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Jacob W Fleming NMLS# 583879 (217) 594-2221

Security National Bank NMLS# 662969 1 W Broadway, Witt, IL 62094

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To help speed up your approval process, please include the following items along with your COMPLETED real estate loan application.

1. Application must be filled out in completion including social security numbersand age or birth date for all applicants along with complete names,addresses, account numbers & phone numbers.

2. Copy of Photo ID (Driver’s license, Sate ID Card or passport)

3. Homeowners/Hazard Insurance Company & Agent Information

4. Copy of most recent month pay stubs showing year-to-date pay

5. Copy of last year’s W-2’s

6. Copy of last two month’s Bank statements

7. Copy of complete set of individual tax returns that are signed

8. Copy of complete set of business tax returns that are signed

9. Profit & loss statement

10. Signed sales contract of new home

11. Signed sales contract of present home

12. Copy of divorce settlement agreement

13. Copy of title evidence (title policy)

14. Landlord name, address and phone number

15. Letter of explanation of employment gap within last two years

Page 1 Early ARM Disclosure Statement

Early ARM DISCLOSURE STATEMENT NMLS ID #662969

Lender: Security National Bank

P.O. Box 427

Witt, IL 62094

Adjustable Rate Mortgage ("ARM")

0/1 Year Adjustable up to 30 years

0/3 Year Adjustable up to 30 years

0/5 Year Adjustable up to 30 years

10/1 Year Adjustable up to 30 years

If you wish to apply for an Adjustable Rate Mortgage (referred to in this Disclosure as an "ARM") with Security

National Bank ("Bank"), you should read the information below concerning the Bank’s ARM mortgage loan

programs. This disclosure describes the features of the specific ARM loan programs that you are considering that

are offered by the Bank. These loans offered by the Bank are all Adjustable Rate Mortgages. The applicable

interest rate and monthly payments will change from time-to-time based upon movements of an interest rate

index. Your monthly payments most likely will increase at some point during the lifetime of your loan. Your

payment will be based on the interest rate, loan balance, and loan term. Because future movements of the index

are related to market conditions that cannot be predicted, it is impossible to know in advance how much you will

have to pay, either each month or over the life of the loan. Interest rate changes and payment changes will be

made according to certain rules that are explained below. THIS IS JUST A GENERAL OUTLINE OF THE BANK’S ARM

PROGRAMS. A DETAILED DESCRIPTION OF THE SPECIFIC ARM PROGRAM YOU CHOOSE WILL BE GIVEN TO YOU IN

THE FORM OF A LOAN ESTIMATE WITHIN THREE BUSINESS DAYS OF YOUR FULLY COMPLETED LOAN APPLICATION.

TERMS OF THE BANK'S ADJUSTABLE RATE MORTGAGE

The ARM offered by the Bank is based on the terms and conditions set forth in the loan estimate, closing statement, and in the promissory note. The interest rate, index and margin values, and any applicable fees listed herein are based upon examples of recent rates and terms used by the Bank.

INTEREST RATE INDEX

The initial interest rate can be fixed for 1 year, 3 years, 5 years, or 10 years based upon your qualification and the program you choose. After the initial fixed rate period, the interest rate will be based on the Wall Street Journal U.S. Prime Rate ("index") plus a margin. The index is: The base rate on corporate loans posted by at least 70% of the 10 Largest U.S. banks. The most recent Index figure

available as of the date 45 days before each Change Date is called the "Current Index. Information about this index is published in the Federal Reserve Statistical Release, Form H.15 (519). Information about this index is announced weekly by the Federal Reserve Board. If the index ceases to be made available, we will choose a new index which is based upon comparable information.

FREQUENCY OF ADJUSTMENTS

The Bank offers ARM loans that adjust every 1, 3, and 5 years. The applicable interest rate and payment amount under the Bank’s ARM loan could be adjusted annually, every 3 years, or every 5 years based on movements of the index. Additionally, the Bank offers a 10 year fixed loan that adjusts annually based on the index starting on the 11th year. The adjustment period as set by the Bank will be disclosed to you on your Loan Estimate Statement (“Preliminary Documents”) which will be given to you within three business days of your initial fully completed application. These Preliminary Documents will help you better understand what your final binding loan documents will look like. The Preliminary Documents may be re-disclosed to you as many times as necessary due to changed circumstances that may occur.

