Amanda Bruce-Koehnke, MLO

NMLS #519975 750 S Orlando Ave Winter Park, FL 32789 Phone: 321-527-7766 Fax: 866-517-1154

USE YOUR TAB KEY TO GO THROUGH FIELDS AND COMPLETE IN FULL DETAIL (Please use 1 form for each applicant. Leave the section blank if the co-borrower has provided the information on their form) Name VAN NGUYEN 3470 Forest Ridge Lane State Heidi Tran FL
Own

Home phone

(443)

742-3752

Current Address City Kissimmee 8/8/11

Zip

34741
Original Value

E-mail

congaidalan@gmail.com $1,000

Date Occupied

If you plan to sell, estimated price?

If rental Landlord name

Phone

(407) 808-5640
City

Monthly Rent

Previous Address (If less than 2 years):

Previous Address State MD 11626 Sun Circle Way Zip 21044 # of years Date of Birth X 14 08/06/1961 Married ages Primary Residence Columbia Own Years of School 20 Rent X

Social Security # Marital Status

212-53-1637 # of dependents Single

Separated

1
X

13
Second Home Investment

Tell us about the property:

X

Single family home Condominium Townhouse X

(monthly condo fee $) (monthly maintenance fee $)

Buyer Ready (no property selected) Please est. sales price & loan amt. 3489 Forest Ridge Lane State $210,000 $3,628 FL Loan Amount Zip 34741

Subject Property address City Kissimmee

Sales Price or Current Value for Refi Real Estate Taxes Current Employment:

$168,000 $1,200

Annual Insurance Estimate

Are you self employed? (Do you own 25% or more of your business?) Employer Name Publix Co.

no

yes

% ownership

Address, City, State, Zip Phone Position/ Title Yearly base salary : Commission (2 yr avg) :

3040 Dyer Blvd, Kissimmee, FL 34741 (407) 933-1524 Pharmacist / Pharmacy Manager Assistant $ $ 75,000 Start Date: mm/dd/yy # Yrs. In this profession 08/20/2011 1

Bonus (2 yr avg) :

Previous Employer, if less than 2 years. Please duplicate on separate form if more than 2 jobs last 2 years:
Previous Employer Name Roanoke-Chowan Hospital Ahoskie, NC () Staff Pharmacist $ 96,000 Start Date: mm/dd/yy End Date: mm/dd/yy

Address, City, State, Zip Phone Position/ Title Yearly base salary :

Income from other sources:

4. Assets (checking / savings / stocks / retirement / other): Name Bank/Financial Inst. Suntrust Bank Gift Funds from Relative>> Net from sale of Home>>> Your automobile(s) 2012 Year Year Camry Make Make (savings, Ck., MM) Ck $26,000 $ $ $ $ $ $ $ $ Current Balance $14,885.16 Estimate value Estimate value

5. Liabilities (credit cards / car loans / student loans / mortgages / child support / alimony /other): Name Student loans Car loan Chase Credit Cards Please answer: Are there any outstanding judgments against you? Have you been declared bankrupt within the last 10 years? Have you been obligated on any loan resulting in foreclosure? Are you currently delinquent on any financial obligations? Are you obligated to pay alimony, child support or separate maintenance? Is any part of the down payment borrowed? Did you co-sign on any loans? Are you a US Citizen? If not please fax Resident Alien card or work Visa Have you owned a home in the last 3 years? If so, how did you take title? Solely Drivers License Number: N250-878-61-786-0 State: FL Yes Yes Yes Yes Yes Yes Yes X Yes Yes With Spouse 09/08/11 X No X No X No X No X No X No X No No X No With Other Person 08/06/20 Monthly Payment $1,000 $409 $460 $ $ $ $ $ $ $ Unpaid Balance 130,000 25,000 15,000

Issued date:

Expiration:

Referred By (Agent or Past Customer):

Name:

Martina Leonard Office: 400 S. Park Avenue, Suite 210, Winter Park, Florida 32789

Phone: Fax:

(321) 202-3608 (407) 628-1210

Email back to Amanda.Bruce@BankofAmerica.com or fax 1-866-517-1154