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1st Mortgage
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Name of Lender
(who you pay)
Loan #
Interest Rate
Unpaid Principal Balance
Payment $
Type of loan
Example: 5 year,
interest only taken out
in October 2004
Adjusting? Y N
Date of adjustment
Number of months behind
Monthly Expenses
Monthly
Amt.
Income
Monthly
Amt.
Mortgage Payment
Net Salary
(after deductions)
Property Taxes
(if not included in Mtg.)
Monthly
Every 2 Weeks
Weekly
Homeowner’s Insurance
(if not included in Mtg.)
Gross Salary
(before deductions)
Association Fees
Monthly
Every 2 Weeks
Weekly
Other Mortgages
Spouse's Net Salary
Automobile Payment
Spouse's Gross Salary
Other Automobile
Loan Payment
Alimony/Child Support
Automobile Insurance
Disability
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Pension/Retirement
Electricity
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Garbage
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Cell Phone
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Cable TV
Gross Difference +/-
Credit Cards (combined
Minimum payments)
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How Many People
in Household
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Alimony/Child Support
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Food/Household
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Miscellaneous
Miscellaneous
Miscellaneous
Miscellaneous
Second Property
- 1st Mortgage
Second Property
- 2nd Mortgage
Third Property
- 1st Mortgage
Third Property
- 2nd Mortgage
*required item
Total Expenses & Balances
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