Disclosure of Fees Earned by Mortgage Broker
NRS 645B.305
M ortgage Broker Name
Applicant/Borrow er Name
Date
Loan Number
M ortgage Broker License No.
Name of Lender
(Indicate if Unknow n)
M ortgage Broker NM LS ID No.
Real Property Collateral Address:
All fees earned by the above listed Mortgage Broker for this loan are identified below. These fees do not include closing costs
and fees that are paid to other persons or companies.
Fee
Application Fee
Yes
No
Processing Fee
Yes
No
Underwriting Fee
Yes
No
Document Preparation Fee
Yes
No
Origination Fee
Yes
No
Yield Spread Premium (YSP)
Yes
No
Service Rights Transfer FeePaid for Sale of Broker' s Right
to Service the Loan
Yes
No
Servicing Fee
Yes
No
M ort gage Broker Fees Disclosure-NV
VM P
W olt ers Kluw er Financial Serv ices
Amount
Responsible Party
Potential Impact on Loan
$
Borrower
Lender
One Time Cost - No Impact On
Loan Terms
$
Borrower
Lender
One Time Cost - No Impact On
Loan Terms
$
Borrower
Lender
One Time Cost - No Impact On
Loan Terms
$
Borrower
Lender
$
Borrower
Lender
$
Borrower
Lender
One Time Cost - No Impact On
Loan Terms
One Time Cost Decreases Interest Rate of
Loan by
%
Increases Interest Rate of
Loan by
%
No Impact on Loan Terms
Reduces Closing Costs Decreases Interest Rate of
Loan by
%
Increases Interest Rate of
Loan by
%
No Impact on Loan Terms
$
Borrower
Lender
One Time Cost - No Impact On
Loan Terms
Borrower
Lender
Added to the Monthly Loan
Payment
$
Monthly
Quarterly
Yearly
Other
Rev . 8 /2 3 /1 0
V M P1 0 6 2 (NV ) (1 0 0 9 )
Page 1 of 2
Fee (Continued)
Other Fee
Yes
No
Amount Paid
Total Paid by Borrower
Total Paid by Lender
TOTAL OF FEES EARNED
BY BROKER
Amount
Responsible Party
$
Potential Impact on Loan
Borrower
Lender
$
$
$
Further Explanation of Above Fees (if any):
M ortgage Broker:
Date
Receipt Acknow ledged:
Applicant/Borrow er:
I/We Agree to the Above Fees.
Date
Date
Date
Date
Refer to the attached Signature Addendum for additional parties and signatures.
M ort gage Broker Fees Disclosure-NV
VM P
W olt ers Kluw er Financial Serv ices
Rev . 8 /2 3 /1 0
V M P1 0 6 2 (NV ) (1 0 0 9 )
Page 2 of 2