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estimated property value
estimated mortgage balance
first name
last name
spouse's name (if applicable)
age of youngest borrower
age of eldest borrower (if applicable)
address
city/state/zip code      
home phone      
cell phone * * *
email address
are your property taxes paid current
are you currently employed
please describe your credit history
are all homeowners of record 62 years of age or older
does your home currently need repairs
comments
 

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