INFORMATION FOR GOVERNMENT MONITORING PURPOSES (Optional)
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 not discriminate either on the 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, the 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