Request Form Template For Verification Of Mortgage Account
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1REQUEST FOR VERIFICATION OF MORTGAGE ACCOUNT
PART I – TO BE COMPLETED BY APPLICANT
NAME AND ADDRESS OF MORTGAGE COMPANY OR BANK:
___________________________________
___________________________________
___________________________________
INFORMATION TO BE VERIFIED:
PROPERTY ADDRESS:
ACCOUNT IN THE NAME OF:
ACCOUNT #:
________________________
__________________________
____________
________________________
________________________
MORTGAGE
SECOND MORTGAGE
CONTRACT SALE
NAME AND ADDRESS OF APPLICANTS(S)
SIGNATURE OF APPLICANT(S):
________________________________
X__________________________________
________________________________
________________________________
X__________________________________
PART II – TO BE COMPLETED BY MORTGAGE COMPANY OR BANK
We have received an application for a loan form the above, to whom we understand you have extended a loan. Please
provide us with the following information:
Date mortgage originated:
__________________
Monthly Payment:
Original mortgage amount:
__________________
Principle and Interest: ____________
Current mortgage balance:
__________________
Taxes:
____________
Insurance:
____________
Total Payment:
____________
Is mortgage current?
Yes
No
Satisfactory account?
Yes
No
SIGNATURE OF DEPOSITORY
TITLE
DATE
PLEASE RETURN COMPLETED FORM TO:
Housing Rehab Program
c/o Administrative Resources association
748 Franklin St.
Columbus, IN 47201
This confidentiality of the information you have furnished will be preserved except where disclosure of this information is required by applicable
law. The form is to be transmitted directly to the lender and is not to be transmitted through the applicant or any other party.
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