Report Mortgage Fraud Form

Note: Required fields are marked with an asterisk (*)

Note: If there are more participants, please include the additional names and contact information in the summary section below

SUSPECT(S) INFORMATION

Last Name or Name of Entity * This field is required. Too many characters used. (max=25).
First Name * A first name is required. Too many characters used. (max=25).
Middle Initial Too many characters used. (max=1).
Business Address * A address is required. Too many characters used. (max=50).
City * A city is required. Too many characters used. (max=30).
State * Invalid State. A state is required. Too many characters used. (max=2).
Zip * Invalid Zip Code. A zip is required.
Phone (example 616-940-8200) * Invalid Phone Number. A phone number is required.
Member of the Grand Rapids Association of REALTORS® * Yes No Don't Know Please make a selection.

TYPE OF FRAUD

Select one or more * Please make a selection.
Dissappearing Second Mortgage
Equity Skimming
Foreclosure Rescue
Inflated Appraisal
Occupancy Fraud
Property Flipping
Silent Second Mortgage
Other

DATE OR RANGE OF SUSPICIOUS ACTIVITY

From (mm/dd/yy) * Invalid Date. A date is required. To (mm/dd/yy) * Invalid Date. A date is required.

TOTAL DOLLAR AMOUNT INVOLVED: (example 1,000.00)

Enter Amount * Invalid DollarAmount. A dollar amount is required.

PLEASE SUMMARIZE THE EVENTS OR TRANSACTION (OPTIONAL)

HAS THIS INFORMATION BEEN REPORTED TO ANOTHER AGENCY?

Select one *
Yes No Don't Know Please make a selection.

IF YES, PLEASE IDENTIFY
Attorney General (AG)
Department of Labor & Economic Growth (DLEG - State Licensing Departement)
Federal Bureau of Investigations (FBI)
Department of Housing & Urban Development (HUD)
Internal Revenue Service (IRS)
Michigan Association of REALTORS® (MAR)
Office of Finance & Insurance (OFIS)
Other

SUPPORTING DOCUMENTATION (if any)

Check below which documents you will be providing. Then fax documents to (616) 940-8216
Listing Agreement
Purchase Agreement
Closing Agreement
Appraisal
Other

YOUR CONTACT INFORMATION (OPTIONAL)

Last Name Too many characters used. (max=25).
First Name Too many characters used. (max=25).
Company Name (if applicable) Too many characters used. (max=50).
Street Address Too many characters used. (max=50).
City Too many characters used. (max=30).
State Invalid State. Too many characters used. (max=2).
Zip Invalid Zip Code.
Phone (example 616-940-8200) Invalid Phone Number. Too many characters used. (max=12).
E-mail Invalid email. Too many characters used. (max=50).