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4506-TRevenue Service

Request for Transcript of Tax Return>Request may be rejected if the form is incomplete or illegible.

OMB No. 1545-1872

Use Form 4506-T to ordera transcriptor other return information free of charge. See the product list below. You can quickly request transcripts by usingautomated self-help service tools. Rease 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, use4506, Request for Copy of Tax Return. There is a fee to get a copy of your return.1a Name shownon tax return. If a joint return, enter the name shownfirst.T)rV|o 10!t/0|Ce f t efftr/Ml2a If a oint return, enter spouse's name shown on tax return.

1 b First social security number on tax return, individual taxpayer identificationnumber,or employer identification number (see instructions)CO-b- S?2b Second social security number or individual taxpayeridentification number if joint tax returnM$- (fi - i(Cot3-e pAcHm

O^Cr-ffO P>tZEZ L ^UCiMU-Pr O "TX4 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. The IRS has nocontrolover what the third party does with the tax information.

If the transcript is being mailed to a third party, en sure that yo u have filled in l ine 6 and l ine 9 before signing. Sign and date the form once yo ufilled in these l ines. Complet ing these steps helps to protect your privacy.6 Transcript requested. Enter the tax form number here (1040, 1065, 1 120, etc.) and check the appropriate box below. Enter only one tax formnumber per request. > I O c ? < ' 'Ci

Date

Title Of ine 1 aabove is a corporation, partnership, estate, or trust)

Spouse's signature DatePrivacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No 37667N Form 4506-T (Rev. 1 -2011)


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g Home Affordable Programquest For Modification and Affidavit {RMA)REQUEST FOR MODIFICATIONAN D AFFIDAVIT (RMA): page 1

M A K I N G H O M E AFFORDABLE.covCOMPLETE AL L THREE PAGES OF THIS FORM

Loan LD. Number QQ 3 3 ServicerBORROWER CO-BORROWER

Borrower's nameSocial Security number Date of birthHome phone number with area codeCell or work number with area code-U3,

Co-borrower's nameSocial Security num ber Date of birth01Home phone number with area code&3'Z. 3T7S 3 tCel! or work number with area code

/ want to :Th e property is my:Th e property is :

PropertyXPrimary Residence ISell theProperty^Ovvner Occupied

J Second Home ] InvestmentH Renter Occupied ...... Vacant

Mailing address -Su: "T AProperty address (if same as mailing address, just write same) E-mail addressis the property listed fo r sale? Li YesHave yo u received an offer on the property? DYesDate o f offer Amo un t of offer $Agent's Name:Agent's Phone Number:F o r Sale b y Owner? i ! Y e sWho pays th e real estate ta x bill on your property?"Xl do [3Lender does 17 Paid by condo or HOA

Are the taxes current? CKres DN oCondominium or HOA F e e s 'JfYes D N o $P a id to : S\

Have you co n ac ted a credit-counseling agenc y for helpIf y e s , please complete the following:Counselor's Name:Agency Name:

Y e s Li N o

Counselor's Phone Number: _Counselor's E-mail:Who pays the hazard insuran ce premium fo r your property?Xldo C S Lender does LJ Paid by Condo or HOA

Is the policy current? XYes DN oName of Insurance C o . :Insurance Co. Tel #:

Hav e you filed for bankruptcy? I ! Y e s 5 o Ifyes: LJ Chapter 7 ^ jChap te r13 Filing Date:_Ha s your bankruptcy been discharged? Z Y e s No Bankruptcy case numberAdditional Liens/Mortgages or Judgments on this property:Lien Holder's Name/Servicer Balance Contact Number Loan Number


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4506-T(Rev. January 2011)Department of theTreasuryInternal Revenue Service

Request for Transcriptof Tax Return> 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 usingour automated self-helpservice 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,useForm 4506, Request fo r 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 shownfirst.Sftmuek IV'Ki&'fapriAr

2a If a joint return, enter spo use's name shown on tax return.

1b First social security number on tax return, individual taxpayer identificationnumber, or employer identification number (see instructions)k45- S'Z- -z

2b Second social security number or individual taxpayeridentification number if joint tax return

3 Current name, address (including apt., room, or suite no.), city, state, and ZIP code (See instructions)NW5


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REQUEST FORMODIFICATION AND AFFIDAVIT (RMA) page 2 COMPLETE ALL THREE PAGES OFTHIS FORM

INCOME/EXPENSES FOR HOUSEHOLD' Number of People in Household:

Monthly Household IncomeMonthly Gross Wages $2300 -00Overtime $Child Support /Alimony/ ; $Separation 2Social Security/SSDI $Other monthly income from $pensions, annuities orretirement plansTips, commissions, bonusand self-employed incomeRents Received ..Unemployment Income l ( i^f* DOFood Stamps/Welfare $ 2 ^^ . D^>Other (investment income,royalties, interest, dividends _^--etc.)Total (Gross Income) $ ( (3 ft > f

Monthly Household Expenses/DebtFirst Mortgage Payment $ $ 2> b&Second Mortgage Payment $ , OtT " 3tfInsurance $ 73 " O*-Property Taxes j $ 2. -S ' O OCredit Cards /Installment $ . ., n ^QLoan(s) (total minimum 100 / 'payment per month)Alimony, child supportpaymentsNet Rental ExpensesHOA/Condo Fees/Property $ -2 ; QOMaintenanceCar Payments S550Other : $ L.

