Sample Form Of Counter-Notification To Mls Property Information Network, Inc. Objecting To A Claim Of Infringement Of Copyright And The Disabling Or Removal Of Material From The Multiple Listing Service (Page 2 of 4) in pdf

result in disapproval of your loan application. This is notice to you as required by the Right to Financial Privacy Act of 1978 that VA or HUD/FHA has a right of access

to financial records held by financial institutions in connection with the consideration or administration of assistance to you. Financial records involving your

transaction will be available to VA and HUD/FHA without further notice or authorization but will not be disclosed or released by this institution to another

GovernmentAgency or Department without your consent except as required or permitted by law. Caution. Delinquencies, defaults, foreclosures and abuses of

mortgage loans involving programs of the Federal Government can be costly and detrimental to your credit, now and in the future. The lender in this transaction, its

agents and assigns as well as the Federal Government, its agencies, agents and assigns, are authorized to take any and all of the following actions in the event loan

payments become delinquent on the mortgage loan described in the attached application: (1) Report your name and account information to a credit bureau; (2) Assess

additional interest and penalty charges for the period of time that payment is not made; (3) Assess charges to cover additional administrative costs incurred by the

Government to service your account; (4) Offset amounts owed to you under other Federal programs; (5) Refer your account to a private attorney, collection agency or

mortgage servicing agency to collect the amount due, foreclose the mortgage, sell the property and seek judgment against you for any deficiency; (6) Refer your

account to the Department of Justice for litigation in the courts; (7) If you are a current or retired Federal employee, take action to offset your salary, or civil service

retirement benefits; (8) Refer your debt to the Internal Revenue Service for offset against any amount owed to you as an income tax refund; and (9) Report any

resulting written-off debt of yours to the Internal Revenue Service as your taxable income. All of these actions can and will be used to recover any debts owed when it

is determined to be in the interest of the lender and/or the Federal Government to do so.

Part IV - Borrower Consent for Social Security Administration to Verify Social Security Number

I authorize the Social Security Administration to verify my Social Security number to the Lender identified in this document and HUD/FHA, through a computer

match conducted by HUD/FHA.

I understand that my consent allows no additional information from my Social Security records to be provided to the Lender, and HUD/FHA and that verification of

my Social Security number does not constitute confirmation of my identity. I also understand that my Social Security number may not be used for any other

purpose than the one stated above, including resale or redisclosure to other parties. The only other redisclosure permitted by this authorization is for review

purposes to ensure that HUD/FHA complies with SSA's consent requirements.

I am the individual to whom the Social Security number was issued or that person's legal guardian. I declare and affirm under the penalty of perjury that the

information contained herein is true and correct. I know that if I make any representation that I know is false to obtain information from Social Security records, I

could be punished by a fine or imprisonment or both.

This consent is valid for 180 days from the date signed, unless indicated otherwise by the individual(s) named in this loan application.

Read consent carefully. Review accuracy of social security number(s) and birth dates provided on this application.

Signature(s) of Borrower(s)

Date Signed

Signature(s) of Co-Borrower(s)

Date Signed

x x

/ /

Part V - Borrower Certification

22. Complete the following for a HUD/FHA Mortgage.

Is it to be sold?

22b. Sales Price

22c. Original MortgageAmount

Yes

22a. Do you own or have you sold other real estate within the

past 60 months on which there was a HUD/FHA mortgage?

Yes

22d. Address

22e.

If the dwelling to be covered by this mortgage is to be rented, is it a part of, adjacent or

contiguous to any project subdivision or group of concentrated rental properties involving

eight or more dwelling units in which you have any financial interest?

Yes

If "Yes" give details.

22f. Do you own more than four dwellings?

Yes

If "Yes" submit form HUD-92561.

Complete for V.A.-Guaranteed Mortgage. Have you ever had a V.A. home Loan?

Yes

23.

24.

