1003 Uniform Residential Loan Application. Page 3/4.

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VI. ASSESTS AND LIABIILTES (cont.)
Schedule of Real Estate Owned (if additional properties are owned, use continuation sheet.)
Property Address (enter S if sold, PS if pending sale or R if rental being held for income)		Type of Property	Present Market Value	Amount of Mortgage & Liens	Gross Rental Income	Mortgage Payments	Insurance, Maintenance, Taxes & Misc .	Net Rental Income
.	.	.	$	$	$	$	$	$
.	.	.	$	$	$	$	$	$
.	.	.	$	$	$	$	$	$
.		Totals	$	$	$	$	$	$

List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s):

Alternate Name	Creditor Name	Account Number

VII. DETAILS OF TRANSACTION		VIII. DECLARATIONS
a. Purchase Price	$	If you answer "yes" to any questions a through i, please use continuation sheet for explanation.	Borrower		Co-Borrower
b. Alterations, improvements, repairs	$	.	Yes	No	Yes	No
c. Land (if acquired separately)	$	a. Are there any outstanding judgments against you?
d. Refinance (incl. debts to be paid off)	$	b. Have you been declared bankruptcy within the past 7 years?
e. Estimated prepaid items	$	c. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
f. Estimated closing costs	$	d. Are you a party to a lawsuit?
g. PMI, MIP, Funding Fee	$	e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, manufactured (mobile) home loans, any mortgage, financial obligation, bond, or loan guarantee. If "Yes," provide details, including date, name and address of Lender, FHA or VA case number, if any, and reasons for the action .)
h. Discount (if Borrower will pay)	$	f. Are you presently delinquent or in default on any federal debt or any other loan, mortgage, financial obligation bond, or loan guarantee? If "Yes," give details as described in the preceding question.
i. Total costs (add items a through h)	$	g. Are you obligated to pay alimony, child support, or separate maintenance?
j. Subordinate financing	$	h. Is any part of the down payment borrowed?
k. Borrower's closing costs paid by seller	$	i. Are you a co-maker or endorser on a note?
l. Other Credits (explain) - -	$	j. Are you a U.S. citizen?
m. Loan amount (exclude PMI, MIP, Funding Fee financed )	$	k. Are you a permanent resident alien?
n. PMI, MIP, Funding Fee financed	$	l. Do you intend to occupy the property as your primary residence? If "Yes," complete question m below
o. Loan amount (add m & n)	$	m. Have you had an ownership interest in a property in the last 3 years?
p. Cash from/to Borrower (subtract j, k, l & o from i)	$	(1) What type of property did you own-principal residence (PR), second home (SH), or investment property (IP)?	______		______
		(2) How did you hold title to the home? Soley by yourself (S), jointly with your spouse (SP), or jointly with another person (O)?	______		______

IX. ACKNOWLEDGMENT AND AGREEMENT
The undersigned specifically acknowledge(s) and agree(s) that: (1) the loan requested by this application will be secured by a first mortgage or deed of trust on the property described herein; (2) the property will not be used for any illegal or prohibited purpose or use; (3) all statements made in this application are made for the purpose of obtaining the loan indicated herein; (4) occupation of the property will be as indicated above; (5) verification or reverification of any information contained in the application may be made at any time by the Lender, its agents, successors and assigns, either directly or through a credit reporting agency, from any source named in this application, and the original copy of this application will be retained by the Lender, even if the loan is not approved; (6) the Lender, its agents, successors and assigns will rely on the information contained in the application and I/we have a continuing obligation to amend and/or supplement the information provided in this application if any of the material facts which I/we have represented herein should change prior to closing; (7) in the event my/our payments on the loan indicated in this application become delinquent, the Lender, its agents, successors and assigns, may in addition to all their other rights and remedies, report my/our name(s) and account information to a credit reporting agency; (8) be transferred to an agent, successor or assign of the Lender with prior notice to me; (9) the Lender, its agents, successors and assigns make no representation or warranties, express or implied, to the Borrower(s) regarding the property, the condition of the property, or the value of the property. Certification: I/We certify that the information provide in this application is true and correct as of the date set forth opposite my/our signature(s) on this application and acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States Code, Section 1001, et seq. and liability for monetary damages to the Lender, its agents, successors and assigns, insurers and any other person may suffer any loss due to reliance upon any misrepresentation which I/we have made on this application.
Borrower's Signature X	Date	Co-Borrower's Signature X	Date

X. INFORMATION FOR GOVERNMENT MONITORING PURPOSES
The following information is requested by the Federal Government for certain types of loans related to a dwelling. In order to monitor the lender's compliance with Equal Credit Opportunity, Fair Housing and Home Mortgage Disclosure laws. You are not required to furnish this information, but are encouraged to do so. The law provides that a lender may neither discriminate on the basis of this information, nor on whether you choose to furnish it. However, if you choose not to furnish it, under Federal regulations this Lender is required to note race and sex on the basis of visual observation or surname. If you do not wish to furnish the above information, please check the box below. Lender must review the above material to assure that the disclosure satisfy all requirements to which the Lender is subject under applicable state law for the particular type of loan applied for.
BORROWER		CO-BORROWER
Race/National Origin:	I do not wish to furnish this information American Indian or Alaskan Native Asian or Pacific Islander Black, not of Hispanic origin Hispanic White, not of Hispanic origin Other (specify) _________________	Race/National Origin:	I do not wish to furnish this information American Indian or Alaskan Native Asian or Pacific Islander Black, not of Hispanic origin Hispanic White, not of Hispanic origin Other (specify) _________________
Sex:	Female Male	Sex:	Female Male
To be Completed by Interviewer This application was taken by: face-to-face interview by mail by telephone	Interviewer's Name (print or type) __________________________________________ Interviewer's Signature / Date __________________________________________ Interviewer's Phone Number (incl. area code) __________________________________________		Name and Address Interviewer's Employer

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