First Bank of Newton
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Home Mortgage Application

First Bank of Newton is located solely within the state of Kansas, county of Harvey, USA. Our trade area includes Harvey county and under certain circumstances neighboring counties including Sedgwick, Reno, Butler, McPherson and Marion. Applications outside our trade area will not be accepted through the Internet.

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

To help the government fight the funding of terrorism and money laundering activities, the USA Patriot Act requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account. What this means for you: when you open an account, we will ask for your name, physical address, date of birth, taxpayer identification number and other information that will allow us to identify you. We may also ask to see your driver's license or other identifying documents. We will let you know if additional information is required.

This application is designed to be completed by the applicant(s) with the Lender's assistance. Applicants should complete this form as "Borrower" and "Co-Borrower", as applicable. Co-Borrower information must also be provided (and the appropriate box checked)when the income or assets of a person other than the Borrower (including the Borrowers's spouse) will be used as a basis for loan qualification, or the income or assets of the Borrower's spouse or other person who has community property rights pursuant to state law will not be used as a basis for loan qualification, but his or her liabilities must be considered because the spouse or other person has community property rights pursuant to applicable law and Borrower resides in a community property state, the security property is located in a community property state, or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan.
* Required Fields
 
If this is an application for joint credit, Borrower and Co-Borrower each agree that we intend to apply for joint credit (sign below):
I. Type of Mortgage and Terms of Loan
VA FHA
Conventional USDA Rural Housing Service
Other(explain):
$
%
Fixed Rate Other(explain):
GPM          ARM(type):
II. Property Information and Purpose of Loan
* / /
Purchase    Construction Other(explain):
Refinance   Construction-Permanent
Primary Residence Secondary Residence Investment
Complete this Section if Construction or Construction-Permanent Loan
$
$
$
$
$
Complete this Section if this is a Refinance Loan
$
$
Made     Cost: $
To be Made
Title Information
First Name:Last Name:
Fee Simple
Leasehold (show Expiration date): / /
III. Borrower Information
Yes No
- -
( ) -
/ /
(mm/dd/yyyy)
Married Separated
Unmarried (include single, divorced, widowed)
Number:
Ages:
* / /
Rent Own
/ /
If residing at present address for less than two years, complete the following:
/ /
Rent Own
Co-Borrower Information:
- -
( ) -
/ /
(mm/dd/yyyy)
Married Separated
Unmarried (include single, divorced, widowed)
Number:
Ages:
/ /
Rent Own
/ /
If residing at present address for less than two years, complete the following:
/ /
Rent Own
IV. Employment Information
     Self Employed
/ /
( ) -
If employed in current position for less than two years or if currently employed in more than one position, complete the following:
     Self Employed
/ /
From: / To: /
         (mm/yyyy)            (mm/yyyy)
$
( ) -
     Self Employed
/ /
From: / To: /
         (mm/yyyy)            (mm/yyyy)
$
( ) -
Co-Borrower Employment Information:
     Self Employed
/ /
( ) -
If employed in current position for less than two years or if currently employed in more than one position, complete the following:
     Self Employed
/ /
From: / To: /
         (mm/yyyy)            (mm/yyyy)
$
( ) -
     Self Employed
/ /
From: / To: /
         (mm/yyyy)            (mm/yyyy)
$
( ) -
V. Monthly Income and Combined Housing Expense Information
Gross Monthly Income
Combined Monthly
Housing Expense
Base Empl. Income**
$
Rent
$
Overtime
First Mortgage (P&I)
Bonuses
Other Financing (P&I)
Commissions
Hazard Insurance
Dividends/Interest
Real Estate Taxes
Net Rental Income
Mortgage Insurance
Other:
(before completing
see the notice in "describe
other income")*
Homeowner Assn. Dues.
Other
Total
$
Total
$
*Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.
Descibe Other Income NOTICE: Alimony, child support, or separate maintenance income need not be revealed if the Borrower or Co-Borrower does not choose to have it considered for repaying this loan.
Borrower/
Co-Borrower:
Explain: Monthly Amount:

$

$

$
VI. Assets and Liabilities
This Statement and any applicable supporting schedules may be completed jointly by both married and unmarried Co-Borrowers if their assets and liabilities are sufficiently joined so that the Statement can be meaningfully and fairly presented on a combined basis; otherwise, separate Statements and Schedules are required. If the Co-Borrower section was completed about a non-applicant spouse or other person, this Statement and supporting schedules must be completed about that spouse or other person also.
Jointly Not Jointly
Assets
$
List checking and savings accounts below
/ /
$
/ /
$
/ /
$
/ /
$
Stocks & Bonds
$
Life Insurance
$
$
$
$
$
$

(make and year)
Make Year Cash or Market Value:
$
$
$
Other Assets: Cash or Market Value:
$
$
$
$
Liabilities and Pledged Assets. List the creditor's name, address and account number for all outstanding debts, including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges, etc. Use continuation sheet, if necessary. Indicate by(*) those liabilities, which will be satisfied upon sale of real estate owned or upon refinancing of the subject property.
Liabilities
/ /
$
$
/ /
$
$
/ /
$
$
/ /
$
$
/ /
$
$
/ /
$
$
/ /
$
$
Alimony/Child Support/Separate Maintenance
$
Job Related Expense(child care, union dues, etc.)
$
 
