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  Total Amount of Debt You Wish To Consolidate
(Do not include Mortgage Balances)
$  .00 (Optional)
  Purchase Year
  Estimated Home Value $    (OK to estimate)
  1st Mortgage Balance $    (OK to estimate)
  1st Mortgage Interest Rate . % (OK to estimate)
  Existing Type of Rate
  Do you have a 2nd mortgage?   Yes No
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