Short Trac

sm

Short Sale Coordination Program

start@shorttrac.com
(888) 485-3432
Fax: (303) 876-1311

Short Sale
Package

Why Take the Long Road

When You Can
Take the Short Trac
 SHORT TRAC SHORT SALE COORDINATION PROGRAM
What is it?
The Short Trac Short Sale Coordination Program is designed to help the seller coordinate and facilitate communications
between the listing associate (“associate”), the lender and the closing/title agent (“closing agent”) through the short sale
process. It is a program offered by Short Trac, a TRG affiliated business. This Program is offered in an effort to assist
your clients through what can be a difficult process.

How do we use it?

Your local Short Trac representative has the Short Trac Short Sale Packet, which includes the following documents:
Realtor Submission Checklist
Borrower / Seller Short Sale Information and Document Checklist
Short Trac Short Sale Agreement (“Agreement”)
Authorization to Obtain Information
Short Sale Coordination Form
TRG’s Affiliated Business Arrangement Disclosure Statement
Affidavit of Arms’ Length Transaction
Sample Hardship Letter
Sample Personal Financial Statement
Associates are encouraged to bring the short sale packet with them on listing appointments that the associate knows, or
believes may be, a short sale listing. A sample packet is attached. Associates are not expected to explain the program
but simply to deliver the materials and direct the seller to contact Short Trac with any questions. Upon receipt of an
executed Short Trac Short Sale Agreement, Short Trac will open a short sale file. Short Trac will begin coordinating
the necessary documents and compiling a completed short sale packet to submit to the lender.

Once the short sale file is opened, the associate should provide Short Trac with a copy of the fully executed Listing
Agreement and Short Sale Listing Addendum. Upon receipt of a fully executed sales contract, the associate must
provide Short Trac with a copy, including the Short Sale Contract Addendum, the most recent CMA, BPO or appraisal
for the subject property, and the escrow deposit.

Who is responsible?
Short Trac will be responsible for (a) the process of coordinating the short sale transaction; (b) reviewing the completed
short sale packet; (c) delivering the seller’s authorization to short sale lender; (d) reviewing all preliminary HUD-1s
before being sent to short sale lender; (e) submitting the short sale packet to short sale lender; (f) delivering weekly file
status updates to the Associate; (g) reviewing all approval letters (h) forwarding all approval letters to the associate and
(i) forwarding the approval letters to the closing agent to complete the closing.

Short Trac will not negotiate or attempt to negotiate anything associated with the short sale transaction.

What does it cost?

The seller will pay Short Trac a fee of $800 at closing. If closing doesn’t occur, no fee will be due. This fee is very
competitive with, if not less than, other third party companies providing a similar service.

Contact Information for Short Trac Team is as follows:

Direct Line: (888) 485-3432
Fax: (303) 876-1311
Email: start@shorttrac.com
 REALTOR’S SUBMISSION CHECKLIST

Please submit the following documentation to Short Trac:

1. Copy of the fully executed Sales Contract with all Addenda including, but not
limited to, any Short Sale Addendum to Purchase and Sale Contract.

2. Copy of the fully executed Listing Agreement and Short Sale Listing
Addendum.

3. Proof of Escrow deposit.

4. Most recent CMA or BPO for the subject property or recent appraisal.

5. Fully completed and executed Short Trac Short Sale Packet which contains:

a. Short Trac Agreement;

b. Authorization to Obtain Information (completed for each
loan/mortgage);
c. Short Sale Coordination Form (Info Sheet);
d. TRG Affiliated Business Arrangement Disclosure Statement;
e. Arms’ Length Transaction Affidavit;
f. Seller’s financial information (tax returns, W-2s, most recent pay
stubs);
g. Latest correspondence received by the homeowner from the existing
lender(s) showing who holds the mortgage and the loan number or
latest mortgage statement and any correspondence from the
homeowner’s association (if any) or their attorneys;
h. Any communications from first mortgagee/lien holder;
i. Any communications from second, third or other subordinate
mortgagee lien holder; and
j. Any communications from Homeowner/Condo Associations.
 SHORT TRAC SHORT SALE PROGRAM
SELLER INFORMATION SHEET

What is it?
The Short Trac Short Sale Program is designed to help you coordinate and facilitate communications between you, your
listing associate (“associate”), the lender and your closing/title agent (“closing agent”) through the short sale process.
It is a Program offered by Short Trac, a TRG affiliated business. This Program is offered in addition to the closing/title
services offered by TRG in connection with the transaction.