1 5 *H *2P1

Total Debt/Expenses $ -S S

Household AssetsChecking Account(s) $ / 0 - 6 ^Checking Account(s) $ /O cP

.-,Savings/ Money Market $ 2.0C~"C Ds $ _Stocks /Bonds ! $

!Other Cash on Hand : $Other Real Estate i $(estimated value)Other i $Other $ __,Do not include the value of life insurance orretirement plans when calculating assets (401 k,pension funds, ann uities, I R A s , Keogh plans, etc.)

iTotal Assets \ $4j-Q-OV

INCOME MUST BEDOCUMENTED* nclude combined income an d expenses from th e borrower an d co-borrower (if any). If you include income an d expenses from a householdmember who is not a borrower, pleasespecify using the back o f this form if necessary.2You are not required to disclose Child Support , Al imony o r Separat ion Ma i n te na nc e in c o m e , unless yo u c h o o s e to h a ve it considered b y y o u r servicer.

INFORMATION FORGOVERNMENT MONITORING PURPOSESThe following information is requested by the federal government in order to monitor compliance with federal statutes that prohibit discrimination inhousing You are not required to furnish this information, but are encouraged to do so. The law provides that a lender or servicer may notdiscriminate either on the basis of this information, or on whether yo u choose to furnish it. If you furnish the information, please provide bothethnicity 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 reguired tonote the information on the basis of visual observation or surname ifyou have made this regues tfora loan modification in person. If you do not wishto furnish the information, please check the box below.

BORROWEREthnicity:

Race:

D I do not wish to furnish this informationI;Hispanic or LatinoII NotHispanic or Latino._ American Indian or Alaska NativeD AsianSspBlack or African AmericanU Native Hawaiian or Other Pacific IslanderT White

CO-BORROWEREthnicity:

I do not wish to furnish this informationQ Hispanic or LatinoL Not Hispanic or Latino

Race: -. American Indian or Alaska NativeJ Asian

"St Black or African AmericanI Native Hawaiian orOther Pacific IslanderD White

Sex: J^ FemaleD Male Sex: :

FemaleTo be completed by interviewer

This request wa s taken by :L J Face-to-fac e interview" . Mail2TelephoneLJ Internet

Interviewer's Name (pr int or type) & ID NumberInterviewer's Signature Date

Name/Address of Interviewer's Employer

Interviewer's Phone Number ( ini - lnHp nren rode)

page 2 o t3


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REQUEST FOR MODIFICATION AND AFFiOAVIT (RMA) page3 CGMPLETIALLTHREE PAGESOFTHISFORMACKNOWLEDGEMENT AN D AGREEMENT

In making this request for consideration under the Mak ing Hom e Affordable Program, I cert ify 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 mortga ge loan, short saie 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 mystatements and may require me to provide supporting documentat ion. ! also understand that know ingly submitting false

information ma y violate Federal law.3 . I understand the Servicer wil l pull a curren t credit report on all borrowers obligated on the Note.4. I understand that if i have intentionally defaulted on m y existing mortgage, eng aged in fraud or misrepresented anyfact(s) in connection with this document, the Servicer may cancel an y Agreement under Making Home Affordable an d

ma y pursue foreclosure on my home.5. That: my property is owner-occupied; ! intend to reside in this property for the next twelve months; i have not received

a condemnation notice; an d there ha s been no change in the ownership of the Property since I signed the documentsfo r the mortgage that I want to modify.6. 1 am willing to provide all requested documents and to respond to all Servicer questions in a t imely manner.7. I understand that the Servicerwill use the information in this document to evaluate my eligibility for a loan modificationor short sale or deed-in-lieu of foreclosure, but the Servicer is not obligated to offer me assistance based solely onthe statem ents in this document.8. I am willing to commit to credit counseling if it is determined that my financial hardship is related to excessivedebt9. I understand that the Servicer will collect and record persona l information, including, but not limited to, my name,address, telephone number, social security number, credit score, income, payment history, government mon itoring

information, and information about account balances and activity, i understand and consent to the disclosure of mypersonal information and the terms of any Making H ome Affordable Agreement by Servicer to (a) the U . S . Departmentof the Treasury, (b ) Fannie Mae and Freddie Mac in connection with their responsibilities under the HomeownerAffordability and Stability Plan; (c) any investor, insurer, guarantor or servicerthat owns, insures, guarantees or servicesmy first lien or subordinate lien (i f applicable) mortgage loan(s); (d ) companies that perform support services inconjunction with Making Home A ffordable; and (e) any HUD-certified housing counsel/!