DEMAND FEATURE. All of Security National Bank’s ARM loan programs contain a demand feature

INTEREST RATE AND PAYMENT ADJUSTMENTS

The initial interest rate and type of ARM will be specified by the Bank on your Preliminary Documents and finalized with your final loan papers signed at closing. The initial interest rate will be based on the index plus or minus a margin per the current Bank qualification standards.

Page 2 Early ARM Disclosure Statement

LIMITATIONS ON INTEREST RATE AND PAYMENT CHANGES

Your interest rate will not increase or decrease on the first change date by more than three (3) percentage points from the initial interest rate. After the first adjustment, your interest rate will not increase or decrease by more than three (3) percentage points per adjustment period. Your interest rate cannot increase more than six (6) percentage points above the initial interest rate over the life of the loan. Your loan will have a floor of the initial proposed rate; which means your loan rate will not decrease to a lower rate than what was initially proposed.

HOW YOUR PAYMENT CAN CHANGE

Your monthly payment will potentially change yearly, every 3 years, every 5 years, or be fixed for 10 years followed by annual adjustments. For example, on a $50,000.00 loan amortized over 30 years with an initial introductory Rate of 6.00% the following could happen: 0/1 Year Adjustable- the maximum amount that the interest rate can rise under this program is six (6) percentage points to 12.00%. The most your rate could change per every 1 year adjustment period is three (3) percentage points. The monthly payment can rise from a first year payment of $300 to a maximum of $508 as early as the third year. 0/3 Year Adjustable-the maximum amount the interest rate can rise under this program is six (6) percentage points to 12.00%. The most your rate could change per every 3 year adjustment period is three (3) percentage points. The monthly payment can rise from a first year payment of $300 to a maximum of $494 as early as the 7th year. 0/5 Year Adjustable-the maximum amount the interest rate can rise under this program is six (6) percentage points to 12.00%. The most your rate could change per every 5 year adjustment period is three (3) percentage points. The monthly payment can rise from a first year payment of $300 to a maximum of $478 as early as the eleventh year. 10/1 Year Adjustable- the maximum amount the interest rate can rise under this program is six (6) percentage points to 12.00%. Your rate is fixed for the initial 10 years of the loan. At the beginning of the 11th year the interest rate will adjust annually in the same way at 1/1 adjustable listed above. The cap on each adjustment period is three (3) percentage points. The monthly payment can rise from a first year payment of $300 to a maximum of $458 as early as the thirteenth year.

ADJUSTMENT NOTICES

The Bank will notify you in writing at least 210, but no more than 240, days before the first payment at the adjusted level is due after the initial interest rate adjustment of the loan. This notice will contain information about the adjustment, including rate, payment amount, and loan balance. You will also be notified at least 60 but no more than 120 days before the first payment at the adjusted level is due after any interest rate adjustments resulting in corresponding payment change. This notice will contain information about the adjustment, including the interest rate, payment amount, and loan balance.

CHANGE DATES

Each new interest rate will become effective on the next change date. Your monthly payment will change as a result of each change in the interest rate, and the monthly payment change will be effective the first monthly payment due date after the interest rate change.

FINANCIAL DIFFICULTY

If you anticipate having trouble making payments please contact the Bank as soon as possible. If you seek an alternative to the upcoming changes to your interest rate and payment the following options may be possible with lender approval: -Refinance your loan with the Bank or another lender; -Sell your home and use the proceeds to pay off your current loan; -Modify your loan terms with the Bank; -Payment forbearance temporarily gives you more time to pay your monthly payment. If you would like the contact information for housing counseling agencies or programs in your area please contact the Consumer Financial Protection Bureau at (855)411-2372 or www.consumerfinance.gov/find-a-housing-counselor/

Applicant Acknowledgement

The applicant, having read the contents of the above disclosure, acknowledges receipt of this disclosure and further

acknowledges that this disclosure was completed in full prior to its receipt. The applicant also acknowledges receipt of the

handbook entitled “Consumer Handbook on Adjustable Rate Mortgages.”