How do we use it?

The Short Trac Short Sale Packet contains the following documents:
Borrower / Seller Short Sale Information and Document Checklist
Short Trac Short Sale Agreement
Authorization to Obtain Information
Short Sale Coordination Form
TRG’s Affiliated Business Arrangement Disclosure Statement
Affidavit of Arms’ Length Transaction (to be executed once a fully executed contract is received)
Sample Hardship Letter
Sample Personal Financial Statement

Once you receive and review the packet and are satisfied you understand the program, you will need to execute the
Short Trac Short Sale Agreement (“Agreement”) and return it to Short Trac. If you have any questions concerning the
program you should contact Short Trac. Upon receipt of an executed Agreement, Short Trac will open a short sale file.
In addition to the Agreement, you will need to complete the Authorization to Obtain Information, Short Sale
Coordination Form, and TRG Business Arrangement Disclosure Statement. You will also need to gather the
information listed on the Borrower/Seller Short Sale Information and Document Checklist. Upon receipt of these items,
Short Trac will begin coordinating the necessary documents and compiling a completed short sale packet to submit to
your lender.

Once all necessary documentation is received, including a fully executed sales contract, Short Trac will submit the
completed short sale packet to your lender. Your closing agent will be responsible for ordering the necessary title
documents to close the transaction and clear any title issues. Any additional information needed by Short Trac will be
coordinated with you and your listing associate. It is not unusual for the lender to request a recent CMA, BPO or
appraisal for the subject property or other documents to support your short sale request. Your cooperation in supplying
this information is crucial in the process. Failure to timely provide this information may result in a delay in the process
and Short Trac cancelling the Agreement. Short Trac will work with you and your associate to coordinate and submit
this information on your behalf.

Who is responsible?
Short Trac will be responsible for (a) the process of coordinating the short sale transaction; (b) reviewing the completed
short sale packet; (c) delivering the seller’s authorization to short sale lender; (d) reviewing all preliminary HUD-1s
before being sent to short sale lender; (e) submitting the short sale packet to short sale lender; (f) delivering weekly file
status updates to the associate; (g) reviewing all approval letters (h) forwarding all approval letters to you and your the
associate and (i) forwarding the approval letters to your closing agent to complete the closing.

Short Trac will not negotiate or attempt to negotiate anything associated with your short sale transaction.

What does it cost?

You will pay Short Trac a fee of $800 at closing. If closing doesn’t occur, no fee will be due. This fee is very
competitive with, if not less than, other third party companies providing a similar service.

Contact Information for Short Trac Team is as follows:

Direct Line: (888) 485-3432
Fax: (303) 876-1311
Email: start@shorttrac.com
 BORROWER/SELLER SHORT SALE
INFORMATION AND DOCUMENT CHECKLIST

NAME(S): ______________________________________________________________

PROPERTY ADDRESS: __________________________________________________

Thank you for selecting Short Trac to assist you in connection with the short sale of your property.
As you are aware, certain information and documentation will be required by your lender(s) in order
to begin considering your “short sale” approval request. Although your lender will provide you
with a list, the following will help you to prepare your submittal:

a. Handwritten or typed hardship letter (sample form attached) explaining your

circumstances and the reasons you are requesting a short sale, include any supporting
documents (i.e., Medical bills, judgments, etc.);

b. Completed Financial Statement (sample form attached). The required form will most
likely come from your lender;

c. Last two months’ pay stubs;

d. Last two years’ W-2’s/1099’s;

e. Last two years’ tax returns;

f. Last two months’ bank statements;

g. Supporting documents as evidence of hardship (medical bills, judgments, etc.); and

h. Divorce documents, if applicable

NOTE: YOU SHOULD GATHER AND KEEP THESE DOCUMENTS IN A SAFE PLACE AND
SUBMIT THEM WHEN REQUESTED IN A SEALED CONFIDENTIAL ENVELOPE. YOU
MAY BE REQUIRED TO PROVIDE UPDATED FINANCIAL INFORMATION
THROUGHOUT THIS PROCESS. PLEASE RETAIN A COPY OF THE DOCUMENTS YOU
SUBMIT FOR YOUR RECORDS.

