Checklist
We need the following documents in order to expedite your modification review:
All Borrowers:
A completed, signed, and dated Borrower Assistance Application from all obligated parties Most recent one (1) full month of paystubs; minimum of two consecutive paystubs for new employment
Most recent bank statement from all accounts, with all pages, for each borrower
Signed and dated federal tax return(s), with all schedules, for the most recent calendar year (If not required to file taxes, provide a signed and dated letter of explanation)
If applicable, most recent HOA statement to verify monthly Homeowners’ Association Dues Completed, signed, and dated IRS Form 4506T or 4506T-EZ
Non-Borrowers
If a non-borrower(s) contributes money towards the mortgage payment and/or household expenses:
Signed and dated letter from non-borrower(s) stating monthly contribution amount A letter of authorization to obtain a credit report on all contributing non-borrowers Proof of income to support contribution amount; see borrower income requirements Most recent bank statement, with all pages, for each contributing non-borrower
Additional documents for other sources of income:
If you are Self-Employed:
Signed and dated tax return(s), with all schedules and forms, for the most recent calendar year (1040s, and if Corporation or LLC, include 1120s, K-1s, and/or 1065s)
Last three (3) months or most recent quarterly, signed and dated, Profit and Loss Statement Last three (3) months business bank statements for the same period reflected on the Profit and Loss Statement
If you own rental properties:
Copy of all fully executed lease agreements
Most recent bank statement, with all pages, to verify rental income deposits (if unable to provide bank statements, please provide cancelled checks or Schedule E of recent tax return) Recent mortgage or payoff statements for all rental properties owned; if loans are not escrowed, provide property tax statement, homeowner’s insurance declaration page, and HOA statement, if applicable
If you receive Fixed Income (e.g. SSI, pension, long term disability, alimony, child support)
Award letter or benefit statement showing the amount, frequency, and duration of pay Most recent bank statement, with all pages, to verify deposits
If you receive Variable Income (e.g. seasonal income, school employees):
Evidence of the frequency and duration of pay, and documentation to support income received (e.g. Employment Contract, Letter of Explanation from Employer, along with paystubs and/or bank statements for the months worked)
In cases where a divorce or legal separation has occurred:
A copy of a divorce decree or legal separation filed/acknowledged with the Court A copy of a recorded Quit Claim Deed or Warranty Deed filed with the County
If your loan is not currently escrowed for property tax and/or hazard insurance:
A copy of the most recent property tax statement and/or hazard insurance declaration page
If you are reapplying due to a change in your circumstances:
A signed and dated letter of explanation and supporting documentation to outline your change in circumstance.
*Note: Any expenses disclosed must be validated with supporting documents (e.g. Alimony, Child Support, Liens, and Judgments)
If you have any questions or concerns regarding this checklist, please contact our office toll free at
1-888-504-7300, Monday through Thursday from 6:00am to 7:00pm, and Friday from 6:00am to 6:00pm Pacific Time.
This completed Borrower Assistance Application and all required documentation must be sent to one of the following locations:
Mail: Attn: Loss Mitigation
Rushmore Loan Management Services LLC
15480 Laguna Canyon Road
Irvine, CA 92618
Questions: Call us at 888-504-7300 M-Th 6:00 am PST to 7:00 pm PST or
F 6:00 am PST to 6:00 PST.
BORROWER ASSISTANCE APPLICATION
If you are experiencing a temporary or long-term hardship and need help, you must complete and submit this application along with other required documentation to be considered for available
options. You must disclose information about (1) your intentions to either keep or transition out of the property; (2) the property’s status; (3) bankruptcy; and (4) your credit counseling agency or
representative, if any.
You must disclose information about your income, expenses and assets. This application also lists the required income documentation that you must submit in support of your request for assistance. You must also complete the Hardship Affidavit in which you disclose the nature of your hardship. The Hardship Affidavit informs you of the required documentation that you must submit in support of your hardship claim.
When you sign and date this application you will make certain certifications, representations and agreements, including certifying that the information you provide in the application is accurate and truthful and that the identified hardship has contributed to your need for mortgage relief.
This application requires a completed and signed IRS Form 4506-T, the required income documentation, the required hardship documentation, a signed and completed Dodd-Frank Certification and, if applicable, a completed and signed Non-Borrower Contribution form
Loan Number: ______________________ (found on your monthly mortgage statement)
I want to: |
Keep the property |
Vacate the property |
Sell the property |
Undecided |
If you wish to keep the property, for how long? ______________________ |
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The property is currently: |
My primary residence |
A second home |
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An investment property |
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The property is currently: |
Owner occupied |
Renter occupied |
Vacant |
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CONTACT INFORMATION
Borrower |
Co-Borrower |
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Borrower Name: _____________________ |
Co-Borrower Name: __________________ |
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SSN _______________ DOB __________ |
SSN _____________ |
DOB __________ |
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Home Phone # ( ) |
Home Phone # ( ) |
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Best time to call: |
Best time to call: |
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Cell/Mobile Phone # ( ) |
Cell/Mobile Phone # ( |
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Best time to call: |
Best time to call: |
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Email: ____________________________ |
Email: ____________________________ |
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My primary language is Spanish. This information will be used to assign you a Spanish-speaking representative when available after your application is received. Mi lengua principal es el español. Esta información sera utilizada para asignar un representante que hable español cuando este disponsible después que su aplicación ha sido recibida. Llámenos al teléfono indicado si necesita ayuda para completar esta aplicación.
Mailing Address: _________________________________________________________
Property Address (if the same as mailing address, just write “same”)
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Have you contacted a credit counseling agency? Yes |
No |
If “Yes”, provide counselor contact information: |
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Agency Name: _________________ |
Counselor Name: ___________________ |
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Counselor Phone #: _________________ |
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Counselor email: ____________________ |
Rushmore may contact this agency about my Loan. Yes No
Do you have a lawyer or other representative we should contact about this application? Yes No
If “Yes”, provide contact information:
Law Firm Name (if any): _________________ Representative Name: _____________
Phone #: _______________________
Email: _________________________
Rushmore should only contact this representative about my Loan. |
Yes |
No |
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PROPERTY INFORMATION
Estimated Market Value of the property: $ _________________________________
Is the property listed for sale? |
Yes |
No |
If “Yes”, what was the listing date? _____________ |
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Have you received an offer on the property? |
Yes |
No |
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Date of Offer: _____________ |
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Amount of Offer: $ ______________ |
Agent’s Name: _____________ |
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Agent’s phone #: ______________ |
For Sale by Owner |
Yes |
No |
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Do you have condominium or homeowner association (HOA) fees? |
Yes |
No |
Total monthly amount: $ ______________ |
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Name and Address that fees are paid to: ________________________________________
______________________________________________________________________
Who pays the real estate tax bill on the property? |
I/We do |
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Servicer does |
Are the taxes current? |
Yes |
No |
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Who pays the homeowners insurance policy on the property? |
I/We do |
Servicer does |
Is the policy current? |
Yes |
No |
Name of Insurance Company: _________________ |
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Insurance Company Phone #: _________________ |
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Are there any liens/other mortgages or judgments on the property? |
Yes |
No |
If “Yes”, provide : |
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Lien holder/Servicer name: ___________________ |
Phone #: ________________ |
Balance Amount: $ ________________ |
Monthly payment amount: $ ________________ |
Lien holder/Servicer name: ___________________ |
Phone #: ________________ |
Balance Amount: $ ________________ |
Monthly payment amount: $ ________________ |
Lien holder/Servicer name: ___________________ |
Phone #: ________________ |
Balance Amount: $ ________________ |
Monthly payment amount: $ ________________ |
MORTGAGE INFORMATION
Has the mortgage on your property ever had a Home Affordable Modification Program (HAMP) trial period plan or permanent modification? Yes No
Has the mortgage on any other property that you or any co-borrower own had a permanent HAMP
BORROWER INFORMATION
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Have you or the co-borrower filed bankruptcy? |
Yes |
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No |
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Chapter 7 |
Chapter 11 |
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Chapter 12 |
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Chapter 13 |
Has the bankruptcy been discharged? |
Yes |
No |
Bankruptcy Case No. : |
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Has/Was the mortgage on the property been reaffirmed? |
Yes |
No |
Don’t know |
If you have or will receive a discharge from a bankruptcy and the mortgage was not reaffirmed in the case, we will only exercise our rights against the property and are not attempting any act to collect the discharged debt from you personally. Your decision to discuss workout options with us is strictly voluntary. You are not obligated to pursue any workout option discussed with us. At your request, we will immediately terminate any such discussions should you no longer wish to purse these options to retain your property.