$
$
$
$
Schedule of Real Estate Owned
/ /
Sold Pending Sale
Rental Being Held for Income
$
$
$
$
$
$
/ /
Sold Pending Sale
Rental Being Held for Income
$
$
$
$
$
$
/ /
Sold Pending Sale
Rental Being Held for Income
$
$
$
$
$
$
List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s):
VII. Details of Transaction
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
$
VIII. Declarations
If you answer, "Yes" to any questions a through i, please use the space below for explaination.
Borrower: Yes No
Co-Borrower: Yes No
Borrower: Yes No
Co-Borrower: Yes No
Borrower: Yes No
Co-Borrower: Yes No
Borrower: Yes No
Co-Borrower: Yes No
Borrower: Yes No
Co-Borrower: Yes No
Borrower: Yes No
Co-Borrower: Yes No
Borrower: Yes No
Co-Borrower: Yes No
Borrower: Yes No
Co-Borrower: Yes No
Borrower: Yes No
Co-Borrower: Yes No
 
Borrower: Yes No
Co-Borrower: Yes No
Borrower: Yes No
Co-Borrower: Yes No
Borrower: Yes No
Co-Borrower: Yes No
Borrower: Yes No
Co-Borrower: Yes No
Borrower: Principal Residence Second Home
Investment Property
Co-Borrower: Principal Residence Second Home
Investment Property
Borrower: By yourself Jointly with your spouse
Jointly with another person
Co-Borrower: By yourself Jointly with your spouse
Jointly with another person
IX. Acknowledgement and Agreement
 
Each of the undersigned specifically represents to Lender and to Lender's actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors and assigns and agrees and acknowledges that: (1)the information provided in this application is true and correct as of the date set forth opposite my signature and that any intentional or negligent misrepresentation of this information contained in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to reliance upon any misrepresentation that I have made on this application, and/or in criminal penalties including, but not limited to, fine or imprisonment or both under provisions of Title 18, United States Code, Sec. 1001, et seq.; (2) the loan requested pursuant to this application (the "Loan") will be secured by a mortgage or deed of trust on the property described in this application; (3) the property will not be used for any illegal or prohibited purpose or use; (4) all statements made in this application are made for the purpose of obtaining a residential mortgage loan; (5) the property will be occupied as indicated in this application; (6) the Lender, its servicers, successors or assigns may retain the original and/or an electronic record of this application whether or not the Loan is approved; (7) the Lender and its agents , brokers, insurers, servicers, successors, and assigns may continuously rely on the information contained in the application, and I am obligated to amend and/or supplement the information provided in this application if any of the material facts that I have represented herein should change prior to closing of the Loan; (8) in the event that my payments on the Loan become delinquent, the Lender, its servicers, successors or assigns may, in addition to any other rights and remedies that it may have relating to such delinquency, report my name and account information to one or more consumer credit reporting agencies; (9) ownership of the Loan and/or administration of the Loan account may be transferred with such notice as may be required by law; (10) neither Lender nor its agents, brokers, insurers, servicers, successors or assigns has made any representation or warranty, express or implied, to me regarding the property or the condition or value of the property; and (11) my transmission of this application as an "electronic record" containing my "electronic signature" as those terms are defined in applicable federal and/or state laws (excluding audio and video recording), or my facsimile transmission of this application containing a facsimile of my signature, shall be as effective, enforceable and valid as if a paper version of this application were delivered containing my original written signature.

Acknowledgement. Each of the undersigned hereby acknowledges that any owner of the Loan, its servicers, successors and assigns, may verify or reverify any information contained in this application or obtain any information or data relating to the loan, for any legitimate business purpose through any source, including a source named in this application or a consumer reporting agency.
 
 
*    
 
 
 
X. Information for Government Monitoring Purposes
*GOVERNMENT MONITORING DATA: IF THE PURPOSE OF THIS LOAN IS FOR HOME IMPROVEMENT, HOME PURCHASE, OR REFINANCE, PLEASE READ AND COMPLETE THE FOLLOWING:
 
The following information is requested by the Federal Government for certain types of loans related to a dwelling in order to monitor the lenderís compliance with equal credit opportunity, fair housing and home mortgage disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation and surname if you have made this application in person. If you do not wish to furnish the information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)
 
    I do not wish to furnish the following information
Hispanic or Latino
Not Hispanic or Latino
American Indian or Alaskan Native
Native Hawaiian or Pacific Islander
Black or African American
Asian
White
Male
Female
 
    I do not wish to furnish the following information
Hispanic or Latino
Not Hispanic or Latino
American Indian or Alaskan Native
Native Hawaiian or Pacific Islander
Black or African American
Asian
White
Male
Female





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FIRST BANK
4 Locations in Newton & Hesston to Serve You
316-283-2600

equal housing lender
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©2012 First Bank of Newton, all rights reserved. Please see our Internet User Agreement. First Bank of Newton is the full legal name of First Bank, located in Newton and Hesston, Kansas.

Harvey County's Oldest Bank... Established 1873