Disclaimer: Short Trac cannot guarantee the results of a short sale. You should consult with accounting and/or legal
professionals concerning the short sale process. Short Trac will not negotiate or attempt to negotiate anything
associated with your short sale transaction. Short Trac is not representing you in the short sale process and any
communication should not be construed as such. The efforts to assist in the coordination of this short sale transaction
should not be construed to mean Short Trac is/or will represent the Seller in a foreclosure or other legal action.
 Short Trac Agreement

This Agreement (the “Agreement”) is entered into as of ____ day of _____________, 2010 (the
“Effective Date”) by and between Short Trac (the “Company”) and
_________________________________ (individually and collectively, the “Customer”). The
Company agrees to assist Customer with the facilitation of a short-sale of property located at
_______________________ (the “Property”) upon the following terms and conditions:

1. Term of the Agreement

1.1 The term of this Agreement shall begin as of the effective date and shall be in full force and
effect until such time as either party provides written notification to the other that said Agreement
should be cancelled.

1.2 If Customer shall neglect or fail to provide any of the documents and/or information by
Company within three (3) calendar days of request, Company shall have the right to immediately
terminate this Agreement.

1.3 If Customer provides false or misleading information to the Company, Company shall have
the right to immediately terminate this Agreement.

2. Fees

Company’s fees for the Services (as defined herein) shall include the payment of a fee of
$800.00 to be paid by the Customer at the closing of the sale of Customer’s Property.

3. Acknowledgement of Limitation of Responsibilities

Company’s services hereunder shall be limited to the organization and transmission of data
provided by Customer to Customer’s mortgage lenders and the transmission of requests made by
said lenders to Customer in connection with Customer’s request for short sale approval (the
“Services”). Company does not represent Customer in any fashion and is not acting as Customer’s
agent. Company will not negotiate on Customer’s behalf with Customer’s lenders to accomplish
the short sale. Company has not and will not provide accounting, tax or legal advice to Customer in
connection with the proposed short sale or Customer’s sale of their Property. Customer further
acknowledges that Customer has been advised to seek tax, legal and accounting advice from
Customer’s advisors. In the event Customer terminates this Agreement, Company will promptly
provide Customer with copies of contact information and correspondence, e-mails or notes of
telephone conversations with Customer’s lender(s).

The Customer acknowledges and agrees they have selected closing agent to perform the
closing and provide title insurance in connection with the sale of this Property. The Customer
understands the title insurance and closing services are separate and distinct from the Services
provided under this Agreement and that there will be separate charges for those title and closing
services. The Customer acknowledges and agrees Short Trac and your closing agent may share,
exchange, and/or communicate information, including but not limited to personal identifying
information and financial information, as needed pursuant to this Agreement.

4. Services Not Provided

The Services shall not include, and this Agreement shall not require the Company to:

4.1 Prepare documents requested by Customer or Customer’s lenders;

4.2 Certify the accuracy of any information provided by Customer;

4.3 Represent Customer or negotiate on Customer’s behalf with Customer’s lenders, real estate
agents or creditors;

4.4 Provide debt relief or bankruptcy services; or

4.5 Provide Customer with any advice concerning the advisability of a short sale.

5. Limitation of Liability

5.1 Company agrees to use its “best efforts” to provide the Services required under this
Agreement in a prompt manner, but in no event shall the Company, its officers, employees,
directors, parents, and/or its affiliates be liable for any damages or liabilities, directly or indirectly
caused by the failure to consummate a short sale, by length of delay in closing, for any potential
damages incurred by Customer for breach of Customer’s agreement of sale and any other damages
expected or unexpected. In no event shall the Company be liable for loss of profits, or any indirect,
special, or consequential damages arising out of any breach of this Agreement.

5.2 Customer agrees Company and its representatives cannot and do not (i) guarantee the results
of a short sale, or (ii) predict the time the short sale process will take or the terms and conditions
which may be imposed by Customer’s lender(s). Customer agrees to hold Company its officers,
employees, directors, parents and/or affiliates harmless from any losses or damages of any nature
that in any way may arise out of or relate to Customer’s efforts to obtain short sale approval,
including, but not limited to, any acts or omissions, including negligence, of Company and its
representatives in providing any Services hereunder. The parties are encouraged to consult with
accounting or legal professionals if they have questions about the short sale process. Company’s
efforts should not be construed to mean Company is or will represent Customer in a foreclosure or
other legal action.

5.3 Company disclaims all warranties of any kind with regard to the subject matter hereof, the
Services to be provided by Company, including without limitation, any implied warranty of
merchantability or fitness for a particular purpose.

