Government Monitoring
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
* Ethnicity
Ethnicity
Hispanic or Latino
NOT Hispanic or Latino
Hispanic or Latino
NOT Hispanic or Latino
* Race/National Origin:
Race/National Origin:
I do not wish to furnish this information
American Indian or Alaskan Native
Asian or Pacific Islander
Black, not of Hispanic Origin
Hispanic
White, not of Hispanic Origin
Other
I do not wish to furnish this information
American Indian or Alaskan Native
Asian or Pacific Islander
Black, not of Hispanic Origin
Hispanic
White, not of Hispanic Origin
Other
* Sex
Sex
Female
Male
Female
Male