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A. Are there any outstanding judgments against you? * Yes No   Yes No
B. Have you been declared bankrupt within the past 7 years? * Yes No   Yes No
C. Have you had property foreclosed upon or given title or deed in lieu thereof in the last 7 years? * Yes No   Yes No
D. Are you a party to a lawsuit? * Yes No   Yes No
E. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? * Yes No   Yes No
F. Are you presently delinquent or in default on any Federal debt or any other loan, mortgage, financial obligation, bond, or loan guarantee? * Yes No   Yes No
G. Are you obligated to pay alimony, child support, or separate maintenance? * Yes No   Yes No
H. Is any part of the down payment borrowed? * Yes No   Yes No
I. Are you a co-maker or endorser on a note? * Yes No   Yes No
J. Are you a U.S. Citizen? * Yes No   Yes No
K. Are you a permanent resident alien? * Yes No   Yes No
L. Do you intend to occupy the property as your primary residence? * Yes No   Yes No

M. Have you had an ownership interest in a property in the last three years?
Yes No   Yes No

M. a) What type of property did you own?


M. b)How did you hold title to the home


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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 not discriminate either on the basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation and surname if you have made this application in person. If you do not furnish this information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which lender is subject under applicable state law for the particular type of loan applied for.)
I do not wish to furnish this information Yes No   Yes No


Race American Indian or Alaska   American Indian or Alaska
White   White
Asian   Asian
Hawiian or Other Pacific Islander   Hawiian or Other Pacific Islander
Black or African American   Black or African American



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