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The Bank of Elk River
<br />LOAN #: 1012000110
<br />VII. DETAILS OF TRANSACTION VIII. DECLARATIONS
<br />I. Other Credits (explain)
<br />fair rid home mortgage disclosure laws. You are not required tv furnish this iniormativn, but are encouraged tv dv so. The law at a lender ma
<br />If you answer "Yes" to any questions a through i, please use Borrower
<br />Co -Borrower
<br />Yes No
<br />to assure that the disclosures satisfy a ents to which the lender is subject under applicable state law rticular type of loan applied for.)
<br />ORROWER 0 I do not wish to furnish this into CO -BOR ROW E o not wish to iurnish this information.
<br />continuation sheet for explanation. Yes No
<br />Race: Q American Indian or Q Asian 0 Black orQ American Indian or Q Asian Q Black or
<br />Alaska Native African A Alaska Native African America
<br />f. Are you presently delinquent or in default on any Federal debt or arty other 0 ®
<br />0 0
<br />ex: [] Female Sex: Q Male
<br />To be Completed by Loan Originator:
<br />loan, mortgage, financial obligation, bond, or loan guarantee?
<br />Q In a face -to -fa w
<br />Q In a t2l@@OWinterview
<br />applicant and submitted by tax or mail
<br />g. Are you obligated to pay alimony, child support, or separate maintenance? 0 [XI
<br />0 0
<br />Vv(.
<br />h. Is any part of the down payment borrowed? 0 ®
<br />0 0
<br />Loan Originator Identifier
<br />Loan Originator's Phone Number (including area code)
<br />i. Are you a co -maker or endorser on a note? 0 ©
<br />0 EJ
<br />763-274-6890
<br />Loan Origination Company's Name
<br />---------------------------------------------------------------
<br />j. Are you a U.S. citizen? ® 0
<br />E] EJ
<br />The Bank of Elk River
<br />495076 1 State License # - 495076
<br />k. Are you a permanent resident alien? 0 0
<br />1. Do you intend to occupy the property as your primary residence? ® Q
<br />If "Yes;' complete question m detour.
<br />m. Have you had an ownership interest in a property in the last three years? © EJ
<br />(1) What type of property did you own — principal residence (PR), second
<br />home (SH), or investment property (I P)? PR
<br />0 0
<br />0 0
<br />0 0
<br />m. Loan amount
<br />(exclude PMI, MIP, Funding Fee financed)
<br />122,500.00
<br />n. PMI, MIP, Funding Fee financed
<br />o. Loan amount (add m& n)
<br />122,500.00
<br />p. Cash from/to Borrower
<br />(792,45)
<br />(subtract j, k, I & o from i)
<br />you hold title to the home — b
<br />(2} How did y y yourself (S), jointly with
<br />your spouse (SP), orjointly with another person (0)? SP
<br />IX. ACKNOWLEDGEMENT AND AGREEMENT
<br />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
<br />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
<br />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
<br />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
<br />18, United States Code, Sec. 1001, e1 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
<br />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
<br />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
<br />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
<br />on the information contained in the application, and I am obligated to amend and/or supplement the information provided in this application it any of the material facts that I have
<br />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
<br />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;
<br />(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,
<br />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
<br />(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
<br />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
<br />of this application were delivered containing my original written signature.
<br />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
<br />int Is app] 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
<br />consumer reporting agency.
<br />B 95GrgPlature Date Co -Borrower's Signature Date
<br />X �Y1bt 7122/2020 J 12:19:22 PDT X
<br />Uniform Residential Loan Application % Fannie Mae Farm 1003 7105 (rev.6109)
<br />Freddie Mac Form 65 7105 (rev.6109) Page 4 Of 5
<br />C GURLA09DI_S 0320
<br />Ellie Mae, Inc. GURLA09S (POD)
<br />07/22/2020 11:25 AM PST
<br />rmation is requested by the Federal Government for certain types of loans rela#ed to a dwelling in order to monitor the lender's complianc al credirtunity,
<br />fair rid home mortgage disclosure laws. You are not required tv furnish this iniormativn, but are encouraged tv dv so. The law at a lender ma
<br />rhev
<br />scriminate either is of this information, or on whether you choose to furnish it. It you furnish the information, please provide bot and race. For race, yv
<br />heck more than onedes/ ou do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to ormation on the basis of visuva#ion
<br />and surname if you have a plica#ion in person. If you do not wish to furnish the information,please the x below. (Lender must review the abovdal
<br />to assure that the disclosures satisfy a ents to which the lender is subject under applicable state law rticular type of loan applied for.)
<br />ORROWER 0 I do not wish to furnish this into CO -BOR ROW E o not wish to iurnish this information.
<br />thnlcity: 0 Hispanic or Latino 0 Not Hispanic or Ethril 0 Hispanic or Latino Q Not Hispanic or Latino
<br />Race: Q American Indian or Q Asian 0 Black orQ American Indian or Q Asian Q Black or
<br />Alaska Native African A Alaska Native African America
<br />Q Native Hawaiian or Q WhiteQ Native Hawaiian or Q White
<br />Other Pacific Islander Other Pacific Islander
<br />ex: [] Female Sex: Q Male
<br />To be Completed by Loan Originator:
<br />This information was provided:
<br />Q In a face -to -fa w
<br />Q In a t2l@@OWinterview
<br />applicant and submitted by tax or mail
<br />gO By the applicant and submitted via e-mail or the Internet
<br />Lree
<br />IiDciQiano s Signatu
<br />Vv(.
<br />Date 712412020 107:53: 50 PDT
<br />L ®' eNt 4slame (print or type)
<br />Loan Originator Identifier
<br />Loan Originator's Phone Number (including area code)
<br />Corey Wempie
<br />956625
<br />763-274-6890
<br />Loan Origination Company's Name
<br />Loan Origination Company Identifier
<br />Loan Origination Company's Address
<br />The Bank of Elk River
<br />495076 1 State License # - 495076
<br />630 Main Street
<br />Elk Rivet-, MN 55330
<br />Uniform Residential Loan Application % Fannie Mae Farm 1003 7105 (rev.6109)
<br />Freddie Mac Form 65 7105 (rev.6109) Page 4 Of 5
<br />C GURLA09DI_S 0320
<br />Ellie Mae, Inc. GURLA09S (POD)
<br />07/22/2020 11:25 AM PST
<br />
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