Applicable for Both V.A. & HUD. As a home loan borrower, you will be legally obligated to make the mortgage payments called for by your mortgage loan

contract. The fact that you dispose of your property after the loan has been made will not relieve you of liability for making these payments. Payment of the

loan in full is ordinarily the way liability on a mortgage note is ended. Some home buyers have the mistaken impression that if they sell their homes when they

move to another locality, or dispose of it for any other reasons, they are no longer liable for the mortgage payments and that liability for these payments is solely

that of the new owners. Even though the new owners may agree in writing to assume liability for your mortgage payments, this assumption agreement will not

relieve you from liability to the holder of the note which you signed when you obtained the loan to buy the property. Unless you are able to sell the property to a

buyer who is acceptable to V.A. or to HUD/FHA and who will assume the payment of your obligation to the lender, you will not be relieved from liability to repay

any claim which V.A. or HUD/FHA may be required to pay your lender on account of default in your loan payments. The amount of any such claim payment will

be a debt owed by you to the Federal Government. This debt will be the object of established collection procedures.

and the V.A. or HUD/FHA established value. I do not and will not have

25.

I, the Undersigned Borrower(s) Certify that:

outstanding after loan closing any unpaid contractual obligation on account of

(1)

I have read and understand the foregoing concerning my liability on the

such cash payment;

loan and Part III Notices to Borrowers.

(b) I was not aware of this valuation when I signed my contract but have elected

(2)

Occupancy: (for V.A. only - mark the applicable box)

to complete the transaction at the contract purchase price or cost. I have paid or

(a) I now actually occupy the above-described property as my home or

will pay in cash from my own resources at or prior to loan closing a sum equal to

intend to move into and occupy said property as my home within a

the difference between contract purchase price or cost and the V.A. or HUD/FHA

reasonable period of time or intend to reoccupy it after the completion of

established value. I do not and will not have outstanding after loan closing any

major alterations, repairs or improvements.

unpaid contractual obligation on account of such cash payment.

(b) My spouse is on active military duty and in his or her absence, I occupy

(4)

Neither I, nor anyone authorized to act for me, will refuse to sell or rent, after the

or intend to occupy the property securing this loan as my home.

making of a bona fide offer, or refuse to negotiate for the sale or rental of, or

otherwise make unavailable or deny the dwelling or property covered by his/her

interest rate reductions)

loan to any person because of race, color, religion, sex, handicap, familial status

(d) While my spouse was on active military duty and unable to occupy the

or national origin. I recognize that any restrictive covenant on this property

property securing this loan, I previously occupied the property that is

relating to race, color, religion, sex, handicap, familial status or national origin is

securing this loan as my home. (for interest rate reduction loans)

illegal and void and civil action for preventive relief may be brought by the

Note: If box 2b or 2d is checked, the veteran's spouse must also sign

Attorney General of the United States in any appropriate U.S. District Court

below.

against any person responsible for the violation of the applicable law.

(3)

Mark the applicable box (not applicable for Home Improvement or

(5) All information in this application is given for the purpose of obtaining a loan to be

Refinancing Loan) I have been informed that ($

) is:

insured under the National Housing Act or guaranteed by the Department of

Veterans Affairs and the information in the Uniform Residential Loan Application

the reasonable value of the property as determined by VA or;

and this Addendum is true and complete to the best of my knowledge and belief.

the statement of appraised value as determined by HUD/FHA.

Verification may be obtained from any source named herein.

Note: If the contract price or cost exceeds the VA "Reasonable Value" or

(6)

HUD/FHA "Statement of Appraised Value," mark either item (a) or item (b),

For HUD Only (for properties constructed prior

whichever is applicable.

to 1978) I have received information on lead

Yes

Not Applicable

paint poisoning.

(a) I was aware of this valuation when I signed my contract and I have

paid or will pay in cash from my own resources at or prior to loan closing a

I am aware that neither HUD/FHA nor V.A. warrants the condition or value of the

(7)

sum equal to the difference between the contractpurchase price or cost

property.

Signature(s) of Borrower(s) - Do not sign unless this application is fully completed. Read the certifications carefully & review accuracy of this application.

Signature(s) of Co-Borrower(s)

Date Signed

Signature(s) of Borrower(s)

Date Signed

(Borrowers Must Sign Both Parts IV and V)Federal statutes provide severe penalties for any fraud, intentional misrepresentation, or criminal connivance or

form HUD-92900-A (09/2010)

conspiracy purposed to influence the issuance of any guaranty or insurance by the V.A. Secretary or the HUD/FHA Commissioner.

page 2

VA form 26-1802a

GCC - 92900A2 (09/10)