In order for us to evaluate your request, you must complete the enclosed packet, in full, and fax or mail it to
Chase with the required documentation.
You may save the form locally to your computer and complete at your own pace. Chase can NOT accept
electronic signatures on these documents, so it's important that you print the document and sign in all the
required places.
Delays in the process are often a result of missing information or signatures on required forms.
This packet contains the following items:
Required Documentation for Borrower and Co-Borrower Checklist -
Detailed list of the documents you must send to us in addition to the packet
Request forModification and Affidavit -
Information about your property, loans, income, etc., as well as details on the circumstances that have
made it difficult for you to stay up-to-date with your mortgage payments
IRS Form4506-T Request for Transcript of Tax Return Form -
Allows Chase to receive a transcript of your tax return to verify income information
Dodd-Frank Eligibility Certification -
The federal government now requires that all borrowers seeking assistance fromthe Making Home
Affordable (MHA) Program complete and sign the enclosed Dodd-Frank Eligibility Certification
If you need any assistance completing this packet please contact us at 866-550-5705.
Please send the completed packet as well as all required documentation to Chase:
BY REGULAR MAIL: BYOVERNIGHT MAIL: BY FAX:
Chase Fulfillment Center
P.O. Box 469030
Glendale, CO 80246
Chase Fulfillment Center
710 South Ash St.
Suite #200
Glendale, CO 80246
866-282-5682
Important Information
Chase is a debt collector.
If you are represented by an attorney, please refer this letter to your attorney and provide us with the attorney's name, address, and telephone number.
If you are currently a debtor in bankruptcy proceedings and subject to the protections of the automatic stay, or if you have received a final
discharge in a bankruptcy, this notice is for compliance and/or informational purposes only and not an attempt to impose personal liability for the
debt in violation of the bankruptcy laws. However, Chase Home Finance LLC still has the right under the Mortgage to foreclose on the Property.
An important reminder for all our customers: As stated in the "Questions and Answers for Borrowers about the Homeowner Affordability and
Stability Plan" distributed by the Obama Administration, "Borrowers should beware of any organization that attempts to charge a fee for housing
counseling or modification of a delinquent loan, especially if they require a fee in advance." Loan modification scams should be reported to
PreventLoanScams.org or by calling (888) 995-HOPE. Chase offers loan modification assistance free of charge (i.e., no modification fee required).
Please call us immediately at 866-550-5705 to discuss your options. The longer you delay the fewer options you may have.
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Loan Number:
Borrower Name(s): Property Address:
1. REQUIRED DOCUMENTATION - DEPENDINGON EMPLOYMENT STATUS
Wage Earner (receive a W-2 from your employer) : If you are Self Employed, please provide:
Two (2) Pay Stubs showing YTD earnings P & L Statement
Last four (4) months complete Business Bank Statements (must
provide all pages)
2. REQUIRED DOCUMENTATION - ALL
Request for Modification and Affidavit (RMA)
IRS Form 4506-T - Request for Transcript of Tax Return
If you are less than 2 payments past due, you must include the most recent statement(s) supporting assets listed on page 2 of
the Request for Modification and Affidavit Form (must provide all pages of statements)
Dodd-Frank Eligibility Certification
The following documentation is required depending on source of additional income:
Social Security, Disability, Death Benefits, Pension, Public Assistance or Unemployment
Benefit statement or letter from provider that states the amount, frequency and duration AND
Evidence of receipt of payment, such as copies of the two most recent bank statements or deposit advances showing deposit amounts
Rental Income
Current Tax Return (must have all Borrower(s) names, signatures and Social Security Numbers included) AND
Current lease agreement and two most recent bank statements or cancelled checks reflecting rental payments
Alimony or Child Support (not required but may be voluntarily offered)
Copy of divorce decree, court verification, separation agreement or letter from provider that states the amount, frequency and duration
AND
Evidence of receipt of such payments, such as copies of the two most recent bank statements or deposit advances showing deposit
amounts
Is your loan currently escrowed for taxes and insurance? No Yes
If No, the following documentation is required:
Most recent property tax bill(s) with a copy of the cancelled check or paid receipt for all recent applicable taxes (County, City, School, etc.)
