Fannie Mae Form 1003 - Uniform Residential Loan Application (Page 4 of 7) in pdf

VI. ASSETS AND LIABILITIES (cont.)

Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet.)

Amount of

Insurance

Property Address (enter S if sold, PS if pending sale

Type of

Present

Mortgages &

Gross

Mortgage

Maintenance,

Net

or R if rental being held for income)

Property

Market Value

Liens

Rental Income

Payments

Taxes & Misc.

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

Borrower

Co-Borrower

b. Alterations, improvements, repairs

use continuation sheet for explanation.

Yes

c. Land (if acquired separately)

Are there any outstanding judgments against you?

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

Have you been declared bankrupt within the past 7 years?

e. Estimated prepaid items

Have you had property foreclosed upon or given title or deed

Estimated closing costs

in lieu thereof in the last 7 years?

g. PMI, MIP, Funding Fee

Are you a party to a lawsuit?

h. Discount (if Borrower will pay)

Have you directly or indirectly been obligated on any loan

which resulted in foreclosure, transfer of title in lieu of

Total costs (add items a through h)

foreclosure, or judgment?

Subordinate financing

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

k. Borrower’s closing costs paid by Seller

home improvement loans, educational loans, manufactured (mobile)

Other Credits (explain)

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.)

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.

m. Loan amount

(exclude PMI, MIP, Funding Fee

Are you obligated to pay alimony, child support, or

separate maintenance?

financed)

Is any part of the down payment borrowed?

n. PMI, MIP, Funding Fee financed

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

Are you a U.S. citizen?

o. Loan amount (add m & n)

Are you a permanent resident alien?

Do you intend to occupy the property as your

primary residence?

p. Cash from/to Borrower

If “Yes,” complete question m below.

(subtract j, k, l & o from i)

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

_____________ _____________

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

jointly with your spouse (SP), or jointly with

another person (O)?

_____________ _____________

IX. ACKNOWLEDGMENT 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 misrepresentation 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 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 representation 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 business purpose through any source, including a source named in this application or a consumer reporting agency.

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

Ethnicity:

Hispanic or Latino

Not Hispanic or Latino

Race:

American Indian or

Asian

Black or

Race:

American Indian or

Asian

Black or

Alaska Native

African

Alaska Native

African

Native Hawaiian or

White

American

Native Hawaiian or

White

American

Other Pacific Islander

Sex:

Female

Male

Sex:

Female

Male

To be Completed by Loan Originator:

This information was provided:

In a face-to-face interview

In a telephone interview

By the applicant and submitted by fax or mail

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

Midwest Minnesota Community

119 Graystone Plaza #100

473988/180389

Detroit Lakes, MN 56501

Development Corporation

Freddie Mac Form 65 6/09

Page 3 of 4

Fannie Mae Form 1003 6/09

1017.CV (9/11)

GOTO(001b87fc)

Fannie Mae Form 1003 - Uniform Residential Loan Application Page 4

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