How much do you owe on the property?
How much is the property worth?
1st Mortgage Balance
1st Mortgage Payment
2nd Mortgage Balance
2nd Mortgage Payment
Equity Line/Other Liens Balance
Equity Line/Other Liens Payment
TOTAL Monthly House Payment
Are all of your payments current ?
Yes No
If your payments are behind, how many?
If your payments are behind, what is the total amount that you are behind?
Have you received any of the following?
Foreclosure/Warning Letter Notice of Default
If so, when?
Has a Sheriff Sale date been set?
Is the house attached to Bankruptcy?
Is the house currently occupied?
Describe any repairs needed:
Additional Comments