2502-0416 9807-redline

Insurance Termination Request
for Multifamily Mortgage

U.S. Department of Housing
and Urban Development
Office of Housing
Federal Housing Commissioner

OMB Approval No. 2502-0416
(exp. 10/31/2015)

Applicant must read all of the Instructions on back before completing this form
1. Type of Request (Place an X in those that apply)
Co-Insurance
Date Deed Recorded, (mm/dd/yyyy) _______________
Mortgagee intends to file a claim
Mortgagee does not intend to file a claim
Prepayment Termination - Mortgage Paid in Full
Voluntary Termination-Attach credit instrument
Mortgagor Redeems Property After Foreclosure
3rd Party Acquires Property At Foreclosure Sale

Full Insurance
Prepayment Termination: Mortgage is paid in full and original credit
instrument is canceled.
Voluntary Termination: Attach the original credit instrument for
cancellation of insurance endorsement.

2. Date of This Request (mm/dd/yyyy)

3. FHA Project Number

4. Mortgagee's Loan No. (if any)

5. Date of Prepayment in Full,if applicable (mm/dd/yyyy) 6. Original Amount of Mortgage

7. Maturity Date (mm/dd/yyyy)

8. The following items are attached, or the statements are applicable:
Certified or cashier's check for $100 for redemption of the preferred stock issued
to FHA/HUD by the mortgagor corporation plus any due and unpaid dividends.

9. Program Information. Check a Yes or No on each of the following:
Yes No

Original Credit Instrument. See Item 1, above.
Prior Approval to Terminate, if required (See reverse)
Certifications:

I certify that no dividends are due.

Nonprofit
Receiving Rent Supplement
Receiving Section 8 Payments
Limited Distribution

I certify that the amount remitted with this form is the full amount due.

The undersigned certifies that the information shown above is true and correct, and the undersigned agrees that upon request of
HUD it will furnish documents
to support the responses shown above.
Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 10 10, 1012; 31 U.S.C. 3729, 3802)
10. Name and Signature of Mortgagors (Complete only if this is a voluntary termination.) 11. Project Name
(If corporate, give name of corporation and title of authorized officer who signs.)

12. HUD Holding Mortgagee Number (To be completed in all instances)

13. HUD Servicing Mortgagee Number (To be completed only ifsubmitted by servicer)

14. Name, Address and Zip Code of Holding Mortgagee (To be completed in all instances)15. Name, Address and Zip Code of Mortgagee's Servicer (To be completed only if
submitted by servicer)

16. Signature of Holding Mortgagee's Authorized Representative

Title of Holding Mortgagee's Authorized Representative

17. Signature of Servicing Mortgagee's Authorized Officer

Title of Servicing Mortgagee's Authorized Officer

For HUD Use Only: The contract of insurance, as identified above, has been terminated in accordance with this request and HUD regulations.
The original document, showing cancellation of the HUD insurance endorsement, is attached.
A refund of unearned insurance premium in the amount of $
has been aut horized for the account of the mortgagor
and a U.S. Treasury check will be sent to your office. This refund and any HUD premium held in escrow may be credited or return ed to the borrower.
Date Document Received (mm/dd/yyyy)

Previous editions are obsolete.

Effective Date of Termination (mm/dd/yyyy)

Signature of Designated HUD Official

Page 1 of 3

Date (mm/dd/yyyy)

form HUD-9807 (10/2012)
ref. Handbook 4350.4

Instructions
Step 1. If the property has 221(d)(4), 231(profit motivated mortgagor) or
213 mortgage insurance, proceed to Step 4.

U.S. Department of HUD
Office of Multifamily Portfolio Management, Room 6160
451 Seventh Street, S.W.
Washington, D.C., 20410

Step 2. If the property is subject to HUD insured or HUD held subordinate
debt, the debt must be fully satisfied before prepayment of the first
mortgage or termination of the mortgage insurance will occur.
Such insurance programs include 241(a), 241(f), or Partial Payment of Claim. Proceed to Step 3.
Step 3. If requesting prepayment of the property’s mortgage, and HUD
consent is required by the mortgage documents and/or the regulations or not, you must; (Prior to submitting form HUD-9807)
A. Look at the list of the following programs on HUD web site
__________________________ which have received a:

E. Upon receipt of the above information, the Office of Multifamily
Portfolio Management in Washington, D.C. will review it and
respond in writing, either approving, disapproving or with
conditions, the request to prepay. This approval is good for a
period of ninety days.
Step 4. Before completing this step, be sure that:
A. All amounts due HUD, including mortgage insurance premiums
and/or late charges and interest, are paid up to date.

(1) Flexible subsidy or Help Loans. While as a general rule,
HUD consent is required for prepayment, there are cases
where the mortgage note is silent. In those cases, consult
the Office of Portfolio Management in Headquarters.

B. You meet the criteria under step 1 or 2, or you received
approval to prepay under step 3, from the Office of Portfolio
Management-Headquarters, and
C. Prepayment has actually taken place. Once prepayment
has occurred, you are to submit the following information to the
address or fax number listed below:

(2) Rent Supplement Contract.
(3) Partial Payment of Claim.
(4) Portfolio Reengineering.

(1) Insurance Termination Request for Multifamily Mortgage,
Form HUD-9807, properly executed and signed by a corporate
officer.

B. Not on the web site list but also requiring prior approval of HUD
are:
(1) Section 231, 232, 236 or 221(d)(3) properties;

New
Language

(2) Copy of Portfolio Management’s approval letter.

a. That are not more than 20 years from the date of final
endorsement,

(3) Copy of the property’s mortgage note(s), rider(s), and
agendums.

b. Originally owned by non-profits due to their 40 year lockin restriction, or

(4) If FHA/HUD owns preferred stock of the mortgagor
corporation, a certified or cashiers check made payable to
the U.S. Department of Housing and Urban Development
for $100 plus due and unpaid dividends should accompany
the correspondence.

c. Originally an LD and sold to NP.
d. For prepayment of an FHA­insured or HUD­held Section 236
mortgage, property owners are strongly encouraged to electronically
submit an optional HUD Section 236 Consolidated Application
Package (attached) to describe proposed preservation transactions,
request HUD approvals, and upload support documents
via www.hudmfpreservation.net.

(5) For Voluntary termination only, the
original credit
instrument must be submitted to the address below for
cancellation of the HUD insurance endorsement. Both the
servicer and mortgagor must sign the form-9807

(2) Section 207/223(f).
a. According to the 223(f)(3) of the National Housing Act,
five years must have elapsed since the date of final
endorsement, or

U.S. Department of HUD
Insurance Operations Branch
P.O. Box 44124
Washington, D.C. 20026-4124

b. If purchased by GNMA pursuant to Section 305 of the
National Housing Act, 20 years must have elapsed since
the date of final endorsement.
C. If the property is in any of the above categories, and has not
received HUD consent, it is not eligible to prepay an
no
further action can occur. Proceed no further.
D. If the property is not one of the categories listed above, it may
or may not be eligible to prepay and you are to submit the
following information to the address below:

Or, by Fax: (202) 401-3246
Step 5. After the contract of mortgage insurance has been terminated by
HUD, a signed copy of the Form HUD-9807, together with a letter
indicating whether a refund is due the mortgagor or funds are due
HUD, will be returned to the mortgagee.

(1) A written request for prepayment
(2) A copy of the mortgage note(s), rider(s) and agendums

For a voluntary termination, cancellation of the HUD insurance
endorsement will be effective on the date all requirements are
met. The original credit instrument that was submitted will be
returned to the mortgagee by Certified/Overnight Mail.

(3) Owner’s requested prepayment date, if known
(4) A written statement that a copy of the above information has
been sent to the HUD Field Office with jurisdiction for the
property.

Previous editions are obsolete.

Page 2 of 3

form HUD-9807 (10/2012)
ref. Handbook 4350.4

Public reporting burden for this collection of information is estimated to average 7 minutes per response, including the time for
reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and
reviewing the collection of information. This information is required to obtain benefits and is mandatory. HUD may not collectthis
information, and you are not required to complete this form, unless it displays a currently valid OMB control number. Anyone with
comments regarding this burden estimate or any other aspect of this information collection, including suggestions for reducing this
burden, may call Field Asset Management Division (202) 708­3730.
Section 24 CFR 207.253(a) and (b) states that notice of the prepayment of the mortgage or loan shall be given to the
Commissioner on a form prescribed by the Commissioner within 30 days from the date of the prepayment. The Section also
states that the original credit instrument for cancellation of the insurance endorsement and the remittance of all sums to which
the Commissioner is entitled shall accompany this form. While no assurances of confidentiality are pledged to respondents,
HUD generally discloses this data only in response to a Freedom of Information request.

Previous editions are obsolete.

Page 3 of 3

form HUD-9807 (10/2012)
ref. Handbook 4350.4

Office of Recapitalization
Version 2A February 1, 2014

Instructions for Section 236 Application
This Application is designed for the following types of Section 236 transactions:

236 Mortgage Prepayments
Flexible Subsidy Deferral
HAP Assumptions
Unit Rent Increases
Nonprofit Retention of Sales Proceeds

IRP Decouplings and Re-decouplings
Tenant Protection Vouchers
LIHPRHA Use Agreement Modifications
Unit Conversions

Other types of approvals (for example, partial payments of claim and modifications to HUD-Held Section 236 loans) should be
discussed with the multifamily field office with jurisdiction over the project.
Applications for new FHA-insured financing for Section 236 transactions will continue to be made through your FHA lender and
the Multifamily Office of Asset Development.
HUD has designed this Application to facilitate the efficient assembly and submission of the appropriate information and
related documentation to HUD. Applicants are strongly encouraged to use this tool to describe proposed preservation
transactions, request HUD approvals, and upload support documents. While HUD does not require applicants to use this tool,
this tool meets HUD's electronic submission requirement while also providing applicants with one central portal through which
to submit all required documentation that is currently collected under established Paperwork Reduction Act (PRA) approval
numbers. The information collection requirements contained in this document have been approved by the Office of
Management and Budget (OMB) under the Paperwork Reduction Act of 1995 (44 U.S.C. 3501-3520) and assigned OMB control
numbers 2502-0416, 2502-0572, and 2502-0577. In accordance with the Paperwork Reduction Act, HUD may not conduct or
sponsor, and a person is not required to respond to, a collection of information unless the collection displays a currently valid
OMB control number.
Cells with light blue background and dark blue font contain information to be supplied by applicants. Some of these cells
contain drop-down menus; if a small down-pointing arrow appears to the right of the cell when you hold the mouse over the
cell, you can click on that arrow to bring up a menu of choices.
If you place your mouse over a '?' in column A you will see additional information that may be helpful.
User entry cells that stretch the width of the form are designed to contain brief narrative responses. If your response is longer
than can be displayed, you can extend the row height. Move the mouse to the horizontal line underneath the row number,
click, and drag the bottom of the row downward until the row is tall enough to display your complete response.
Simple Transactions Combining Prepayment and Conversion to Market Rents (No Ongoing Affordability)
If (1) you are proposing to prepay your 236 mortgage and (2) you have the right to prepay without requiring a discretionary
approval from HUD and (3) you don’t have any other components in your transaction that require HUD’s approval with the
exception of requesting tenant protection vouchers, then you will only be required to complete four Sections of the
Application.
Other Transactions ("Preservation Transactions")
If you are proposing to prepay your 236 mortgage and seek HUD’s approval on other components of your transaction,
regardless of whether or not HUD’s approval to prepay is required, you will be required to complete only those Sections of the
Application that pertain to the approvals you are seeking.

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See the Instructions worksheet for general instructions.
Below, text in italics contains instructions, guidance or explanations. Cells in dark blue bold font with light blue background
are for information that you will enter. If you place your mouse over a '?' in column A you will see additional information that
may be helpful.
When you have finished, the List of Exhibits worksheet will show all Exhibits that your transaction requires.
To begin, complete Section 1 below. Section 1 will capture key information about the transaction, the property and its Section
236 loan. Later you will be asked to return here to click the 'Reveal Remaining Sections' radio button which will reveal any
other parts of the Application that apply to your transaction.
Section 1. Transaction Overview
Section 1.A. Key Information
Date This Document Was Completed:
Property Name
Transaction: Select the transaction type below that best characterizes the intended outcome of your proposed transaction.

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"Preservation of Affordability" means that you seek to preserve this property as an affordable multifamily housing
resource and to extend its useful life by strengthening its financial position and overall physical condition.
"Conversion" means that you seek to prepay the existing Section 236 loan as a means to eliminating the existing
affordability restrictions and to converting the units to market-based rents.
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Transaction Type
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The first mortgage loan is currently:
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FHA Number
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Physical Address (Street)
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Physical Address (City, State, Zip)
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Is this project a tenant co-operative?
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Current Owner Legal Entity Name
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Contact Person
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Email address
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Telephone
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Title
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Mailing Address (Street)
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Mailing Address (City, State, Zip)
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Anticipated Closing Date
If it is not possible to achieve the Anticipated Closing Date, explain the potential consequences for the transaction if closing is
delayed.
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Is a sale of the property proposed, as part of this transaction?
Identify the mortgagee (lender) for the existing first mortgage loan. If the existing first mortgage loan is HUDHeld, enter "HUD-Held" on the first line below and leave the remaining lines blank.
Mortgagee (Lender) Name
Contact Person

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Email address
Telephone
Title
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Mailing Address (City, State, Zip)
Section 1.B. Existing Use Agreements
If the property has any of the following Use Agreements, indicate the type(s) of Use Agreement below.
ELIHPA Use Agreement?
LIHPRHA Use Agreement?
Flexible Subsidy Use Agreement?
IRP (Decoupling) Use Agreement?
LIHTC Use Agreement or LURA?
Mark-to-Market Use Agreement?
Portfolio Re-Engineering Use Agr?
Partial Payment of Claim Use Agr?
Other Use Agreement?
Please indicate any other subsidy programs that are currently in effect at the property.

Section 1.C. Summary Information on Project-Based Rental Assistance Contracts
Please indicate each existing project-based rental assistance contract. This might include Section 8 Loan Management SetAside ("S8 LMSA") contracts, Rental Assistance Payments ("RAP") contracts, and/or Rent Supplement contracts. The term "#
Units" means the number of units assisted under the contract.
Contract Number
Type
# Units
Expires

Section 1.D. Summary Information on Unit Mix, Occupancy and Vacancy
Please provide information about the unit mix for the property. The Term "# Units" means the total number of units of this
type (whether occupied or vacant, assisted or non-assisted). "Contract Units" means units with project based rental
assistance (project based Section 8, project based vouchers, RAP, Rent Supplement). "Occupied" means the actual number of
units that are currently leased to tenants. "Average vacancy" means the average vacancy rate for this unit type over the past
twelve months.
Unit Type
0 Bedroom / Efficiency
1 Bedroom
2 Bedroom
3 Bedroom
4 Bedroom
Other
Other
Other

# Units

Total number of units

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Contract Units Occupied

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Avg Vacancy

0.0%

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Section 1.E. Key Transaction Characteristics and Types of HUD Approvals Needed
Indicate the features of your proposed transaction and the types of HUD approvals you are requesting:
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?

Prepay Insured or HUD-Held 236 Loan
Prepay Non-Insured State Agency 236 loan
Decouple the Remaining IRPs
Modify a Decoupling Approval
Issue Tenant Protection Vouchers
Defer Repayment of Flex Sub Loan
Increase in HAP Rents
Increase in Non-HAP Rents
Approve Proceeds to Nonprofit Seller
Modify a LIHPRHA Use Agreement
Unit Conversion (e.g., 0BRs to 1BRs)
Assumption of HAP Contract(s)
? Assumption of RAP Contract
? Assumption of Rent Supp Contract
Any Other HUD Approval

Yes
No

See Section 3

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Please indicate whether the property has filed an application to participate in the Rental Assistance Demonstration ("RAD")
program, to convert an existing RAP or Rent Supplement contract to project based vouchers.
Applied for RAD?
This completes Section 1. You must now click the radio button below titled 'Reveal Remaining Sections'. This will reveal any
remaining portions of the Questionnaire that are required for your proposed transaction. Section 2 includes questions that
apply to multiple types of approvals. Sections 3 through 12 each apply to a specific type of approval. If you later make a
change in Section 1, click the 'Reveal Remaining Sections' button one more time.

Application

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Master List of Exhibits Required for
, 0 Units
Current FHA
Required?

Exhibit #

Exhibit Name

Yes
N/A
N/A
N/A

01-01

01-02

General Exhibits
Section 236 Application
Complete the Financial Exhibits Worksheet
Complete, Copy and Sign the Cert of Finl Exhibits Worksheet
Consent of Owner to Release Information to Purchaser

Yes
Yes

02-01
02-02

Exhibits for Prepayment Requests
Prepayment Request
Documentation of tenant notice

N/A
N/A
N/A
N/A
N/A
N/A

03-01
03-02
03-03
03-04
03-05
03-06

Exhibits for Decoupling Requests
Substantive Description
Support Letter from Existing Insured Mortgagee
Financial Exhibits (Sources and Uses, Pro Forma CF, Certification)
Disclosure of other Federal / State / Local Assistance
Capability Statement
As-Is Appraisal and/or Rent Comparability Study If Required

N/A
N/A
N/A
N/A

04-01
04-02
04-03
04-04

Exhibits for Flexible Subsidy Operating Assistance Deferral
Deferral Request
Financial Statements
Financial Exhibits (Sources and Uses, Pro Forma CF, Certification)
Capability Statement

N/A

05-01

Exhibits for Increase in Unit Rents
Applicant's BBRI Proposal for Non S8 Tenants

N/A
N/A
N/A
N/A

06-01
06-02
06-03
06-04

Exhibits for Request to Assign / Assume PBRA Contract(s)
Request for Assignment of PBRA Contract
Capability Statement
Certification of Purchaser
Authority to Sign

N/A
N/A

08-01
08-02

Exhibits for Nonprofit Retention of Sales Proceeds
Purchaser's Request
Purchaser's Agreement

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Master List of Exhibits Required for
, 0 Units
Current FHA
Required?

Exhibit #

Exhibit Name

N/A
N/A
N/A
N/A

08-03
08-04
08-05
08-06

Capability Statement
Purchaser's Capital Needs Assessment
Purchaser's Repair Plan
Financial Exhibits (Sources and Uses, Pro Forma CF, Certification)

N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A
N/A

09-01
09-02
09-03
09-04
09-05
09-06
09-07
09-08
09-09
09-10
09-11
09-12
09-13
09-14
09-15

Exhibits for Unit Conversions
Unit Conversion Request
Consent of the Lender
Vacancy Information
Evidence of Need for Conversion
Pre- and Post-Conversion Rental Schedules
Annual Operating Statements
Financial Exhibits (Sources and Uses, Pro Forma CF, Certification)
Capital Needs Assessment
Proposed Rehabilitation
Evidence of Notice to Tenants
Non Displacement Certification
Relocation Plan and Tenant Selection Plan
Unit Conversion Agreement
Environmental Review
Capability Statement

N/A
N/A
N/A
N/A
N/A
N/A
N/A

10-01
10-02
10-03
10-04
10-05
10-06
10-07

Exhibits for LIHPRHA-ELIHPA Use Agreement Modification
Request to Modify Use Agreement
Fair Housing and Civil Rights Certification
Capability Statement
Financial Exhibits (Sources and Uses, Pro Forma CF, Certification)
Financing Plan
Environmental
Request for 20 Year HAP and Preservation Exhibit

N/A
N/A

11-01
11-02

Exhibits for Re-Decoupling
Request for 20 Year HAP Extension
Re-Decoupling Request

Yes
Yes

Overall Certification
Submit Any Needed Previous Participation Requests to Field Office

Page 6

Application for Section 236 Preservation:
Exhibit 01-02 Consent of Owner for HUD to Release Information to Purchaser
Re: the 0 unit apartment project commonly known as 0, located in 0 (the 'Property')
To: Department of Housing and Urban Development, its Secretary, officials, employees, agents and contractors (collectively,
“HUD”)
The undersigned ("Owner") represents and warrants that it is the owner of the above referenced Property. The Owner is
considering the sale of the Property to 0 (which, including its officials, employees, agents and contractors are collectively
referred to herein as the “Prospective Purchaser”). To facilitate the sale Owner hereby requests, authorizes and directs HUD to
cooperate directly with the Prospective Purchaser and release information about the Owner and the Property, including, without
limitation, any and all financial information, which may be requested from time to time by Prospective Purchaser. Until such
direction is revoked in writing and acknowledged by HUD, HUD may continue to release any and all requested information. HUD
is hereby released and Owner hereby covenants and agrees to indemnify and hold HUD harmless from and for the release of
such information.
Owner hereby acknowledges that the release of such information by HUD is not deemed to be HUD’s consent to either the sale
or the Prospective Purchaser qualifications, and such consent remains subject to all applicable statutes and any regulations
issued by HUD pursuant thereto that apply to the Property, Owner or Prospective Purchaser, including all current requirements
in HUD handbooks and guides, notices, and mortgagee letters that apply to the Property, and all future updates, changes and
amendments thereto, as they become effective. Handbooks, guides, notices, and mortgagee letters are available on HUD's
official website: (http://www.hud.gov/offices/adm/hudclips/index.cfm, or a successor location to that site).

Authorized Signature __________________________________________________
Date: __________________________________________
By: enter name here
Of: 0
Its: enter role here
Phone Number of Individual Signing: enter phone number here

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Proposed Closing Date
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Business Terms for Proposed New 1st Mortgage Loan (If Applicable)
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Loan Type
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Principal Amount
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Interest Rate
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Amortization Term (years)
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Maturity (years)
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Mortgage Insurance Premium
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Calculated Monthly P+I Payment
$0.00
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Actual Monthly P+I Payment
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Proposed Sources of Funds
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Proposed Amount
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1st Mortgage
$0
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Total Tax Credit Equity
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Deferred Developer Fee (to Owner)
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Deferred Developer Fee (to Purchaser)
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Deferred Developer Fee (to Third Party)
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HOME
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CDBG
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Flexible Subsidy Loan
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Replacement Reserve
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Residual Receipts
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Total Sources
$0
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Sources and Uses Balance?
Yes
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Application for Section 236 Preservation: Sources and Uses
For
Comments

Comments

Indicate whether the sources of funds listed above include all "HUD Assistance" and "Other Governmental Assistance" (as such terms are defined in the Certification
of Financial Exhibits) that to the knowledge of the Applicant are either (1) available for the proposed transaction or (2) are being pursued for use in the proposed
transaction. Discuss below any "HUD Assistance" (including, without limitation, project based rental assistance contracts or FHA mortgage insurance) or "Other
Governmental Assistance" (including, without limitation, loan guarantees, tax credits, and rebates) that is not indicated as a source of funds above.

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Indicate whether the proposed transaction includes any form of tax credit and, if so, indicate whether there is any identity of interest between the investor and the
developer. If there is an identity of interest (for example, the general partner intends to use a state credit on its individual tax return), provide documentation that
the price proposed to be paid by the identity of interest investor is reasonable. If the transaction includes any form of tax credit that is not shown as a source of
funds, provide an explanation.
2

Proposed Uses of Funds
Rehabilitation Costs:
Hard Cost
General Requirements
Builder Profit / Fee
Builder Overhead
Bond Premium
Hard Cost Contingency
Other (describe)
Other (describe)
Rehabilitation Related Costs:
Architect's Design and Supervision Fee
Real Estate Attorney
Marketing
Surveys
Appraisal
Market Study
Environmental Report
Other (describe)
Other (describe)
Financing Related Costs:
Construction Interest
Real Estate Taxes During Construction
Insurance During Construction
Mortgage Insurance Premium
Title & Recording
Contingency (Financing Costs & Other Soft Costs)
Lender's Origination Fee

Financial (S+U)

5/11/2015 9:06 AM OAHP Application Review Tool with PRA

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94
95
96
97
98
99
100
101
102
103
104
105

B

C

D

E

F

G

H

Application for Section 236 Preservation: Sources and Uses
For
Lender's Legal Fees
Bond Issuance Costs
Other (describe)
Other (describe)
Acquisition Related Costs:
TIP Cash Portion of Sales Price to Seller
Brokerage Fee (to Seller)
Brokerage Fee (to Purchaser)
Brokerage Fee (to Third Party)
Prepaid Rent
Pay Off Existing 1st Mortgage Balance
TIP Pay Off Existing Flexible Subsidy Balance
Pay Off Other Existing Debt Balance
Other (describe)
Other (describe)
Developer Fee:
TIP Gross Amount of Developer Fee (to Owner)
TIP Gross Amount of Developer Fee (to Purchaser)
TIP Gross Amount of Developer Fee (to 3rd Party)
Reserves and Other Project Accounts:
Replacement Reserve (post-closing balance)
Operating Reserve
Debt Service Reserve
Other Project Account (describe)
Other Project Account (describe)
Total Uses
Sources and Uses Balance?

