Uniform Residential Loan Application Citizens National Bank at Brownwood

Uniform Residential Loan Application

Verify and complete the information on this application. If you are applying for this loan with others, each additional Borrower must provide information as directed by your Lender.

Section 1: Borrower Information

This section asks about your personal information and your income from employment and other sources, such as retirement, that you want considered to qualify for this loan.

Section 1a. Personal Information

Name(Required)

First Middle Last Suffix

Alternate Names

List any names by which you are known or any names under which credit was previously received (First, Middle, Last, Suffix)

Social Security Number(Required)

(or Individual Taxpayer Identification Number)

Date of Birth(Required)

Citizenship(Required)

U.S. Citizen

Permanent Resident Alien

Non-Permanent Resident Alien

Type of Credit(Required)

I am applying for Individual Credit.

I am applying for Joint Credit.

Total Number of Borrowers

List Name(s) of Other Borrower(s) Applying for this Loan

(First, Middle, Last, Suffix)

Marital Status(Required)

Married

Separated

Unmarried

Number of Dependants

(not listed by another Borrower)

Ages of Dependants

Home Phone

Cell Phone

Work Phone

Email(Required)

Address(Required)

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How Long at Current Address(Required)

(Years/Months)

Housing(Required)

No primary housing expense

Own

Rent

Monthly Expense(Required)

If at Current Address for FEWER than 2 years, list Former Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How Long at Former Address

(Years/Months)

Housing

No primary housing expense

Own

Rent

Monthly Expense

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

if different from Current Address

Section 1b. Current Employment/Self-Employment and Income

Employer or Business Name

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Position or Title

Start Date

How long in this line of work?

(Years/Months)

Check if this statement applies:

I am employed by a family member, property seller, real estate agent, or other party to the transaction.

Base Monthly Income

Monthly Overtime

Monthly Bonus

Monthly Commission

Monthly Military Entitlements

Other Monthly Income

TOTAL Monthly Income

Owner?

Check if you are the Business Owner or Self-Employed

Ownership %

I have an ownership share of less than 25%.

I have an ownership share of 25% or more.

Monthly Income (or Loss)

Section 1c. IF APPLICABLE, Complete Information for Previous Employment/Self Employment and Income

Employer or Business Name

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Position or Title

Start Date

How long in this line of work?

(Years/Months)

Check if this statement applies:

I am employed by a family member, property seller, real estate agent, or other party to the transaction.

Base Monthly Income

Monthly Overtime

Monthly Bonus

Monthly Commission

Monthly Military Entitlements

Other Monthly Income

TOTAL Monthly Income

Owner?

Check if you are the Business Owner or Self-Employed

Ownership %

I have an ownership share of less than 25%.

I have an ownership share of 25% or more.

Monthly Income (or Loss)

Section 1d. IF APPLICABLE, Complete Information for Previous Employment/Self Employment and Income

Provide at least 2 years of current and previous employment and income.

Employer or Business Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Position or Title

Start Date

End Date

Owner?

Check if you are the Business Owner or Self-Employed

Previous Gross Monthly Income

Section 1e. Income from Other Sources

Income Source

NOTE: Reveal alimony, child support, separate maintenance or other income ONLY IF you want it considered in determining your qualification for this loan.

Monthly Income

Income Source

NOTE: Reveal alimony, child support, separate maintenance or other income ONLY IF you want it considered in determining your qualification for this loan.

Monthly Income

Income Source

NOTE: Reveal alimony, child support, separate maintenance or other income ONLY IF you want it considered in determining your qualification for this loan.

Monthly Income

Income Source

NOTE: Reveal alimony, child support, separate maintenance or other income ONLY IF you want it considered in determining your qualification for this loan.

Monthly Income

Income Source

NOTE: Reveal alimony, child support, separate maintenance or other income ONLY IF you want it considered in determining your qualification for this loan.

Monthly Income

Income Source

NOTE: Reveal alimony, child support, separate maintenance or other income ONLY IF you want it considered in determining your qualification for this loan.

Monthly Income

TOTAL:

Section 2: Financial Information - Assets and Liabilities

This section asks about things you own that are worth money and that you want considered to qualify for this loan. It then asks about your liabilities (or debts) that you pay each month, such as credit cards, alimony, or other expenses.

Section 2a. Assets - Bank Accounts, Retirement, and Other Accounts You Have

Account Type

Financial Institution

Account Number

Cash or Market Value

Account Type

Financial Institution

Account Number

Cash or Market Value

Account Type

Financial Institution

Account Number

Cash or Market Value

Account Type

Financial Institution

Account Number

Cash or Market Value

Account Type

Financial Institution

Account Number

Cash or Market Value

TOTAL Cash or Market Value

Section 2b. Other Assets and Credits You Have

Asset or Credit Type

Cash or Market Value

Asset or Credit Type

Cash or Market Value

Asset or Credit Type

Cash or Market Value

Asset or Credit Type

Cash or Market Value

Section 2c. Liabilities - Credit Cards, Other Debts, and Leases that You Owe

List all liabilities below (except real estate) and include deferred payments.

Account Type

Company Name

Account Number

Unpaid Balance

To be paid off at or before closing?

Yes

Monthly Payment

Account Type

Company Name

Account Number

Unpaid Balance

To be paid off at or before closing?

Yes

Monthly Payment

Account Type

Company Name

Account Number

Unpaid Balance

To be paid off at or before closing?

Yes

Monthly Payment

Account Type

Company Name

Account Number

Unpaid Balance

To be paid off at or before closing?

Yes

Monthly Payment

Account Type

Company Name

Account Number

Unpaid Balance

To be paid off at or before closing?

Yes

Monthly Payment

Section 2d. Other Liabilities and Expenses

Include all other liabilities and expenses below.

Liability Type

Monthly Payment

Liability Type

Monthly Payment

Liability Type

Monthly Payment

Section 3: Financial Information - Real Estate

This section asks you to list all properties you currently own and what you owe on them.

Do you own any real estate?

Yes

Section 3a. Property You Own

If you are refinancing, list the property you are refinancing FIRST.

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Property Value

Status

Intended Occupancy:

Monthly Insurance, Taxes, Association Dues, etc.

if not included in Monthly Mortgage Payment

Monthly Rental Income

For 2-4 Unit Primary or Investment Property

Mortgage Loans on this Property

Creditor Name

Account Number

Monthly Mortgage Payment

Unpaid Balance

To be paid off at or before closing

Yes

Type

Credit limit

(if applicable)

Creditor Name

Account Number

Monthly Mortgage Payment

Unpaid Balance

To be paid off at or before closing

Yes

Type

Credit limit

(if applicable)

Section 3b. IF APPLICABLE, Complete Information for Additional Property

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Property Value

Status

Intended Occupancy:

Monthly Insurance, Taxes, Association Dues, etc.

if not included in Monthly Mortgage Payment

Monthly Rental Income

For 2-4 Unit Primary or Investment Property

Mortgage Loans on this Property

Creditor Name

Account Number

Monthly Mortgage Payment

Unpaid Balance

To be paid off at or before closing

Yes

Type

Credit limit

(if applicable)

Creditor Name

Account Number

Monthly Mortgage Payment

Unpaid Balance

To be paid off at or before closing

Yes

Type

Credit limit

(if applicable)

Section 3c. IF APPLICABLE, Complete Information for Additional Property

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Property Value

Status

Intended Occupancy:

Monthly Insurance, Taxes, Association Dues, etc.

if not included in Monthly Mortgage Payment

Monthly Rental Income

For 2-4 Unit Primary or Investment Property

Mortgage Loans on this Property

Creditor Name

Account Number

Monthly Mortgage Payment

Unpaid Balance

To be paid off at or before closing

Yes

Type

Credit limit

(if applicable)

Creditor Name

Account Number

Monthly Mortgage Payment

Unpaid Balance

To be paid off at or before closing

Yes

Type

Credit limit

(if applicable)

Section 4: Loan and Property Information

This section asks about the loan's purpose and the property you want to purchase or refinance.

Section 4a. Loan and Property Information

Loan Amount

Loan Purpose

Purchase

Refinance

Other

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Number of Units

Property Value

Occupancy

Primary Residence

Second Home

Investment Property

FHA Secondary Residence

Yes

Mixed-Use Property

Yes

If you will occupy the property, will you set aside space within the property to operate your own business? (e.g., daycare facility, medical office, beauty/barber shop)

Manufactured Home

Yes

Is the property a manufactured home? (e.g., a factory built dwelling built on a permanent chassis)

Section 4b. Other New Mortgage Loans on the Property You are Buying or Refinancing

Creditor Name

Lien Type

First Lien

Subordinate Lien

Monthly Payment

Loan Amount / Amount to be Drawn

Credit Limit

(if applicable)

Creditor Name

Lien Type

First Lien

Subordinate Lien

Monthly Payment

Loan Amount / Amount to be Drawn

Credit Limit

(if applicable)

If this property is meant for Purchase Only please check this box:

Purchase Only

(this property is not meant for rental purposes)

Section 4c. Rental Income on the Property You Want to Purchase

Complete if the property is a 2-4 Unit Primary Residence or an Investment Property

Expected Monthly Rental Income

Section 4d. Gifts or Grants You Have Been Given or Will Receive for this Loan

Include all gifts and grants below.

Asset Type

Deposited/Not Deposited

Deposited

Not Deposited

Source

Cash or Market Value

Asset Type

Deposited/Not Deposited

Deposited

Not Deposited

Source

Cash or Market Value

Section 5: Declarations

This section asks about specific questions about the property, your funding, and your past financial history.

Section 5a. About this Property and Your Money for this Loan

Will you occupy the property as your primary residence?

Yes

If YES, have you had an ownership interest in another property in the last three years?

Yes

What type of property did you own?

How did you own the title to the property?

If this is a Purchase Transaction: Do you have a family relatioship or business affiliation with the seller of the property?

Yes

Are you borrowing any money for this realestate transaction (e.g., money for your closing costs or down payment) or obtaining any money from another part, such as seller or realtor, that you have not disclosed on this loan application?

Yes

If YES, what is the amount of this money?

Have you or will you be applying for a mortgage loan on another property (not the property securing this loan) on or before closing this transaction that is not disclosed on this loan application?

Yes

Have you or will you be applying for any new credit (e.g., installment loan, credit card, etc.) on or before closing this loan that is not disclosed on this application?

Yes

Will this property be subject to a lien that could take priority over the first mortgage lien, such as a clean energy lien paid through your property taxes (e.g., the Property Assessed Clean Energy Program)?

Yes

Section 5b. About Your Finances

Are you a co-signer or guarantor on any debt or loan that is not disclosed on this application?

Yes

Are there any outstanding judgements against you?

Yes

Are you currently delinquent or in default on a federal debt?

Yes

Are you a party to a lawsuit in which you potentially have any personal financial liability?

Yes

Have you conveyed title to any property in lieu of foreclosure in the past 7 years?

Yes

Within the past 7 years, have you completed a pre-foreclosure sale or short sale, whereby the property was sold to a third party and the Lender agreed to accept less than the outstanding mortgage balance due?

Yes

Have you had property foreclosed upon in the last 7 years?

Yes

Have you declared bankruptcy within the past 7 years?

Yes

If YES, identify the type(s) of bankruptcy:

Chapter 7

Chapter 11

Chapter 12

Chapter 13

Section 6: Acknowledgements and Agreements.

This section tells you about your legal obligations when you sign this application.

Definitions

"Lender" includes the Lender's agents, service providers and any of their successors and assigns.
"Other Loan Participants" (this includes any actual or potential owners of a loan resulting from this application (the "Loan"), (ii) acquirers of any beneficial or other interest in the Loan,(iii) any mortgage insurer,(iv) guarantor, (v)any servicers or service providers of the Loan, and (vi) any of these parties' service providers, successors or assigns.

I agree to, acknowledge, and represent the following: (1) The Complete Information for this Application

The information I have provided in this application is true, accurate, and complete as of the date I signed this application.
If the information I submitted changes or I have new information before closing of the Loan, I must change and supplement this application, including providing anyupdated/supplemented real estate sales contract.
For purchase transactions: The terms and conditions of any real estate sales contract signed by me in connection with this application are true, accurate, and complete to the best of my knowledge and belief. I have not entered into any other agreement, written or oral, in connection with this real estate
The Lender and Other Loan Participants may rely on the information contained in the application before and after closing of the
Any intentional or negligent misrepresentation of information may result in the imposition of:
- (a) civil liability on me, including monetary damages, if a person suffers any loss because the person relied on any misrepresentation that I have made on this application, and/or
- (b) criminal penalties on me including, but not limited to, fine or imprisonment or both under the provisions of federal law (18 U.S.C. §§ 1001 et seq.).

(2) The Property's Security

The Loan I have applied for in this application will be secured by a mortgage or deed of trust which provides the Lender a security interest in the property described in this application.

(3) The Property's Appraisal, Value, and Condition

Any appraisal or value of the property obtained by the Lender is for use by the Lender and Other Loan Participants.
The Lender and Other Loan Participants have not made any representation or warranty, express or implied, to me about the property, its condition, or its value.

(4) Electronic Records and Signatures

The Lender and Other Loan Participants may keep any paper record and/or electronic record of this application, whether or not the Loan is approved.
If this application is created as (or converted into) an "electronic application", I consent to the use of "electronic records" and "electronic signatures" as the terms are defined in and governed by applicable federal and/or state electronic transactions laws.
I intend to sign and have signed this application either using my:
- (a) electronic signature; or
- (b) a written signature and agree that if a paper version of this application is converted into an electronic application, the application will be an electronic record, and the representation of my written signature on this application will be my binding electronic signature.
I agree that the application, if delivered or transmitted to the Lender or Other Loan Participants as an electronic record with my electronic signature, will be as effective and enforceable as a paper application signed by me in

(5) Delinquency

- The Lender and Other Loan Participants may report information about my account to credit bureaus. Late payments, missed payments, or other defaults on my account may be reflected in my credit report and will likely affect my credit score.
- If I have trouble making my payments I understand that I may contact a HUD-approved housing counseling organization for advice about actions I can take to meet my mortgage

(6) Authorization for Use and Sharing of Information By signing below, inaddition to the representations and agreements made above, I expressly authorize the Lender and Other Loan Participants to obtain, use, and share with each other (i) the loan application and related loan information and documentation, (ii) a consumer report on me, and (iii) my tax return information, as necessary to perform the actions listed below, for so long as they have an interest in my loan of its servicing:

(a) process and underwrite my loan;
(b) verify any data contained in my consumer credit report, my loan application and other information supporting my loan application;
(c) inform credit and investment decisions by the Lender and Other Loan Participants;
(d) perform audit, quality control, and legal compliance analysis and reviews;
(e) perform analysis and modeling for risk assessments;
(f) monitor the account for this loan for potential delinquencies and determine any assistance that may be available to me; and
(g) other actions permissible under applicable law.

Date

Section 7: Military Service.

This section asks questions about your (or your deceased spouse's) military service.

Military Service - Did you (or your decease spouse) ever serve, or are you currently serving, in the United States Armed Forces?

Yes

If YES, check all that apply

Currently serving on active duty

Currently retired, discharged, or separated from service

Only period of service was a non-activated member of the Reserve or National Guard

Surviving spouse

Section 8: Demographic Information

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, Federar 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. You may select one or more designations for "Ethnicity" and one or more designations for "Race:" 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. If you do not wish to provide some or all of this information, please check below.

Ethnicity

Hispanic or Latino

Not Hispanic or Latino

I do not wish to provide this information

Hispanic or Latino

Mexican

Puerto Rican

Cuban

Other

If OTHER, please specify

For Example: Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on.

Sex

Female

Male

I do not wish to provide this information

Race

American Indian or Alaskan Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

I do not wish to provide this information

If ASIAN

Asian Indian

Chinese

Filipino

Japanese

Korean

Vietnamese

Other Asian

If OTHER ASIAN, please specify

For Example: Hmang, Laotian, Thai Pakistani, Cambodian, and so on.

If NATIVE HAWAIIAN or OTHER PACIFIC ISLANDER

Native Hawaiian

Guamanian or Chamorro

Samoan

Other Pacific Islander

If OTHER PACIFIC ISLANDER, please specify

For Example: Fijian, Tongan, and so on.

Section 9: Loan Originator Information

Loan Originator Organization Name: Citizens National Bank
Address: 1 Carnegie Brownwood, TX 76801
Loan Originator Organization NMLSR ID# 405710

Loan Originator Name: Mary E. Barnes
Loan Originator NMLSR ID# 266574
Email: mbarnes@cnb-brownwood.com
Phone: 325-643-3545

Loan Originator Name: Stephanie Johnston
Loan Originator NMLSR ID# 1110885
Email: sjohnston@cnb-brownwood.com
Phone: 325-643-3545

Uniform Residential Loan Application - Unmarried Addendum

For Borrower Selecting the Unmarried Status

Lenders Instructions for Using the Unmarried Addendum The Lenders may use the Unmarried Addendum only when a Borrower selected "Unmarried" in Section 1 and the information collected is necessary to determine how State property laws directly or indirectly affecting creditworthiness apply, including ensuring clear title. For example, the Lender may use the Unmarried Addendum when the Borrower resides in a State that recognizes civil unions, domestic partnerships, or registered reciprocal beneficiary relationships or when the property is located in such a State. "State" means any state, the District of Columbia, The Commonwealth of Puerto Rico, or any territory or'possession of the United States.

If you selected "Unmarried" in Section 1, is there a person who is not your legal spouse but who currently has real property rights similar to those of legal spouse?

Yes

If YES, indigate the type of relatioship and the State in which the relationship was formed.

Civil Union

Domestic Partnership

Registered Reciprocal Beneficiary Relationship

Other

For example, indicate if you are in a civil union, domestic partnership, registered reciprocal beneficiary relationship, or other relationship recognized by the State in which you currently reside or where the property is located.

State:

Section 1: Additional Borrower Information

This section asks about your personal information and your income from employment and other sources, such as retirement, that you want considered to qualify for this loan.

Section 1a. Personal Information

Name

First Middle Last Suffix

Alternate Names

List any names by which you are known or any names under which credit was previously received (First, Middle, Last, Suffix)

Social Security Number

(or Individual Taxpayer Identification Number)

Date of Birth

Citizenship

U.S. Citizen

Permanent Resident Alien

Non-Permanent Resident Alien

Type of Credit

I am applying for Individual Credit.

I am applying for Joint Credit.

Total Number of Borrowers

List Name(s) of Other Borrower(s) Applying for this Loan

(First, Middle, Last, Suffix)

Marital Status

Married

Separated

Unmarried

Number of Dependants

(not listed by another Borrower)

Ages of Dependants

Home Phone

Cell Phone

Work Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How Long at Current Address

(Years/Months)

Housing

No primary housing expense

Own

Rent

Monthly Expense

If at Current Address for FEWER than 2 years, list Former Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

How Long at Former Address

(Years/Months)

Housing

No primary housing expense

Own

Rent

Monthly Expense

Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

if different from Current Address

Section 1b. Current Employment/Self-Employment and Income

Employer or Business Name

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Position or Title

Start Date

How long in this line of work?

(Years/Months)

Check if this statement applies:

I am employed by a family member, property seller, real estate agent, or other party to the transaction.

Base Monthly Income

Monthly Overtime

Monthly Bonus

Monthly Commission

Monthly Military Entitlements

Other Monthly Income

TOTAL Monthly Income

Owner?

Check if you are the Business Owner or Self-Employed

Ownership %

I have an ownership share of less than 25%.

I have an ownership share of 25% or more.

Monthly Income (or Loss)

Section 1c. IF APPLICABLE, Complete Information for Previous Employment/Self Employment and Income

Employer or Business Name

Phone

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Position or Title

Start Date

How long in this line of work?

(Years/Months)

Check if this statement applies:

I am employed by a family member, property seller, real estate agent, or other party to the transaction.

Base Monthly Income

Monthly Overtime

Monthly Bonus

Monthly Commission

Monthly Military Entitlements

Other Monthly Income

TOTAL Monthly Income

Owner?

Check if you are the Business Owner or Self-Employed

Ownership %

I have an ownership share of less than 25%.

I have an ownership share of 25% or more.

Monthly Income (or Loss)

Section 1d. IF APPLICABLE, Complete Information for Previous Employment/Self Employment and Income

Provide at least 2 years of current and previous employment and income.

Employer or Business Name

Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Position or Title

Start Date

End Date

Owner?

Check if you are the Business Owner or Self-Employed

Previous Gross Monthly Income

Section 1e. Income from Other Sources

Income Source

NOTE: Reveal alimony, child support, separate maintenance or other income ONLY IF you want it considered in determining your qualification for this loan.

Monthly Income

Income Source

NOTE: Reveal alimony, child support, separate maintenance or other income ONLY IF you want it considered in determining your qualification for this loan.

Monthly Income

Income Source

NOTE: Reveal alimony, child support, separate maintenance or other income ONLY IF you want it considered in determining your qualification for this loan.

Monthly Income

Income Source

NOTE: Reveal alimony, child support, separate maintenance or other income ONLY IF you want it considered in determining your qualification for this loan.

Monthly Income

Income Source

NOTE: Reveal alimony, child support, separate maintenance or other income ONLY IF you want it considered in determining your qualification for this loan.

Monthly Income

Income Source

NOTE: Reveal alimony, child support, separate maintenance or other income ONLY IF you want it considered in determining your qualification for this loan.

Monthly Income

TOTAL:

Section 2: Financial Information - Assets and Liabilities

My information for section 2 is listed on the Uniform Residential Loan Application with:

Section 3: Financial Information - Real Estate

This section asks you to list all properties you currently own and what you owe on them.

My information for section 3 is listed on the Uniform Residential Loan Application with:

Section 4: Loan and Property Information

This section asks about the loan's purpose and the property you want to purchase or refinance.

My information for section 4 is listed on the Uniform Residential Loan Application with:

Section 5: Declarations

This section asks about specific questions about the property, your funding, and your past financial history.

Section 5a. About this Property and Your Money for this Loan

Will you occupy the property as your primary residence?

Yes

If YES, have you had an ownership interest in another property in the last three years?

Yes

What type of property did you own?

How did you own the title to the property?

If this is a Purchase Transaction: Do you have a family relatioship or business affiliation with the seller of the property?

Yes

If YES, what is the amount of this money?

Have you or will you be applying for a mortgage loan on another property (not the property securing this loan) on or before closing this transaction that is not disclosed on this loan application?

Yes

Have you or will you be applying for any new credit (e.g., installment loan, credit card, etc.) on or before closing this loan that is not disclosed on this application?

Yes

Section 5b. About Your Finances

Are you a co-signer or guarantor on any debt or loan that is not disclosed on this application?

Yes

Are there any outstanding judgements against you?

Yes

Are you currently delinquent or in default on a federal debt?

Yes

Are you a party to a lawsuit in which you potentially have any personal financial liability?

Yes

Have you conveyed title to any property in lieu of foreclosure in the past 7 years?

Yes

Have you had property foreclosed upon in the last 7 years?

Yes

Have you declared bankruptcy within the past 7 years?

Yes

If YES, identify the type(s) of bankruptcy:

Chapter 7

Chapter 11

Chapter 12

Chapter 13

Section 6: Acknowledgements and Agreements.

This section tells you about your legal obligations when you sign this application.

My signature for section 6 is on the Uniform Residential Loan Application with:

Section 7: Military Service.

This section asks questions about your (or your deceased spouse's) military service.

Military Service - Did you (or your decease spouse) ever serve, or are you currently serving, in the United States Armed Forces?

Yes

If YES, check all that apply

Currently serving on active duty

Currently retired, discharged, or separated from service

Only period of service was a non-activated member of the Reserve or National Guard

Surviving spouse

Section 8: Demographic Information

Ethnicity

Hispanic or Latino

Not Hispanic or Latino

I do not wish to provide this information

Hispanic or Latino

Mexican

Puerto Rican

Cuban

Other

If OTHER, please specify

For Example: Argentinean, Colombian, Dominican, Nicaraguan, Salvadoran, Spaniard, and so on.

Sex

Female

Male

I do not wish to provide this information

Race

American Indian or Alaskan Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

White

I do not wish to provide this information

If ASIAN

Asian Indian

Chinese

Filipino

Japanese

Korean

Vietnamese

Other Asian

If OTHER ASIAN, please specify

For Example: Hmang, Laotian, Thai Pakistani, Cambodian, and so on.

If NATIVE HAWAIIAN or OTHER PACIFIC ISLANDER

Native Hawaiian

Guamanian or Chamorro

Samoan

Other Pacific Islander

If OTHER PACIFIC ISLANDER, please specify

For Example: Fijian, Tongan, and so on.

Section 9: Loan Originator Information

Uniform Residential Loan Application - Unmarried Addendum

For Borrower Selecting the Unmarried Status

If you selected "Unmarried" in Section 1, is there a person who is not your legal spouse but who currently has real property rights similar to those of legal spouse?

Yes

If YES, indigate the type of relatioship and the State in which the relationship was formed.

Civil Union

Domestic Partnership

Registered Reciprocal Beneficiary Relationship

Other

State:

Borrowers' Certification and Authorization

CERTIFICATION

The Undersigned certify the following:

I/We have applied for a mortgage loan through Citizens National Bank . In applying for the loan, I/We completed a loan application containing various information on the purpose of the loan, the amount and source of the down payment, employment and income information, and the assets and liabilities. I/We certify that all of the information is true and complete. I/We made no misrepresentations in the loan application or other documents, nor did I/We omit any pertinent information.
I/We understand and agree that Citizens National Bank reserves the right to change the mortgage loan review processes to a full documentation program. This may include verifying the information provided on the application with the employer and/or the financial institution.
I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements when applying for this mortgage, as applicable under the provisions of Title 18, United States Code, Section 1014.

AUTHORIZATION TO RELEASE INFORMATION To Whom It May Concern:

I/We have applied for a mortgage loan through Citizens National Bank . As part of the application process, Citizens National Bank and the mortgage guaranty insurer (if any), may verify information contained in my/our loan application and in other documents required in connection with the loan, either before the loan is closed or as part of its quality control program.
I/We authorize you to provide to Citizens National Bank and to any investor to whom Citizens National Bank may sell my mortgage, any and all information and documentation that they request. Such information includes, but is not limited to, employment history and income; bank, money market and similar account balances; credit history; and copies of income tax returns.
Citizens National Bank or any investor that purchases the mortgage may address this authorization to any party named in the loan application.
A copy of this authorization may be accepted as an original.

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ESIGN DISCLOSURES AND CONSENT

Federal law requires you receive certain disclosures and information about the products, services or accounts you may receive or access in connection with your relationship with us ('Required Information'). With your consent we can deliver Required Information to you by a) displaying or delivering the Required Information electronically; and b) requesting that you print or download the Required Information and retain it for your records. This notice contains important information before you consent to electronic delivery of Required Information. Your consent also permits the general use of electronic records and electronic signatures in connection with the Required Information. After you have read this Esign Disclosures and Consent, if you agree to receive Required Information from us electronically, and if you agree to the general use of electronic records and electronic signatures in connection with our relationship, please "SIGN" below and Return To: Statement of electronic disclosures: If you consent to electronic disclosures, that consent applies to all Required Information we give you or receive from you in connection with our relationship and the associated notices, disclosures, and other documents. You agree to print out or download Required Information when we advise you to do so and keep it for your records. If you are unable to print or download any Required Information, you may call us and request paper copies. If you need to update your e·-mail address or other contact information with us, you may do so by calling us and requesting necessary updates. Your consent does not mean that we must provide the Required Information electronically. We may at our option deliver Required Information on paper. We may also require that certain communications from you be delivered to us on paper at a specified address. Required Software/Hardware Hardware and software minimum requirements to access and store the electronic information:

Hardware: Hard drive
Devices: iOS; Android; Windows
Operating System: Windows 8, 8.1, 10; Mac OS X
Browsers: Internet Explorer 8, 9, 10, 11; Chrome; Firefox; Safari (MacOS); Opera (Note: Cookies must be enabled)
Software: Adobe Acrobat or similar software to view PDF files
Printer ( for printed copies)

If you do not have the required software and/or hardware, or if you do not wish to use electronic records and signatures for any other reason, you can request paper copies of the Required Information to be sent to you by calling us. Withdrawing Consent You have the right to withdraw electronic consent without disrupting the processing of your loan. However, any documents you signed electronically before you withdrew your consent will be considered legally valid and enforceable. Any electronic documents or disclosures may be obtained in paper form and delivered by mail. The procedure to withdraw the electronic consent can be accomplished by choosing and clicking on the "Opt Out" tab. You may, or may not, incur additional charges by Opting Out of the electronic consent, or for receiving paper copies of documents. Please refer to our fee schedule for our current fees related to these matters. This fee schedule may change from time to time; you will be notified of any such change. I have read the information about the use of electronic records, disclosures, notices, and email, and consent to the use of electronic records for the delivery of Required Information in connection with our relationship. I will be able to view this information using my computer and software. I have an account with an internet service provider, and I am able to send e-mail and receive e-mail with hyperlinks to websites and attached files. I also consent to the use of electronic records and electronic signatures in place of written documents and handwritten signatures.

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