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Reggie Loan # 197017

Monthly Payments Breakdown June 2010


Bal
Mortgage (1st residence) ### 205000
Mortgage (Rental) $630.00
Auto Loan (2) $700.00 29899
Furniture $75.00 1000
Student
Electricity $300.00
Cable, Internet $122.94
Water/Sewage $15.00
Auto Insurance $89.60
Life Insurance $35.00
Health Insurance
Gas auto Maintenance $200.00
Food family expenses $400.00
Doctors, Hosp, Dentist $50.00
Drugs prescribed $265.97
Clothing, shoes, etc $75.00
Spending cash entertainment$40.00

###
FINANCIAL WORKSHEET Loan Number

BORROWER NAME
Name Social Security Number
Name Social Security Number
Home telephone Number Work Telephone Number

ADDRESS INFORMATION
Home Address
Property Address (if different)

EXPENSES

Category Description Monthly Balance Delinquent


Payment Due Y/N
Monthly Payments Mortgage or Land Contract / Rent

Alimony / Child Support


Child Care
Other Mortgages (2nd)
LOANS Auto
Auto
Furniture Appliance Loans
Installment loans
Student Loans
Student Loans
CREDIT CARDS $0.00 $0.00 0
#1 Sam's Club
#2
#3
#4
#5
UTILITIES
Electricity
Water
Heating
Telephone
Other (lawn care)
INSURANCE
Auto
Health
Life
Dental

DONATIONS
Church
Other
DUES Union
Club
Other
MEDICAL NOT
COVERED BY INS Doctor/Dentist/Hospital
Drugs
CAR
Gas/Maintenance
Monthly Parking / Tolls
FOOD
Family
School / Work Lunches
CLOTHING
New Clothes / Shoes
Drycleaning
Uniforms / Required Items
Miscellaneous
Spending Money / Entertainment
Cable TV on Phone
Clubs / Sports / Hobbies
Vacations
SAVINGS
Savings Bonds
Credit Union
Bank

TOTAL $0.00

INCOME
DESCRIPTION BORROWER CO-BORROWER TOTAL
Net Salary / Wages $0.00 $0.00 $0.00
Net Overtime Pay
Commissions
Bonuses
TOTAL $0.00 $0.00 $0.00

RECAP
ITEM CURRENT
TOTAL INCOME $0.00
TOTAL EXPENSES $0.00

DIFFERENCE $0.00
ASSETS / LIABILITIES
DESCRIPTION ESTIMATED VALUE AMOUNT OWED NET VALUE
Home $0.00 $0.00 $0.00
Other Property $0.00 $0.00 $0.00
Auto (retail) $0.00 $0.00 $0.00
Auto $0.00 $0.00 $0.00
Bank Accounts $0.00
$0.00 $0.00 $0.00
Boats
Cash Value of Life
Insurance
Collections
Computers
IRA/Keough Accounts
401 K ESOP Accounts
Stocks/Bonds/Cds
Trailers
IRS Liens
Other Investments
Other Investments

I agree that the financial information that I have provided is an accurate statement of
my financial status. I understand and acknowledge that any action taken by the lender
of my mortgage loan upon my behalf will be made in strict reliance to the financial
information provided.

Submitted this ______ day of ______, 2010

By ______________________________________ ____/_____/____
Signature of Borrower Date

By ______________________________________ ____/_____/____
Signature of Borrower Date

Final Instructions:
1 Review the financial worksheet to make sure that it is correct
2 Make sure you have signed and dated the form.
3 Attach last 2 years federal tax forms
4 Attach last 2 pay stubs for all wages reported.
5 Make copies and of everything and keep them for your records

DO NOT SEND ORIGINALS

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