VA Form 26-6850 Notice of Default

OMB Control No. 2900-0021
Respondent Burden: 10 minutes
Expiration Date: XX-XX-XXXX

NOTICE OF DEFAULT
(Chapter 37, Title 38, U.S.C.)

DATE OF THIS NOTICE

TYPE

VA LOAN NUMBER (NOTE: Loan

INSTRUCTIONS: Please type or print. Note the special instructions for "VA Loan
No." and Items 1-4 and 7, as these entries will be used for VA coding purposes. For
38 CFR 36.4600 Loans, code a "4" in the block titled "TYPE".

number must be numeric, 12 digits)

HOLDER'S NOTICE

To (Complete Regional Office/Center Address)

HOLDER'S NAME, ADDRESS AND TELEPHONE NO.

DEPARTMENT OF VETERANS AFFAIRS
LOAN GUARANTY DIVISION

PURPOSE OF LOAN

(Check one)

HOME (1)
HOME CONDO (0)

SERVICING AGENT'S NAME, ADDRESS AND
TELEPHONE NO. (Complete only if different from

HOME REFIN. (5)
MANUFACTURED
HOME (8)

holder shown above)

SERVICER CODE (6 Digits)

DESCRIPTION OF DELINQUENT
NOTE: Enter number only 1. SERVICER LOAN NO.
without spaces, dashes, etc.
DO NOT ENTER MORE
THAN 14 CHARACTERS
Enter last name,
comma, first name
and middle initial

2. DATE OF FIRST UNCURED DEFAULT

EXAMPLE: Enter 05 01 93
for May 1, 1993.

3B. NAME OF PRESENT OWNER

4. ADDRESS OF
PRESENT OWNER

B. CITY AND STATE

(Per loan instruments)
DAY
EXAMPLE: Enter MONTH
06 01 93 for
June 1, 1993

6. PROPERTY ADDRESS (If different than Item 4)

9. AMOUNT OF EACH INSTALLMENT

8. ORIGINAL VETERAN'S NAME AND PRESENT ADDRESS
YEAR

(Present Owner)

YEAR

5. COUNTY OR PARISH (Property Location)

C. ZIP
CODE

7. DATE OF FIRST PAYMENT

3A. SOCIAL SECURITY NO.

DAY

NOTE
Item 3B: Do not enter more
than 25 characters in this area

A. NUMBER AND STREET OR RURAL ROUTE

(Entries in Items A
and B MUST be
limited to 25
characters)

MONTH

(If different than Items 3B and 4 above)

PRINCIPAL AND INTEREST
OTHER
TOTAL

10. OTHER DEFAULT (Specify, real estate, taxes,
insurance, special assessments, etc.)

$

TAX AND INSURANCE

11.
AMOUNT
OF
DEFAULT

$

PRINCIPAL
INTEREST
TAX AND INSURANCE
TOTAL

$

12. INTEREST RATE AND OUTSTANDING
LOAN BALANCE
A. INTEREST
B. DATE
C. AMOUNT
RATE

$

HOLDER'S LOAN SERVICING
13.
CONTACT(S)
WITH
MORTGAGOR

14. DATES OF PROPERTY
INSPECTIONS

15. CONDITION OF PROPERTY

FACE TO FACE
TELEPHONE
A. MONTHLY
INCOME

17.

NUMBER

TYPE
LETTER/WIRE

B. MONTHLY
OBLIGATIONS

C. BORROWER'S ATTITUDE
TOWARD DEFAULT

D. PLACE OF EMPLOYMENT

16. PROPERTY OCCUPIED BY
ORIGINAL
VETERAN

TENANT

TRANSFEREE

VACANT

E. WORK
TELEPHONE NO.

F. HOME
TELEPHONE NO.

BORROWER
SPOUSE
18. IS FORBEARANCE WARRANTED?

19. REASON FOR DEFAULT

20. SUMMARY OF LOAN SERVICING (Must give complete details to support conclusion that forbearance is not warranted. Include repayment schedules or other

arrangements, etc.)

21. NAME AND TITLE OF AUTHORIZED OFFICIAL (Type or Print)

HOLDER

22. SIGNATURE OF AUTHORIZED OFFICIAL

SERVICING AGENT
PRIVACY ACT INFORMATION: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title 38,
Code of Federal Regulations 1.576 for routine uses (e.g., to a member of Congress inquiring on behalf of a veteran) as identified in the VA system of records, 55VA26, Loan Guaranty Home,
Condominium and Manufactured Home Loan Applicant Records, Specially Adapted Housing Applicant Records, and Vendee Loan Applicant Records - VA, and published in the Federal
Register. Your obligation to respond is mandatory under 38 CFR 36.4315, 36.4317.
RESPONDENT BURDEN: We need this information to determine compliance with the applicable reporting requirements of VA regulations. We estimate that you will need an average of
20 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is displayed.
You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the OMB Internet Page at
www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.
VA FORM
XXXX

26-6850

Distribution Copy List: