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Mortgage Application
Please Print and Fill out Form and Fax to: 305-895-1236

JOANN J. PARKER
MORTGAGE BROKERAGE BUSINESS
TELEPHONE 305-893-3080               FAX 305-895-1236
625 NE 123rd STREET  NORTH MIAMI FLORIDA 33161
(Short Form)

NAME OF BORROWER ______________________ HOME TEL:(    )______________

ADDRESS ________________________________ CITY ______________________

STATE ___________ ZIP _____________

DATE OF BIRTH _________/ _________/ ___________

SOCIAL SECURTY _____________________________

CO-BORROWER:

NAME ____________________________________ HOME TEL: (    )_____________

ADDRESS ________________________________ CITY ______________________

STATE ____________ ZIP _____________

DATE OF BIRTH _________/ _________/ ___________

SOCIAL SECURTY _____________________________

GROSS MONTHLY INCOME ( BORROWER ) _________________________
GROSS MONTHLY INCOME ( CO-BORROWER ) ______________________

TIME ON JOB ( BORROWER) ________________ ( CO-BORROWER ) ___________________

MONTHLY OBLIGATION ( BORROWER ) ____________________________

MONTHLY OBLIGATION ( CO-BORROWER ) ________________________

TOTAL CASH TO CLOSE _________________________

SOURCE OF CASH _______________________________
(GIFT, SAVINGINGS, SALE, ETC.. EXPLAIN)



_________________________     _________          ___________________          ______
SIGNATURE                                       DATE                    SIGNATURE                                DATE
(Signature Required)