
Monthly Gross Wages
$ Other Mortgages*** $ Checking Account(s) $
Overtime
$ Other Home Insurance*** $ Checking Account(s) $
Savings / Money Market $
CDs $
Stocks/Bonds $
Other Cash on Hand $
Other Real Estate $
$
$
Food Stamps/Welfare
$ Property Taxes*** $ $
Taxable Social Security
or Retirement Income
$ Car Payments $ $
Auto Insurance $ $
Utilities $ $
Tips, commissions,
bonus, and overtime
$ Cable $ $
Gross Rents Received***
$ $ $
Other_______________
$ Other_________________ $ Other________________ $
Total(Gross Income)
$ Total Debt/Expenses $ Total Assets: $
Alimony, child support, or separation maintenance payments as qualifying income:*
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Unemployment Income $
Alimony, Child Support
payments**
$
Untaxed Social Security /
SSD
Credit Cards/ Installment
Loan(s) (total minimum
payments per month)
$ $
$
Child Support /
Alimony**
Contribution Amount:
I contribute the following income to the expenses of the household and towards the mortgage payments each month and will
continue to do so for the foreseeable future (Check one):
________ 100% of my income _________ Other Amount
IRS Forms:
Do you earn a wage?
INCOME & EXPENSES WORKSHEET
All Contributor Monthly Income Sources
(Documentation is required to support
contibution amount)
Monthly Contributor Expenses/Debt Contributor Assets
Self-employed Income $
HOA/Condo Fees
(Documentation
Required)***
$
Rental income: Provide your most recent Federal Tax return with all schedules, including Schedule E and
“Other Earned Income” such as bonuses, commissions, housing allowance, tips, or overtime:
Reliable third-party documentation describing the amount and nature of the income (e.g., employment contract or printouts
documenting tip income).
For each contributor who receives self-employed income, provide your
most recent signed and dated quarterly or year-to date profit and loss
statement.
** Notice: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it considered for repaying this loan.
*** Include rental income / expenses received from all properties you own EXCEPT a property for which you are contributing to in this Section.
a copy of the current lease agreement with either two (2) months bank statements or cancelled rent checks demonstrating
receipt of rent.
Documentation showing the receipt of payment, such as copies of the two most recent bank statements showing deposit
amounts.
Documentation showing the amount and frequency of the benefits, such as letters, exhibits, disability policy or benefits
statement from the provider, and
Social Security, disability or death benefits, pension, public assistance, or adoption assistance:
Are you self-employed?
For each contributor who is a salaried employee or hourly wage earner,
provide the most recent pay stub(s) that reflects
at least 30 days of year-to-date income.
Include a signed IRS Form 4506-T or 4506T-EZ
Copy of divorce decree, separation agreement, or other written legal agreement filed with a court, or court decree that states
the amount of the alimony, child support, or separation maintenance payments and the period of time over which the
payments will be received, and
Copies of your two most recent bank statements or other third-party documents showing receipt of payment.
*Notice: Alimony, child support, or separate maintenance income need not be revealed if you do not choose to have it
considered for repaying this loan.
Copies of the two most recent investment statements or bank statements supporting receipt of this income.
Investment income: