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OMB Approved No. 2900-0029

Respondent Burden: 20 Minutes

CREDIT STATEMENT OF PROSPECTIVE PURCHASER

PRIVACY ACT INFORMATION - The information collected on this form will serve as an application for credit from VA in connection with an offer to purchase a

VA-acquired property, as authorized by law (38 U.S.C. 1820(a)(5)). Failure to provide the requested credit information could result in disapproval of your application

for a loan. Under the Debt Collection Act of 1982, VA is required to collect the social security numbers of loan applicants. VA may conduct computer matches to

verify the information which you furnish. Under the Financial Privacy Act of 1978, VA may obtain financial records held by financial institutions in connection with

the consideration or administration of assistance to you. Such financial records will be available to VA without further notice or authorization. VA records will not be

disclosed outside VA unless authorized by law including the routine uses identified in VA system of records, 55VA26, Loan Guaranty Home, Condominium and

Manufactured Home Loan Applicant Records, Specially Adapted Housing Applicant Records and Vendee Loan Applicant Records - VA, published in the Federal

RESPONDENT BURDEN: VA may not conduct or sponsor, and respondent is not required to respond to this collection of information unless it displays a valid

OMB Control Number. Public reporting burden for this collection of information is estimated to average 20 minutes per response, including the time for reviewing

instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. If you have

comments regarding this burden estimate or any other aspect of this collection of information, call 1-800-827-1000 for mailing information on where to send your

comments.

GENERAL INFORMATION

1A. APPLICANT(S) NAME(S) AND MAILING ADDRESS

2. VA PROPERTY IDENTIFIER

3. VA PROPERTY ADDRESS

1B. HOME TELEPHONE NO.

(

)

4. DOWNPAYMENT

5. REQUESTED LOAN

6. REHABILITATION AMOUNT

8. APPLICANT HOME STATUS

9. MARITAL STATUS

10. AGES OF DEPENDENTS OTHER THAN SPOUSE

7. TERM AND INTEREST

YEARS

PERCENT

RENT

MARRIED

SEPARATED

YEARS

OWN

UNMARRIED

11. ATTACHMENTS

12. NEAREST RELATIVE NOT LIVING WITH APPLICANT

ALL INCOME DOCUMENTS

SEPARATE CREDIT STATEMENT FROM

NAME:

STREET:

OTHER (Specify)

CITY:

(A Co-applicant who is not the spouse of the

STATE:

ZIP CODE:

Applicant named in Item 1)

TELEPHONE NO.: (

)

13. IF ANY OF THE FOLLOWING THREE STATEMENTS APPLIES TO THE REQUESTED LOAN, THEN CREDIT INFORMATION CONCERNING THE SPOUSE WILL BE

NECESSARY TO EVALUATE THE CREDIT RISK. PLEASE MARK THE STATEMENTS THAT APPLY TO THE REQUESTED LOAN:

THE APPLICANT IS MARRIED AND RESIDES IN, OR THE PROPERTY IS LOCATED IN, A COMMUNITY PROPERTY STATE

THE APPLICANT WILL RELY ON INCOME FROM ALIMONY, CHILD SUPPORT OR SEPARATE MAINTENANCE OR ON THE INCOME OR ASSETS OF A SPOUSE TO

REPAY THE LOAN

THE APPLICANT WILL BE JOINTLY OBLIGATED WITH THE SPOUSE TO REPAY THE LOAN

APPLICANT

SPOUSE/CO-APPLICANT

14A. DATE OF BIRTH

14B. SOCIAL SECURITY NUMBER

15A. DATE OF BIRTH

15B. SOCIAL SECURITY NUMBER

14C. EMPLOYER NAME AND MAILING ADDRESS

14D. DATES (From-To)

15C. EMPLOYER NAME AND MAILING ADDRESS

15D. DATES (From-To)

14E. MONTHLY

15E. MONTHLY

INCOME

SELF EMPLOYED

14F. JOB TITLE/TYPE OF BUSINESS

14G. BUSINESS TELEPHONE

15F. JOB TITLE/TYPE OF BUSINESS

15G. BUSINESS TELEPHONE

(

)

(

)

NOTE - If working for more than one employer, or employed at present job less than two years, continue to furnish job or training

information to cover the latest two-year period. Use a separate sheet, if necessary.

16A. PREVIOUS EMPLOYER’S NAME AND MAILING

16B. DATES (From-To)

17A. PREVIOUS EMPLOYER’S NAME AND MAILING

17B. DATES (From-To)

ADDRESS

16C. MONTHLY

17C. MONTHLY

INCOME

SELF EMPLOYED

16D. JOB TITLE/TYPE OF BUSINESS

16E. BUSINESS TELEPHONE

17D. JOB TITLE/TYPE OF BUSINESS

17E. BUSINESS TELEPHONE

(

)

(

)

18. COMBINED ASSETS AND CASH/MARKET VALUES

OTHER LOAN/GIFT TO BUY THIS PROPERTY

FURNITURE, HOUSEHOLD GOODS

CASH ON HAND, CHECKING ACCOUNTS

VEHICLE (YEAR AND MODEL)

SAVINGS ACCOUNTS, CERTIFICATES, BONDS

OTHER

STOCKS, OTHER SECURITIES

OTHER

REAL ESTATE OWNED OTHER THAN HOME

OTHER

VA FORM

EXISTING STOCK OF VA FORM 26-6705b, SEP 1995,

26-6705b

PURCHASE OFFER NO:

DEC 1998

WILL BE USED.

AUTHORIZATION TO RELEASE INFORMATION

I hereby authorize VA (United States Department of Veterans Affairs) to verify records of my past and present employment and income, as well as

financial accounts and other asset balances, to obtain a consumer and/or business credit report and verify information regarding my past and present

credit accounts, including rental accounts, in order to process my credit statement to VA. I acknowledge that VA is in compliance with the Right to

Financial Privacy Act of 1978 (Title XI, Public Law 95-630), in connection with this request for access to financial records. I request all referenced

employers, financial institutions, landlords and other creditors to accept a photocopy of this signed authorization as evidence of my consent to release

the requested information to VA.

SIGNATURE OF APPLICANT

DATE SIGNED

SIGNATURE OF SPOUSE/ CO-APPLICANT

DATE SIGNED

26-6705b

VA FORM

EXISTING STOCK OF VA FORM 26-6705b, SEP 1995,

CONTINUED ON REVERSE

DEC 1998

WILL BE USED.