150-101-159 (Rev. 01-17)
Form OR-SFC, Financial Statement—Page 3
Real property. Include a copy of the deed and a copy of homeowners/rental insurance policy with riders and supporting documentation of loan balance.
Attach additional pages as needed.
Policy number
Life insurance. Attach additional pages as needed.
Name of insurance company Agent’s name and phone Type
$
Face amount
Loan/cash
surrender value
Owner of record
Total. Enter this amount on line 7, section 4 (asset and liability analysis) ........................
Securities. Include stocks, bonds, mutual funds, money market funds, securities, 401(k), etc. Attach additional pages as needed.
Type Where located
$
Quantity or denomination Current value
Total. Enter this amount on line 8, section 4 (asset and liability analysis) ........................
Current market value
Personal property. Include water craft, RVs, air craft, business equipment, and/or machinery. Attach additional pages as needed.
Year, make, model, license number Lender/lien holder Current payoff
$
Total. Enter this amount on line 6, section 4 (asset and liability analysis) ........................
Available equity
(cannot be less than -0-)
Section 3. (continued) General financial information (personal and business)
A. Physical address
Type
(single- or multi-family dwelling,
lot, rental, etc.)
Mortgage lender’s name and address
Parcel number:_______________
How is title held:______________________________________ Purchase price: _________________ Purchase date: __________________
Current market value: _______________________Mortgage balance: ___________________________ Equity: ___________________________
B. Physical address
Type
(single- or multi-family dwelling,
lot, rental, etc.)
Mortgage lender’s name and address
Parcel number:_______________
How is title held:______________________________________ Purchase price: _________________ Purchase date: __________________
Current market value: _______________________Mortgage balance: ___________________________ Equity: ___________________________
C. Physical address
Type
(single- or multi-family dwelling,
lot, rental, etc.)
Mortgage lender’s name and address
Parcel number:_______________
How is title held:______________________________________ Purchase price: _________________ Purchase date: __________________
Current market value: _______________________Mortgage balance: ___________________________ Equity: ___________________________