Orange — Borrower's Information

Source: https://www.occourts.org/system/files/informationform.pdf

Superior Court of California, County of Orange Foreclosure Relief Settlement Conference Program Borrower Information

To participate effectively in a settlement conference, your lender must consider your circumstances to determine possible options. Please complete this form to the best of your knowledge and bring the completed form, together with the other required documentation, to the Settlement Conference.

Borrower Information

Borrower name(s): ____________________________________________________________________

Loan Number: ________________________________________________________________________

Property Address: ____________________________________________________________________

City: __________________________________ State: _____ Zip Code: _____________

Is the property for sale? ___ Yes ___ No Listing date: _________________ Price: ______________

Realtor name: _______________________________________ Realtor Phone: ___________________

Borrower Occupied? ___ Yes ___ No Number of people in household: ___ How long? ___________

Mailing address (if different): ____________________________________________________________

City: __________________________________ State: _____ Zip Code: _____________

Phone Numbers: Home: ___________________________ Work: ____________________________

Cell: ____________________________ Other: ____________________________

Email: ______________________________________________________________________________

Mortgage Information

First Mortgage Lender: __________________________________ Type of Loan: __________________

Loan Number: _______________________________ Date You Closed Your Loan: ________________

Second Mortgage Lender: ________________________________ Type of Loan: __________________

Loan Number: _______________________________ Date You Closed Your Loan: ________________

Total Mortgage Payment(s) amount: $___________________ Taxes & Insurance; $________________

Date of last payment: _________________________ Primary Reason for Default: ___________________________________________________________

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Is the loan in Bankruptcy: ___ Yes ___ No If yes, provide the names, location of court, case number and attorney: __________________________ New February 2010 Foreclosure Relief Settlement Conference Program – Borrower Information Form page 1

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Assets Amount Owed Value Home $ $ Other Real Estate $ $ Retirement Funds $ $ Investments $ $ Checking $ $ Savings $ $ Other $ $

Transportation Model Year Amount Owed Value Automobile #1 $ $ Automobile #2 $ $ Other (vehicles, boats, $ $ motorcycles)

Income: Employer(s) Net Monthly Wage

1. $

2. $

3. $

Additional Income (Description – not wages) Monthly Amount

1. $

2. $

Borrower Pay Days: ______________________ Co-Borrower Pay Days: ________________________

Monthly Expenses: (Include only expenses you are currently paying) Expense Amount Expense Amount Mortgage $ Food $ 2nd Mortgage $ Utilities $ Automobile Payment(s) $ Condominium/Neighborhood Fees $ Auto Insurance $ Medical (not covered by insurance) $ Auto Fuel/repairs $ Other property payments $ Credit Card Payments $ Telephone/Cell Phone $ Installment Loan Payments $ Cable TV $ Child Support/Alimony $ Spending Money $ Day Care/Child Care/Tuition $ Other Expenses $

Amount Available for Monthly Mortgage Payments Based on Income and Expenses: $___________

Bring the following additional documentation to the Settlement Conference:

___ Proof of Income (minimum two months) ___ Last two bank statements ___ Proof of any expected income for the last 45 days ___ Copy of a current utility bill ___ Signed 4506-T form ___ Latest federal and California tax returns ___ Letter explaining reason for delinquency and any supporting documentation ___ Listing agreement (if property is currently on the market)

New February 2010 Foreclosure Relief Settlement Conference Program – Borrower Information Form page 2