Loan Modification Worksheet
Loan Modification/Short Sale Financial Worksheet
The following is a sample of a financial information worksheet that may be used in an application to your lender for a loan modification, or short sale consideration.
BORROWER INFORMATION: LOAN NUMBER: ________________________
: LOAN NUMBER: ________________________
LOAN NUMBER: ________________________
Mortgagor_________________________________
Social Security Number _____________________
Home #___________________________________________
Work #___________________________________
Property Address __________________________________________________________
Mailing Address _________________________________________________________
Home Phone # _____________________________________
Work #____________________________________
Co-Mortgagor _____________________________________
Social Security Number ______________________
Mailing Address _________________________________________________________________
# Family Members ________________
**************************************************************************************
MONTHLY INCOME DATA
Description Mortgagor Co-Mortgagor Total
Net Salary $_____________ $______________ $____________
Net O/T $_____________ $______________ $____________
Commission $_____________ $______________ $_____________
Bonus $_____________ $______________ $_____________
SSI $_____________ $______________ $_____________
Alimony/Child Support $____________ $______________ $_____________
TOTAL $_____________ $______________ $_____________
**************************************************************************************
Place of Employment How Long?
Mortgagor ______________________________________
Address __________________________________________________________
Co-Mortgagor _________________________________________ _______________
Address ___________________________________________________________
EXPENSES
Monthly Obligations Monthly Payment Balance Due Past due? # months
Mortgage $ ________________ $ _____________ _________________
2nd Lien $________________ $ _____________ _________________
Other Mtg $________________ $ _____________ _________________
Alimony $________________ $ _____________ _________________
Child Support $________________ $ _____________ _________________
Child Care $________________ $ _____________ _________________
Loans
Automobile $________________ $ _____________ _________________
Furniture/Appliance $________________ $ _____________ _________________
Finance Company $________________ $ _____________ _________________
Finance Company $________________ $ _____________ _________________
Installment $________________ $_____________ _________________
Credit Cards
Visa $________________ $_____________ _________________
MasterCard $________________ $_____________ _________________
American Express $________________ $_____________ _________________
________________ $________________ $_____________ _________________
________________ $________________ $_____________ _________________
________________ $________________ $_____________ _________________
________________ $________________ $_____________ _________________
Utilities
Electricity $________________ $_____________ _________________
Heating/Gas $________________ $_____________ _________________
Telephone $________________ $_____________ _________________
Water/Sewer $________________ $_____________ _________________
Insurance
Homeowners $________________ $_____________ _________________
Automobile $________________ $_____________ _________________
Health $________________ $_____________ _________________
Life $________________ $_____________ _________________
Dental $________________ $_____________ _________________
Donations
Church $________________ $_____________ _________________
Charity $________________ $_____________ _________________
Dues
Union $_______________ $______________ __________________
HOA $_______________ $______________ __________________
Club $_______________ $______________ __________________
Other $_______________ $______________ __________________
Medical (not covered by insurance)
Doctor/Dentist $_______________ $______________ __________________
Hospital $_______________ $______________ __________________
Drugs $_______________ $______________ __________________
Car
Gasoline $_______________ $______________ __________________
Maintenance $_______________ $______________ __________________
Monthly Parking $_______________ $______________ __________________
Food
Family $_______________ $______________ __________________
School/Work Lunches $_______________ $______________ _________________
Clothing
New Clothes $_______________ $______________ __________________
Dry Cleaning $_______________ $______________ __________________
Uniforms $_______________ $______________ __________________
Miscellaneous
Spending Money $_______________ $______________ __________________
Cable TV $_______________ $______________ __________________
Clubs/Sports/Hobbies $_______________ $______________ __________________
Entertainment $_______________ $______________ __________________
Vacations $_______________ $______________ __________________
Gifts $_______________ $______________ __________________
IRS Liens $_______________ $______________ __________________
________________ $_______________ $______________ __________________
________________ $_______________ $______________ __________________
TOTAL Expenses: $________________ $______________ $_________________
**************************************************************************************
RECAP:
Total Income: $_____________
Total Expenses: $____________
Difference: $_________________
Checking Account Savings Account
Account #______________________________ # ________________________________
Balance $_______________________________ $______________________________________
IRA $_______________________________ Stocks/Bonds $__________________________
401K $_______________________________ Annuities $_____________________________
**************************************************************************************
ASSETS
Estimated Value Amount Owed Net Value
Home $_______________ $_______________ $_____________
Other Real Estate $_______________ $_______________ $_____________
Automobile $_______________ $_______________ $_____________
Make/Model $_______________ $_______________ $_____________
Automobile $_______________ $_______________ $_____________
Make/Model $_______________ $_______________ $_____________
Checking Accounts $_______________ $_______________ $_____________
Savings Accounts $_______________ $_______________ $_____________
Boat $_______________ $_______________ $_____________
Cash Value Life Ins.$_______________ $_______________ $_____________
Collections $_______________ $_______________ $_____________
Computers$_______________ $_______________ $_____________
Jewelry $_______________ $_______________ $_____________
IRA$_______________ $_______________ $_____________
401K $_______________ $_______________ $_____________
Stocks/Bonds/CD?s $_______________ $_______________ $_____________
Other Investments $_______________ $_______________ $_____________
**************************************************************************************
I/we agree that the financial information provided is an accurate statement of my financial status. I understand that the Lender may verify this information at its option, by ordering a credit report,
and I agree that the Lender has my permission to do so. I understand that any legal action already taken will not be canceled until an approved work out is completed.
Submitted this ___________ day of ___________________2009.
_______________________________________
Mortgagor
_______________________________________
Co-Mortgagor
Final Instructions: Review the worksheet and make sure it is correct. Sign and date the form. Make copies of everything you have submitted and keep them for your records.