SERVICE MEMBERS
Is any borrower an active duty service member? Yes No
If “Yes”, has any borrower been deployed away from his/her primary residence or received a
permanent Change of Station order? |
Yes |
No |
Is any borrower the surviving spouse of a deceased service member who was on active duty at the
EMPLOYMENT INFORMATION
Borrower
Company Name: ______________________________ Start Date: ________________
Job Title: _______________________
Co-Borrower
Company Name: ______________________________ Start Date: ________________
Job Title: _______________________
4
OTHER PROPERTY FOR WHICH ASSISTANCE IS REQUESTED
Complete this section ONLY if you are requesting mortgage assistance for a property that is not your principal residence.
I am requesting mortgage assistance with a rental property that is not your principal residence:
Yes |
No |
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I am requesting mortgage assistance with a second or seasonal home: |
Yes |
No |
If “Yes” to either, I want to: |
Keep the property |
Sell the property |
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Property Address: _____________________________________________ Loan Number: __________
Do you have a second mortgage on the property? |
Yes |
No |
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If “Yes”: Servicer Name: __________________________________________ |
Loan Number: __________ |
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Do you have condo or Homeowner’s association (HOA) fee? |
Yes |
No |
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If “Yes”: Monthly Fee: _______________ Are HOA fees current? |
Yes |
No |
Name and address fees are paid to: ____________________________________________
Does your mortgage payment include taxes and insurance? |
Yes |
No |
If “NO”: Are taxes and insurance paid and current? |
Yes |
No |
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Annual Homeowner’s Insurance: ____________________ Annual Property Taxes: ___________________
Vacant and available for rent
Occupied by a tenant as their principal residence
Other: _______________________________________________________
If rental property is occupied by a tenant:
Term/Lease of Occupancy (MM/DD/YYYY - MMMM/DD/YYYY): ______________________________
Gross Monthly Rent: $ ________________________________
If rental property is vacant, describe efforts to rent property:
______________________________________________________________________________________________
If applicable, describe relationship and duration of non-rent paying occupant of rental property:
Is the property for sale? |
Yes No |
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If “Yes”, Listing Agent Name: ____________________________________________ |
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Listing Agent Phone #: _________________________________________________ |
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Listing Date: ___________________________ Have you received purchase offer? Yes |
No |
Amount of Offer: $ _________________________________________ Closing Date:_________________
5
RENTAL PROPERTY CERTIFICATION
You must complete this certification if you are requesting mortgage assistance with respect to a rental property.
By checking this box and initialing below, I am requesting a mortgage modification under MHA with respect to the rental property described in this section and I hereby certify under penalty of perjury that each of the following statements is true and correct with respect to that property:
1.1 intend to rent the property to a tenant or tenants for at least five years following the effective date of my mortgage modification. I understand that the servicer, the U.S. Department of Treasury, or their respective agents may ask me to provide evidence of my intention to rent the property during such time. I further understand that such evidence must show that I used reasonable efforts to rent the property to a tenant or tenants on a year- round basis, if the property is or becomes vacant during such five-year period.
Note: The term “reasonable efforts” includes, without limitation, advertising the property for rent in local newspaper, websites, or other commonly used forms of written or electronic media, and/or engaging a real estate or other professional to assist in renting the property, in either case, at or below market rent.
2.The property is not my secondary residence and I do not intent to use the property as a secondary residence for at least five years following the effective date of my mortgage modification. I understand that if I do use the property as a secondary residence during such five-year period, my use of the property may be considered to be inconsistent with the certifications I have made herein.
Note: The Term “secondary residence” includes, without limitation, a second home, vacation home or other type of residence that I personally use or occupy on a part-time, seasonal or other basis.
3.I do not own more than five (5) single-family homes (i.e., one-to-four unit properties) exclusive of my primary residence.
Notwithstanding the residence, or permit my legal dependent, parent or grandparent to occupy it as their principal residence with no rent charged or collected, none of which will be considered to be inconsistent with the certifications made herein.
This certificate is effective on the earlier of the date listed below or the date the RMA is received by you servicer.
