Dual Status Disclosure printable pdf download

The printed portions of this form, except for differentiated additions, have been approved by the Colorado Real Estate Commission. (DSD 17-1-09)

(Mandatory 3-09)

THIS DISCLOSURE IS MADE PURSUANT TO THE REQUIREMENTS OF THE COLORADO REAL

ESTATE COMMISSION AND THE DIRECTOR OF THE COLORADO DIVISION OF REAL ESTATE.

DUAL STATUS DISCLOSURE

(REAL ESTATE BROKER AND MORTGAGE BROKER)

The broker, _______________________________________, is a licensed real estate broker and a licensed

mortgage broker in the State of Colorado.

THE BUYER/BORROWER IS NOT REQUIRED TO USE THE BROKER’S SERVICES TO OBTAIN

A MORTGAGE LOAN. THERE MAY BE OTHER MORTGAGE BROKERS THAT PROVIDE

SIMILAR SERVICES.

The Broker ____ IS ____ IS NOT acting in a dual capacity as a real estate broker and a mortgage broker in this

transaction. The Broker ____ IS ____ IS NOT accepting a placement fee, commission or other valuable

consideration for directly or indirectly placing a loan with a mortgage lender or its representative.

The Buyer/Borrower ________________________________________________________

____ DOES _____ DOES NOT consent to the Broker acting in a dual capacity as a licensed real estate broker

and a licensed mortgage broker in the transaction. The Buyer/Borrower ____ DOES ____ DOES NOT consent

to the Broker receiving a placement fee, commission or other valuable consideration for placing a loan with a

mortgage lender or its representative in the real estate transaction.

THIS IS NOT A CONTRACT AND IS NOT COMPREHENSIVE FO ALL DISCLOSURES

REQUIRED BY §§ 12-61-101, C.R.S., et. Seq., 12-61-801, C.R.S., et. Seq., and 12-61-901, C.R.S., et. Seq.

BUYER/BORROWER ACKNOWLEDGMENT:

The Buyer acknowledges receipt of this document on _____________________.

___________________________________________

__________________________________________

Buyer/Borrower

BROKER ACKNOWLEDGMENT:

On _______________________, the Broker provided _________________________ (Buyer/Borrower) with a

copy of this document via __________________________ and retained a copy for the Broker’s records.

Broker also acknowledges that Broker has made a full and fair disclosure to the Buyer/Borrower of all material

features of the loan product and all facts material to the transaction.

___________________________________________

Broker

Dual Status Disclosure