Current insurance declaration page for all applicable coverage types (must show premium amount for homeowners, flood and wind)
Most recent hazard and flood insurance policy so that we can ensure adequate hazard and flood insurance coverage on your property and
complete your modification request
If your modification includes an extension of the maturity date or capitalization of unpaid balances for your loan and the property is
located in a Special Flood Hazard Area, as part of the modification process we are required by law to send you another flood notice
confirming your propertys flood status. As a result, if you receive this additional notice from us with your final modification
package, all you need to do is to immediately sign the flood notice acknowledgement, as required, and return it to us. The
modification will not be processed until the signed acknowledgement is returned.
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REQUEST FOR MORTGAGE ASSISTANCE (RMA) page 1 COMPLETE ALL FOUR PAGES OF THIS FORM
Loan I.D. Number Servicer
BORROWER CO-BORROWER
Borrower's name Co-borrower's name
Social Security number Social Security number
Home phone number with area code Home phone number with area code
Cell or work number with area code Cell or work number with area code
I want to: Keep the Property Sell the Property
The property is my: Primary Residence Second Home Investment
The property is: Owner Occupied Renter Occupied for less than 12 months Vacant for less than 12 months
Mailing address
Property address (if same as mailing address, just write same) E-mail address
Is the property listed for sale? Yes No Have you contacted a credit-counseling agency for help? Yes No
Have you received an offer on the property? Yes No If yes, please complete the following:
Date of offer _________, Amount of Offer $_________ Counselor's Name:
Agent's Name: Agency Name:
Agent's Phone Number: Counselor's Phone Number:
For Sale by Owner? Yes No Counselor's Email:
Who pays the Real Estate Tax bill on your property? Who pays the hazard insurance policy for your property?
I do Lender does Paid by condo or HOA I do Lender does Paid by condo or HOA
Are the taxes current? Yes No Is the policy current? Yes No
Condominium or HOA Fee Yes No $ ______________ Name of Insurance Co. ______________________________
Paid to:
_____________________________________________________
Insurance Co. Tel #: ________________________________
Have you filed for bankruptcy? Yes No If yes: Chapter7 Chapter13 Filing Date:
Has your bankruptcy been discharged? Yes No Bankruptcy Case number _____________________
Additional Liens/Mortgages or Judgments on this property:
Lien Holders Name/Servicer Balance Contact Number Loan Number
HARDSHIP AFFIDAVIT
I (We) am/are requesting review under the Making Home Affordable program.
I am having difficulty making my monthly payment because of financial difficulties created by (check all that apply):
My household income has been reduced. For example: unemployment,
underemployment, reduced pay or hours, decline in business earnings, death,
disability or divorce of a borrower or co-borrower.
My monthly debt payments are excessive and I am overextended with my
creditors. Debt includes credit cards, home equity or other debt.
My expenses have increased. For example: monthly mortgage payment reset,
high medical or health care costs, uninsured losses, increased utilities or property
taxes.
My cash reserves, including all liquid assets, are insufficient to maintain my
current mortgage payment and cover basic living expenses at the same time.
I am unemployed and (a) I am receiving/will receive unemployment benefits or
(b) my unemployment benefits ended less than 6 months ago.
Other:
Explanation (continue on a separate sheet of paper if necessary): .