Initials: _______ |
_______________________ |
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Borrower |
Date |
Initials: _______ |
_______________________ |
____________ |
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Co-Borrower |
Date |
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FINANCIAL INFORMATION |
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Borrower Monthly Income |
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Borrower Assets |
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Gross Wages |
$ |
Checking Account |
$ |
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Overtime |
$ |
Checking Account |
$ |
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Child support/Alimony* |
$ |
Savings/Money Market |
$ |
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Non-Taxable Social Security/SSDI |
$ |
Stocks/Bonds/CDs |
$ |
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Taxable SS Benefits or Other |
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Expected Assets (e.g., inheritance, |
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Monthly Income (e.g., Annuities |
$ |
$ |
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or Retirement Plans, etc.) |
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tax, returns, etc.) |
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Tips, Commissions, Bonus and |
$ |
Total Amount in Additional |
$ |
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Self-employment income |
Assets (e.g. trusts) |
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Rents Received |
$ |
Other Real Estate Owned |
$ |
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(estimated value) |
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Unemployment Income |
$ |
Retirement |
$ |
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Food stamps/Welfare |
$ |
Other Cash on Hand |
$ |
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Other |
$ |
Other |
$ |
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Co-Borrower Monthly Income |
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Co-Borrower Assets |
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Gross Wages |
$ |
Checking Account |
$ |
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Overtime |
$ |
Checking Account |
$ |
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Child support/Alimony* |
$ |
Savings/Money Market |
$ |
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Non-Taxable Social Security/SSDI |
$ |
Stocks/Bonds/CDs |
$ |
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Taxable SS Benefits or Other |
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Expected assets (e.g., inheritance, |
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Monthly Income (e.g., Annuities |
$ |
$ |
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or Retirement Plans, etc.) |
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tax, returns, etc.) |
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Tips, Commissions, Bonus and |
$ |
Total Amount in Additional |
$ |
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Self-Employment Income |
Assets (e.g. trusts) |
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Rents Received |
$ |
Other Real Estate Owned |
$ |
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(estimated value) |
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Unemployment Income |
$ |
Retirement |
$ |
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Food Stamps/Welfare |
$ |
Other Cash on Hand |
$ |
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Other |
$ |
Other |
$ |
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*Child Support, alimony, separation maintenance need not be disclosed if you do not want it considered in support of your Loan payments.
Monthly Household Expenses
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First Mortgage |
$ |
Electric |
$ |
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Second Mortgage |
$ |
Gas |
$ |
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Homeowner’s Insurance* |
$ |
Trash |
$ |
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Property Taxes |
$ |
Cable |
$ |
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HOA/Condo Fees/Property |
$ |
Cell phone |
$ |
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Maintenance |
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Student Loan (if not deferred) |
$ |
Food |
$ |
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Car Payment |
$ |
Clothing |
$ |
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Credit Cards/Other Installment |
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Out of Pocket Medical/Dental |
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Loans (minimum monthly |
$ |
$ |
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Expenses |
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payment) |
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Car Expense/Gas |
$ |
Life Insurance |
$ |
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Alimony/Child Support Payments |
$ |
Mortgage Payments on Other |
$ |
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Properties |
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Other |
$ |
Other |
$ |
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If you want Rushmore to consider Non-Borrower/Contributor Income (a person who resides in the property or contributes to household income but is not a listed Borrower on the Loan), please submit a completed and signed Non-Borrower Contribution form with this application.
7
REQUIRED INCOME DOCUMENTATION
Please refer to the Checklist included in this package
Any income documentation that you submit as part of your Borrower Assistance Application should be dated within 90 days of the time documentation is received by Rushmore.
Additional documentation may be required if income not supported.
HARDSHIP AFFIDAVIT
I (We) are having difficulty or expect to have difficulty making monthly mortgage payments because of the reason(s) set forth below. Please check the primary reason and submit the required documentation demonstrating your primary hardship.
If your Hardship Is: |
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Then the required documentation is: |
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Unemployment |
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Please state dates of unemployment |
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(e.g. MM/DD/YYYY to MM/DD/YYYY): |
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____/____/______ to ____/____/______ |
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____/____/______ to ____/____/______ |
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Reduction in Income: a hardship that has |
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Provide a written description of your |
caused a decrease in your income due to |
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circumstances on the attached hardship letter. |
circumstances beyond your control (e.g., |
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reduction in overtime or regular working hours, |
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reduction in base pay). |
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Increase in Housing Expenses: a hardship that |
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Provide a written description of your |
has caused an increase in your housing expense |
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circumstances below or on the attached hardship |
due to circumstances beyond your control. |
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letter: |
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8 |