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EMPLOYMENT HISTORY <br />Applicant's Employer <br />Name <br />Occupation <br />Previous Employer <br />Name <br />Occupation <br />Co-Applicant's Employer <br />Name <br />Occupation <br />Previous Employer <br />Address <br />Date you began work <br />City/State/Zip <br />Address City/State/ZI P <br />From To <br />Address <br />Date you began work <br />City/State/ZI P <br />Name Address City/State/ZIP <br />Occupation From To <br />EXISTING llEBT ON PROPERTY TO BE REHABILITATED <br />Original Mortgage Amount <br />FHA Insured: Yes ^ <br />bender <br />Unpaid Balance <br />Name Address City/State/ZIY <br />PREVIOUS FORECLOSURE RECORD <br />Have you ever been obligated on a home loan, or a home improvement loan, which resulted in foreclosure, deed <br />in lieu of foreclosure, or judgment? Yes ^ No ® (If yes, complete 1 and 2 below). <br />(1) Lender <br />Name Address City/State/7.1 P <br />(2) Property _ <br />Name Address City/State/Z I P <br />COMPLF,TION OF ITEMS FROM PAGE 2 REQUIRING AllDITIONAL SPACE <br />ITEM NO INFORMATION <br />APPLICANT'S CERTIFICATION <br />1 certify that the information given by me is accurate to the best of my knowledge. [give permission for any authorized employee of <br />the local public agency to verity any statement made by me. I Jessie Brumfield and Joanna Watkins agree to abide by their <br />requirements in connection with any loan that may be made based upon this application. <br />PENALTY FOR FALSE OR FRAUDULENT STATEMENT. I understand that under U.SC. Title i8, Section 3001, any <br />untruthful or deliberately misleading statements made by me on this application or my use of any untruthful or misleading statement on <br />a document supporting this application, can result in prosecution under Federal taw, and that I can be fined, not more than $10,000, <br />and/or imprisoned for not more than 5 years, if found guilty. <br />No ^ <br />APPLICANT DATE CO-APPLICANT DATE <br />