Form FR HMDA-LAR

> OMB Nos. 1557-0159 (OCC), 3064-0046 (FDIC),
>
> 1550-0021 (OTS), 7100-0247 (FRB),
>
> 2502-0539 (HUD); and 3133-0166 (NCUA).

LOAN/APPLICATION REGISTER

TRANSMITTAL SHEET

**You must complete this transmittal sheet (please type or print) and
attach it to the Loan/Application Register, required by the Home
Mortgage Disclosure Act, that you submit to your supervisory agency.**

Agency Total line entries contained in

Reporter's Identification Number Code Reporter's Tax Identification
Number attached Loan/Application Register

\|\_\|\_\|\_\|\_\|\_\|\_\|\_\|\_\|\_\|\_\| - \|\_\| \|\_\|\_\| -
\|\_\|\_\|\_\|\_\|\_\|\_\|\_\| \_\_\_\_\_\_\_\_

The Loan/Application Register that is attached covers activity during
the year \_\_\_\_\_\_ and contains a total of \_\_\_\_\_\_ pages.

Enter the name and address of your institution. The disclosure statement
that is produced by the Federal Financial Institutions Examination
Council will be mailed to the address you supply below:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name of Institution

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

City, State, ZIP

Enter the name and address of any parent company:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Name of Parent Company

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Address

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

City, State, ZIP

Enter the name, telephone number, facsimile number, and e-mail address
of a person who may be contacted about questions regarding your
register:

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(\_\_\_)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
(\_\_\_)\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ \_\_\_\_\_\_\_\_\_\_\_\_\_

Name Telephone Number Facsimile Number E-Mail Address

An officer of your institution must complete the following section.

**I certify to the accuracy of the data contained in this register.**

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_

Name of Officer Signature Date

**LOAN/APPLICATION REGISTER** Page \_\_\_\_of\_\_\_\_ Form FR HMDA-LAR

Agency

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ Reporter\'s
Identification Number Code

Name of Reporting Institution City, State, Zip
\|\_\_\|\_\_\|\_\_\|\_\_\|\_\_\|\_\_\|\_\_\|\_\_\|\_\_\|\_\_\| \--
\|\_\_\|

All columns (except Reasons for Denial) must be completed for each
entry. See the instructions for details.

<table>
<colgroup>
<col style="width: 15%" />
<col style="width: 4%" />
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</colgroup>
<tbody>
<tr class="odd">
<td colspan="8">Application or Loan Information</td>
<td colspan="2">Action Taken</td>
<td colspan="4">Property Location</td>
<td colspan="7">Applicant Information<br />
A = Applicant CA = Co-Applicant</td>
<td rowspan="3">Type of<br />
Pur-<br />
chaser<br />
of Loan</td>
<td rowspan="3">Reasons<br />
for<br />
Denial<br />
(optional)</td>
<td colspan="3">Other Data</td>
</tr>
<tr class="even">
<td rowspan="2"><p>Application or</p>
<p>Loan Number</p></td>
<td rowspan="2">Date<br />
Application<br />
Received<br />
mm/dd/ccyy</td>
<td rowspan="2">Loan<br />
Type</td>
<td rowspan="2">Prop-<br />
erty<br />
Type</td>
<td rowspan="2">Pur-<br />
pose</td>
<td rowspan="2">Owner<br />
Occu-<br />
pancy</td>
<td rowspan="2">Loan<br />
Amount<br />
In<br />
Thou-<br />
sands</td>
<td rowspan="2">Pre-<br />
ap-<br />
proval</td>
<td rowspan="2">Type</td>
<td rowspan="2">Date<br />
(mm/dd/ccyy)</td>
<td rowspan="2"><p>Five-<br />
Digit</p>
<p>MSA/MD</p>
<p>Number</p></td>
<td rowspan="2">Two-<br />
Digit<br />
State<br />
Code</td>
<td rowspan="2">Three-<br />
Digit<br />
County<br />
Code</td>
<td rowspan="2">Six-Digit<br />
Census<br />
Tract</td>
<td colspan="2">Ethnicity</td>
<td colspan="2">Race</td>
<td colspan="2">Sex</td>
<td rowspan="2">Gross<br />
Annual<br />
Income<br />
in<br />
thou-<br />
sands</td>
<td rowspan="2"><p>Rate</p>
<p>Spread</p></td>
<td rowspan="2">HOEPA Status</td>
<td rowspan="2">Lien<br />
Status</td>
</tr>
<tr class="odd">
<td>A</td>
<td>CA</td>
<td>A</td>
<td>CA</td>
<td>A</td>
<td>CA</td>
</tr>
<tr class="even">
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</table>