5.4 Customer acknowledges that Customer’s real estate broker and sales associate(s)
(collectively, “Broker”) have not made any representations of any nature regarding the Company’s
Services or the matters described herein and Customer agrees to hold Broker harmless from any
claims or losses in any way arising out of, or relating to, this Agreement or the Services.

5.5 Customer hereby covenants to hold-harmless, indemnify, and defend, Short Trac their
employees, agents, predecessors, successors, assigns, parents and affiliates from any and all liability
for any and all claims and/or damages in any way arising out of or by reason of, and any and all
known and unknown, foreseen and unforeseen damages and claims resulting from, or which may or
will result or arise out of, directly or indirectly, this Agreement or the Services contemplated or
performed by Short Trac.

6. General

6.1 This Agreement is the entire Agreement between the parties and it supersedes all prior
agreements and understandings between the parties concerning the subject matter herein. It may be
modified only by written agreement signed by duly authorized representatives of each party.

6.2. Any party to this Agreement bringing a legal action or proceeding against any other party
arising out of or relating to this Agreement or the transactions contemplated hereby shall bring the
legal action in a state or federal court sitting in Tampa, Florida (the “Designated Courts”). Each
party consents to the exclusive personal jurisdiction of the Designated Courts for the purpose of all
legal actions and proceedings arising out of or relating to this Agreement or the transactions
contemplated hereby. Each party agrees that the exclusive choice of forum set forth in this Section
does not prohibit the enforcement of any judgment obtained in the Designated Courts or any other
appropriate forum.

6.3 Each party to this Agreement consents to the Designated Courts as the sole and exclusive
venue for any legal action or other proceeding arising out of or relating to this Agreement or the
transactions contemplated hereby. Each party to this Agreement knowingly and voluntarily waives,
to the fullest extent permitted by law, (a) any objection which it may now or later have to a
Designated Court as the proper venue for any legal action or proceeding arising out of or relating to
this Agreement, and (b) any claim that any action or proceeding brought in a Designated Court has
been brought in an inconvenient forum.

6.4 Any notice, demand or other communication to a party to this Agreement that is permitted
or required under this Agreement shall be given in writing, and shall be deemed to have been duly
delivered (a) when delivered by personal delivery, (b) three (3) days after being deposited with the
United States Postal Service for mailing by first class mail, postage prepaid, certified mail, with
return receipt requested (regardless of whether the return receipt is subsequently received), or (c)
one business day after being deposited with a nationally recognized courier service for overnight
delivery; and in each case addressed by the sender to the recipient at the address first indicated
above, to such other address as a party may notify the other party in writing in conformity with the
provisions of this Section.

6.5 Each party hereto agrees to take all further action, and to execute, acknowledge, and deliver
any other documents, which may be reasonably necessary, appropriate, or desirable to carry out this
Agreement.

6.6 Nothing in this Agreement, whether express or implied, is intended or may be construed to
confer upon, or to grant to, any individual or entity (other than the parties and their legal and
personal representatives, heirs, successors, and permitted assignees) any right, remedy, or claim
under or because of this Agreement or any covenant, condition, or stipulation of it.

6.7 The parties may not amend this Agreement orally. The parties may amend this Agreement
only by a written agreement signed by all of the parties to this Agreement.

6.8 Neither this Agreement nor any rights or performance hereunder may be assigned or
otherwise transferred by either party.

6.9 Any provision of or obligation under this Agreement, which contemplates performance or
observance subsequent to any termination or expiration of this Agreement, shall survive any such
termination or expiration, and shall continue in full force and effect. In addition, all provisions of
this Agreement shall survive the termination or expiration of this Agreement to the fullest extent
necessary to give the parties the full benefit of the bargain expressed herein and of the intent
contemplated hereunder.

In witness of this, the undersigned have executed this Agreement as of the day and year first written
above.

