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

Agency

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Reporter\'s Identification Number Code

Name of Reporting Institution City, State, Zip
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<tbody>
<tr class="odd">
<td colspan="6"><p>Application or</p>
<p>Loan Information</p></td>
<td colspan="2">Action Taken</td>
<td colspan="4">Property Location</td>
<td colspan="5"><p>Applicant Information</p>
<p>A = Applicant CA = Co-Applicant</p></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><p>Application or</p>
<p>Loan Number</p></td>
<td><p>Date</p>
<p>Application</p>
<p>Received</p>
<p>(mm/dd/ccyyy)</p></td>
<td>Type</td>
<td><p>Pur-</p>
<p>pose</p></td>
<td><p>Owner</p>
<p>Occu-</p>
<p>pancy</p></td>
<td><p>Loan</p>
<p>amount</p>
<p>in</p>
<p>thou-</p>
<p>sands</p></td>
<td>Type</td>
<td><p>Date</p>
<p>(mm/dd/ccyy)</p></td>
<td><p>Four-</p>
<p>Digit</p>
<p>MA Number</p></td>
<td><p>Two-</p>
<p>Digit</p>
<p>State</p>
<p>Code</p></td>
<td><p>Three-</p>
<p>Digit</p>
<p>County</p>
<p>Code</p></td>
<td><p>Six-Digit</p>
<p>Census</p>
<p>Tract</p></td>
<td colspan="2"><p>Race or</p>
<p>National Origin</p></td>
<td colspan="2">Sex</td>
<td><p>Gross</p>
<p>Annual Income in</p>
<p>thou-</p>
<p>sands</p></td>
<td><p>Type of</p>
<p>Pur-</p>
<p>chaser</p>
<p>of Loan</p></td>
<td>Reasons for Denial (Optional)</td>
</tr>
<tr class="odd">
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td></td>
<td>A</td>
<td>CA</td>
<td>A</td>
<td>CA</td>
<td></td>
<td></td>
<td></td>
</tr>
<tr class="even">
<td><p>Example of Loan Originated</p>
<p>L B - 6 8 7 4 3 9</p></td>
<td>01/15/2003</td>
<td>2</td>
<td>1</td>
<td>1</td>
<td>00065</td>
<td>1</td>
<td>02/22/2003</td>
<td>8840</td>
<td>51</td>
<td>059</td>
<td>4 2 1 9 . 8 5</td>
<td>3</td>
<td>8</td>
<td>1</td>
<td>4</td>
<td>0024</td>
<td>7</td>
<td></td>
</tr>
<tr class="odd">
<td><p>Example of Application Denied</p>
<p>0 1 2 3 4 5 6 7 8 9 - 9 8 7 6 5 4 3 2 1 0</p></td>
<td>03/20/2003</td>
<td>1</td>
<td>1</td>
<td>1</td>
<td>00125</td>
<td>3</td>
<td>04/30/2003</td>
<td>0450</td>
<td>01</td>
<td>015</td>
<td>0 0 2 1 . 0 0</td>
<td>5</td>
<td>4</td>
<td>2</td>
<td>1</td>
<td>0055</td>
<td>0</td>
<td>4 1 5</td>
</tr>
<tr class="even">
<td><strong>(A)</strong></td>
<td><strong>(B)</strong></td>
<td><strong>(C)</strong></td>
<td><strong>(D)</strong></td>
<td><strong>(E)</strong></td>
<td><strong>(F)</strong></td>
<td><strong>(G)</strong></td>
<td><strong>(H)</strong></td>
<td><strong>(I)</strong></td>
<td><strong>(J)</strong></td>
<td><strong>(K)</strong></td>
<td><strong>(L)</strong></td>
<td><strong>(M)</strong></td>
<td><strong>(N)</strong></td>
<td><strong>(O)</strong></td>
<td><strong>(P)</strong></td>
<td><strong>(Q)</strong></td>
<td><strong>(R)</strong></td>
<td><strong>(S)</strong></td>
</tr>
</tbody>
</table>

All columns (except Reasons for Denial) must be completed for each
entry. See the HMDA-LAR instructions for explanations regarding the
proper use of each code listed below.