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REQUEST FOR MORTGAGE ASSISTANCE (RMA) page 2 COMPLETE ALL FOUR PAGES OF THIS FORM
INCOME/EXPENSES FOR HOUSEHOLD
1
Number of People in Household:
Monthly Household Income Monthly Household Expenses/Debt Household Assets
Monthly Gross wages $0 First Mortgage Payment $0 Checking Account(s) $0
Overtime $0 Second Mortgage Payment $0 Saving s/ Money Market $0
Child Support / Alimony
2
$0 Mortgage Insurance $0 Stocks / Bonds / CDs $0
Social Security/SSDI $0 Property Taxes $0 Other Cash on Hand $0
Other monthly income from
pensions, annuities or
retirement plans
$0 Property Insurance ** $0 Other Real Estate (estimated
value)
$0
Tips, commissions, bonus and
self-employed income
$0 Credit Cards / Installment
Loan(s) (total minimum
payment per month)
$0 Other $0
Rents Received $0 Alimony, child support
payments
$0
Unemployment Income $0 Net Rental Expenses $0
Food Stamps/Welfare $0 HOA/Condo Fees/Property
Maintenance
$0
Other (spouse's Income,
investment income, royalties,
interest, dividends etc)
$0 Car Payments $0
Other $0 Do not include the value of life insurance or
retirement plans when calculating assets (401k,
pension funds, annuities, IRAs, Keogh plans,
etc.)
Total (Gross Income) $0 Total Debt/Expenses $0 Total Assets $0
INCOME MUST BE DOCUMENTED
1 Include combined income and expenses from the borrower and co-borrower (if any). If you include income and expenses from a household member
who is not a borrower, please specify using the back of this form if necessary.
2 You are not required to disclose Child Support, Alimony or Separation Maintenance income, unless you choose to have it considered by
your servicer. ** Includes flood insurance, if any.
INFORMATION FOR GOVERNMENT MONITORING PURPOSES
The following information is requested by the federal government in order to monitor compliance with federal statutes that prohibit discrimination in housing. You are not
required to furnish this information, but are encouraged to do so. The law provides that a lender or servicer may not discriminate either on the basis of this
information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one
designation. If you do not furnish ethnicity, race, or sex, the lender or servicer is required to note the information on the basis of visual observation or surname if you have
made this request for a loan modification in person. If you do not wish to furnish the information, please check the box below.
BORROWER I do not wish to furnish this information CO-BORROWER I do not wish to furnish this information
Ethnicity: Hispanic or Latino Ethnicity: Hispanic or Latino
Not Hispanic or Latino Not Hispanic or Latino
Race: American Indian or Alaska Native Race: American Indian or Alaska Native
Asian Asian
Black or African American Black or African American
Native Hawaiian or Other Pacific Islander Native Hawaiian or Other Pacific Islander
White White
Sex: Male Sex: Male
Female Female
To be Completed by Interviewer
Name/Address of Interviewer's Employer
This request was taken by: Interviewer's Name (print or type) & ID Number
Face-to-face interview
Interviewer's Signature Date
Mail
Telephone
Interviewer's Phone Number (include area code)
Internet
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REQUEST FOR MORTGAGE ASSISTANCE (RMA) page 3 COMPLETE ALL FOUR PAGES OF THIS FORM
DODD-FRANK CERTIFICATION
The following information is requested by the federal government in accordance with the Dodd-Frank Wall Street Reform and
Consumer Protection Act (Pub. L. 111-203).You are required to furnish this information. The law provides that no person shall be
eligible to begin receiving assistance from the Making Home Affordable Program, authorized under the Emergency Economic
Stabilization Act of 2008 (12 U.S.C. 5201 et seq.), or any other mortgage assistance program authorized or funded by that Act, if such
person, in connection with a mortgage or real estate transaction, has been convicted, within the last 10 years, of any one of the
following: (A) felony larceny, theft, fraud, or forgery, (B) money laundering or (C) tax evasion.
I/we certify under penalty of perjury that I/we have not been convicted within the last 10 years of any one of the following in connection
with a mortgage or real estate transaction:
(a) felony larceny, theft, fraud, or forgery
(b) money laundering or
(c) tax evasion.
