HUD-50111 Section 184 Addendum to Uniform Resendential Loan Applic

Section 184 Addendum to Uniform Residential Loan Application
Part I-Identifying Information
3. Borrower's Name & Present Address (Include zip code)

1. Section 184 Case No.

2. Lender’s Case No

4. Interest Rate
5. Proposed Maturity
Yrs.
Yr s.

7. Property Address (including name of subdivision, lot & block no.
& zip code)

8. Lender’s I.D. Code
12. Lender's Name & Address (include zip code)

6. Loan Amount (with financed
guarantee fee)
months
mos. $

9.Sponsor / Agent I.D. Code

10. Name & Address of Sponsor / Agent

11. Lender's Telephone Number
Type or Print all entries clearly

13. First time Homebuyer? _____
14. Please indicate type of loan:
 Streamline with appraisal
 Streamline without appraisal
 Credit Qualifying with cash out
 Newly constructed- Less than 1 year
 Credit Qualifying with no cash out
 Credit Qualifying with escrow

 Acquisition of existing
 Single Close Proposed
 Acquisition/Rehab of existing
 Acquisition-Less than 1 year

Part II - Lender’s Certification
15. The undersigned lender makes the following certifications to allow issuance of a firm commitment for a loan guarantee.
A. The loan terms furnished in the Uniform Residential Loan Application and this Addendum are true, accurate and complete.
B. The information contained in the Uniform Residential Loan Application and this Addendum was obtained directly from the borrower by an
employee of the undersigned lender or its duly authorized agent and is true to the best of the lender’s knowledge and belief.
C. The credit report submitted on the subject borrower (and co-borrower, if any) was ordered by the undersigned lender or its duly authorized
agent directly from the credit bureau which prepared the report and was received directly from said credit bureau.
D. The verification of employment and verification of deposits were requested and received by the lender or its duly authorized agent without
passing through the hands of any third persons and are true to the best of the lender’s knowledge and belief.
E. The Uniform Residential Loan Application and this Addendum were signed by the borrower after all sections were completed.
F. This proposed loan to the named borrower meets the income and credit requirements of the governing law in the judgment of the undersigned.
G. To the best of my knowledge and belief, I and my firm and its principals: (1) are not presently debarred, suspended, proposed for debarment,
declared ineligible, or voluntarily excluded from covered transactions by any Federal department or agency; (2) have not, within a three-year period
preceding this proposal, been convicted or had a civil judgment rendered against them for (a) commission of fraud or a criminal offense in connection
with obtaining, attempting to obtain, or performing a public (Federal, State or local) transaction or contract under a public transaction; (b) violation
of Federal or State antitrust statutes or commission of embezzlement, theft, bribery, falsification or destruction of records, making false statements,
or receiving stolen property; (3) are not presently indicted for or otherwise criminally or civilly charged by a governmental entity (Federal, State or
local) with commission of any of the offenses enumerated in paragraph G(2) of this certification; and (4) have not, within a three-year period
preceding this application/proposal, had one or more public transactions (Federal, State or local) terminated for cause or default.
H. The undersigned lender understands and agrees that it is responsible for the omissions, errors, or acts of its agents.
Signature of Officer of Lender

Date (mm/dd/yyyy)

Title of Officer of Lender

Part III - Notices to Borrowers. The information requested on the Uniform Residential Loan Application and this Addendum is authorized by 12 U.S.C. 1701 et seq..
The Debt Collection Act of 1982, Pub. Law 97-365, and HUD’s Housing and Community Development Act of 1987, 42U.S.C. 3543, require persons applying for a
federally insured or guaranteed loan to furnish his/her social security number (SSN). You must provide all the requested information, including your SSN. HUD may
conduct a computer match to verify the information you provide. HUD may disclose certain information to Federal, State and local agencies when relevant to civil,
criminal, or regulatory investigations and prosecutions. It will not otherwise be disclosed or released outside of HUD, except as required and permitted by law. The
information will be used to determine whether you qualify as a mortgagor. Any disclosure of information outside of HUD will be made only as permitted by law. Failure to
provide any of the requested information, including SSN, may result in disapproval of your loan application. This is notice to you as required by the Right to Financial
Privacy Act of 1978 that HUD has a right of access to financial records held by financial institutions in connection with the consideration or administration of assistance to
you. Financial records involving your transaction will be available to HUD without further notice or authorization but will not be disclosed or released by this institution to
another Government Agency or Department without your consent except as required or permitted by law. Delinquencies, defaults, foreclosures and abuses of
mortgage loans involving programs of the Federal Government can be costly and detrimental to your credit, now and in the future. The lender in this transaction, its
agents and assigns as well as the Federal Government, its agencies, agents and assigns, are authorized to take any and all of the following actions in the event loan
payments become delinquent on the mortgage loan described in the attached application: (1)Report your name and account information to a credit bureau; (2) Assess
additional interest and penalty charges for the period of time that payment is not made; (3)Assess charges to cover additional administrative costs incurred by the
Government to service your account; (4) Offset amounts owed to you under other Federal programs; (5) Refer your account to a private attorney, collection agency or
mortgage servicing agency to collect the amount due, foreclose the mortgage, sell the property and seek judgment against you for any deficiency; (6) Refer your
account to the Department of Justice for litigation in the courts; (7) If you are a current or retired Federal employee, take action to offset your salary, or civil service
retirement benefits; (8) Refer your debt to the Internal Revenue Service for offset against any amount owed to you as an income tax refund; and (9) Report any
resulting written-off debt of yours to the Internal Revenue Service as your taxable income. All of these actions can and will be used to recover any debts owed when it

Page 1 of 4

HUD-50111 (09/2012)

is determined to be in the interest of the lender and/or the Federal Government to do so.

Section 184 Addendum to Uniform Residential Loan Application
Part IV - Borrower Consent for Social Security Administration to Verify Social Security Number
I authorize the Social Security Administration to verify my Social Security number to the Lender identified in this document and HUD, through a
computer match conducted by HUD. I understand that my consent allows no additional information from my Social Security records to be provided to
the Lender, and HUD and that verification of my Social Security number does not constitute confirmation of my identity. I also understand that my
Social Security number may not be used for any other purpose than the one stated above, including resale or re-disclosure to other parties. The
only other re-disclosure permitted by this authorization is for review purposes to ensure that HUD complies with SSA's consent requirements. I am
the individual to whom the Social Security number was issued or that person's legal guardian. I declare and affirm under the penalty of perjury that the
information contained herein is true and correct. I know that if I make any representation that I know is false to obtain information from Social Security
records, I could be punished by a fine or imprisonment or both. This consent is valid for 180 days from the date signed, unless indicated
otherwise by the individual(s) named in this loan application.
Read consent carefully. Review accuracy of social security number(s) and birth dates provided on this application.
Signature(s) of Borrower(s)

Date Signed

Signature(s) of Co - Borrower(s)

Date Signed

Part V - Borrower Certification
16. Do you own or have you sold other real estate within the
past 24 months on which there was a mortgage?

16b. Is it to be
sold?

Yes

Yes

No

No

16c. If yes, was the mortgage a Section 184 guaranteed
loan?
Yes

No

17. As a home loan borrower, you will be legally obligated to make the mortgage payments called for by your mortgage loan contract. The fact that you
dispose of your property after the loan has been made will not relieve you of liability for making these payments. Payment of the loan in full is ordinarily
the way liability on a mortgage note is ended. Some home buyers have the mistaken impression that if they sell their homes when they move to another locality,
or dispose of it for any other reasons, they are no longer liable for the mortgage payments and that liability for these payments is solely that of the new owners.
Even though the new owners may agree in writing to assume liability for your mortgage payments, this assumption agreement will not relieve you from liability to
the holder of the note which you signed when you obtained the loan to buy the property. Unless you are able to sell the property to a buyer who is
acceptable to HUD and who will assume the payment of your obligation to the lender, you will not be relieved from liability to repay any claim which HUD may be
required to pay your lender on account of default in your loan payments. The amount of any such claim payment will be a debt owed by you to the Federal
Government. This debt will be the object of established collection procedures.
18. I, the Undersigned Borrower(s) Certify that:

(1) I have read and understand the foregoing concerning my liability on
the loan and Part III Notices to Borrowers.
I have been informed that ($
) is
the statement of appraised value as determined by HUD.
Note: If the contract price or cost exceeds the Uniform Residential Appraisal Report,
mark either item (a) or item (b), whichever is applicable.
 (a) I was aware of this valuation when I signed my contract and I have paid
or will pay in cash from my own resources at or prior to loan closing a sum equal
to the difference between the contract purchase price or cost and the HUD
established value. I do not and will not have outstanding after loan closing any unpaid
contractual obligation on account of such cash payment;
 (b) I was not aware of this valuation when I signed my contract but
have elected to complete the transaction at the contract purchase price
or cost. I have paid or will pay in cash from my own resources at or prior
to loan closing a sum equal to the difference between contract purchase
price or cost and the HUD/ FHA established value. I do not and will not
have outstanding after loan closing any unpaid contractual obligation
on account of such cash payment.

(2) Neither I, nor anyone authorized to act for me, will refuse to sell,
after the making of a bona fide offer, or refuse to negotiate for the
sale of, or otherwise make unavailable or deny the dwelling or
property covered by his/ her loan to any person because of race, color,
religion, sex, handicap, familial status or national origin. I recognize that
any restrictive covenant on this property relating to race, color, religion,
sex, handicap, familial status or national origin is illegal and void and civil
action for preventive relief may be brought by the Attorney General of
the United States in any appropriate U.S. District Court against any person
responsible for the violation of the applicable law.
(3) All information in this application is given for the purpose of obtaining
a loan to be insured under the Section 184 Statute and the information in the
Uniform Residential Loan Application and this Addendum is true and
complete to the best of my knowledge and belief. Verification may be
obtained from any source named herein.
(4) For properties constructed prior to 1978, I have received information on
lead paint poisoning.
(5)I am aware that HUD does not warrant the condition or value of the
property

Signature(s) of Borrower(s) -- Do not sign unless this application is fully completed. Read the certifications carefully & review accuracy of this
application.
Signature(s) of Borrower(s)

Date Signed

Federal statutes provide severe penalties for any fraud or intentional misrepresentation contained on this form.

Page 3 of 4

Signature(s

Borrower's Certificate:
The undersigned certifies that:
(a) I will not have outstanding any other unpaid obligations contracted in connection with the mortgage transaction or the purcha se of
the said property except obligations which are secured by property or collateral owned by me independently of the said mortga ged
property, or obligations approved by the Secretary;
(b) The undersigned intends to occupy the subject property for the term of the Section 184 loan;
(c) All charges and fees collected from me as shown in the settlement statement have been paid by my own funds(or HUD approved gift
funds), and no other charges have been or will be paid by me in respect to this transaction;
(d) Neither I, nor anyone authorized to act for me, will refuse to sell, after the making of a bona fide offer, or refuse to negotiate for the
sale of or otherwise make unavailable or deny the dwelling or property covered by this loan to any person because of race, color,
religion, sex, handicap, familial status or national origin. I recognize that any restrictive covenant on this property relating to race,
color, religion, sex, handicap, familial status or national origin is illegal and void and any such covenant is hereby specifically
disclaimed. I understand that civil action for preventative relief may be brought by the Attorney General of the United States in any
appropriate U.S. District Court against any person responsible for a violation of this certificate.

Borrower'(s) Signature(s) & Date

Lender's Certificate

:

The undersigned certifies that to the best of its knowledge:
(a) The statements made in its application for insurance and in this Certificate are true and correct;
(b) The conditions appearing in any outstanding commitment issued under the above case number have been fulfilled;
(c) Complete disbursement of the loan has been made to the borrower, or to his/her creditors for his/her account and with his/her consent;
(d) The security instrument has been recorded and is a good and valid first lien on the property described;
(e) No charge has been made to or paid by the borrower except as permitted under HUD regulations;
(f) The copies of the credit and security instruments which are submitted herewith are true and exact copies as executed and filed for record;
(g) Lender has not paid any kickbacks, fee or consideration of any type, directly or indirectly, to any party in connection with this
transaction except as permitted under HUD regulations and administrative instructions.
I, the undersigned, as authorized representative of
mortgagee at this time of closing of this mortgage loan, certify that I have personally reviewed the mortgage loan documents, closin g
statements, application for insurance endorsement, and all accompanying documents.

Lender’s Name

Title of Lender’s Officer

Signature of Lender’s Officer & Date

’