Telephones (landlines and cell phones) Homeowners insurance (if not included in mortgage) Gifts Birthdays Trash service Major Holidays House maintenance and furnishings Plowing /Lawn care Real Estate Taxes (if not already in Personal Fitness or health club mortgage) Barber or beauty shop mortgages Toiletries Children s allowances Transportation Tobacco products Gas Beer, wine or liquor Car payment Car payment Entertainment Car insurance Movies, sporting events, concerts, etc. Car inspections Video rentals Car repairs and maintenance Internet service License plates and registration fees Cable/satellite TV Public transportation or taxi Restaurant and take-out meals Gambling and lottery tickets Food Social club Groceries Vacations/Trips School lunches Hobbies or crafts Work-related (lunches and snacks) Miscellaneous Insurance Checking account and money order fees Health (medical and dental, if not Pet care and supplies payroll deducted) Postage Life Disability Medical Debts Doctor Student loan Dentist Credit card (monthly minimum) Prescriptions/out-of-pocket/co-pays Credit card (monthly minimum) Medical bills Childcare Personal loan Childcare or baby sitters Child support or alimony Savings Savings Clothing Clothing Laundry and dry cleaning Donations Religious or charity Total All Monthly Expenses $ License No NMLS No

5 Mortgage Information Is your mortgage payment past due? Yes No If yes, how many months past due? Are your property taxes current? Yes No If not, how much do you owe? $ Are your property taxes escrowed? Yes No Is your homeowner s insurance current: Yes No If not, how much do you owe? $ Is your homeowner s insurance escrowed? Yes No Are there other liens on the property? Yes No 1 st Mortgage Lender: Account No. Balance of Debt $ Payment Amount: Interest Rate 2 nd Mortgage Lender: Account No. Balance of Debt $ Payment Amount: Interest Rate Have you contacted your lender to request assistance in resolving the delinquency? Yes No What is the reason(s) for delinquency or default? Are there circumstances that you expect will change in the near future that will increase your household income? Have you been foreclosed on or declared bankruptcy in the last 7 years? Explain: Affirmation and Signature(s): I/We affirm that all of the answers given in this application are correct. I/We understand that the information in this application will be held in confidence and used solely for the purpose of this program. Applicant Signature Date Co-Applicant Signature Date License No NMLS No

6 Counseling Agreement Housing Counseling Disclosure Agreement 1. I understand that Windham & Windsor Housing Trust provides various types of housing counseling as outlined in the attached agency brochure. I voluntarily seek such counseling, after which I will receive recommendations for handling my housing needs, possibly including referrals to other agencies, as appropriate. 2. I understand that Windham & Windsor Housing Trust receives funds from various sources and as a result of the requirements of such funding sources Windham & Windsor Housing Trust may be required to share some of my personal information with these sources as part of program monitoring, compliance and evaluation. I authorize the sharing by Windham & Windsor Housing Trust of such information with its funding sources. 3. I further give permission for Windham & Windsor Housing Trust and/or their agents to follow-up with me for purposes of program evaluation, and to share with other representatives of Windham & Windsor Housing Trust, and with outside agencies or entities, information obtained during these discussions if required or necessary. 4. I may be referred to other services or agencies, as appropriate, as they may be able to assist me with issues that have been identified. I understand that I am not obligated to use any of the services or agencies that have been or may be offered to me. 5. Counselors may answer questions and provide information but will not give legal advice. If I want legal advice I understand I must work with an attorney or other individual qualified to provide legal advice. 6. I understand that the Windham & Windsor Housing Trust and its agents provide information and education on various loan products, housing programs or other issues and I further understand that the counseling I receive in no way obligates me to choose any of the particular products, housing products or any recommendation whatsoever. Windham & Windsor Housing Trust has no financial relationship with the industry partners. 7. I understand that Windham & Windsor Housing Trust and its counselors are providing information only. And that I may use such information in whatever manner I choose and that Windham & Windsor Housing Trust and its counselors are NOT acting in a fiduciary capacity and that any actions or choices I make are mine, and mine alone. Applicant Signature Date Co-Applicant Signature Date License No NMLS No