+----------------------+----------------------+------------------------+
| **Application or     | Action Taken:        | **Type of Purchaser**  |
| Loan Information**   | **(G)**              | **(R)**                |
|                      |                      |                        |
| Type: **(C)**        | 1 \-- Loan           | 0 \-- Loan was not     |
|                      | originated           | originated or was not  |
| 1 \-- Conventional   |                      | sold in calendar year  |
| (any loan other than | 2 \-- Application    | covered by register    |
| FHA, VA, or FmHA     | approved but not     |                        |
| loans                | accepted             | 1 \-- FNMA (Federal    |
|                      |                      | National Mortgage      |
| 2 \-- FHA-insured    | 3 \-- Application    | Association)           |
| (Federal Housing     | denied by financial  |                        |
| Administration)      | institution          | 2 \-- GNMA (Government |
|                      |                      | National Mortgage      |
| 3 \-- VA-guaranteed  | 4 \-- Application    | Association)           |
| (Veterans            | withdrawn by         |                        |
| Administration)      | applicant            | 3 \-- FHLMC (Federal   |
|                      |                      | Home Loan Mortgage     |
| 4 -- FSA/RHS --      | 5 \-- File closed    | Corporation)           |
| (guaranteed Farm     | for incompleteness   |                        |
| Service Agency or    |                      | 4 -- FAMC (Federal     |
| Rural Housing        | 6 \-- Loan purchased | Agricultural Mortgage  |
| Service)             | by your institution  | Corporation)           |
|                      |                      |                        |
|                      |                      | 5 \-- Commercial bank  |
|                      |                      |                        |
|                      |                      | 6 \-- Savings bank or  |
|                      |                      | savings association    |
|                      |                      |                        |
|                      |                      | 7 \-- Life insurance   |
|                      |                      | company                |
|                      |                      |                        |
|                      |                      | 8 \-- Affiliate        |
|                      |                      | institution            |
|                      |                      |                        |
|                      |                      | 9 \-- Other type of    |
|                      |                      | purchaser              |
|                      |                      |                        |
|                      |                      | **Reasons for Denial   |
|                      |                      | (optional)** **(S)**   |
|                      |                      |                        |
|                      |                      | 1 \-- Debt-to-income   |
|                      |                      | ratio                  |
|                      |                      |                        |
|                      |                      | 2 \-- Employment       |
|                      |                      | history                |
|                      |                      |                        |
|                      |                      | 3 \-- Credit history   |
|                      |                      |                        |
|                      |                      | 4 \-- Collateral       |
|                      |                      |                        |
|                      |                      | 5 \-- Insufficient     |
|                      |                      | cash (downpayment,     |
|                      |                      | closing costs)         |
|                      |                      |                        |
|                      |                      | 6 \-- Unverifiable     |
|                      |                      | information            |
|                      |                      |                        |
|                      |                      | 7 \-- Credit           |
|                      |                      | application incomplete |
|                      |                      |                        |
|                      |                      | 8 \-- Mortgage         |
|                      |                      | insurance denied       |
|                      |                      |                        |
|                      |                      | 9 \-- Other            |
+----------------------+----------------------+------------------------+
| Purpose: **(D)**     | **Applicant          |                        |
|                      | Information**        |                        |
| 1 \-- Home purchase  |                      |                        |
| (one-to-four family) | Race or National     |                        |
|                      | Origin: **(M) (N)**  |                        |
| 2 \-- Home           |                      |                        |
| improvement          | 1 \-- American       |                        |
| (one-to-four family) | Indian or Alaskan    |                        |
|                      | Native               |                        |
| 3 \-- Refinancing    |                      |                        |
| (home purchase or    | 2 \-- Asian or       |                        |
| home improvement,    | Pacific Islander     |                        |
|                      |                      |                        |
| one-to-four family)  | 3 \-- Black          |                        |
|                      |                      |                        |
| 4 \-- Multifamily    | 4 \-- Hispanic       |                        |
| dwelling (home       |                      |                        |
| purchase, home       | 5 \-- White          |                        |
| improvement, and     |                      |                        |
| refinancings)        | 6 \-- Other          |                        |
|                      |                      |                        |
|                      | 7 \-- Information    |                        |
|                      | not provided by      |                        |
|                      | applicant in mail or |                        |
|                      | telephone            |                        |
|                      |                      |                        |
|                      | application          |                        |
|                      |                      |                        |
|                      | 8 \-- Not applicable |                        |
+----------------------+----------------------+------------------------+
| Owner-Occupancy:     | Sex: **(O) (P)**     |                        |
| **(E)**              |                      |                        |
|                      | 1 \-- Male           |                        |
| 1 \-- Owner-occupied |                      |                        |
| as a principal       | 2 \-- Female         |                        |
| dwelling             |                      |                        |
|                      | 3 \-- Information    |                        |
| 2 \-- Not owner      | not provided by      |                        |
| occupied             | applicant in mail or |                        |
|                      | telephone            |                        |
| 3 \-- Not applicable |                      |                        |
|                      | application          |                        |
|                      |                      |                        |
|                      | 4 \-- Not applicable |                        |
+----------------------+----------------------+------------------------+