<p> United States Department of Agriculture- Rural Development 504 Loan Program Pre-Application</p><p>APPLICANT INFORMATION Applicant #1 Applicant #2 Name Name</p><p>Home Phone (incl. Area Code) Date of Birth Home Phone (incl. Area Code) Date of Birth</p><p>Dependents (Not Listed by Applicant #2) Dependents (Not Listed by Applicant #1) No. Ages No. Ages</p><p>Property Address (Street. Town, Zip) Property Address (Street. Town, Zip)</p><p>Mailing Address, if different from above Mailing Address, if different from above</p><p>HOUSEHOLD INCOME Gross Monthly Income Applicant #1 Applicant #2 Wages </p><p>Pensions </p><p>VA Benefits </p><p>Social Security/SSD </p><p>SSI </p><p>TANF </p><p>Child Support </p><p>Other </p><p>Other Benefits HEAP Fuel Assistance- Annual amount received Food Stamps- Monthly amount received Earned Income Credit- Annual amount received Unemployment Benefits- Weekly amount received Childcare- Annual expense </p><p>Rural Development is an Equal Opportunity Lender, Provider, and Employer. Complaints of discrimination should be sent to USDA, Director, Office of Civil Rights, Washington, D. C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). Revised (3.24.2008) Complete for all household members EXCEPT Applicant #1 and Applicant #2 Name Age Are you Do you want to be Annual wage Sources of Annual Source of Non- a full considered for an Income Wage Non-Wage Wage Income time adjustment to Income Income (social security, student? household income (employer) child support, etc.) for a disabling y/n condition? y/n</p><p>ASSETS 1. Do you have liquid assets (cash,stocks/bonds,CD’s) in excess of $7,500? Yes No </p><p>2. Do you own real estate other than your primary residence? Yes No </p><p>3. What is the size of your lot in acres or in square footage? </p><p>4. Can your property be subdivided? Yes No Don’t Know </p><p>HOUSING EXPENSES Mortgage Payment $ per Month Unpaid Balance (Principle & Interest only)</p><p>Other Financing Payment $ per Month Unpaid Balance (Principle & Interest only)</p><p>Homeowners Insurance Real Estate Taxes</p><p>$ per Year $ per Year </p><p>LIABILITIES List the creditor’s name, monthly payment, and balance for all outstanding debts, including auto loans, charge accounts, medical, credit cards, etc. If you pay child support and/or pay for child care, include the monthly payments. Liability(not listed above) Monthly Payment Unpaid Balance</p><p>Child Support Child Care </p><p>Rural Development is an Equal Opportunity Lender, Provider, and Employer. Complaints of discrimination should be sent to USDA, Director, Office of Civil Rights, Washington, D. C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). Revised (3.24.2008) CREDIT 1. Are your bills paid up to date? Yes No Don’t Know </p><p>2. How is your credit? Excellent Good Poor Don’t Know </p><p>3. Have you declared bankruptcy within the last 3 years? Yes No </p><p>4. Are there any outstanding judgments against you? Yes No Don’t Know </p><p>HOUSING INFORMATION 1. Does your name(s) appear on the Deed to your property? Yes No </p><p>2. Is your home located on a rented/leased lot? Yes No </p><p>3. Is your home a single family dwelling? Yes No </p><p>4. What is the age and market value of your property? Age: Market Value: </p><p>5. Does your property have an in-ground pool? Yes No </p><p>6. Briefly describe the condition of your home and list the repairs you are seeking to have done to your home.</p><p>I certify to the best of my knowledge that all of the information that I have provided is correct and accurate.</p><p>APPLICANT #1</p><p>Signature: Email Application to: Date: [email protected]</p><p>Or sent to: APPLICANT #2 Rural Development 1423 Broadway, Suite 3 Signature: Bangor, ME 04401</p><p>Date: </p><p>Rural Development is an Equal Opportunity Lender, Provider, and Employer. Complaints of discrimination should be sent to USDA, Director, Office of Civil Rights, Washington, D. C. 20250-9410, or call (800) 795-3272 (voice) or (202) 720-6382 (TDD). Revised (3.24.2008)</p>