____________________________________________________ ___________________

Applicant Date

__________________________________________________________ _____________________

Applicant Date

APPRAISAL NOTICE

References in the boxes above are for Lender's use only and do not limit the applicability of this document to any particular loan or item.

Applicant: Lender: SECURITY NATIONAL BANK WITT PO BOX 427 1 W Broadway Witt, IL 62094 (217) 594-2221

Document Date:

We may order an appraisal to determine the property's value and charge you for this appraisal. We will promptly give you a copy of any appraisal, even if your loan does not close.

You can pay for an additional appraisal for your own use at your own cost.

By signing below, you acknowledge receipt of this Appraisal Notice.

APPLICANT:

LaserPro, Ver. 15.4.11.007 Copr. D+H USA Corporation 1997, 2015. All Rights Reserved. · L:IJ..aserpro\CFI\LPL\B14APPR.FC

Authorization To Release Information

TO MY/OUR EMPLOYER, BANKS, LANDLORDS, CREDITORS, ETC:

This is your authorization to furnish any and all employment and earnings records, information regarding any bank and deposit accounts, information regarding my residence, and any information regarding my/our credit accounts to:

Security National Bank 1 W Broadway Witt, IL 62094

Telephone # (217) 594-2221 Fax # (217) 594-2255

A copy of this signed authorization shall be accepted as an original.

All materials and facts collected from said investigation for the purpose of this transaction will become the property of Security National Bank.

This shall also apply to reverification as part of any Quality Control Program Review of a closed loan.

Your prompt reply will be sincerely appreciated.

I/We hereby authorize release of all information requested by the above.

Date

Print Name

Applicant Signature Applicant Signature

Print Name

Form 4506-T(Rev. September 2015)Department of the Treasury Internal Revenue Service

Request for Transcript of Tax Return▶ Do not sign this form unless all applicable lines have been completed.

▶ Request may be rejected if the form is incomplete or illegible.▶ For more information about Form 4506-T, visit www.irs.gov/form4506t.

OMB No. 1545-1872

Tip. Use Form 4506-T to order a transcript or other return information free of charge. See the product list below. You can quickly request transcripts by using our automated self-help service tools. Please visit us at IRS.gov and click on “Get a Tax Transcript...” under “Tools” or call 1-800-908-9946. If you need a copy of your return, use Form 4506, Request for Copy of Tax Return. There is a fee to get a copy of your return.

1a Name shown on tax return. If a joint return, enter the name shown first.

1b First social security number on tax return, individual taxpayer identification number, or employer identification number (see instructions)

2a If a joint return, enter spouse’s name shown on tax return. 2b Second social security number or individual taxpayer identification number if joint tax return

3 Current name, address (including apt., room, or suite no.), city, state, and ZIP code (see instructions)

4 Previous address shown on the last return filed if different from line 3 (see instructions)

5 If the transcript or tax information is to be mailed to a third party (such as a mortgage company), enter the third party’s name, address, and telephone number.

Caution: If the tax transcript is being mailed to a third party, ensure that you have filled in lines 6 through 9 before signing. Sign and date the form once you have filled in these lines. Completing these steps helps to protect your privacy. Once the IRS discloses your tax transcript to the third party listed on line 5, the IRS has no control over what the third party does with the information. If you would like to limit the third party’s authority to disclose your transcript information, you can specify this limitation in your written agreement with the third party.

6 Transcript requested. Enter the tax form number here (1040, 1065, 1120, etc.) and check the appropriate box below. Enter only one tax form number per request. ▶

a Return Transcript, which includes most of the line items of a tax return as filed with the IRS. A tax return transcript does not reflect changes made to the account after the return is processed. Transcripts are only available for the following returns: Form 1040 series, Form 1065, Form 1120, Form 1120-A, Form 1120-H, Form 1120-L, and Form 1120S. Return transcripts are available for the current year and returns processed during the prior 3 processing years. Most requests will be processed within 10 business days . . . . . .

b Account Transcript, which contains information on the financial status of the account, such as payments made on the account, penalty assessments, and adjustments made by you or the IRS after the return was filed. Return information is limited to items such as tax liability and estimated tax payments. Account transcripts are available for most returns. Most requests will be processed within 10 business days .

c Record of Account, which provides the most detailed information as it is a combination of the Return Transcript and the Account Transcript. Available for current year and 3 prior tax years. Most requests will be processed within 10 business days . . . . . .

