Pre-purchase Intake Package

The purpose of this intake is to permit Morningstar Urban Development Inc. (MUDI) to determine where you are in the home-buying process. We will verify certain information and pull your credit report (soft pull), then review your information related to different home purchase options. If after you one on one session you are mortgage ready, you will be referred to one of our lending partners; if you are not yet mortgage ready, you will be referred to our Pre-Purchase coaching program. Please complete this form, read through the information provided, and sign and date where indicated.

* In addition to your information and signatures, each adult/applicant will also need to provide a copy of the last 2 paystubs and credit report check fee of $25.69. *You may pay with cash, money order, cashier’s check, or credit card (+ an electronic processing fee).

Pre-Purchase Intake Form

CLIENT INFORMATION AND EMPLOYMENT

Full Name(Required)

First Last

SS #(Required)

DOB(Required)

Contact Number(Required)

Contact Type

Cell Phone

Home Number

Email(Required)

Enter Email Confirm Email

By providing an e-mail address, you attest it’s secure & you can & will check it regularly

Veteran?

Yes

Active Duty

Is There A Co-applicant?(Required)

Yes

Co-applicant Full Name

First Last

Co-Applicant SS #

Co-Applicant DOB

Co-Applicant Contact Number

Co-Applicant Contact Type

Cell Phone

Home Number

Co-Applicant Email

Enter Email Confirm Email

By providing an e-mail address, you attest it’s secure & you can & will check it regularly

Is Co-Applicant A Veteran?

Yes

Active Duty

HOUSEHOLD INFORMATION

Household size(Required)

Please enter a number from 1 to 10.

# of Dependents(Required)

Please enter a number from 0 to 20.

Ages of Dependents

Address(Required)

Street Address Address 2/P O Box City State ZIP Code

County(Required)

How long at residence?(Required)

Please enter a number from 1 to 50.

Is this a rental property?(Required)

Yes

If yes, monthly rent amount:

Please enter a number from 1 to 6000.

HOUSEHOLD INCOME: Provide information regarding ALL income received by the household in the sections below:

Current Occupation:(Required)

Employer:(Required)

Title:(Required)

Start Date:

Gross Monthly Income (before taxes):(Required)

Net Monthly Income (after taxes):(Required)

Income Is:

Full Time

Part Time

Seasonal

Self Employment

Commissioned Income

Average Hours Worked Per Week:

Self Employed – What is your average estimated monthly income?

How often do you get paid?

Select all that apply

2nd Job or Previous Job?

Second Job

Previous Job

N/A

Employer (Previous or Second):

Start Date:

End Date (If previous job):

(leave blank if this is a second job)

Income

Co-Applicant's Current Occupation:

Co-Applicant's Current Employer:

Co-Applicant's Title:

Co-Applicant's Start Date:

Before Taxes

Co-Applicant's Gross Monthly Income:

Income before taxes

Co-Applicant's Net Monthly Income:

Income After Taxes

Co-Applicant's Income is:

Full Time

Part Time

Seasonal

Self Employment

Commissioned Income

Co-Applicant's Average Hours Worked Per Week:

Self Employed – What is your average estimated monthly income?

How Often Does Co-Applicant Get Paid

Choose all that apply.

Co-Applicant's 2nd Job or Previous Job?

Second Job

Previous Job

N/A

Co-Applicant's Employer (Previous or Second)

Co-Applicant's Previous or Second Start Date:

Co-Applicant's Previous or Second End Date:

Co-Applicant's Previous or Second Income

OTHER HOUSEHOLD INCOME: List ALL others living in the household and how much (if any) income they receive:

Are there others living in the household beside client or co-client that earn an income?

Yes

Other Occupant's Name

Other Occupant's Birth Date

Other Occupant's Source Type

Other Occupant's Amount Received

Frequency

Any Additional Occupants?

Yes

Other Occupant's Name (2)

Other Occupant's Birth Date (2)

Other Occupant's Source Type (2)

Other Occupant's Amount Received (2)

Frequency (2)

Are There Any Additional Occupants Besides The Previous 2?

Yes

Other Occupant's Name (3)

Other Occupant's Date (3)

Other Occupant's Source Type (3)

Other Occupant's Amount Received (3)

Frequency (3)

Are There Any Additional Occupants Besides The Previous 3?

Yes

Other Occupant's Name (4)

Other Occupant's Date (4)

Other Occupant's Source Type (4)

Other Occupant's Amount Received (4)

Frequency (4)

PLEASE CHECK ALL THAT APPLY

Have you ever filed for bankruptcy?(Required)

Yes

When was the filing date?

Bankruptcy Type?

Chapter 7

Chapter 13

Is the bankruptcy discharged?

