Credit Union Services Organization - Retail B - Member Financial Statement
Name (First, Middle, Last)
Married Unmarried (divorced, widowed) Separated
Current Street Address
No. Years
City
State
Zip
� Own
� Rent
Dependants
Soc. Sec. #
Home Phone #

Employment Data (Current)
Employer
Self Employed Telephone #
Street Address
City
State
Hire Date
Job Title
Gross Monthly Income

If Employed in current position for less than two years, or if currently employed in more than on position, complete the following:
Employer
Self Employed Telephone #
Street Address
City
State
Hire Date
Job Title
Gross Monthly Income

Name (First, Middle, Last)
Married Unmarried (divorced, widowed) Separated
Current Street Address
No. Years
City
State
Zip
� Own
� Rent
Dependants
Soc. Sec. #
Home Phone #

Employment Data (Current)
Employer
Self Employed Telephone #
Street Address
City
State
Hire Date
Job Title
Gross Monthly Income

If Employed in current position for less than two years, or if currently employed in more than on position, complete the following:
Employer
Self Employed Telephone #
Street Address
City
State
Hire Date
Job Title
Gross Monthly Income


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Describe Other Income: alimony, child support or separate maintenance income need not be revelaed if the
Borrower (B) or Co-Borrower (C) does not choose to have it considered for pre-qualification.
B/C Monthly Amount

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Assets (List all savings. Attach seperate sheet if neccessry.)
Type of
Account		 Account #/Company Name
and Location		 Aprox.
Balance
Checking
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Savings
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IRA/
Retirement
Type of
Account		 Account #/Company Name
and Location		 Aprox.
Balance
Checking
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Savings
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IRA/
Retirement

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Real Estate Owned
Property Address (S-sold, PS- pending sale
or R-if rental being held for income)		 Type of
Property		 Present Mrkt
Value		 Amt. of Mtgs
& Liens		 Gross Rental
Income		 Mortgage
Payments		 Insurance,
Maintenance
Taxes & Misc.		 Net Rental
Income
Totals

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Creditors (Attach seperate sheet if neccessary.)
Type of Loan Creditor's Name Account No. Acct. Bal. Mo. Pymnt.
Rent �
Mortgage

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If you answer "yes" to any questions (a) through (i), please comment.
Borrower Co-Borrower
Yes No Yes No
a) Are there any outstanding judgements against you?
b) Have you been declared bankrupt withing 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 in a lawsuit?
e) Have you directly or indeirectly been obligated on any laon which resulted in foredlosure, transfer of title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufacturered (mobile) home loans, any mortgage, financial obligation, bond, or laon guarantee. If "yes," provide details, including date, name and address of Lender, FHA or VA case number, if any, and resaons for teh 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 in the preceding questions.
g) Are you oligated to pay alimony, child support, or separate maintenence?
h) Is any part of the down payment borrowed?
i) Are you a co-maker or endorser on a note?
j) Are you a US citizen?
k) Are youa permanent resident alien?
l) Do you intend to occupy the property as your primary residence? If "yes," complete question m.
m)�� Have you had an ownership interest in a property in the last three years?�
1. What type of property did you own - principal residence (PR), second home (SH), or investment property (IP)?
2. How did you hold title to the home - solely by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?

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By signing below, I/We certify that the information on this statement and on any attachments, both written or printed, represents my/our
current financial condition. I/We hereby authorize you to make inquiries to credit report services and to my/our employers
as to my/our earnings.

I/We authorize you to gather whatever credit information you consider necessary and appropriate. I/We understand that you will retain this statement whether or not an approval letter is isued.

I/We agree that a photo copy of facsimilie of this application shall be as binding as the origianl.

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Signature of Applicant
X		 Date
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Signature of Co-Applicant
X		 Date

E-mail:��������


Interest Rate:______________ Term:_______________ Loan Program #_________________
Approx. Loan Amt.:$____________ Trans. Type:�Purchase � Refinance �Cash Out Refinance
CU Contact Person:_____________________Date:__________ Best Time to Call Member:______a.m. _____p.m.
Omaha Federal Credit Union, 3001 So. 82nd Ave., Omaha, NE, 68124-3258
Phone #: 402-399-9001 ext.______� Fax: 402-399-0129 � Source of Down Payment_________________

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