Uniform Residential Loan Application Form (Page 4 of 4) in pdf

VII. DETAILS OF TRANSACTION

VIII. DECLARATIONS

a. Purchase price

If you answer "Yes" to any questions a through i,

Borrower Co-Borrower

please use continuation sheet for explanation.

Yes No

b. Alterations, improvements, repairs

a. Are there any outstanding judgments against you?

c. Land (if acquired separately)

b. Have you been declared bankrupt within the past 7 years?

d. Refinance (incl. debts to be paid off)

c. Have you had property foreclosed upon or given title or deed in lieu thereof

e. Estimated prepaid items

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?

h. Discount (if Borrower will pay)

(This would include such loans as home mortgage loans, SBA loans, home improvement

i. Total costs (add items a through h)

loans, educational loans, manufactured (mobile) home loans, any mortgage, financial

obligation, bond, or loan guarantee. If "Yes," provide details, including date, name, and

j. Subordinate financing

address of Lender, FHA or VA case number, if any, and reasons for the action.)

k. Borrower's closing costs paid by Seller

f. Are you presently delinquent or in default on any Federal debt or any other

loan, mortgage, financial obligation, bond, or loan guarantee?

l. Other Credits (explain)

If "Yes," give details as described in the preceding question.

g. Are you obligated to pay alimony, child support, or separate maintenance?

h. Is any part of the down payment borrowed?

i. Are you a co-maker or endorser on a note?

- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -

j. Are you a U. S. citizen?

k. Are you a permanent resident alien?

l. Do you intend to occupy the property as your primary residence?

If "Yes," complete question m below.

m. Loan amount (exclude PMI, MIP,

Funding Fee financed)

m. Have you had an ownership interest in a property in the last three years?

(1) What type of property did you own-principal residence (PR),

n. PMI, MIP, Funding Fee financed

second home (SH), or investment property (IP)?

o. Loan amount (add m & n)

(2) How did you hold title to the home-solely by yourself (S),

p. Cash from/to Borrower (subtract j, k, l &

jointly with your spouse (SP), or jointly with another person (O)?

o from i)

IX. ACKNOWLEDGEMENT AND AGREEMENT

Each of the undersigned specifically represents to Lender and to Lender's actual or potential agents, brokers, processors, attorneys, insurers, servicers, successors and assigns and

agrees and acknowledges that: (1) the information provided in this application is true and correct as of the date set forth opposite my signature and that any intentional or negligent mis-

representation of this information contained in this application may result in civil liability, including monetary damages, to any person who may suffer any loss due to reliance upon any

misrepresentation that I have made on this application, and/or in criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States

Code, Sec. 1001, et seq.; (2) the loan requested pursuant to this application (the "Loan") will be secured by a mortgage or deed of trust on the property described in this application; (3) the

property will not be used for any illegal or prohibited purpose or use; (4) all statements made in this application are made for the purpose of obtaining a residential mortgage loan; (5) the

property will be occupied as indicated in this application; (6) the Lender, its servicers, successors or assigns may retain the original and/or an electronic record of this application, whether

or not the loan is approved; (7) the Lender and its agents, brokers, insurers, servicers, successors and assigns may continuously rely on the information contained in the application, and

I am obligated to amend and/or supplement the information provided in this application if any of the material facts that I have represented herein should change prior to closing of the

Loan; (8) in the event that my payments on the Loan become delinquent, the Lender, its servicers, successors, or assigns may, in addition to any other rights and remedies that it may

have relating to such delinquency, report my name and account information to one or more consumer credit reporting agencies; (9) ownership of the Loan and/or administration of the Loan

account may be transferred with such notice as may be required by law; (10) neither Lender nor its agents, brokers, insurers, servicers, successors or assigns has made any representa-

tion or warranty, express or implied, to me regarding the property or the condition or value of the property; and (11) my transmission of this application as an "electronic record" containing

my "electronic signature," as those terms are defined in applicable federal and/or state laws (excluding audio and video recordings), or my facsimile transmission of this application

containing a facsimile of my signature, shall be as effective, enforceable and valid as if a paper version of this application were delivered containing my original written signature.

Acknowledgement. Each of the undersigned hereby acknowledges that any owner of the Loan, its servicers, successors and assigns, may verify or reverify any information

contained in this application or obtain any information or data relating to the Loan, for any legitimate purpose through any source, including a source named in this application

or a consumer reporting agency.

Right to Receive Copy of Appraisal I/We have the right to a copy of the appraisal report used in connection with this application for credit. To obtain a copy, I/we must send

Creditor a written request at the mailing address Creditor has provided.Creditor must hear from us no later than ____ days after Creditor notifies me/us about the action taken

on this application, or I/we withdraw this application.

If you would like a copy of the appraisal report, contact:

Dimond Mortgage Inc

524 H Paseo Del Pueblo Sur Taos, NM 87571

Borrower's Signature

Date

Co-Borrower's Signature

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

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 wish to furnish the information, please check the box below. (Lender must review the above

material to assure that the disclosures satisfy all requirements to which the lender is subject under applicable state law for the particular type of loan applied for.)

BORROWER

I do not wish to furnish this information

CO-BORROWER

I do not wish to furnish this information

Ethnicity:

Hispanic or Latino

Not Hispanic or Latino

Hispanic or Latino

Not Hispanic or Latino

American Indian or

Race:

American Indian or

Asian

Black or

Race:

Asian

Black or

Alaska Native

African American

Alaska Native

African American

Native Hawaiian or Other Pacific Islander

White

Native Hawaiian or Other Pacific Islander

White

Sex:

Female

Male

Sex:

Female

Male

To be Completed by Loan Originator:

This information was provided:

In a face-to-face interview

By the applicant and submitted by fax or mail

In a telephone interview

By the applicant and submitted via e-mail or the internet

Loan Originator's Signature

Date

Loan Originator's Name (print or type)

Loan Originator Identifier

Loan Originator's Phone Number (including area code)

Loan Origination Company's Name

Loan Origination Company Identifier

Loan Origination Company's Address

Dimond Mortgage Inc

190187

524 H Paseo Del Pueblo Sur

(P) 575-758-5566 (F) 575-758-5850

Taos, NM 87571

Uniform Residential Loan Application

Page 4

of 4

Freddie Mac Form 65

7/05 (rev. 6/09)

Fannie Mae Form 1003 7/05 (rev. 6/09)

Calyx Form - Loanapp4.frm (11/09)

Uniform Residential Loan Application Form Page 4

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