1429 Route 9 Fort Edward, NY 12828 | Phone (518)792-2151 | Fax (518)792-1147
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Own / Rent:
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Monthly Retirement Income:
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Gross Child Support Income:
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Monthly Net Rental Income:
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Name of Bank for Checking:
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Current Lot Value:
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Address:
Present Value:
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Pending Sale:
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Mortgage Balance:
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Mortgage Payments:
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Gross Monthly Rent:
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Property Type:
Car Loans / Leases?
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    YES NO
1 - Approximate Balance:
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Monthly Payment:
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2 - Approximate Balance:
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Monthly Payment:
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Personal Loans?
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    YES NO
1 - Approximate Balance: $ $
Monthly Payment: $ $
2 - Approximate Balance: $ $
Monthly Payment: $ $
Credit Cards?
    YES NO
    YES NO
1 - Approximate Balance: $ $
Req. Min. Monthly Payment: $ $
2 - Approximate Balance: $ $
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3 - Approximate Balance: $ $
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4 - Approximate Balance: $ $
Req. Min. Monthly Payment: $ $
Student Loans?
    YES NO
    YES NO
Total of All Balances: $ $
Total of All Monthly Payments: $ $
Alimony / Child Support?
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    YES NO
Monthly Payment: $ $
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Are there any Judgments against you or accounts currently in collection? YES NO
Have you been declared bankrupt within past 7 years? YES NO
Have you had any foreclosures in the past 7 years? YES NO
Are there any lawsuits pending against you? YES NO
Are you a coMaker or Endorser on any credit with someone else? YES NO
Will this home be your primary residence? YES NO
Are you a U.S. citizen? YES NO
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MH Imperial Homes ~ Custom Built Modular Homes

1429 Route 9 Fort Edward, NY 12828
Phone (518)792-2151 | Fax (518)792-1147

www.MHImperialHomes.com

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