The printed portions of this form, except differentiated additions, have been approved by the Colorado Real Estate Commission. (DSD 17-1-09) (Mandatory 8-09)
THIS DISCLOSURE IS MADE PURSUANT TO THE REQUIREMENTS OF THE COLORADO REAL ESTATE COMMISSION AND THE DIRECTOR OF THE COLORADO DIVISION OF REAL ESTATE.
DUAL STATUS DISCLOSURE (REAL ESTATE BROKER AND MORTGAGE LOAN ORIGINATOR) ___________________________, is a licensed real estate broker and a licensed mortgage loan originator in the State of Colorado. THE BUYER/BORROWER IS NOT REQUIRED TO USE THE MORTGAGE LOAN ORIGINATOR’S SERVICES TO OBTAIN A MORTGAGE LOAN. THERE MAY BE OTHER MORTGAGE LOAN ORIGINATORS THAT PROVIDE SIMILAR SERVICES. The Broker/Mortgage Loan Originator is acting in a dual capacity as a real estate broker and a ✔ mortgage loan originator in the transaction. The Broker/Mortgage Loan Originator Is Is Not accepting a placement fee, commission or other valuable consideration for directly or indirectly placing a loan with a mortgage lender or its representative. The Buyer/Borrower ____________________________________________________ Does Does Not consent to the Broker/Mortgage Loan Originator acting in a dual capacity as a licensed real estate broker and a licensed mortgage loan originator in the transaction. The Buyer/Borrower Does Does Not consent to the Broker/Mortgage Loan Originator receiving a placement fee, commission or other valuable consideration for placing a loan with a mortgage lender or its representative in the real estate transaction.
THIS IS NOT A CONTRACT AND IS NOT COMPREHENSIVE OF ALL DISCLOSURES REQUIRED BY §§ 12-61-101, C.R.S., et. seq., 12-61-801, C.R.S., et. seq., and 12-61-901, C.R.S., et. seq. BUYER/BORROWER ACKNOWLEDGMENT: The Buyer acknowledges receipt of this document on _______________. _________________________________ Buyer/Borrower
BROKER/MORTGAGE LOAN ORIGINATOR ACKNOWLEDGMENT: On ____________________________, the Broker/Mortgage Loan Originator provided ______________________________ (Buyer/Borrower) with a copy of this document via__________________________ and retained a copy for the Broker’s/Mortgage Loan Originator’s records. Broker/Mortgage Loan Originator also acknowledges that Broker/Mortgage Loan Originator has made a full and fair disclosure to the Buyer/Borrower of all material features of the loan product and all facts material to the transaction. ________________________________________
Broker/Mortgage Loan Originator DSD 17-1-09 DUAL STATUS DISCLOSURE
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