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Get Statement Of Proposed Ownership

E check appropriate box) That I am an officer/partner/trustee of (Name of Applicant) Serving as . That in my capacity as such I have (title) in the name of the Firm applied for Change of Control of a Mortgage Banker/Mortgage Broker/Mortgage Loan Servicer That I am an individual applicant. That the ownership of the will be distributed (Name of licensee or registrant) as follows: Owner % Ownership and that no other person will further invest any funds in the mortgage banker/mortgage broker/m.

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