Company Customer

Date: _______________________ Date:_________________________

By: ________________________ By:___________________________

Customer

Date: _________________________

By: ___________________________
 AUTHORIZATION TO OBTAIN INFORMATION

The undersigned hereby authorize Short Trac and/or __________________[ENTER NAME

OF LISTING ASSOCIATE] (“Realtor”) to discuss with or inquire about and/or to request/receive
information related to the undersigned’s mortgage loan accounts and/or any other account placed
either voluntarily or involuntarily against the undersigned either individually, jointly or against the
undersigned’s property. The undersigned further authorizes you (i.e., the lender, bank, and/or
creditor) to accept a copy of this signed document as authorization to discuss my account(s) with
Short Trac and/or Realtor and to release to them any and all requested information, including but
not limited to, payoff statements, changes to instructions or payoff statements, demand letters,
subordination agreements, satisfaction letters, paid-in-full letters, co-creditor information or
attorney information.

Specifically, the undersigned authorizes_________________[ENTER NAME OF

LENDER] to discuss with or respond to inquiries from Short Trac and/or Realtor or to provide to
Short Trac and/or Realtor any information and/or document requested in connection with the
loan/mortgage described below:

Loan Number: _________________________________

Property Address: _________________________________

_________________________________

Mailing Address: _________________________________

(if different than above)
_________________________________

________________________________ ________________________________
Borrower Signature Borrower Signature

Borrower Printed Name: Borrower Printed Name:

 Short Sale Coordination Form

Full Legal Name:___________________________________________________________

DOB: ________________________________________________________________

SSN: _________________________________________________________________

Mailing Address: _______________________________________________________

_____________________________________________________________________

Short Sale Property Address, if different from mailing address:

_____________________________________________________________________

Main Contact Number: __________________________________________________

Alternate Contact Number: _______________________________________________

Best time of the day to reach you: __________________________________________

Your Email Address: ____________________________________________________

Your Fax Number: ______________________________________________________

Preferred method to receive documents (circle one): Mail Fax E-mail

_____________________________________________________________________

Are you the only person on the deed? Yes / No

Co-Owners:

Name Address Relationship SSN DOB

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Are you the only person on the mortgage? Yes / No

Are you the only person on the note securing the mortgage? Yes / No
 Co-Borrowers:

Name Address Relationship SSN DOB

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

______________________________________________________________________

Are all Owners U.S. Citizens? Yes / No

Is this your primary residence?_______ Tenant Occupied?________ Vacant? ______

Investment________

Do you know mortgage balances: First ____________ Second: ______________

Has it been more than one year since the property was mortgaged / refinanced?______

What type of mortgage do you have?

____Conventional/Fixed ____Adjustable Rate ____Home Equity Line of Credit

Names and account numbers of all loans/lien holders?

Are you current with the mortgage(s)? ______________________________________

If not, how many payments have you missed, and what is the total for the missed
payments, including late fees and costs? ____________________________________
Current with HOA Fees? Y / N__ Past due amounts: $________________________
Next payment due date? __________
How much? ______________ Have you received any letters from HOA?_______

Current on the property taxes? ____________________________________________

Any other liens (e.g., IRS/child support/alimony) on the property/Amounts?

________________________________________________________________________

________________________________________________________________________

Have you talked to your lender about a short sale or loan workout? _______________

Have they said that they would consider a short sale? _________________________

Who have you spoken to/contact info: _____________________________________

____________________________________________________________________

Have you been assigned a loss-mitigator? If yes, name/contact info:______________

_____________________________________________________________________

When was the last time you spoke with the lender? ___________________________

What documents have you sent them or have they requested?

____________________________________________________________________

Have they sent you a short sale packet or other documentation? ________________

Have you received:

Letters from the bank: _______________________________________________

Notice of Seizure: __________________________________________________

Court papers or papers from any attorneys? ______________________________

Have you spoken with an attorney? ________________________________________

Have you spoken with an accountant? ______________________________________

Please do not provide any communications between you and your lawyer or accountant as
doing so may result in your waiver of any attorney/accountant – client privilege that may
exist.
 AFFIDAVIT OF ARMS’ LENGTH TRANSACTION

BEFORE ME, the undersigned authority, duly authorized to take acknowledgments and
administer oaths personally appeared _____________________ (“Affiant”), who deposes and says
under penalties of perjury:

