Form 12927-1 Home Equity and Homeowner Loan Application

Form 12927-1 is a U.S. Senate form also known as the "Home Equity And Homeowner Loan Application". The latest edition of the form was released in July 1, 2009 and is available for digital filing.

Download a fillable PDF version of the Form 12927-1 down below or find it on U.S. Senate Forms website.

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United States Senate
HOME EQUITY AND
TION
Federal Credit Union
HOMEOWNER LOAN APPLICA
DATE
APPLICANT ACCOUNT NO.
CO-APPLICANT ACCOUNT NO.
Amount Requested:
Line of Credit $ ________________
Closed End $ ________________
Purpose:
Approximate Value:
Property Type:
Single Family Home
Condominium
Townhouse
Other
Property Address:
MARRIED APPLICANTS may apply for a separate account. Check the type of credit account for which you wish to apply.
Individual Credit – You must complete the applicant section about yourself and the other section about your spouse if: (1) You live in a community property state
(AK, AZ, CA, ID, LA, NM, NV, P.R., TX, WA, WI); (2) your spouse will use the account; or (3) you are relying on your spouse’s income as a source of repayment.
Joint Credit – If you are applying for a joint account or an account that you and another person will use, you must complete the applicant and other section.
________ ________ Initial here if you intend to apply for Joint Credit
APPLICANT
SPOUSE
CO-APPLICANT
CO-SIGNER
Complete for secured credit or if you live in a community property state.
Complete for secured credit or if you live in a community property state.
MARRIED
SEPARATED
UNMARRIED (Single, Divorced, Widowed)
MARRIED
SEPARATED
UNMARRIED (Single, Divorced, Widowed)
FIRST NAME
INITIAL
LAST NAME
FIRST NAME
INITIAL
LAST NAME
SOCIAL SECURITY NO.
DRIVER’S LICENSE NO. & STATE
BIRTH DATE
SOCIAL SECURITY NO.
DRIVER’S LICENSE NO. & STATE
BIRTH DATE
HOME PHONE NO.
NO. OF DEP.
AGE OF DEPENDENTS OTHER
HOME PHONE NO.
NO. OF DEP.
AGE OF DEPENDENTS OTHER
MOTHER’S MAIDEN NAME
E-MAIL ADDRESS
RELATIONSHIP TO APPLICANT
CURRENT STREET ADDRESS
APT. NO.
SINCE
CURRENT STREET ADDRESS
APT.
SINCE
NO.
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
FORMER STREET ADDRESS
YEARS THERE
FORMER STREET ADDRESS
YEARS THERE
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
PERSONAL REFERENCE
RELATIONSHIP
PERSONAL REFERENCE
RELATIONSHIP
EMPLOYMENT & INCOME
If you are self-employed, attach a financial statement and your most recent income tax return.
CURRENT EMPLOYER
HIRE DATE
CURRENT EMPLOYER
HIRE DATE
WORK PHONE NO.
WORK PHONE NO.
POSITION
MONTHLY NET INCOME
POSITION
MONTHLY NET INCOME
$
$
FORMER EMPLOYER (if current less than 2 years)
FORMER EMPLOYER (if current less than 2 years)
OTHER INCOME
You need not list income from alimony, child support or separate maintenance unless you wish it considered for purposes of granting this credit.
SOURCE OF OTHER INCOME
FREQUENCY
MONTHLY INCOME
SOURCE OF OTHER INCOME
FREQUENCY
MONTHLY INCOME
1.
$
1.
$
2.
$
2.
$
ASSETS & DEPOSITS
Please check the appropriate box below. INDICATE:
A - Applicant
OR
C - Spouse/Co-Applicant
CURRENT
CURRENT
CHECK ONE “
CHECK ONE “
FINANCIAL INSTITUTION
FINANCIAL INSTITUTION
BALANCE
BALANCE
A
C
TYPE
A
C
TYPE
$
$
$
$
$
$
AUTO 1
YEAR
MAKE
VALUE
AUTO 1
YEAR
MAKE
VALUE
$
$
REAL ESTATE
VALUE
OTHER ASSETS
VALUE
$
$
2004 ConmarSystems, Inc., Peachtree City, GA 30269 - Rev. 6/09 EFORM 12927-1
ARD 7/09
United States Senate
HOME EQUITY AND
TION
Federal Credit Union
HOMEOWNER LOAN APPLICA
DATE
APPLICANT ACCOUNT NO.
CO-APPLICANT ACCOUNT NO.
Amount Requested:
Line of Credit $ ________________
Closed End $ ________________
Purpose:
Approximate Value:
Property Type:
Single Family Home
Condominium
Townhouse
Other
Property Address:
MARRIED APPLICANTS may apply for a separate account. Check the type of credit account for which you wish to apply.
Individual Credit – You must complete the applicant section about yourself and the other section about your spouse if: (1) You live in a community property state
(AK, AZ, CA, ID, LA, NM, NV, P.R., TX, WA, WI); (2) your spouse will use the account; or (3) you are relying on your spouse’s income as a source of repayment.
Joint Credit – If you are applying for a joint account or an account that you and another person will use, you must complete the applicant and other section.
________ ________ Initial here if you intend to apply for Joint Credit
APPLICANT
SPOUSE
CO-APPLICANT
CO-SIGNER
Complete for secured credit or if you live in a community property state.
Complete for secured credit or if you live in a community property state.
MARRIED
SEPARATED
UNMARRIED (Single, Divorced, Widowed)
MARRIED
SEPARATED
UNMARRIED (Single, Divorced, Widowed)
FIRST NAME
INITIAL
LAST NAME
FIRST NAME
INITIAL
LAST NAME
SOCIAL SECURITY NO.
DRIVER’S LICENSE NO. & STATE
BIRTH DATE
SOCIAL SECURITY NO.
DRIVER’S LICENSE NO. & STATE
BIRTH DATE
HOME PHONE NO.
NO. OF DEP.
AGE OF DEPENDENTS OTHER
HOME PHONE NO.
NO. OF DEP.
AGE OF DEPENDENTS OTHER
MOTHER’S MAIDEN NAME
E-MAIL ADDRESS
RELATIONSHIP TO APPLICANT
CURRENT STREET ADDRESS
APT. NO.
SINCE
CURRENT STREET ADDRESS
APT.
SINCE
NO.
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
FORMER STREET ADDRESS
YEARS THERE
FORMER STREET ADDRESS
YEARS THERE
CITY
STATE
ZIP CODE
CITY
STATE
ZIP CODE
PERSONAL REFERENCE
RELATIONSHIP
PERSONAL REFERENCE
RELATIONSHIP
EMPLOYMENT & INCOME
If you are self-employed, attach a financial statement and your most recent income tax return.
CURRENT EMPLOYER
HIRE DATE
CURRENT EMPLOYER
HIRE DATE
WORK PHONE NO.
WORK PHONE NO.
POSITION
MONTHLY NET INCOME
POSITION
MONTHLY NET INCOME
$
$
FORMER EMPLOYER (if current less than 2 years)
FORMER EMPLOYER (if current less than 2 years)
OTHER INCOME
You need not list income from alimony, child support or separate maintenance unless you wish it considered for purposes of granting this credit.
SOURCE OF OTHER INCOME
FREQUENCY
MONTHLY INCOME
SOURCE OF OTHER INCOME
FREQUENCY
MONTHLY INCOME
1.
$
1.
$
2.
$
2.
