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Grand Rapids Association of REALTORS

Report Activity Form

To submit suspicions of mortgage fraud to the Grand Rapids Association of REALTORS® for consideration, please complete the following form to the best of your ability. Please note that the information that you provide may be forwarded to other authorities for investigation.

SUSPECT(S) INFORMATION (Note: if there are more participants, please include the additional names and contact information in the summary section below):
Last Name or Name of Entity:
First Name:
Middle Initial:
Business Address:
City:
State:
Zip:
Business Phone (include area code):
Member of the Grand Rapids Association of REALTORS®: Yes No

TYPE OF FRAUD:
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): / /    To (mm/dd/yy): / /

TOTAL DOLLAR AMOUNT INVOLVED

PLEASE SUMMARIZE THE EVENTS OR TRANSACTION:

HAS THIS INFORMATION BEEN REPORTED TO ANOTHER AGENCY?
Yes No

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:
First Name:
Company Name (if applicable):
Street Address:
City:
State:
Zip:
Phone (include area code):
E-mail: