Mortgage Loan Application

Ozona National Bank

Uniform Residential Loan Application

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* Indicates Required Information

This 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 will not be used as a basis for loan qualification, but his or her liabilities must be considered because the Borrower 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 property state as a basis for repayment of the loan.

* Please Choose the location you wish to submit this application to: Ozona San Antonio (LPO) San Marcos Wimberley
TYPE OF MORTGAGE AND TERMS OF LOAN
Mortgage Applied for: Amount Requested: * $	Agency Case Number: ____________ Lender Case Number: ____________
Interest Rate % _______ No. of Months: Amortization Type:

PROPERTY INFORMATION AND PURPOSE OF LOAN
Subject Property Address (street, city, state, ZIP code) *						No. of Units
						Year Built
Legal Description of Subject Property
Purpose of Loan:	If other, please explain:			Property will be:
Complete the next line if construction or construction-permanent loan.
Year Lot Acquired	Original Cost $	Amt. Existing Liens $	(a) Present Value of Lot $	(b) Cost of Improvements $		Total (a+b) $
Complete the next line if a refinance loan.
Year Acquired	Original Cost $	Amt. Existing Liens $	Purpose of Refinance $	Describe Improvements: Cost: $
Title will be held in what Name(s)			Manner in which Title will be held:		Estate will be held in: If Leasehold, list expiration date:
Source of Down Payment, Settlement Charges and/or Subordinate Financing (explain)

BORROWER INFORMATION
Borrower		Co-Borrower
Borrower's Name *		Co-Borrower's Name
Social Security Number *		Social Security Number
Driver's License Number		Driver's License Number
Home Phone Number *		Home Phone Number
Date of Birth *		Date of Birth
Years School		Years School
Marital Status *	Unmarried (includes single, divorced, widowed)	Marital Status	Unmarried (includes single, divorced, widowed)
Dependents (not listed by Co-Borrower)	No. Ages	Dependents (not listed by Borrower)	No. Ages
Present Address *	City * State * Zip *	Present Address	City State Zip
Number of Years at this address Years: Own Rent		Number of Years at this address Years: Own Rent
Mailing address, if different from Present address :		Mailing address, if different from Present address :
Former Address (if less than 2 years at present address)	City State Zip	Former Address (if less than 2 years at present address)	City State Zip
Number of Years at this address Years: Own Rent		Number of Years at this address Years: Own Rent

EMPLOYMENT INFORMATION
Borrower		Co-Borrower
Name of Employer		Name of Employer
Self Employed?	Years on this job Years employed in this line of work/profession? yrs.	Self Employed?	Years on this job Years employed in this line of work/profession? yrs.
Address	City State Zip	Address	City State Zip
Position/Title		Position/Title
Business Phone		Business Phone
If employed in current position for less than two years or if currently employed in more than one position, complete the following:
Name of Employer		Name of Employer
Self Employed?	Dates (from-to) Monthly Income	Self Employed?	Dates (from-to) Monthly Income
Address	City State Zip	Address	City State Zip
Position/Title		Position/Title
Business Phone		Business Phone

MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION
GROSS MONTHLY INCOME				COMBINED MONTHLY HOUSING EXPENSE
Item	Borrower	Co-Borrower	Total	Item	Present	Proposed
Base Empl. Income *	$	$	$	Rent	$
Overtime				First Mortgage (P&I)		$
Bonuses				Other Financing (P&I)
Commissions				Hazard Insurance
Dividends/Interest				Real Estate Taxes
Net Rental Income				Mortgage Insur.
Other (Before completing, see notice under Describe Other Income below)				Homeowner Assn. Dues
				Other

Total	$	$	$	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 or Co-Borrower does not choose to have it considered for repaying this loan.
Item				Monthly Amount
				$
				$
				$
				$
				$

ASSETS AND LIABILITIES
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 that the 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 about a spouse, this Statement and supporting schedules must be completed about that spouse also. Completed: Jointly Not Jointly
Assets (Description)	Cash or Market Value
Name and address of Bank, S&L, or Credit Union (List checking and savings accounts)
Acct. No.	$
Name and address of Bank, S&L, or Credit Union (List checking and savings accounts)
Acct. No.	$
Name and address of Bank, S&L, or Credit Union (List checking and savings accounts)
Acct. No.	$
Name and address of Bank, S&L, or Credit Union (List checking and savings accounts)
Acct. No.	$
Stocks & Bonds (Company name/number & description) Acct. No.	$
Life Insurance net cash value: $ Face amount: $	$
Subtotal Liquid Assets	$
Real Estate owned (enter market value from schedule of real estate owned)	$
Vested interest in retirement fund	$
Net worth of business(es) owned (attach financial statement)	$
Automobiles owned (make and year)	$
	$
	$
Other Assets (itemize)	$
Total Assets (a)	$

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.
Liabilities	Monthly Payment & Mos. Left to Pay	Unpaid Balance
Name and address of Company	$	$
Acct. No.
Name and address of Company	$	$
Acct. No.
Name and address of Company	$	$
Acct. No.
Name and address of Company	$	$
Acct. No.
Name and address of Company	$	$
Acct. No.
Name and address of Company	$	$
Acct. No.
Alimony/Child Support/Separate Maintenance Payments Owed to:	$
Job Related Expense (child care, union dates, etc.)	$
Total Monthly Payments	$
	Total Liabilities (b)	$
Net Worth (a minus b) »	$


SCHEDULE OF REAL ESTATE OWNED (If additional properties are owned, use continuation sheet)
Address of Property	Type of Property Indicate S if Sold, PS if Pending Sale or R if Rental being held for income	Present Market Value	Amt. of Mort. & Liens	Gross Rental Income	Mort. Paymts.	Taxes, Ins., Maint. and Misc.	Net Rental Income
		$	$	$	$	$	$


Totals		$	$	$	$	$	$

LIST PREVIOUS CREDIT REFERENCES
Borrower or CoBorrower	Creditor's Name and Address	Account Number	Purpose	Highest Balance	Date Paid




List any additional names under which credit has previously been received.

DETAILS OF TRANSACTION
a. Purchase Price	$
b. Alterations, improvements, repairs	$
c. Land (if acquired separately)	$
d. Refinance (including 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. 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)	$

DECLARATIONS
If you answer "Yes" to any question a through i, please explain in the box below.	Borrower		Co-Borrower
	Yes	No	Yes	No
a. Are there any outstanding judgments against you?
b. Have you been declared bankrupt within the past 7 years?
c. Have you had a property foreclosed upon or given title or deed in lieu thereof in the last 7 years?
d. Are you a party to a law suit?
e. Have you directly or indirectly been obligated on any loan which resulted in foreclosure, transfer of title in lieu of foreclosure, or judgment? (This would include such loans as home mortgage loans, SBA loans, home improvement loans, educational loans, 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, and reasons for the actions.)
f. Are you presently delinquent or in default on any Federal debt or any other 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 3 years? (1) What type of property did you own: principle residence (PR) second home (SH), or investment property (IP)? (2) How did you hold title to the home: solely by yourself (S), jointly with spouse (SP), or jointly with another person (O)?


Explanations:

ACKNOWLEDGMENT AND AGREEMENT

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 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 misrepresentation of this information contained in this application may result in civil liablity, including monetary damages, to any person who may suffer any loss due to reliance 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 18, United States Code, Sec. 1001, et 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 herein; (3) the property will not be used for any illegal or prohibited purpose or use; (4) all statements made in the application are made for the purpose of obtaining a residential mortgage loan; (5) the property will be occupied as indicated herein; (6) By signing below I/We authorize that verification or reverification of any information contained in the application may be made at any time by the Lender, its agents, successors and assigns, either directly or through a credit reporting agency, from any source named in this application, and the original copy of this application will be retained by the Lender, even if the loan is not approved; (7) the Lender and its agents, 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 information provided in this application if any of the material facts that I have represented herein should change prior to closing the Loan; (8) in the event that my payments on the Loan become delinquent, the owner or servicer of the Loan 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 credit 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 Lender nor its agents, brokers, insurers, servicers, successors or assigns has made any representation or warranty, express or implied, to me regarding the property of the condition or value of the property; 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 (excluding 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 of this application were delivered containing my original written signature.

Borrower's Signature: * Date: *

Co-Borrower's Signature: Date:

Certification: BY CLICKING THE SUBMIT BUTTON BELOW, I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our name(s) on this application and acknowledge my/our understanding that any intentional or negligent misrepresentation(s) of the information contained in this application may result in civil liability and/or criminal penalties including, but not limited to, fine or imprisonment or both under the provisions of Title 18, United States code, Section 1001, et seq. and liability for monetary damages to the Lender, its agents, successors and assigns, insurers and any other person who may suffer any loss due to reliance upon any misrepresentation which I/we have made on this application.

I understand the under the US Patriot ACT, this financial Institution is obligated to verify the identity of each customer opening a new account, or each new owner being added to an existing deposit account. I also understand and agree that if the institution is not able to verify the identity of all owners of this account within a reasonable time, it may close the account at any time without providing advance notice.

I certify that everything I have stated in this application and on any attachments is correct. By signing below, and clicking the submit button, I authorize you to verify account history through CheckSystems.

INFORMATION FOR GOVERNMENT MONITORING PURPOSES

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 neither discriminate on the basis of this information, nor on whether you choose to furnish it. However, if you choose not to furnish it, under Federal regulations this Lender is required to note race and sex on the basis of visual observation or surname. If you do not wish to furnish the above information, please check the box below. (Lender must review the above material to assure that the disclosures satisfy all requirements to which the Lender is subject under applicable state law for the particular type of loan applied for.)

BORROWER			CO-BORROWER
	I do not wish to furnish this information.			I do not wish to furnish this information.
Ethnicity	Hispanic or Latino	Not Hispanic or Latino	Ethnicity	Hispanic or Latino	Not Hispanic or Latino
Race/National Origin	American Indian or Alaskan Native	Asian	Race/National Origin	American Indian or Alaskan Native	Asian
	Black or African American	White		Black or African American	White
	Native Hawaiian or Other Pacific Islander			Native Hawaiian or Other Pacific Islander
Sex	Female	Male	Sex	Female	Male

To be Completed by Interviewer
__ face-to-face interview		Interviewer's Name: ______________________			Ozona National Bank P.O. Box 430 Ozona, TX 76943
__ by mail __ by telephone		Interviewer's Signature: ____________________
__ by computer __ Internet		Interviewer's Phone Number: _______________

If you choose not to send this application by email you can mail this Application by using the print function on your browser and mailing it to the desired bank location.

Fannie Mae Form 1003/Rev. 01/04