$
ASSETS & DEPOSITS
Please check the appropriate box below. INDICATE:
A - Applicant
OR
C - Spouse/Co-Applicant
CURRENT
CURRENT
CHECK ONE “
CHECK ONE “
FINANCIAL INSTITUTION
FINANCIAL INSTITUTION
BALANCE
BALANCE
A
C
TYPE
A
C
TYPE
$
$
$
$
$
$
AUTO 1
YEAR
MAKE
VALUE
AUTO 1
YEAR
MAKE
VALUE
$
$
REAL ESTATE
VALUE
OTHER ASSETS
VALUE
$
$
2004 ConmarSystems, Inc., Peachtree City, GA 30269 - Rev. 6/09 EFORM 12927-1
ARD 7/09
Be sure to list all open accounts with or without a balance. Attach separate sheet if necessary
CREDIT INFORMATION
A - APPLICANT
C - SPOUSE/CO-APPLICANT
D - DEBTS TO BE PAID OFF
CHECK ONE
MONTHLY
LIST ALL OBLIGATIONS INCLUDING CREDIT UNION LOANS
ACCOUNT NUMBER
BALANCE
PAYMENTS
A
C
D
APPLICANT
CO-APPLICANT
APPLICANT
CO-APPLICANT
PLEASE INDICATE: A - Applicant
C - Co-Applicant
PLEASE INDICATE: A - Applicant
C - Co-Applicant
YES
NO
YES
NO
YES
NO
YES
NO
Have you ever filed a petition for bankruptcy?
Is income listed likely to be reduced in the next two years?
1.
5.
Date:
Have you ever had any auto, or furniture repossessed or
Have you ever had credit in any other name?
2.
6.
property foreclosed upon?
What Name?
Date:
Are you a co-borrower or co-signer of any loan or lease?
Have you any suits pending, judgments filed, alimony or
3.
7.
For Whom?
child support awards against you?
Where?
4.
Do you have any past due bills?
8.
Do you pay child support or alimony?
INFORMATION FOR GOVERNMENT MONITORING PURPOSES
NOTE: If proceeds are to be used for Home Improvement please complete this section.
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 that a lender may discriminate neither on the basis of this information, nor on whether you choose to furnish it. If you furnish the
information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under
Federal regulations, this lender is required to note the information on the basis of visual observation or surname. If you do not wish to furnish the 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:
I do not wish to furnish this information
Ethnicity
Hispanic or Latino
NOT Hispanic or Latino
Ethnicity
Hispanic or Latino
NOT Hispanic or Latino
Race:
American Indian or
Asian
Black or African
Race:
American Indian or
Asian
Black or African
Alaskan Native
American
Alaskan Native
American
Native Hawaiian or
White
Native Hawaiian or
White
Other Pacific Islander
Other Pacific Islander
Sex:
Female
Male
Sex:
Female
Male
Interviewer’s Name (print or type)
Name and Address of Interviewer’s Employer
To be Completed by interviewer
This application was taken by:
Face-to-Face interview
Interviewer’s Signature
Date (Name)
(Address)
by Mail
by Telephone
by Internet
Interviewer’s Phone Number (incl. area code)
(City)
(State)
(Zip)
SIGNATURES
The undersigned applies for the credit indicated in this application to be secured by a mortgage or deed of trust on the property described herein, and
represents that the property will not be used for any illegal or restricted purpose, and that all statements made in this application are true and are made for
the purpose of obtaining the loan. The Credit Union or its agent is authorized to investigate your creditworthiness, employment history, and to obtain a credit
report and to answer questions about their credit history with you. You understand that any false or misleading statements in your application may cause any
loan to be in default. You agree that this application shall be the Credit Union’s property whether or not this application is approved. The USA Patriot Act
requires that we obtain, verify, and record information that identifies each person who opens an account.
APPLICANT SIGNATURE
DATE
OTHER APPLICANT
DATE
X
X
2004 ConmarSystems, Inc., Peachtree City, GA 30269 - Rev. 6/09 EFORM 12927-1
Member Request
To Provide Homeowners Policy
Homeowners Insurance Company
Name of Insurance Agent
Insurance Company Address
City
State
Zip
Homeowner’s Policy Number
RE:
Dear Agent:
Please accept my permission to provide a copy of the homeowners policy listed above
outlining all corresponding coverage, limits and deductibles to:
UNITED STATES SENATE
FEDERAL CREDIT UNION
Loan Services
P.O. Box 77920
Washington, DC 20013-8920
Additionally, please provide a written endorsement naming the UNITED STATES
SENATE FEDERAL CREDIT UNION as _____ First _____ Second ____ Third mortgagor.
Notify the Credit Union of any cancellation. Thank you.
X
X
Name(s) – please print
Address
City
State
Zip
ConmarSystems, Inc., Peachtree City, GA - EFORM 52595-B

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