MORTGAGE AMELIORATION

APPLICATION AND AGREEMENT

The person/s completing this form declare/s under penalty
of law that all information submitted in preparation for an
attempted mortgage amelioration is true and accurate to
the best of their knowledge.
IMPENDING SALE DATE: ___/___/___ County: __________ State:
________Day of Week:_________
Property Address:
__________________________________________________________________
Owner 1 Full Name: _____________________________________So. Sec
#:_____________________
Drivers License#:________________________State:_________ Email:
_______________________
Phone: ____________________ Mobile: _____________________ Fax:
______________________
Owner 2 Full Name: ______________________________________So. Sec.
#:___________________
Drivers License#:________________________State:_________
Email:_______________________
Phone: _____________________ Mobile: ____________________ Fax:
______________________
Is the property occupied? Y / N If occupied, Homeowner or
tenant? ________________________
How long has the subject property been owned by applicant?
________Is the property listed? Y / N
Who is the FIRST mortgage holder?
_____________________________________________________
What was the original date of the FIRST mortgage?
________________________________________
Approximate balance of the FIRST mortgage? $__________________
Mo/Pmt? (P&I) $___________
Is this an FHA or VA loan? Y/N If Yes, which one?
_________________________________________
Is the FIRST mortgage adjustable, graduated or a fixed rate loan?

Adjustable _____ Fixed_____

Are payments on the FIRST mortgage current? Y/N
many months in arrears? ______

If No, how

Is there a second mortgage? Y/N

Who is the 2nd mortgage holder?
______________________________________________________
What was the original date of the 2nd mortgage?
_________________________________________
Approximate balance of SECOND mortgage? $________________
Mo/Pmt? (P&I) $_____________
Is this an FHA or VA loan? Y/N If Yes, which one?
_________________________________________
Is the SECOND mortgage adjustable, graduated or fixed rate?
Adjustable _______ Fixed_______
Are the SECOND mortgage payments current? Y/N
many months in arrears? ________

If No, how

Property Taxes? (Annual amount) $_____________ Hazard Insurance?

Monthly: $_______________
Is there any Private Mortgage Insurance (PMI) Mo/Pmt) $_____________
Name of PMI Carrier (company, bank,
etc)_______________________________________________________________________
_________________
Is property owner aware of any other encumbrances or clouds re. nonmortgage liens against the property Y / N
If other liens
explain.___________________________________________________________________
_______
Has the homeowner received notice of Foreclosure Sale Date? Y / N If yes,
what is the scheduled date ?________
If Has a sale date ever been postponed? Y / N If yes, How many
postponements have there been?___________
Has the property owner ever filed for a bankruptcy? Y/N If Yes, Chapter
thirteen pr seven ?________________
Date of the bankruptcy filing? _____________ Date that bankruptcy was fully
discharged?__________________
Has the property owner petitioned for a loan modification or offer and
compromise (short sale)? Y/N If yes, what
was the date (month/year) of the petitions?__________________ Was such

petition accepted by the lender? Y/N

Has the owner ever received any approval or rejection letter regarding
loan modification or short sale?
Y/N
If yes, what was the lender's decision, and date of the acceptance or
rejection from the lender?
___________________________________________________________________________
__________________
Is there a Homeowners Association? Y/N If Yes, what is the address?
1st
HOA_______________________________________________________Phone_________
______
2nd
HOA______________________________________________________Phone__________
_____
By my signature below, I acknowledge a clear understanding that there
are no guarantees being made relative to efforts to extinguish the
mortgage obligations relative to the subject property on the basis of fraud
and deception on the part of the lenders in question. I further agree to
hold the publisher and preparer of this document, and all related parties
free and harmless from future claims of unsubstantiated impropriety,
errors or omissions relative to attempts to assist in bringing about the
removal or modification of all mortgage liens relative to the subject
property.
____________________________________________________________
______________
Signature
Date
____________________________________________________________
Print Name
____________________________________________________________
______________
Signature
Date
____________________________________________________________
Print Name