Licensee Information or Affidavit Filed in Accordance with Real Property Article, § 3-104.1, Annotated Code of Maryland
Licensee Information
Maryland Mortgage Lender Name:____________________________________________
Maryland Mortgage Lender License Number:__________________________________
Maryland Mortgage Loan Originator Name:____________________________________
Maryland Mortgage Loan Originator License Number:__________________________
Affidavit in Lieu of Maryland Mortgage Lender or Maryland Mortgage Loan Originator Licensee Information
(Check the box and complete the information for the applicable selection(s) below. As used herein, the term "Loan" means the mortgage loan secured by the security instrument attached hereto [for subsequent filings insert: "or, if no instrument is attached, by the security instrument recorded at liber/book ______, folio/page ______"].)
Affidavit of Individual Mortgage Loan Originator:
[ ] I, ________________________________ [Insert name of affiant], whose address is _______________________________ [Insert address of affiant], hereby affirm, under the penalties of perjury, that I am the individual who originated the Loan and, in connection therewith, I am exempt from the licensing requirements under Financial Institutions Article, §§ 11-601 through 11-618, Annotated Code of Maryland.
Affidavit of Lender:
[ ] I, ________________________________ [Insert name of affiant], hereby affirm, under the penalties of perjury, that I am the [Insert Title] of _______________________________ [Insert the name of the lender (the "Lender") that made the Loan]. The Lender's address is _______________________________ [Insert address of Lender]. I am duly authorized by the Lender to execute this affidavit. The Lender, in connection with the Loan, is exempt from the licensing requirements under Financial Institutions Article, §§ 11-501 through 11-524, Annotated Code of Maryland.
Affidavit of Lender (on its own behalf and on behalf of its employee who originated the Loan):
[ ] I, ________________________________ [Insert name of affiant], hereby affirm, under the penalties of perjury, that I am the _______________________ [Insert Title] of _______________________________ [Insert the name of the lender (the "Lender") that made the Loan]. The Lender's address is _______________________________ [Insert address of Lender]. I am duly authorized by the Lender to execute this affidavit. The Lender, in connection with the Loan, is exempt from the licensing requirements under Financial Institutions Article, §§ 11-501 through 11-524, Annotated Code of Maryland. The employee of the Lender who originated the Loan is exempt from the licensing requirements under Financial Institutions Article, §§ 11-601 through 11-618, Annotated Code of Maryland.
Affidavit of Mortgage Broker (on behalf of its employee who originated the mortgage loan):
[ ] I, _______________________________ [Insert name of affiant], hereby affirm, under the penalties of perjury, that I am the _______________________________ [Insert title] of _______________________________ [Insert the name of the broker (the "Broker") that brokered the Loan]. The Broker's address is _______________________________ [Insert address of Broker]. I am duly authorized by the Broker to execute this affidavit. The employee of the Broker, _______________________________ [Insert name of employee (the "Employee")], is the individual who originated the Loan. The Employee, in connection with the Loan, is exempt from the licensing requirements under Financial Institutions Article, §§ 11-601 through 11-618, Annotated Code of Maryland.
I SOLEMNLY AFFIRM, under the penalties of perjury and upon personal knowledge, that the contents of the foregoing paper are true. __________________Date _______________________________Signature of Affiant (Signing on behalf of Lender) _______________________________Print Name and Title of Affiant ____________________________ Date ________________Signature of Affiant (Individual Mortgage Loan Originator) _______________________________Print Name of Affiant __________________ Date _______________________________ Signature of Affiant (Signing on Behalf of Mortgage Broker) _______________________________Print Name and Title of Affiant
Md. Code Regs. 09.03.11.02
Regulations .02 adopted effective December 29, 2008 (35:26 Md. R. 2247)
Regulation .02 amended effective March 15, 2010 (37:5 Md. R. 427); amended effective 44:13 Md. R. 621, eff. 7/3/2017