Report Mortgage Fraud Form

To submit suspicions of mortgage fraud to the Grand Rapids Association of REALTORSŪ 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.

Notes: Required fields are marked with and asterisk (*)
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*
First Name*
Middle Initial
Business Address*
City*
State*
Zip*
Phone (example 616-940-8200)*
Member of the Grand Rapids Association of REALTORSŪ* Yes No Don't Know

TYPE OF FRAUD
Select one or more * Disappearing Second Mortgage
Equity Skimming
Foreclosure Rescue
Inflated Appraisal
Occupancy Fraud
Property Flipping
Silent Second Mortgage
Property Flopping
Buy and Bail
Other

DATE OR RANGE OF SUSPICIOUS ACTIVITY
From*
To*

TOTAL DOLLAR AMOUNT INVOLVED (example 1,000)
Amount*

PLEASE SUMMARIZE THE EVENTS OR THE TRANSACTION (OPTIONAL)

HAS THIS INFORMATION BEEN REPORTED TO ANOTHER AGENCY?
Select one* Yes No Don't Know
If yes, please identify Attorney General
Department of Labor and Economic Growth (DLEG - State Licensing Departement)
Federal Bureau of Investigations (FBI)
Department of Housing and Urban Development (HUD)
Internal Revenue Service (IRS)
Michigan Association of REALTORSŪ (MAR)
Office of Finance & Insurance (OFIS)
Other

SUPPORTING DOCUMENTATIONS (if any)
Check 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 applicaple)
Street Address
City
State
Zip
Phone (example 616-940-8200)
E-mail