MASSACHUSETTS UREA FORMALDEHYDE FOAM INSULATION CERTIFICATE (UFFI)

Date:
Loan No:
Buyer/Borrower:
Mortgage Broker: Nationwide Mortgage Loan Company
Property Address:
Seller:

This disclosure is provided to you pursuant to Massachusetts law (Mass. Gen. Laws Ann. ch. 167, § 47).

NOTICE

It is unlawful, under Mass. Gen. Laws Ann. ch. 167, § 47, for any bank, lending institution or mortgagee ("Mortgage Broker") doing business in the Commonwealth of Massachusetts to discriminate in any manner in the financing of a home or dwelling against homeowners or dwellings where the indoor ambient formaldehyde level is .10 parts per million or below.

ACKNOWLEDGMENT
___ The residential dwelling is insulated with Urea Formaldehyde Foam Insulation (UFFI), and has an indoor ambient formaldehyde level of ____ parts per million.
___ The residential dwelling is not insulated with Urea Formaldehyde Foam Insulation (UFFI).
By signing below, you certify that the above information is true and correct.

Print Name ____________________________

MA L UFFI Discl