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CEE / CEE_Application / 9-18 <br />Section 6: Information for government Monitoring Purposes <br />These questions apply to all applicants. If you answer "yes" to question 1-5, please provide a written explanation, including the circumstances <br />and dates. Use a separate piece of paper if necessary. <br />Applicant <br />Yes Yes No <br />Co-Applicant <br />No <br />1: Are there any outstanding judgments or liens against you? <br />Explanation: <br />2: Have you declared bankruptcy (Chapter 7 or 13) within the last 36 Months? <br />3: Have you had any property foreclosed upon or given title or deed-in-lieu thereof in the past 36 <br />months? <br />4: Are you a co-maker or endorser of a note that is not included in the above listed debts? <br />5: Are you obligated to pay alimony, child support or separate maintenance? <br />6. Do you intend to occupy this property (at least one unit) as your primary residence? <br />Applicant Co-Applicant <br />I do not wish to furnish this information <br />Ethnicity:Hispanic or Latino <br />Japanese <br />Race:American Indian or Alaskan Native <br />Native Hawaiian or Other Pacific Islander <br />Asian <br />Black or African American <br />White <br />Sex:Male Female <br />I do not wish to furnish this information <br />Ethnicity:Hispanic <br />Not Hispanic or Latino <br />Race: <br />Japanese <br />Asian <br />Black or African American <br />White <br />Sex:Male Female <br />To be completed by Lender <br />This information was provided by: <br />By the applicant and submitted by fax or mail <br />In a face-to-face interview <br />By the applicant and submitted via email or the Internet <br />In a telephone interview <br />8. Are you a permanent resident alien? <br />7. Are you a U.S. citizen? <br />Not Hispanic or Latino <br />Chinese <br />Asian Indian <br />Other Asian <br />Puerto Rican <br />Cuban <br />Mexican <br />Other Hispanic or Latino - enter race <br />Puerto Rican <br />Cuban <br />Mexican <br />Other Hispanic or Latino <br />Filipino <br />Vietamese <br />Koreon <br />Native Hawaiian <br />Guamanian or Chamorro <br />Samoan <br />Other Pacific Islander - enter race <br />Chinese <br />Asian Indian <br />Other Asian <br />Filipino <br />Vietamese <br />Koreon <br />Native Hawaiian <br />Guamanian or Chamorro <br />Samoan <br />Other Pacific Islander - enter race <br />American Indian or Alaskan Native <br />Native Hawaiian or Other Pacific Islander <br />3 of 5