Yes

Provide discharge date:

PLEASE CHECK ALL THAT APPLY

Race/Ethnic background:(Required)

African–American

Hispanic

Asian

Native – American

White

Other

If Other, Please explain:

Country of Origin (Place of Birth):(Required)

Family Size(Required)

Age & Gender of Dependent(s):

Marital Status:(Required)

Dependent with disability:

Yes

Gender:(Required)

Male

Female

Head of Household?(Required)

Yes

Active Military:

Yes

Veteran:

Yes

Residency Status:(Required)

US Citizen

Resident Alien (Green Card Holder)

Work Visa

Non-Resident Alien

Highest Level of Education:(Required)

High School Diploma

Some College

Associates Degree

Bachelors Degree

Masters/Doctorate Degree

None of the above

* PROGRAM PARTICIPATION QUESTIONS

1. Have you worked with MUDI before?(Required)

Yes

If so, when?

What other organizations have you contacted?(Required)

2. Are you currently receiving assistance through them?

Yes

If yes, date of last contact?

3. How did you hear about MUDI's Pre-Purchase program?

4. Have either the client or co-client filed bankruptcy within the past 3 years?(Required)

Not Sure

Yes

If yes, what type

Chapter 7

Chapter 13

Other

Explain 'Other':

Discharge date

5. Have either the client or co-client owned a house within the past 3 years?(Required)

Yes

6. Are you currently working with a realtor?(Required)

Yes

Please provide Realtor's name

All of the information that I/We have provided in this intake application is correct and factual. No information has been withheld. I/We understand that deliberately providing inaccurate information or an unwillingness to timely proved the counselor with the necessary information or documents to assist me/us can result in an adverse outcome/result. It will also result in the closing of my/our file and no further assistance from the counselor will be provided.

Signature(Required)

Signature (Co-Client)

HOUSEHOLD BUDGET WORKSHEET Use this sheet to determine and capture your income, expenses and disposable income. Please do not include and monies deducted from your take home pay.

Monthly Take Home Income (NET)

Salary/Wages/Commissions/Self-Employment Income

Salary/Wages/Commissions/Self-Employment Income (Spouse)

Social Security Income

Pension/Retirement

Interest on Accounts

Alimony / Child Support

Real Estate Rent (income)

Investment Dividends

Unemployment / Food Stamps

Other Take Home Income

TOTAL TAKE HOME INCOME

Monthly Living Expenses

Alimony / Child Support (outgoing)

Child Care

Children’s Activities

Tuition and School Supplies

Auto Gas and Repair

Auto Insurance

Telephone (Home, Cell, Pager)

Internet Access (AOL, MSN, DSL)

Cable TV/Satellite Fees

Electric Bill

Gas and Oil Bill

Water Bill

Trash Disposal

Property Services (Gardner, Pool)

Security Services (Alarm)

Food (In-Home / Groceries)

Food (Out of Home / Lunch, Dining)

Prescriptions

Household Items

Personal Care (Grooming)

Memberships (Health Clubs etc.)

Health and Dental Insurance

Life and Disability Insurance

Homeowner/Condo Association Fees

Homeowners/Renters Insurance (If not already included in mortgage)

Property Taxes (If not already included in mortgage)

Charitable Contributions

Clothing Laundry & Dry Cleaning

Clothing Purchases

OTHER (Describe)

TOTAL MONTHLY Living Expenses

Other Monthly Living Expenses Description:

Housing Payments

Rent

1st Mortgage

2nd Mortgage

Land Lease (Trailer Park, other)

Total Housing Payments

Secured Debts ( Monthly Payments)

Student Loans

Auto Loans/Leases

Recreation (Boat, ATV, etc.)

Past Due Taxes

Other Debts

Other Loans

Total Secured Debt

UNSECURED DEBT (Monthly payment)

Credit Card 1

Credit Card 2

Credit Card 3

Credit Card 4

Credit Card 5

Personal Loan 1 (Payday Loans, Finance Loans, etc)

Personal Loan 2 (Payday Loans, Finance Loans, etc)

Medical Bill Payment

Other Unsecured Debt

Total Unsecured Debt

Assets

Cash On Hand

Checking Account

Saving Account

Anticipated Tax refund

IRA/Keogh Accounts

Stocks/Bonds/CD’s/Annuities, etc.

Other Assets

Signature (Budget Worksheet)(Required)

Signature – Co-Applicant (Budget Worksheet)

Hidden

SUMMARY (OFFICE USE ONLY)

Hidden

Disposable Income **

Hidden

Disposable Income as Percent

Name

This field is for validation purposes and should be left unchanged.

Pre-Purchase Intake Form

OTHER HOUSEHOLD INCOME: List ALL others living in the household and how much (if any) income they receive:

Monthly Take Home Income (NET)

Monthly Living Expenses

Housing Payments

Secured Debts ( Monthly Payments)

UNSECURED DEBT (Monthly payment)

Assets

SUMMARY (OFFICE USE ONLY)

Upcoming Events

Services & Programs

Contact Info