Uniform Residential Loan Application€¦ · I. TYPE OF MORTGAGE AND TERMS OF LOAN II. PROPERTY INFORMATION AND PURPOSE OF LOAN III. BORROWER INFORMATION IV. EMPLOYMENT INFORMATION

130 HL - FNMA 1003/FHLMC 65 (3/12/13)Stock No. 11518W.B.A.

Freddie Mac Form 65 6/09 Page 1 of 4 Fannie Mae Form 1003 6/09

Uniform Residential Loan ApplicationThis application is designed to be completed by the applicant(s) with the Lender’s assistance. Applicants should complete this form as “Borrower” or “Co-Borrower,” as applicable. Co-Borrower information must also be provided (and the appropriate box checked) when � the income or assets of a person other than the “Borrower” (including the Borrower’s spouse)will be used as a basis for loan qualification or � the income or assets of the Borrower’s spouse or other person who has community property rights pursuant to state law will not beused as a basis for loan qualification, but his or her liabilities must be considered because the spouse or other person has community property rights pursuant to applicable law andBorrower resides in a community property state, the security property is located in a community property state, or the Borrower is relying on other property located in a community prop-erty state as a basis for repayment of the loan.

If this is an application for joint credit, Borrower and Co-Borrower each agree that we intend to apply for joint credit (sign below):

_____________________________________________________ _________________________________________________________Borrower Co-Borrower

I. TYPE OF MORTGAGE AND TERMS OF LOAN

II. PROPERTY INFORMATION AND PURPOSE OF LOAN

III. BORROWER INFORMATION

IV. EMPLOYMENT INFORMATION

Mortgage � VA � Conventional � Other (explain):Applied for: � FHA � USDA/Rural Housing Service

Purpose of Loan � Purchase � Construction � Other (explain):

� Refinance � Construction-Permanent

� Married �� Separated

Property will be:

� � �

Amortization � Fixed Rate � Other (explain):Type: � GPM � ARM (type):

Agency Case Number

Amount

$

Subject Property Address (street, city, state & ZIP) No. of Units

Interest Rate

%

No. of Months

Lender Case Number

Legal Description of Subject Property (attach description if necessary)

Title will be held in what Name(s)

Source of Down Payment, Settlement Charges, and/or Subordinate Financing (explain)

Borrower’s Name (include Jr. or Sr. if applicable)

Social Security Number

Former Address (street, city, state, ZIP) � Own � Rent______________No. Yrs. Former Address (street, city, state, ZIP) � Own � Rent______________No. Yrs.

Present Address (street, city, state, ZIP) � Own � Rent______________No. Yrs.

Mailing Address, if different from Present Address Mailing Address, if different from Present Address

Present Address (street, city, state, ZIP) � Own � Rent______________No. Yrs.

Name & Address of Employer � Self Employed

Position/Title/Type of Business Business Phone (incl. area code)

Home Phone (incl. area code)

Dependents (not listed by Co-Borrower)no. ages

DOB (MM/DD/YYYY) Yrs. School

Co-Borrower’s Name (include Jr. or Sr. if applicable)

Manner in which Title will be held Estate will be held in:

� Fee Simple

� Leasehold(show expiration date)

Complete this line if construction or construction-permanent loan.

Year LotAcquired

Complete this line if this is a refinance loan.

YearAcquired

Year Built

PrimaryResidence

SecondaryResidence Investment

Original Cost

$

Original Cost

$

Amount Existing Liens

$

Amount Existing Liens

$

(a) Present Value of Lot

$

Purpose of Refinance

(b) Cost of Improvements

$

Describe Improvements � made � to be made

Cost: $

Total (a + b)

$

Borrower Co-Borrower

Borrower Co-Borrower

Unmarried (include single,divorced, widowed)

Unmarried (include single,divorced, widowed)

Social Security Number Home Phone (incl. area code) DOB (MM/DD/YYYY) Yrs. School

� Married �� Separated

Dependents (not listed by Borrower)no. ages

If residing at present address for less than two years, complete the following:

If employed in current position for less than two years or if currently employed in more than one position, complete the following:

Yrs. on this job

Yrs. employed in this lineof work/profession



Yrs. on this job

Yrs. employed in this lineof work/profession



Dates (from - to)

Monthly Income

$



Dates (from - to)

Monthly Income

$



Dates (from - to)

Monthly Income

$



Dates (from - to)

Monthly Income

$


V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION

VI. ASSETS AND LIABILITIES

Gross Monthly Income Borrower Co-Borrower Total Present ProposedCombinedMonthly Housing Expense

Base Empl. Income*

Overtime

Bonuses

Commissions

Dividends/Interest

Net Rental Income

Other (before completing, seethe notice in “describe otherincome.” below.)

Total

$ $ $

$ $ $

Rent

First Mortgage (P&I)

Other Financing (P&I)

Hazard Insurance

Real Estate Taxes

Mortgage Insurance

Homeowner Assn. Dues

Other:

Total

$

$

$$

* Self Employed Borrower(s) may be required to provide additional documentation such as tax returns and financial statements.

Describe Other Income Notice: Alimony, child support, or separate maintenance income need not be revealed if the

Borrower (B) or Co-Borrower (C) does not choose to have it considered for repaying this loan.

B/C Monthly Amount

$

This Statement and any applicable supporting schedules may be completed jointly by both married and unmarried Co-Borrowers if their assets and liabilities are sufficiently joined so thatthe Statement can be meaningfully and fairly presented on a combined basis; otherwise, separate Statements and Schedules are required. If the Co-Borrower section was completed abouta non-applicant spouse or other person, this Statement and supporting schedules must be completed about that spouse or other person also.

Completed �� Jointly �� Not Jointly

ASSETS

DescriptionCash deposit toward purchase held by:

List checking and savings accounts below

Name and address of Bank, S&L, or Credit Union

Acct. No. $

Cash or MarketValue

$


Acct. No. $


Acct. No. $


Acct. No. $

Stocks & Bonds (Company name/number $& description)

Life Insurance net cash value $

Face amount: $

Real estate owned (enter market value $

from schedule of real estate owned)

Net worth of business(es) owned $

(attach financial statement)

Automobiles owned (make and year) $

Other Assets (itemize) $

Vested interest in retirement fund $

Subtotal Liquid Assets $

Liabilities and Pledged Assets. List the creditor’s name, address and account number for all outstanding debts,including automobile loans, revolving charge accounts, real estate loans, alimony, child support, stock pledges,etc. Use continuation sheet, if necessary. Indicate by (*) those liabilities, which will be satisfied upon sale of realestate owned or upon refinancing of the subject property.

LIABILITIES

Name and address of Company

Acct. No.

Monthly Payment &Months left to Pay

$ Payment/Months

UnpaidBalance

$


Acct. No.

$ Payment/Months $


Acct. No.

$ Payment/Months $


Acct. No.

$ Payment/Months $


Acct. No.

$ Payment/Months $


Acct. No.

$ Payment/Months $


Acct. No.

$ Payment/Months

Alimony/Child Support/Separate Maintenance PaymentsOwed to:

Job Related Expense (child care, union dues, etc.)

Total Monthly Payments

Net Worth

(a minus b)

$

$

$

$$

$

� Total Liabilities b.$Total Assets a.

0.000.000.000.000.000.000.000.00

0.00 0.00 0.00 0.00 0.00

0.00

0.00

0.00 0.00 0.00


��

VI. ASSETS AND LIABILITIES (cont.)

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

Property Address (enter S if sold, PS if pending saleor R if rental being held for income)

Type ofProperty

Totals $ $ $ $ $ $

$ $ $ $ $ $

PresentMarket Value

Amount ofMortgages & Liens

GrossRental Income

MortgagePayments

NetRental Income

InsuranceMaintenance,Taxes & Misc.�

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 $

b. Alterations, improvements, repairs

c. Land (if acquired separately)

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

e. Estimated prepaid items

f. Estimated closing costs

g. PMI, MIP, Funding Fee

h. Discount (if Borrower will pay)

i. Total costs (add items a through h)

j. Subordinate financing

k. Borrower’s closing costs paid by Seller

l. Other Credits (explain)

m. Loan amount

(exclude PMI, MIP, Funding Fee financed)

n. PMI, MIP, Funding Fee financed

o. Loan amount (add m &n)

p. Cash from/to Borrower

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

If you answer “Yes” to any questions a through i, please use continuation

sheet for explanation.

a. Are there any outstanding judgments against you?

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

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

thereof in the last 7 years?

d. Are you a party to a lawsuit?

e. Have you directly or indirectly been obligated on any loan which resultedin foreclosure, transfer of title in lieu of foreclosure, or judgment?(This would include such loans as home mortgage loans, SBA loans, home improvement loans, educationalloans, 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, andreasons for the action.)

f. Are you presently deliquent or in default on any Federal debt or anyother loan, mortgage, financial obligation, bond, or loan guarantee?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. 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), jointlywith your spouse (SP), or jointly with another person (O)?

Borrower

Yes No

� ��

� ��

Co-Borrower

Yes No

� ��

� ��

� �

� ��

� �

� �

� ��

� �

IX. ACKNOWLEDGMENT AND AGREEMENT

X. INFORMATION FOR GOVERNMENT MONITORING PURPOSES

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 andacknowledges 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 thisinformation 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 havemade 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 loanrequested 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 orprohibited 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 thisapplication; (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 itsagents, 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 informationprovided 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 oneor 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 Lendernor 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 theproperty; 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 (excludingaudio 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 applicationwere 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 thisapplication 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 reportingagency.

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 eitheron 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 onedesignation. 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 havemade 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 allrequirements to which the lender is subject under applicable state law for the particular type of loan applied for.)

Borrower’s Signature: Date Co-Borrower’s Signature: Date

X X

BORROWER

Ethnicity:

Race:

Sex:

��

�

�

�

�

To be Completed by Loan Originator:

This information was provided:In a face-to-face interviewIn a telephone interviewBy the applicant and submitted by fax or mailBy the applicant and submitted via e-mail or the Internet

��

CO-BORROWER

Ethnicity:

Race:

Sex:

��

�

�

�

�

I do not wish to furnish this information

Hispanic or Latino Not Hispanic or Latino

American Indian or Alaska Native

Asian White Black or African American

Native Hawaiian or Other Pacific Islander

Female Male

I do not wish to furnish this information

Hispanic or Latino Not Hispanic or Latino

American Indian or Alaska Native

Asian White Black or African American

Native Hawaiian or Other Pacific Islander

Female Male

Loan Originator’s Signature

XLoan Originator’s Name (print or type)

Loan Origination Company’s Name

Loan Originator Identifier

Loan Origination Company Identifier

Loan Originator’s Phone Number (including area code)

Loan Origination Company’s Address

Date

0.00 0.00 0.00 0.00 0.00 0.00

0.00

0.00

0.00

(573)769-2001

HOMEBANK 450000 400 South Main, PO Box 311, Palmyra, MO 63461

Continuation Sheet/Residential Loan Application

Use this continuation sheet if youneed more space to complete theResidential Loan Application.Mark B for Borrower or C forCo-Borrower.

Borrower: Agency Case Number:

Lender Case Number:Co-Borrower:

I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable underthe provisions of Title 18, United States Code, Section 1001, et seq.

Borrower’s Signature: Date Co-Borrower’s Signature: Date

X X


IMPORTANT INFORMATION ABOUT

PROCEDURES FOR OBTAINING CREDIT

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and

record information that identifies each person who obtains credit.

What this means for you: When you obtain credit, we will ask for your name, address, date of birth, and other information that will allow us to identify

you. We may also ask to see your driver’s license or other identifying documents.

NOTICE: We may report information about your account to credit bureaus. Late payments, missed payments, or other defaults on your account may be

reflected in your credit report.

NOTICE TO MARRIED APPLICANTS: No provision of any marital property agreement, unilateral statement under §766.59, Wis. Stats., or court decree

under §766.70 adversely affects the interest of the creditor unless the creditor, prior to the time the credit is granted or an open-end credit plan is entered

into, is furnished a copy of the agreement, statement or decree or has actual knowledge of the adverse provision.

Mortgage Application Checklist The following documents may be required through the mortgage application process, but are not required to receive a

Loan Estimate.

Income

� Past two years w-2’s & tax returns � Most recent paycheck stubs (30 day minimum) � Contact name & phone number to verbally verify employment � Verification of other income: social security, child support, retirement, etc. � If self-employed: past two years tax returns including all schedules and a profit and loss statement for

the current year signed by your accountant Assets

� Last two months statements for all bank and credit union accounts � Most recent retirement account statement – if used for down payment or funds

Other Information Needed

� Copy of driver's license for each borrower � Homeowner’s insurance agents name & phone number � Divorce decrees, if applicable, including property settlements, modifications, etc.

For Purchases Only

� Contact name, phone number and address of all landlords for the past two years � Accepted purchase agreement and copy of listing sheet

Please note that any material changes in your employment, income, assets and/or credit must be reported to us as soon as possible, as it may affect your financing. Also, you may provide computer print-outs of any of the above documents, provided that they are dated and contain your full name, the institutions names, and the full account number.

Revised: 03/2015 als

Credit Application and Borrower’s Certification

Type of Credit Requested-Check the appropriate boxes below and complete the applicable section.

□ secured □ individual credit – relying solely on my income or assets □ unsecured □ individual credit – relying on my income or assets as well as

income or assets from other sources □ joint credit – we intend to apply for joint credit

□ entity owners – the undersigned understand they may be asked to co-sign or guarantee the loan being requested as they are the owners, officers or control parties for the entity.

Amount Requested Payment Due Desired Proceeds of Credit to be used for $______________ __________________ ____________________________ Loan Number _______________ Date of Application ________________ Above references are for lender’s use only and do not limit the applicability of this document to any particular loan or item.

CERTIFICATION The undersigned hereby certifies the accuracy of all financial statements provided in connection with this credit application and indicates that our financial condition has not materially changed by signing below.

-------------------------------------------- Fold to Copy -------------------------------------------- AUTHORIZATIONS

1) (I/We) authorize the bank to perform any credit investigation necessary to verify information supplied to us by the following means:

• By contacting banks or other credit sources disclosed to us to verify balance, collateral and payment history.

• By requesting and obtaining a credit report from a third party Credit Reporting Agencies.

• By contacting references provided. 2) (I/We) authorize the bank to report (my/our) names and information regarding this loan to

Credit Reporting Agencies. 3) (I/We) understand a copy of this authorization may be mailed or faxed to (my/our) creditors

as authorization to release information on (my/our) account directly to HOMEBANK and any information received will be held strictly confidential and covered under the HOMEBANK’s privacy policy.

4) In the event (my/our) loan is approved, (I/we) hereby authorize the HOMEBANK to request payoff information directly from any creditor we intend to refinance with the proceeds.

Entity Name (if Applicable): _______________________________ ___________________________________ _______________________________ Borrower Borrower ___________________________________ _______________________________ Borrower Borrower ____________________________________ ______________________________ Guarantor/Co-signer Guarantor/Co-signer Fees to be Collected: $_________ Interest $_________Other Fees = __________ Total to be Collected

NOTICE OF RIGHT TO RECEIVE COPY OF APPRAISAL/APPRAISAL EVALUATION

FROM: HOMEBANK 400 SOUTH MAIN P.O. BOX 311 PALMYRA, MO 63461

TO:

Loan Number: _________________

Property Address: ______________________________________________________________

Right to Receive Copy

We may order an appraisal to determine the property’s value and charge you for this appraisal. We will promptly give you a copy of any appraisal/appraisal evaluation, even if your loan does not close.

You can pay for an additional appraisal for your own use at your own cost.

Acknowledgment

By signing below, you acknowledge you have received this Disclosure.

_____________________________________________________Date ____________________

_____________________________________________________Date ____________________

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Demographic Information Addendum. This section asks about your ethnicity, sex, and race.

Demographic Information of Borrower

The purpose of collecting this information is to help ensure that all applicants are treated fairly and that the housing needs of communities and neighborhoods are being fulfilled. For residential mortgage lending, federal law requires that we ask applicants for their demographic information (ethnicity, sex, and race) in order to monitor our compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to provide this information, but are encouraged to do so. The law provides that we may not discriminate on the basis of this information, or on whether you choose to provide it. However, if you choose not to provide the information and you have made this application in person, federal regulations require us to note your ethnicity, sex, and race on the basis of visual observation or surname. The law also provides that we may not discriminate on the basis of age or marital status information you provide in this application. Instructions: You may select one or more “Hispanic or Latino” origins and one or more designations for “Race.” If you do not wish to provide some or all of this information, select the applicable check box.

EthnicityHispanic or Latino

Mexican Puerto Rican CubanOther Hispanic or Latino Enter origin:

Examples: Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, etc.

Not Hispanic or LatinoI do not wish to provide this information

SexFemaleMale I do not wish to provide this information

RaceAmerican Indian or Alaska Native Enter name of enrolled or principal tribe: Asian

Asian Indian Chinese FilipinoJapanese Korean VietnameseOther Asian Enter race:Examples: Hmong, Laotian, Thai, Pakistani, Cambodian, etc.

Black or African AmericanNative Hawaiian or Other Pacific Islander

Native Hawaiian Guamanian or Chamorro SamoanOther Pacific Islander Enter race:

Examples: Fijian, Tongan, etc.WhiteI do not wish to provide this information

To Be Completed by Financial Institution (for application taken in person):

Was the ethnicity of the Borrower collected on the basis of visual observation or surname? NO YESWas the sex of the Borrower collected on the basis of visual observation or surname? NO YESWas the race of the Borrower collected on the basis of visual observation or surname? NO YES

The Demographic Information was provided through:

Face-to-Face Interview (includes Electronic Media w/ Video Component) Telephone Interview Fax or Mail Email or Internet

Borrower Name:Uniform Residential Loan ApplicationFreddie Mac Form 65 • Fannie Mae Form 1003Revised 08/2016 • Effective 01/2018

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–

Demographic Information Addendum. This section asks about your ethnicity, sex, and race.

Demographic Information of Borrower

The purpose of collecting this information is to help ensure that all applicants are treated fairly and that the housing needs of communities and neighborhoods are being fulfilled. For residential mortgage lending, federal law requires that we ask applicants for their demographic information (ethnicity, sex, and race) in order to monitor our compliance with equal credit opportunity, fair housing, and home mortgage disclosure laws. You are not required to provide this information, but are encouraged to do so. The law provides that we may not discriminate on the basis of this information, or on whether you choose to provide it. However, if you choose not to provide the information and you have made this application in person, federal regulations require us to note your ethnicity, sex, and race on the basis of visual observation or surname. The law also provides that we may not discriminate on the basis of age or marital status information you provide in this application. Instructions: You may select one or more “Hispanic or Latino” origins and one or more designations for “Race.” If you do not wish to provide some or all of this information, select the applicable check box.

EthnicityHispanic or Latino

Mexican Puerto Rican CubanOther Hispanic or Latino Enter origin:

Examples: Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, etc.

Not Hispanic or LatinoI do not wish to provide this information

SexFemaleMale I do not wish to provide this information

RaceAmerican Indian or Alaska Native Enter name of enrolled or principal tribe: Asian

Asian Indian Chinese FilipinoJapanese Korean VietnameseOther Asian Enter race:Examples: Hmong, Laotian, Thai, Pakistani, Cambodian, etc.

