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F,MPLOYMF,NT HISTORY <br />Applicant's Employer <br />Name Address <br />Occupation <br />Previous Employer <br />Name <br />Occupation <br />Date you began work <br />Address <br />From To <br />Co-Applicant's Employer <br />Name Address <br />Occupation <br />Previous Employer <br />Occupation <br />Date you began work <br />Address <br />From To <br />City/State/Zip <br />City/State/ZI P <br />City/State/ZIP <br />City/State/ZIP <br />EXISTING DEBT ON PROPERTY TO BE REHABILITATED <br />Original Mortgage Amount Unpaid Balance <br />FHA Insured: Yes ^ No ^ <br />Lender <br />Name <br />Name Address City/State/ZI P <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 ® pfyes, complete 1 and 2 below). <br />(I) Lender <br />Name Address City/State/Z[P <br />(2) Property <br />Name <br />Address <br />City/State/Z I P <br />COMPLETION OF ITEMS FROM PAGE 2 REQUIRING ADDITIONAL SPACE <br />ITEM NO INFORMATION <br />APPLICANT'S CERTIFICATION <br />I certify that the information given by me is accurate to the best of my knowledge. 1 give permission for any authorized employee of <br />the local public agency to verify any statement made by me. 1 Charles P. Wilson and Esther Jane Wilson agree to abide <br />by their requirements in connection with any loan that may be made based upon this application. <br />PENALTY FOR FALSE OR FRAUDULENT STATEMENT. 1 understand that under U.S.C. Title 18, Section 1001, 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 law, and that 1 can be fined, not more than $10,000, <br />and/or imprisoned for not more than 5 years, if found Guilty. <br />APPLICANT <br />DATE CO-APPLICANT <br />DATE <br />