7 PRIVACY POLICY AND PRACTICES Windham & Windsor Housing Trust values your trust. Protecting your confidential information is important to us. This notice describes our policy regarding the collection and disclosure of personal information. Windham & Windsor Housing Trust does not sell or share any personal information with commercial companies for the purpose of marketing their products to you. What Information We Collect Personal information means information that identifies an individual and is not otherwise publicly available information. This includes personal financial information, such as credit history, income, employment history, financial assets, bank account information, financial debts, social security number, and other information you provide on an intake form or loan application. We collect the personal information in order to provide financial fitness, counseling, counseling to prepare you for applying for a home mortgage from a conventional lender, counseling to prevent foreclosure, and our own lending for down payment, closing costs, home rehab, or other purposes related to home purchase or foreclosure prevention. Restrictions on Disclosure of Personal Information In general, Windham & Windsor Housing Trust discloses personal information only when necessary to provide services to you, or when allowed by law. We may disclose the following kinds of personal information about you: Information we receive from you on applications for a loan or other product or service, such as name, address, telephone number, social security number, assets and income; Information about your transactions with us, such as your loan balance, payment history and parties to your transactions Information we receive from third parties such as credit bureaus, including information about your credit worthiness and your credit history We may disclose your personal information to the following types of unaffiliated third parties: Financial service providers, such as companies engaged in providing home mortgages, reverse mortgages, or home equity loans; service providers with whom we may coordinate efforts in order to make efficient use of resources, such as SEVCA (Weatherization), VHCB Lead Abatement, VT Center for Independent Living, Rural Development USDA or other nonprofit community resources; third parties when the information is provided to help complete a transaction initiated by you, such as reporting a payoff on a loan, or to otherwise administer our business, and third parties who are involved in program review, auditing, research, or oversight purposes. License No NMLS No

8 We may disclose personal information about you to third parties as permitted by law, such as auditors in connection with a financial audit of us, to government entities, in response to subpoenas, and to credit bureaus. In material intended for public distribution, such as newspaper articles, Windham & Windsor Housing Trust publications, press releases, or reports to funding sources, it is sometimes useful to illustrate our services by highlighting our work with a family or individual. In those cases we will specifically seek your permission to use any personal information. Medical Information We will not use or share personally identifiable medical information about you for any purpose other than that which is authorized by you. Protecting the Confidentiality of Your Personal Information All Windham & Windsor Housing Trust employees are required to use strict standards of care regarding the confidentiality of your personal information as outlined in Personnel Policies. Employees not adhering to our policies are subject to disciplinary action. We maintain physical and electronic security procedures to safeguard the confidentiality and integrity of personal information in our possession and to guard against unauthorized access. Our safeguards comply with federal regulations to guard your personal information. If You Want More Information If you have any questions regarding our Privacy Policy, please contact the Director of the HomeOwnership Center at (802) or write to Windham & Windsor Housing Trust, 68 Birge Street, Brattleboro VT By signing below, I/we affirm that we have read and understand the above Privacy Policies. Applicant Signature Date Co-Applicant Signature Date License No NMLS No

9 AUTHORIZATION TO RELEASE INFORMATION Loan # Name(s) of Person(s) applying for technical or financial assistance: Address: Telephone Number(s): I authorize the Windham & Windsor Housing Trust HomeOwnership Center to: Social Security Number: Social Security Number:_ (a) pull my/our credit report to review my/our credit file for housing counseling in connection with my pursuit on a loan to purchase real property; (b) pull my/our credit report and review my/our credit file for informational inquiry purposes; and (c) obtain a copy of the HUD-1 Settlement Statement, Appraisal, and Real Estate Note(s) when I purchase a home, from the lender who made me/us a loan and/or the title company that closed the loan. I hereby authorize my mortgage lender to release to the WWHT HomeOwnership Center a copy of my HUD 1 settlement statement to help the center meet its reporting and statistical requirements. My signature below authorizes the release of financial information to the WWHT HomeOwnership Center, any credit reporting agency or any mortgage lender. It also authorizes the WWHT HomeOwnership Center to share information with VHFA and NeighborWorks for the purpose of evaluating the success of the HomeOwnership program. This information includes, but is not limited to: income verification of all family members, credit report, debts, or information on the property I wish to purchase or which I already own. Authorization is further granted to use a photo static reproduction of this form if required to obtain any information necessary to complete my consumer credit report. As a client of the WWHT HomeOwnership Center, I understand that, should I have difficulty in paying my mortgage, I have the option of contacting the HomeOwnership Center for assistance in working with my lender to prevent the loss of my home. I hereby authorize the loan servicer(s) or assigned attorney to release any information on my loan and financial situation to Windham & Windsor Housing Trust for purposes of saving my home or resolving a problem related to my loan. I have received a copy of WWHT s Privacy Policy All information contained and submitted in support of this application is true and complete to the best of my knowledge. Borrower Signature: Date: Please Print Name: Borrower Signature: Date: Please Print Name: License No NMLS No