Black or African AmericanNative Hawaiian or Other Pacific Islander

Native Hawaiian Guamanian or Chamorro SamoanOther Pacific Islander Enter race:

Examples: Fijian, Tongan, etc.WhiteI do not wish to provide this information

To Be Completed by Financial Institution (for application taken in person):

Was the ethnicity of the Borrower collected on the basis of visual observation or surname? NO YESWas the sex of the Borrower collected on the basis of visual observation or surname? NO YESWas the race of the Borrower collected on the basis of visual observation or surname? NO YES

The Demographic Information was provided through:

Face-to-Face Interview (includes Electronic Media w/ Video Component) Telephone Interview Fax or Mail Email or Internet

Borrower Name:Uniform Residential Loan ApplicationFreddie Mac Form 65 • Fannie Mae Form 1003Revised 08/2016 • Effective 01/2018

CRITICAL CLIENT INFORMATION REGARDING DEBT AND CREDIT

Thank you for allowing us to assist you with your home financing needs. Our top priority is to provide our clients with outstanding, personalized service and a stress-free mortgage process. To help ensure there are no surprises and your loan closes as expected, it is of critical importance that you are aware of the following:

All existing and new debts must be considered for qualification purposes prior to funding your loan. This means that your file could be subject to a pre-funding check to verify that:

• You have not acquired any new debt or opened any new accounts/loans; • Your current loan balances have not increased (applies to loans, credit cards, lines of credit, etc.) • You do not have any new delinquencies on any existing account or any new public records

(judgments, bankruptcies, etc.) • Your credit score has not decreased.

These requirements apply to the borrower and any co-borrowers on the loan. If any of the above changes are discovered through verification or obtaining of a new credit report, the file is subject to re-qualification and/or re-underwriting.

If we must re-qualify and/or re-underwrite your loan, you must qualify with your updated debt and credit profile. If you no longer qualify, we may not be able to fund your loan and any charges incurred would be your responsibility.

If you suspect your credit or debt profile may have changed at any point between your approval and loan funding, please notify your Loan Officer as soon as possible. This will help us stay “ahead of the curve” and do everything we can to ensure your loan funds without any challenges.

Thank you for your cooperation! We look forward to serving you.

By signing below, I acknowledge I read and understood the information provided above.

____________________________________ _____________________________________

Borrower Date Borrower Date

Affiliated Business Arrangement DisclosureBankers Systems™ VMP® 12/2017Wolters Kluwer Financial Services © 2014 18.1.0.1520-J20180209N Page 1 of 2

Affiliated Business Arrangement Disclosure Statement

Borrower

Loan Number:

LenderHOMEBANK400 S MainP O Box 311Palmyra, MO 63461

Date: Property:

This is to give you notice that HOMEBANK has a business relationship with Maine Street Title Services. The nature ofthe relationship (and percentage of ownership interest) is:

Maine Street Title Services Subsidiary of Holding Corp, 100%

Because of this relationship, this referral may provide HOMEBANK a financial or other benefit.

x Set forth below is the estimated charge or range of charges for the settlement services listed. You are NOT requiredto use the listed provider(s) as a condition for l settlement of your loan on [or] x purchase, sale, or refinance of thesubject property. THERE ARE FREQUENTLY OTHER SETTLEMENTSERVICE PROVIDERS AVAILABLE WITH SIMILAR SERVICES.YOU ARE FREE TO SHOP AROUND TO DETERMINE THATYOU ARE RECEIVING THE BEST SERVICES AND THE BESTRATE FOR THESE SERVICES.Provider and settlement service Charge or range of chargesMaine Street Title Services, Incoming/OutgoingWire Charges, if applicable

$25.00

Maine Street Title Services, Express DeliveryFee per Package, if applicable

$20.00

Maine Street Title Services, Title Search Fee $75.00Maine Street Title Services, Closing Fee $150.00Maine Street Title Services, Closing ProtectionLetter

$25.00

Maine Street Title Services, Curative ServicesFee, if applicable

$50.00

Maine Street Title Services, Title InsurancePremium

$1.40 per Thousand to $0.24 per Thousand

l Set forth below is the estimated charge or range of charges for the settlement services of an attorney, credit reportingagency or real estate appraiser that we, as your lender, will require you to use, as a condition of your loan on this property,to represent our interests in the transaction.

Affiliated Business Arrangement DisclosureBankers Systems™ VMP® 12/2017Wolters Kluwer Financial Services © 2014 18.1.0.1520-J20180209N Page 2 of 2

ACKNOWLEDGMENTI/We have read this disclosure form, and understand that HOMEBANK is referring me/us to purchase the above-describedsettlement service(s) and may receive a financial or other benefit as a result of this referral.

Borrower

Date Date

Rev 11/02/2015

FACTS WHAT DOES HOMEBANK DO WITH YOUR PERSONAL INFORMATION?

Why? Financial companies choose how they share your personal information. Federal law gives consumers the right to limit some but not all sharing. Federal law also requires us to tell you how we collect, share, and protect your personal information. Please read this notice carefully to understand what we do.

What? The types of personal information we collect and share depend on the product or service you have with us. This information can include: Social Security number and income Account balances and payment history Credit history and credit scores

When you are no longer our customer, we continue to share your information as described in this notice.

How? All financial companies need to share customers’ personal information to run their everyday business. In the section below, we list the reasons financial companies can share their customers’ personal information; the reasons HOMEBANK chooses to share; and whether you can limit this sharing.

Reasons we can share your personal information Does HOMEBANK share? Can you limit this sharing?

For our everyday business purposes— such as to process your transactions, maintain your account(s), respond to court orders and legal investigations, or report to credit bureaus

Yes No

For our marketing purposes— to offer our products and services to you No No

For joint marketing with other financial companies No No

For our affiliates’ everyday business purposes— information about your transactions and experiences No No

For our affiliates’ everyday business purposes— information about your creditworthiness No No

For our affiliates to market to you No No

For non-affiliates to market to you No No

Questions? Call us at 573-769-2001 or Toll-Free at 1-855-577-2001 or go to www.myhomebank.bank

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Who we are Who is providing this notice? HOMEBANK

What we do How does HOMEBANK protect my personal information?

To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. These measures include computer safeguards and secured files and buildings.

How does HOMEBANK collect my personal information?

We collect your personal information, for example, when you Open an account or deposit money Pay your bills or apply for a loan Use your credit or debit card

We also collect your personal information from others, such as credit bureaus.

Why can’t I limit all sharing? Federal law gives you the right to limit only sharing for affiliates’ everyday business purposes—information

about your creditworthiness affiliates from using your information to market to you sharing for non-affiliates to market to you

State laws and individual companies may give you additional rights to limit sharing.

Definitions Affiliates Companies related by common ownership or control. They can be

financial and nonfinancial companies. Our affiliates include companies with a common corporate identity of

HOMEBANK; financial companies such as Home Bank of California, Byron B. Webb, Inc., LaJolla Fund LLC, and others, such as The Webb Co. LLC and Maine Street Services, LLC

Non-affiliates Companies not related by common ownership or control. They can be financial and nonfinancial companies. HOMEBANK does not share with non-affiliates so they can market

to you.

Joint marketing A formal agreement between nonaffiliated financial companies that together market financial products or services to you.

HOMEBANK does not jointly market.

Other important information HOMEBANK works diligently to safeguard the information you give to us. We do NOT share any information about you, except as permitted by law. We restrict access to information about you to those employees who need to know that information to provide products or services to you. We maintain physical electronic and procedural safeguards to protect this information.

400 S. Main

P.O. Box 311

Palmyra, Missouri 63461

573-769-2001

Fax 573-769-2345

IMPORTANT INFORMATION ABOUT THE PROCEDURES FOR OPENING A

NEW ACCOUNT

To help the government fight the funding of Terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify, and record information that identifies each person who opens an account.

What that means for you: When you open an account, we will ask for your name,

address, date of birth, and other information that will allow us to identify you. We will also ask to copy your driver's license

Identification is for verification of identity only and will in no way be used in the loan credit process

***Payment made by you in person, by mail or electronically Monday through Friday, will be credited on the day we receive them. ***Payments received on Saturday will be credited on the next business day.

Documents

Uniform Residential Loan Application€¦ · I. TYPE OF MORTGAGE AND TERMS OF LOAN II. PROPERTY INFORMATION AND PURPOSE OF LOAN III. BORROWER INFORMATION IV. EMPLOYMENT INFORMATION