1. Affiant is over the age of eighteen and is competent to make this statement.
2. This affidavit is made with regard to the following described property:
[ENTER LEGAL DESCRIPTION]
3. I affirm that I am selling this property to _____________________________, the “Buyers”.
4. To the best of my knowledge, the sales price of the Property represents fair market for
comparable properties in the area.
5. I am not a relative, by blood or marriage of the Buyers.
6. The property described in item 2 is currently being conveyed in an arms’ length transaction
for good consideration between strangers.
7. No special consideration has been given to the Buyers with regard to the sales price.
8. No party to the sales contract is a family member, business associate or shares a business
interest with the Affiant.
9. There are no hidden/undisclosed terms or special understandings between the Affiant and
Buyers or their respective agents.
10. The Affiant and Buyers, nor their respective agents, have any agreements, written or
implied, that will allow the Affiant to remain in the Property as a renter or to regain
ownership of the Property at anytime after the execution of this short sale transaction.
11. No parties to this transaction shall receive any proceeds from this transaction except for the
approved sales commission paid to brokers.
12. Affiant(s) hereby agree to indemnify and hold Short Trac harmless of and from any and all
loss, claim, cost, damage and/or expense of any kind or character whatsoever, including
attorneys’ fees, which Short Trac shall or may suffer or become liable resulting from their
reliance on the matters set forth in this affidavit.
________________________________
Seller Signature
___________________________
Seller Printed Name
STATE OF
COUNTY OF
Sworn to, affirmed, acknowledged and subscribed before me this day of
, 20 , by __________________________________, who: [ ] is personally known to me;
or [ ] produced as identification.

NOTARY PUBLIC SIGNATURE

Print Name:
My Commission Expires:
Stamp/Seal:
 NOTE: THIS IS A FORM ONLY. PLEASE USE THIS INFORMATION IN PREPARING YOUR
OWN HARDSHIP LETTER IN YOUR OWN WORDS.

SAMPLE HARDSHIP LETTER

(One Letter for EACH Lender)

Date:

(Name and Address of Lender)

Re: Property Address:

Loan No.:

To Whom It May Concern:

Please consider this as my formal request to review my financial situation for the purpose of reducing the required
amount to payoff my existing loan in order to avoid the potential of foreclosure.

I am unable to continue to make my monthly mortgage payment due to the following extenuating circumstances (please
explain in detail your circumstances):

Sincerely,

Owner/Borrower Owner/Borrower

Please attach copies of all applicable documentation to support this Hardship Letter.
 PERSONAL FINANCIAL STATEMENT
NOTE: PLEASE GATHER INFORMATION NECESSARY TO COMPLETE THIS TYPE OF FORM. THIS FORM REQUESTS
INFORMATION GENERALLY REQUESTED BY THE SHORT SALE LENDERS.

Date Prepared: Loan Number(s):

Borrower’s Name:
Borrower’s Employer:
Co-Borrower’s Name:
Co-Borrower’s Employer:
Phone Number: Evening:
Number of Dependants:
Property Address:
Mailing address (if different):

MONTHLY INCOME:

Borrower’s Monthly NET income: $

Co-Borrower’s Monthly NET income: $
Other Income: $
(Please circle) Child Support, Alimony, Rental, Other $

MONTHLY EXPENSES:

MONTHLY MONTHLY MONTHLY

BALANCE OWED
EXPENSE PAYMENT PAYMENT
nd
Mortgage Payment $_______________ 2 Mortgage $_______________ $_______________
Child Care $_______________ Other Mortgages $_______________ $_______________
Alimony/Child Support $_______________ Rent Paid $_______________ $_______________
Telephone $_______________ Doctor Bills $_______________ $_______________
Cell Phone/Pager $_______________ Hospital Bills $_______________ $_______________
Gas/Oil $_______________ Auto Loan Pymt $_______________ $_______________
Electricity $_______________ Auto Loan Pymt $_______________ $_______________
Trash/Sewer $_______________ *Homeowner’s Ins $_______________ $_______________
Food $_______________ *Property Taxes $_______________ $_______________
Water $_______________
Auto Insurance $_______________ *If not included in mortgage payment
Transportation/Gas $_______________
Life Insurance $_______________
Cable/Satellite $_______________
Clothing $_______________
Prescriptions $_______________

OTHER MONTHLY EXPENSES (Example: Credit Cards, Department Store Cards, IRS Lien):

Paid to: Balance: Monthly Payment:

1.__________________________ $___________________ $__________________
2.__________________________ $___________________ $__________________
3.__________________________ $___________________ $__________________

If additional space is needed, please continue to list on reverse side.

The undersigned represents and warrants that the information submitted in this personal financial statement is true, accurate and
complete. The information and documentation provided does not omit any material fact or matter that makes the information or
documentation presented misleading.

Borrower _______________________________ Date _____________________________

Borrower _______________________________ Date _____________________________