I/we understand that the servicer, the U.S. Department of the Treasury, or their agents may investigate the accuracy of my statements
by performing routine background checks, including automated searches of federal, state and county databases, to confirm that I/we
have not been convicted of such crimes. I/we also understand that knowingly submitting false information may violate Federal law.
This certification is effective on the earlier of the date listed below or the date received by your servicer.
ACKNOWLEDGEMENT AND AGREEMENT
In making this request for consideration under the making Home Affordable Program, I certify under penalty of perjury:
1. That all of the information in this document is truthful and the event(s) identified on page 1 is/are the reason that I need to
request a modification of the terms of my mortgage loan, short sale or deed-in-lieu of foreclosure.
2. I understand that the Servicer, the U.S. Department of the Treasury, or their agents may investigate the accuracy of my
statements and may require me to provide supporting documentation. I also understand that knowingly submitting false
information may violate Federal law.
3. I understand the Servicer will pull a current credit report on all borrowers obligated on the Note.
4. I understand that if I have intentionally defaulted on my existing mortgage, engaged in fraud or misrepresented any fact(s) in
connection with this document, the Servicer may cancel any Agreement under Making Home Affordable and may pursue
foreclosure on my home.
5. That: my property is owner-occupied; I intend to reside in this property for the next twelve months; I have not received a
condemnation notice; and there has been no change in the ownership of the Property since I signed the documents for the
mortgage that I want to modify.
6. I am willing to provide all requested documents and to respond to all Servicer questions in a timely manner.
7. I understand that the Servicer will use the information in this document to evaluate my eligibility for a loan modification or short
sale or deed-in-lieu of foreclosure, but the Servicer is not obligated to offer me assistance based solely on the statements in this
document.
8. I am willing to commit to credit counseling if it is determined that my financial hardship is related to excessive debt.
9. If I was discharged in a Chapter 7 bankruptcy proceeding subsequent to the execution of the Loan Documents, or am currently
entitled to the protections of any automatic stay in bankruptcy, I acknowledge that Servicer is providing the information about the
Making Home Affordable program at my request and for informational purposes, and not as an attempt to impose personal
liability for the debt evidenced by the Note.
10. I understand that the Servicer will collect and record personal information, including, but not limited to, my name, address,
telephone number, social security number, credit score, income, payment history, government monitoring information, and
information about account balances and activity. I understand and consent to the disclosure of my personal information and the
terms of any Making Home Affordable Agreement by Servicer to (a) the U.S. Department of the Treasury, (b) Fannie Mae and
Freddie Mac in connection with their responsibilities under the Homeowner Affordability and Stability Plan; (c) any investor,
insurer, guarantor or servicer that owns, insures, guarantees or services my first lien or subordinate lien (if applicable) mortgage
loan(s); (d) companies that perform support services in conjunction with Making Home Affordable; and (e) any HUD-certified
housing counselor.
11. I understand that if Servicer offers me a trial period plan under the Making Home Affordable Program, and I fail to accept or
complete the trial plan for any reason, including, for example, declining the trial plan offer, failing to accept the trial plan offer,
failing to make trial plan payments in a timely manner, or failing to accept a final modification at the end of the trial period, I may
permanently lose eligibility for a modification under the Making Home Affordable Program and any other modification
programoffered by Servicer.
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The undersigned certifies/y under penalty of perjury that all statements in this document are true and correct.
Borrower Signature Social Security Number Date of Birth Date
Co-Borrower Signature Social Security Number Date of Birth Date
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REQUEST FOR MORTGAGE ASSISTANCE (RMA) page 4 COMPLETE ALL FOUR PAGES OF THIS FORM
HOMEOWNER'S HOTLINE
If you have questions about this document or the Making Home Affordable Program, please call your servicer.
If you have questions about the program that your servicer cannot answer or need further counseling, you can call the
Homeowners HOPE Hotline at 1-888-995-HOPE (4673). The Hotline can help with questions about the program and offers
free HUD-certified counseling services in English and Spanish.
