Note Assessment

YOUR FULL NAME

Phone Number

Your Address

Your City, State, & Zip

Type Of Property

Other

Property Address

Property City, State & Zip

Is The Property Occupied?

Original Note Amount ($$)

Interest Rate (%)

Original Down Payment Amount ($$)

Date of First Payment ($$)

Number of Payments Made

Number of Remaining Payments

Are Payments On Time?

Position of Your Note

Any Outstanding Liens?

Is There A Balloon Payment?

Balloon Amount ($$)

Balloon Due Date

Payment Frequency

Payment Amount you Receive ($$)

Current Prpoperty Sale Price ($$)

Is Your Note Current or Delinquent?

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