7 Verification of Nonfiling, which is proof from the IRS that you did not file a return for the year. Current year requests are only available after June 15th. There are no availability restrictions on prior year requests. Most requests will be processed within 10 business days . .

8 Form W-2, Form 1099 series, Form 1098 series, or Form 5498 series transcript. The IRS can provide a transcript that includes data from these information returns. State or local information is not included with the Form W-2 information. The IRS may be able to provide this transcript information for up to 10 years. Information for the current year is generally not available until the year after it is filed with the IRS. For example, W-2 information for 2011, filed in 2012, will likely not be available from the IRS until 2013. If you need W-2 information for retirement purposes, you should contact the Social Security Administration at 1-800-772-1213. Most requests will be processed within 10 business days .

Caution: If you need a copy of Form W-2 or Form 1099, you should first contact the payer. To get a copy of the Form W-2 or Form 1099 filed with your return, you must use Form 4506 and request a copy of your return, which includes all attachments.

9 Year or period requested. Enter the ending date of the year or period, using the mm/dd/yyyy format. If you are requesting more than four years or periods, you must attach another Form 4506-T. For requests relating to quarterly tax returns, such as Form 941, you must enter each quarter or tax period separately.

Caution: Do not sign this form unless all applicable lines have been completed.

Signature of taxpayer(s). I declare that I am either the taxpayer whose name is shown on line 1a or 2a, or a person authorized to obtain the tax information requested. If the request applies to a joint return, at least one spouse must sign. If signed by a corporate officer, 1 percent or more shareholder, partner, managing member, guardian, tax matters partner, executor, receiver, administrator, trustee, or party other than the taxpayer, I certify that I have the authority to execute Form 4506-T on behalf of the taxpayer. Note: For transcripts being sent to a third party, this form must be received within 120 days of the signature date.

Signatory attests that he/she has read the attestation clause and upon so reading declares that he/she has the authority to sign the Form 4506-T. See instructions.

Phone number of taxpayer on line 1a or 2a

Sign Here

▲

Signature (see instructions) Date

▲

Title (if line 1a above is a corporation, partnership, estate, or trust)

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Spouse’s signature Date

For Privacy Act and Paperwork Reduction Act Notice, see page 2. Cat. No. 37667N Form 4506-T (Rev. 9-2015)

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Please take the attached Service Provider List Home for your reference

SETTLEMENT SERVICE PROVIDER LIST DISCLOSURE

If your loan request is approved, there will be various settlement services required in connection with

your loan for which you are free to shop around for your own provider. These services will be noted on

your Loan Estimate which will be given to you within three business days of your completed loan

application.

To assist you, we have provided the names of possible providers for the required settlement services.

However, you are not obligated to use any provider that we list. Instead, you are free to shop around

and arrange for your own provider for the required settlement service.

TITLE INSURANCE:

Montgomery County Christian County

Spears Title Co Advanced Title Group, Inc

218 S Main St, Hillsboro, IL 62049 101 S Washington St, Taylorville, IL 62568

217-532-3113 217-824-8007

Fayette County Bond County

Burtschi Brothers & Co Illinois Real Estate Services, Inc

415 W Gallatin St, Vandalia, IL 62471 1355 Illinois 127, Greenville, IL 62246

618-283-2102 618-664-9400

Macoupin County Construction Loans

Community Title & Escrow Illinois Real Estate Services, Inc

518 W. Union Ave, Litchfield, IL 62056 107 S Main Street, Hillsboro, IL 62049

217-324-2599 217-532-9400

Attorney Deed Preparation Services

Barbara Adams, P.C. – 109 S Main St, Hillsboro, IL 62049 217-532-5432

OTHER SERVICES THAT MAY BE REQUIRED YOU CAN SHOP FOR:

Pest Inspection Home Inspection

Rare Pest Control All Pro Home Inspections

471 N 1250 East Rd, Morrisonville, IL 62546 17948 Windy Hill Rd, Staunton, IL 62088

217-287-7368 618-339-4152

Survey Septic Tank/Well Inspection

McDonough-Whitelow, P.C. Hilton Plumbing

9025 IL Route 127 103 W 2nd

Street

Taylor Springs, IL 62089 Pana, IL 62557

217-532-9233 217-562-2012

Applicant Acknowledgement:

Name:_______________________________________ Date:______________

Name:_______________________________________ Date:______________

Page 1 of Electronic Signature Authorization and Disclosure

Security National Bank

Electronic Signature Authorization and Disclosure

Mortgage E-Sign Disclosure This Security National Bank E-Sign Disclosure (“Disclosure”) applies to the mortgage loan that you have requested. The words “we,” “us,” and “our” means Security National Bank and the words “you” and “your” means you, the individual(s) who have applied for the loan.

