Report Mortgage Fraud 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.

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 REALTORS®* 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 REALTORS® (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