Bella Homes Questionnaire

UNITED STATES OF AMERICA and
STATE OF COLORADO, ex rel. John W. Suthers, Attorney General,

v. BELLA HOMES, LLC. et al.

Case #: 2012-CV-00390, United States District Court for the District of Colorado

About You

Have you previously submitted a response to this questionnaire?: *

Yes

If yes, please provide a brief description for the additional submission?:

i.e.; name change, change of address, etc.

Primary Borrower

First Name: *

Please enter your first name only ie. (John)

Last Name: *

Please enter your last name only ie. (Smith)

Co-Borrower

If applicable:

First Name:

Please enter your first name only ie. (John)

Last Name:

Please enter your last name only ie. (Smith)

Property Address

Property Address: *

City: *

County: *

State: *

Zip Code: *

Phone #: *

Email: *

Mailing Address

If different from above:

Mailing Address:

City:

County:

State:

Zip Code:

Questionnaire

Date your transaction closed with Bella Homes: *

How much have you paid to Bella Homes?: * $

How much of a refund did you receive from Bella Homes, if any?: * $

Residency Status: *

Currently reside in the home

Lost home due to foreclosure or deed-in-lieu

Sold home

Other

If Other:

Please provide a brief description:

Acknowledgement

***Important notice: Please preserve and maintain all documents and correspondence relating to Bella Homes.***

I swear and attest under the law that I am the above named individual and my responses to the foregoing are true and accurate to the best of my knowledge.

Digitally signed by: *

Type your complete legal name to acknowledge the preceding.

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