As used in this Disclosure, “Communication” means any authorization, agreement, disclosure, notice, or other information related to your Account, including but not limited to information that we are required by law to provide to you in writing. It should be noted that electronic communication in not required by Security National Bank. You may choose to receive all loan communication by paper if you so choose.

The Scope of Communications to Be Provided in Electronic Form When you select “I agree to the terms” with respect to the loan, you agree that we may provide you with any Communications relating to that Account in electronic format, and that we may discontinue sending paper communications to you, unless and until you withdraw your consent as described below. Your consent to receive electronic Communications and transactions includes, but is not limited to:

• Initial disclosures or agreements for your loan• Notices or disclosures about a change in the terms of your loan• Appraisals

Method of Providing Communications to You in Electronic Form All Communications that we provide to you in electronic form will be provided via e-mail at the e-mail address you specify on this disclosure.

How to Withdraw Consent You may withdraw your consent to receive Communications in electronic form by contacting us at 217-594-2221. We may treat your provision of an invalid e-mail address or the subsequent malfunction of apreviously valid address as a withdrawal of your consent to receive electronic communications. We willnot impose any fee to process the withdrawal of your consent to receive electronic Communications.Any withdrawal of your consent to receive electronic Communications will be effective only after wehave a reasonable period of time to process your withdrawal.

How to Update Your Records It is your responsibility to provide us with true, accurate and complete e-mail address, contact, and other information related to this Disclosure Account(s), and to maintain and update promptly any changes in this information. You can update such information (such as your e-mail address) by contacting the loan officer.

Hardware and Software Requirements In order to access, view, and retain electronic Communications that we make available to you, you must have:

Page 2 of Electronic Signature Authorization and Disclosure

• E-mail Address• Internet browser• An e-mail account with Internet service provider and e-mail software in order to participate in our

electronic Communications programs• A personal computer, operating system and telecommunications connections to the Internet

capable of receiving, accessing, displaying, and either printing or storing, communicationsreceived in electronic form from us via a plain text-formatted e-mail.

Requesting Paper Copies We will not send you a paper copy of any Communication from us, unless you request it or we otherwise deem it appropriate to do so. You can obtain a paper copy of an electronic Communication by printing it yourself or by requesting that we mail you a paper copy, provided that such request is made no later than seven years after we first provided the electronic communication to you. To request a paper copy, contact us by telephone at 217-594-2221. We may charge you a reasonable service charge for the delivery of paper copies of any Communication provided to you electronically pursuant to your authorization. We reserve the right, but assume no obligation, to provide a paper (instead of electronic) copy of any Communication that you have authorized us to provide electronically.

Communications in Writing All Communications in either electronic or paper format from us to you will be considered “in writing.” You should print or download for your records a copy of your Early Disclosures, this Disclosure, your initial authorization to receive e-mail disclosures, any changes to that authorization, and any other Communication that is important to you.

Federal Law You acknowledge and agree that your consent to electronic Communications is being provided in connection with a transaction affecting interstate commerce that is subject to the federal Electronic Signatures in Global and National Commerce Act, and that you and we both intend that the Act apply to the fullest extent possible to validate our ability to conduct business with you by electronic means.

Termination/Changes We reserve the right, in our sole discretion, to discontinue the provision of your electronic Communications, or to terminate or change the terms and conditions on which we provide electronic communications. We will provide you with notice of any such termination or change as required by law.

By signing below the applicant acknowledges their intent to voluntarily receive loan correspondence electronically:

Borrower Signature:___________________________________________ Date:_____________

Email: _____________________________________________________

Co-borrower Signature: _________________________________________ Date:______________

Email:_____________________________________________________