10 -1Borrower Signature Date C o- Date

Co-Borrower Signature Date Co-Borrower Signature Date

C o-Borrower Signature Date Co-Borrower Signature

If you have quest ions about this documen t or th e modification process, please call your servicer.If you have quest ions about the program thatyour servicer cannot answer or need further counseling,you can call th e Homeowner 's HOPE Hotline at 1-888-995-HOPE (4673), T he Hotline can help with quest ions aboutth e program a nd offers free HUD-cert i f ied counseling services in English and Spanish,

888-995-tjOPf_iSr'*HOPE"Hotline

Be advised that bysigning this documentyouunderstand that anydocumentsand informationyousubmit to your servicer in connection with the MakingHome Affordable Program are under penalty of perjury. Any misstatement of material fact made in the completion of these documents including but notlimited to misstatement regarding your occupancy in your home, hardship circumstances, and/or income, expenses, or assets will subject you to potentialcriminal investigation and prosecution for the following crimes: perjury, false statements, mail fraud, and wire fraud. The information contained in thesedocuments issubject to examination and verification. Any potential misrepresentation will be referred to the appropriate lawenforcement authority for investigation an d prosecution. B ysigning this document you certify, rep resent an d agree that"Under penalty of perjury, al l documents an d information I have provided to Lender in connection with the Making HomeAffordable Program, including the documents an d information regarding my eligibility for the program, are true an d 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 sentto Hotline Office of the Special Inspector G eneral for Troubled Asset Relief Program, 1801 LS t. NW , Washington, DC 2022 0.


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Aurora Bank2617 CO LLE GE PARK P.O. BOX1706 SCOTTSBLUFF, NE69363-1706

PHON E : 800-550-0508 FAX: 866-517-7975Making Home Affordable ProgramRequest for Modification an d AffidavitAddendumBorrower Name(s): ' )/ 7u f tt H7^' < ' /VOLoan #: O0 j? ,?G 0 ST/Prooertv Address: C/7V 3 QZCtfrQ f 2 LBest N um be r toCall: (B) ~Jl -3 ~ &-^1Best Time to Call: (B) Mo&Û^CiE-mail A ddress: (B)

fî-(^ L_iij f f t / t i ^ '

^ &(C,ft fJô T A 7? ^9'( C B ) 7/3 - 2^T- ^692( C B ) A/i/-VW -fHf^ C ,Other: To iL^Tf 1 - 'tSOther: Total Other Expenses*

Monthly Amount$ 3 < b f c - c o$ 'Zg-5-co$ 2,50 - C O$ / O C co$$ c f o - o o$ 30 . a^$ ( G C - c o$ - 5 T N .00$ /5"


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HAMP INCOME USE CERTIFICATIONTo be considered under the Home Affordable M odification Program (HA MP), you must meet certain eligibilityrequirements outlined by the U.S . Treasury Department, concerning the use of your income. If you have anyquestions regarding this Certification, please contact Aurora Loan Services toll free at 1-800-550-0509.

B O R R O WE RXI DO / I do NOTcertify that:M y income is not currently being used as the basis for a H A M P Trial Payment Plan. My income has not beenpreviously used as the basis for a completed HAMP permanent modification. i3kwer Signature DateB O R R O WE R^OOO / I do NOTcertify that:M y income is not currently being used as the basis for a HAM P Trial Payment Plan. M y income has not beenpreviously used as the basis for a completed HA M P permanent modification.

Borroweragnatulte/fy Date

B O R R O WE RI DO / 1 do NOTcertify that:My income is not currently being used as the basis for a HAM P Trial Payment Plan. M y income has not beenpreviously used as the basis for a completed HAMP permanent modification.

Borrower Signature Date

BORROWERI DO / I do NOT certify that:My income is not currently being used as the basis for a HA M P Trial Payment Plan. M y income has not beenpreviously used as the basis for a com pleted H AM P permanent modification.

Bo rrower Signature Date

In making this certification, I/we certify under penalty of perjury that all of the information in this document istruthful and that I/we understand that the Servicer, the U.S. Department of the Treasury, or their agents m ayinvestigate the accuracy of m y statements by performing ro utine background checks, including autom ated searchesof federal, state and county databases, to confirm that I/we have not been convicted of such crimes. I/we alsounderstand tha t knowingly submitting false information may violate Federal law.


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