NOTICE TO BORROWERS
Be advised that by signing this document you understand that any documents and information you submit to your servicer in connection with the
Making Home Affordable Program are under penalty of perjury. Any misstatement of material fact made in the completion of these documents
including but not limited to misstatement regarding your occupancy in your home, hardship circumstances, and/or income, expenses, or assets
will subject you to potential criminal investigation and prosecution for the following crimes: perjury, false statements, mail fraud, and wire fraud.
The information contained in these documents is subject to examination and verification. Any potential misrepresentation will be referred to the
appropriate law enforcement authority for investigation and prosecution. By signing this document you certify, represent and agree that: "Under
penalty of perjury, all documents and information I have provided to Lender in connection with the Making Home Affordable Program, including
the documents and information regarding my eligibility for the program, are true and correct." If you are aware of fraud, waste, abuse,
mismanagement or misrepresentations affiliated with the Troubled Asset Relief Program, please contact the SIGTARP Hotline by calling
1-877-SIG-2009 (toll-free), 202-622-4559 (fax), or www.sigtarp.gov. Mail can be sent to Hotline Office of the Special Inspector General for
Troubled Asset Relief Program, 1801 L St. NW, Washington, DC 20220.
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Form
4506-T
Request for Transcript of Tax Return
(Rev. January 2012) Department of the
Treasury Internal Revenue Service
Request may be rejected if the form is incomplete or illegible. OMB No. 1545-1872
Tip: Use Form 4506-T to order a transcript or other return information free of charge. See the product list below. You can quickly request transcripts by using
our automated self-help service tools. Please visit us at IRS.gov and click on "Order a Transcript" or call 1-800-908-9946. If you need a copy of your return,
use Form 4506, Request for Copy of Tax Return. There is a fee to get a copy of your return.
1a Name shown on tax return. If a joint return, enter the name shown first. 1b First social security number on tax return, individual taxpayer
identification number, or employer identification number (see
instructions)
______ - ___ - ______
2a If a joint return, enter spouse's name shown on tax return 2b Second social security number or individual taxpayer identification
number if joint tax return
______ - ___ - ______
3 Current address (including apt., room, or suite no.), city, state and ZIP code (see instructions)
4 Previous address shown on the last return filed if different from line 3 (see instructions)
5 If the transcript or tax information is to be mailed to a third party (such as a mortgage company), enter the third party's name, address, and
telephone number.
Regular Mail: Overnight Mail: Phone Number:
Chase Fulfillment Center
PO Box 469030
Glendale, CO 80246
Chase Fulfillment Center
710 South Ash Street, Suite 200
Glendale, CO 80246
866-550-5705
Caution.
If the transcript is being mailed to a third party, ensure that you have filled in line 6 and line 9 before signing. Sign and date the form once you have filled in these lines.
Completing these steps helps to protect your privacy. discloses your IRS transcript to the third party listed on line 5, the IRS has no control over what the third party does with the
information. If you would like to limit the third party's authority to disclose your transcript information, you can specify this limitation in your written agreement with the third party.
6 Transcript requested. Enter the tax form number here (1040, 1065, 1120, etc.) and check the appropriate box below. Enter only one tax form
number per request. 1040
a Return Transcript which includes most of the line items of a tax return as filed with the IRS. A tax return transcript does not reflect changes
made to the account after the return is processed. Transcripts are only available for the following returns: Form 1040 series, Form 1065, Form
1120, Form 1120A, Form 1120H, Form 1120L, and Form 1120S. Return transcripts are available for the current year and returns processed
during the prior 3 processing years. Most requests will be processed within 10 business days . . . . . .
b Account Transcript,which contains information on the financial status of the account, such as payments made on the account, penalty
assessments, and adjustments made by you or the IRS after the return was filed. Return information is limited to items such as tax liability and
estimated tax payments. Account transcripts are available for most returns. Most requests will be processed within 30 calendar days. . .
c Record of Account,which provides the most detailed information as it is a combination of the Return Transcript and the Account Transcript.
Available for current year and 3 prior tax years. Most requests will be processed within 30 calendar days . . . . . .
7 Verification of Nonfiling, which is proof from the IRS that you did not file a return for the year. Current year requests are only available after June
15th. There are no availability restrictions on prior year requests. Most requests will be processed within 10 business days .
8 Form W-2, Form 1099 series, Form 1098 series, or Form 5498 series transcript. The IRS can provide a transcript that includes data from these
information returns. State or local information is not included with the Form W-2 information. The IRS may be able to provide this transcript
information for up to 10 years. Information for the current year is generally not available until the year after it is filed with the IRS. For example, W-2
information for 2010, filed in 2011, will not be available from the IRS until 2012. If you need W-2 information for retirement purposes, you should
contact Social Security Administration at 1-800-772-1213. Most requests will be processed within 45 days . . .
Caution.
If you need a copy of Form W-2 or Form 1099, you should first contact the payer. To get a copy of the Form W-2 or Form 1099 filed with your return,
you must use Form 4506 and request a copy of your return, which includes all attachments.
9 Year or period requested. Enter the ending date of the year or period, using the mm/dd/yyyy format. If you are requesting more than four years or
periods, you must attach another Form 4506-T. For requests relating to quarterly tax returns, such as Form 941, you must enter each quarter or tax
period separately.
12/31/2011 12/31/2010
_________________ _________________ _________________
Check this box if you have notified the IRS or the IRS has notified you that one of the years for which you are requesting a transcript involved identity
theft on your federal tax return . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . .
Caution: Do not sign this form unless all applicable lines have been completed.
Signature of taxpayer(s). I declare that I am either the taxpayer whose name is shown on line 1a or 2a, or a person authorized to obtain the tax
information requested. If the request applies to a joint return, either husband or wife must sign. If signed by a corporate officer, partner, guardian, tax
matters partner, executor, receiver, administrator, trustee, or party other than the taxpayer, I certify that I have the authority to execute Form 4506-T on
behalf of the taxpayer. Note. For transcripts being sent to a third party, this form must be received within 120 days of signature date.
Telephone number of taxpayer
on line 1a or 2a
Signature (see instructions) Date
Sign
Here
Title (if line 1a above is a corporation, partnership, estate, or trust)
Spouse's signature Date
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Dodd-Frank Certification
The following information is requested by the federal government in accordance with the Dodd-Frank Wall
Street Reform and Consumer Protection Act (Pub. L. 111-203). You are required to furnish this
information. The law provides that no person shall be eligible to begin receiving assistance from the
Making Home Affordable Program, authorized under the Emergency Economic Stabilization Act of 2008 (12
U.S.C. 5201 et seq.), or any other mortgage assistance program authorized or funded by that Act, if such
person, in connection with a mortgage or real estate transaction, has been convicted, within the last 10
years, of any one of the following: (A) felony larceny, theft, fraud, or forgery, (B) money laundering or (C) tax
evasion.
I/we certify under penalty of perjury that I/we have not been convicted within the last 10 years of any one of
the following in connection with a mortgage or real estate transaction:
(a) felony larceny, theft, fraud, or forgery,
(b) money laundering or
(c) tax evasion.
I/we understand that the servicer, the U.S. Department of the Treasury, or their agents may investigate the
accuracy of my statements by performing routine background checks, including automated searches of
federal, state and county databases, to confirm that I/we have not been convicted of such crimes. I/we also
understand that knowingly submitting false information may violate Federal law.
This Certificate is effective on the earlier of the date listed below or the date received by your servicer.
Borrower Signature Social Security Number Date of Birth Date
Co-Borrower Signature Social Security Number Date of Birth Date
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