If you answer “Yes” to any questions (a) through (i), please use comment box for explanation.
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 in formation, but are encouraged to do so. The law provides that a lender may not discriminate either on t he basis of this information, or on whether you choose to furnish it. If you furnish the information, please provide both ethnicity and race. For race, you may check more than one designation. If you do not furnish ethnicity, race, or sex, under Federal regulations, this lender is required to note the information on the basis of visual observation and surname if you have made this application in person. If you do not wish to furnish the 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.)
I do not wish to furnish the below information
American Indian or Alaska Native
Black or African American
Native Hawaiian or Other Pacific Islander