First National Bank of Cokato

IMPORTANT INFORMATION ABOUT PROCEDURES FOR OPENING A NEW ACCOUNT

To help the government fight the funding of terrorism and money laundering activities, Federal law requires all financial institutions to obtain, verify and record information that identifies each person who opens an account. An account includes: Investments, Safe Deposit, Loans and Deposit Accounts.

What this means for you: When you open an account, we will ask for your name, address, date of birth and other information that will allow us to identify you. We will also ask to see your driver's license or other identifying documents. In some cases, identification will be requested for those banking with The First National Bank of Cokato prior to October 1, 2003 because original documentation was not obtained with the opening of the account. In all cases, protection of our customer's identity and confidentiality is the Bank's pledge to you.

The identity information is not being obtained for credit decision purposes.

UNIFORM RESIDENTIAL LOAN APPLICATION

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 of assets of a person other than the "Borrower" (including the Borrower's spouse) will be used as a basis for loan qualification

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, or the Borrower is relying on other property located in a community property state as a basis for repayment of the loan.

I. TYPE OF MORTGAGE AND TERMS OF LOAN

Mortgage Applied for:

VA	Conventional	Other
FHA	FmHA

Agency Case Number:

Lender Case Number:

Amount:

Interest Rate:

Number of Months:

Amortization Type:

Fixed Rate	Other (explain):
GPM	ARM (type):

II. PROPERTY INFORMATION AND PURPOSE OF LOAN

Subject Property Address:

City:

State:

Zip Code:

Number of Units:

Legal Description of Subject Property:
(attach description if necessary)

Year Built:

Purpose of Loan:

Purchase	Construction
Refinance	Construction-Permanent
Other (explain):

Property will be:

Primary Residence

Secondary Residence

Investment

Complete the following if construction or construction-permanent loan.

Year Lot Acquired:

Original Cost: $

Amount Existing Liens:

(a) Present Value of Lot:

(b) Cost of Improvements:

Total a + b:

Complete the following if this is a refinance loan.

Year Acquired:

Original Cost: $

Amount Existing Liens:

Purpose of Refinance:

Describe Improvements:	Made:
	To Be Made:
	Cost:	$

Title will be held in what name?:

Manner in which Title will be held:

Estate will be held in:

Fee Simple

Leasehold
(show expiration date)

Source of Down Payment, Settlement Charges and / or Subordinate Financing (explain):

III. BORROWER INFORMATION

Borrower

Borrower's Name:
(include Jr. or Sr. if applicable)

Social Security Number:

Home Phone:
(include area code)

Age:

Years of School:

Marital Status:

Married
Separated
Unmarried (include single, divorced, widowed

Dependents: (not listed by co-borrower)	Number:
Dependents: (not listed by co-borrower)	Ages:

Present Address: own rent Number of years:	Street or PO Box:
	City:
	State:
	Zip Code:

If residing at present address for less than two years, complete the following:

Former Address: own rent Number of years:	Street or PO Box:
	City:
	State:
	Zip Code:

Former Address: own rent Number of years:	Street or PO Box:
	City:
	State:
	Zip Code:

Co-Borrower

Co-Borrower's Name:
(include Jr. or Sr. if applicable)

Social Security Number:

Home Phone:
(include area code)

Age:

Years of School:

Marital Status:

Married
Separated
Unmarried (include single, divorced, widowed

Dependents: (not listed by borrower)	Number:
Dependents: (not listed by borrower)	Ages:

Present Address: own rent Number of years:	Street or PO Box:
	City:
	State:
	Zip Code:

If residing at present address for less than two years, complete the following:

Former Address: own rent Number of years:	Street or PO Box:
	City:
	State:
	Zip Code:

Former Address: own rent Number of years:	Street or PO Box:
	City:
	State:
	Zip Code:

IV. EMPLOYMENT INFORMATION

Borrower

Self-Employed:

Employer Name:

Employer Address:

Years on this Job:

Years employed in this line of work / profession:

Position:

Title:

Type of Business:

Business Phone:
(include area code)

If employed in current position for less than two years or if currently employed in more than one position, complete the following:

Self-Employed:

Employer Name:

Employer Address:

Dates (from - to):

Monthly Income:

Position:

Title:

Type of Business:

Business Phone:
(include area code)

Self-Employed:

Employer Name:

Employer Address:

Dates (from - to):

Monthly Income:

Position:

Title:

Type of Business:

Business Phone:
(include area code)

Co-Borrower

Self-Employed:

Employer Name:

Employer Address:

Years on this Job:

Years employed in this line of work / profession:

Position:

Title:

Type of Business:

Business Phone:
(include area code)

If employed in current position for less than two years or if currently employed in more than one position, complete the following:

Self-Employed:

Employer Name:

Employer Address:

Dates (from - to):

Monthly Income:

Position:

Title:

Type of Business:

Business Phone:
(include area code)

Self-Employed:

Employer Name:

Employer Address:

Dates (from - to):

Monthly Income:

Position:

Title:

Type of Business:

Business Phone:
(include area code)

V. MONTHLY INCOME AND COMBINED HOUSING EXPENSE INFORMATION

Gross Monthly Income	Borrower	Co-Borrower	Total
Base Empl. Income*:	$	$	$
Overtime:	$	$	$
Bonuses:	$	$	$
Commissions:	$	$	$
Dividends / Interest:	$	$	$
Net Rental Income:	$	$	$
Other: (before completing, see the notice in "describe other income" below)	$	$	$
Total:	$	$	$

Combined Monthly Housing Expense	Present	Proposed
Rent:	$	$
First Mortgage (P&I):	$	$
Other Financing (P&I):	$	$
Hazard Insurance:	$	$
Real Estate Taxes:	$	$
Mortgage Insurance:	$	$
Homeowner Assn. Dues:	$	$
Other:	$	$
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.)

Borrower:

Monthly Amount: $

Co-Borrower:

Monthly Amount: $

VI. 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

List checking and savings accounts below

Name of Bank, SYL, or Credit Union:

Address of Bank, SYL, or Credit Union:

Account Number:

Cash or Market Value:

Name of Bank, SYL, or Credit Union:

Address of Bank, SYL, or Credit Union:

Account Number:

Cash or Market Value:

Name of Bank, SYL, or Credit Union:

Address of Bank, SYL, or Credit Union:

Account Number:

Cash or Market Value:

Name of Bank, SYL, or Credit Union:

Address of Bank, SYL, or Credit Union:

Account Number:

Cash or Market Value:

Stocks & Bonds

Company Name:

Account Number:

Description:
Cash or Market Value:

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:

Year:

Cash or Market Value:
$

Make:

Year:

Cash or Market Value:
$

Make:

Year:

Cash or Market Value:
$

Other Assets (itemize):

Cash or Market Value:

Item #1:

Item#2:

Item#3:

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. Indicate by (*) those liabilities which will be satisfied upon sale of real estate owned or upon refinancing of the subject property.

Name of Company:

Address of Company:

Account Number:

Months Left to Pay:

Monthly Payment:

Unpaid Balance:

Name of Company:

Address of Company:

Account Number:

Months Left to Pay:

Monthly Payment:

Unpaid Balance:

Name of Company:

Address of Company:

Account Number:

Months Left to Pay:

Monthly Payment:

Unpaid Balance:

Name of Company:

Address of Company:

Account Number:

Months Left to Pay:

Monthly Payment:

Unpaid Balance:

Name of Company:

Address of Company:

Account Number:

Months Left to Pay:

Monthly Payment:

Unpaid Balance:

Name of Company:

Address of Company:

Account Number:

Months Left to Pay:

Monthly Payment:

Unpaid Balance:

Name of Company:

Address of Company:

Account Number:

Months Left to Pay:

Monthly Payment:

Unpaid Balance:

Alimony/Child Support/Separate Maintenance Payments Owed to:
Amount:	$

Job Related Expense: (child care, union dues, etc.)
Amount:	$

Total Liabilities b:

Total Monthly Payments:

Net Worth (a minus b):

Schedule of Real Estate Owned (If additional properties are owned, use continuation sheet.)

Property Address:

Enter S if sold, PS if pending sale or R if rental being held for income:

Type of Property:

Present Market Value:

Amount of Mortgages & Liens:

Gross Rental Income:

Mortgage Payments:

Insurance, Maintenance, Taxes & Miscellaneous:

Net Rental Income:

Property Address:

Enter S if sold, PS if pending sale or R if rental being held for income:

Type of Property:

Present Market Value:

Amount of Mortgages & Liens:

Gross Rental Income:

Mortgage Payments:

Insurance, Maintenance, Taxes & Miscellaneous:

Net Rental Income:

Property Address:

Enter S if sold, PS if pending sale or R if rental being held for income:

Type of Property:

Present Market Value:

Amount of Mortgages & Liens:

Gross Rental Income:

Mortgage Payments:

Insurance, Maintenance, Taxes & Miscellaneous:

Net Rental Income:

Total Present Market Values:

Total Mortgages & Liens:

Total Gross Rental Income:

Total Mortgage Payments:

Total Insurance, Maintenance, Taxes & Miscellaneous:

Total Net Rental Income:

List any additional names under which credit has previously been received and indicate appropriate creditor name(s) and account number(s).

Alternate Name:

Creditor Name:

Account Number:

Alternate Name:

Creditor Name:

Account Number:

VII. DETAILS OF TRANSACTION

a. Purchase Price:

b. Alterations, Improvements, Repairs:

c. Land (if acquired separately):

d. Refinance (incl. 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. Borrower's Closing Costs Paid by Seller:

l. 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)

VIII. DECLARATIONS

If you answer "yes" to any questions a through i, please use continuation sheet for explanation.
	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 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 action.)
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 three years? If yes, answer questions below. (1) What type of property did you own? (PR) principal residence (SH) second home (IP) investment property (2) How did you hold title to the home? (S) by yourself (SP) jointly with your spouse (O) jointly with another person

IX. ACKNOWLEDGMENT AND AGREEMENT

The undersigned specifically acknowledge(s) that: (1) the loan requested by this application will be secured by a first mortgage or deed of trust on the property described herein; (2) the property will not be used for any illegal or prohibited purpose or use; (3) all statements made in this application are made for the purpose of obtaining the loan indicated herein; (4) occupation of the property will be as indicated above; (5) 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; (6) the Lender, its agents, successors and assigns will rely on the information contained in the application and I/we have a continuing obligation to amend and/or supplement the information provided in this application if any of the material facts which I/we have represented herein should change prior to closing; (7) in the event my/our payments on the loan indicated in this application become delinquent, the Lender, its agents, successors and assigns, may, in addition to all their other rights and remedies, report my/our name(s) and account information to a credit reporting agency; (8) ownership of the loan may be transferred to successor or assign of the Lender without notice to me and/or the administration of the loan account may be transferred to an agent, successor or assign of the Lender with prior notice to me; (9) the Lender, its agents, successors and assigns make no representations or warranties, express or implied, to the Borrower(s) regarding the property, the condition of the property, or the value of the property.
Certification: I/We certify that the information provided in this application is true and correct as of the date set forth opposite my/our signature(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.

______________________________ Borrower's Signature (To be signed at processing)	________________ Date
______________________________ Co-Borrower's Signature (To be signed at processing)	________________ Date

X. INFORMATION FOR GOVERNMENT MONITORING PURPOSES

For home purchases, home improvements, and refinances of home purchases or home improvement loans, complete Section X. For loans that are not home purchases, home improvements or refinances, do not complete Section X. 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
I do not wish to furnish this information

Race / National Origin:	American Indian or Alaskan Native
	Asian or Pacific Islander
	Black, not of Hispanic origin
	Hispanic
	White, not of Hispanic origin
	Other (specify)

Sex:	Male
	Female

CO-BORROWER
I do not wish to furnish this information

Race / National Origin:	American Indian or Alaskan Native
	Asian or Pacific Islander
	Black, not of Hispanic origin
	Hispanic
	White, not of Hispanic origin
	Other (specify)

Sex:	Male
	Female

CONTINUATION SHEET / RESIDENTIAL LOAN APPLICATION

Use this continuation sheet if you need more space to complete the Residential Loan Application.

Borrower:

Co-Borrower:

NOTICE OF RIGHT TO APPRAISAL COPY

You have the right to a copy of the appraisal report used in connection with your application for credit. If you wish a copy, please write to us at the mailing address we have provided. We must hear from you no later than 90 days after we notify you about the action taken on your credit application or you withdraw your application. In your letter, give us the following information: Loan or application number (if known), date of application, name(s) of loan applicant(s) property address, and current mailing address.

I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements concerning any of the above facts as applicable under the provisions of Title 18, United States Code, Section 1001, et seq.


______________________________ Borrower's Signature (To be signed at processing)	________________ Date
______________________________ Co-Borrower's Signature (To be signed at processing)	________________ Date

THIS SECTION TO BE COMPLETED BY INTERVIEWER

This application was taken:	By Face To Face Interview
	By Mail
	By Telephone
	Online
Interviewer's Name: (print or type)
Interviewer's Phone Number: (include area code)
Name of Interviewer's Employer:
Address of Interviewer's Employer:

______________________ Interviewer's Signature:	__________ Date:

Member FDIC

Equal Housing Lender

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