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Thou questions apply to all applicants. Vyyrorou answer "yes"to question 1-5, please provide a cannot explanation, including the circumstances <br />and dates. Use separace piece ofpaper sfnecessary. <br />Applicant Co-Apithcant <br />Yes No Yes No <br />1: Arc there any ouotandingiudgments a liens against you? 171 11 0 0 <br />2: Have you declared bankruptcy (Chapter 7 or 13) within the last 36 Months? El 13 El 13 <br />3: aveyou any property ancose upon or given title or decd -in -lieu therw int -peat <br />0 13 13 0 <br />a: Are you a w -maker or endorser of a note shat is nut included in the ab., listed debit? 13 11 11 0 <br />5: Arc you obligated to pay alimony, child support or separate maintrnancc?13 El El <br />6. Do you intend to occupy this property (at (rest one unit) as your prises, residence? <br />7. Are you a U.S. citiun? <br />S. Are you a pemseneot resident alien? <br />Explanation: <br />Section 6: Information for government Monitoring Purposes <br />Applicant <br />Co -Applicant <br />❑ I do not wish to furnish this information <br />❑ I do not wish to famish this information <br />Ethnicity: <br />❑ Hispanic or Latino <br />p <br />Ethnicity: <br />❑ Hispanic <br />❑ Mexican <br />❑ Mexican <br />❑ Puerto Rican <br />❑ Puerto Rican <br />❑ Cuban <br />❑ Cuban <br />❑ Other Hispanic or Latino <br />❑ Other Hispanic or Latino - enter race <br />❑ Not Hispanic or Latino <br />❑ Not Hispanic or Latino <br />Race: <br />❑ American Indian or Alaskan Native <br />Race: <br />❑ American Indian or Alaskan Native <br />❑ Asian <br />❑ Asian <br />❑ Asian Indian ❑ Korean <br />❑ Asian Indian ❑ Koreon <br />❑ Japanese ❑ Filipino <br />❑ Japanese ❑ Filipino <br />❑ Chinese ❑ Vietamese <br />❑ Chinese ❑ Vietamese <br />❑ Other Asian <br />❑ Other Asian <br />❑ Black or African American <br />❑ Black or African American <br />❑ Native Hawaiian or Other Pacific Islander <br />❑ Native Hawaiian or Other Pacific Islander <br />❑ Native Hawaiian <br />❑ Native Hawaiian <br />❑ Guamanian or Cbamonm <br />❑ Guamanian or Chamorro <br />❑ Samoan <br />❑ Samoan <br />❑ Other Pacific Islander - enter race <br />❑ Other Pacific Islander -enter race <br />❑ White <br />❑ White <br />Sex: ❑ Male ❑ Female Sex: ❑ Male ❑ Female <br />To be completed by Lender <br />This information was provided by: <br />❑ In a face-to-face interview ❑ In a telephone interview <br />❑ By the applicant and submitted by fax or mail ❑ By the applicant and submitted via email or the Internet <br />3 of 5 <br />fEEIfEE�Irc>tuel0.lB <br />