Financial (S+U)

$0
Yes

5/11/2015 9:06 AM OAHP Application Review Tool with PRA

I

A
1
2
3
106

B

C

D

E

F

G

H

Application for Section 236 Preservation: Sources and Uses
For

Financial (S+U)

5/11/2015 9:06 AM OAHP Application Review Tool with PRA

I

Application for Section 236 Preservation: Pro Forma Stabilized Cash Flow Projection
For
Projected Occupancy Restrictions -- Not Applicable
Projected Occupancy Restrictions
Units 30% or less of AMI
Units at 31-40% of AMI
Units at 41-50% of AMI
Units at 51-60% of AMI
Units at 61-80% of AMI
Units at market rates
Non revenue units (e.g., staff units)

Rent

Total

# Units

$0
$0
$0
$0
$0
$0
$0

Totals

0

TIP

Estimate of Stabilized Cash Flow -- Not Applicable

TIP

Estimated Stabilized Income and Expenses (In Current Dollars As Of the Closing Date)
Income (revenue as positive amounts, vacancy and bad debt as negative amounts)

5120/5121 Total Rent Revenue (Apartments)
5140/5170 Rent Revenue (Commercial)
5180-5195 Other Rent Revenue
5220 Vacancy Loss (Apartments)
5240/5270 Vacancy Loss (Commercial)
5290 Vacancy Loss (Other)
5250 Concessions
6370 Bad Debt Loss (Apartments)
6370 Bad Debt Loss (Commercial)
TIP 5440 R4R Investment Income
5410/5490 Other Financial Revenue
5910 Laundry and Vending Revenue
5920 Tenant Charges
TIP 5945 IRP Revenue
5990 Miscellaneous Revenue

Effective Gross Income (EGI)

$0

Not available for operations

$0

Input as negative debt service below

$0

Expenses (enter as positive amounts)
62xx Renting Expenses
6310/6330 Office Salaries / Manager Salaries
6311 Office Expenses
TIP Office Rent / Rent Free Unit(s)
6320 Management Fee
6340 Legal Expense
6350 Audit Expense
6351 Bookkeeping Fees
6390 Miscellaneous Administrative
64xx Total Utility Expense
6510 Maintenance Payroll
6515 Maintenance Supplies
6520 Maintenance Contracts
6525 Garbage and Trash Removal
6530 Security Payroll / Contract
6546-6590 Other Maintenance Expense
6710 Real Estate Taxes
6711 Payroll Taxes
6720 Property & Liability Insurance
6721 Fidelity Bond Insurance
6722 Worker's Compensation Insurance
6723 Health Insurance / Other Benefits
6790 Misc Taxes, Licenses, Permits, Insurance

Total Expenses

$0

Replacement Reserve Deposit (positive)
Other Reserve Deposit (describe)
Other Reserve Deposit (describe)

Adjusted Net Operating Income
1st Mortgage P+I (positive)
1st Mortgage MIP (positive)
IRP Applied to Debt Service (negative)
Other Debt Service (describe)
Other Debt Service (describe)
Other Debt Service (describe)

$0

$0

Other Debt Service (describe)

Operating Cash Flow

$0

Application for Section 236 Preservation: 10 Year Cash Flow Projection -- Not Applicable
For
Income / Expense Category
Income (OAHP-HUD Categories)
Assisted / Unassisted GPR
Commercial Income
Other Income Sources
Apt Vacancy
Comml Vacancy
Other Vacancy
Apt Bad Debt
Comml Bad Debt

Stabilized
Projection

Trending
Factor

Year 1

Year 2

Year 3

Year 4

Year 5

Year 6

Year 7

Year 8

Year 9

Year 10

$0
$0
$0
$0
$0
$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0

Effective Gross Income (EGI)

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

Expenses (OAHP-HUD Categories)
Real Estate Taxes
Insurance
Utilities and Garbage Removal
Management Fees
Salaries & Benefits
Other Administrative
Oper./Repairs & Maintenance
Security
Other

$0
$0
$0
$0
$0
$0
$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0
$0

$0
$0
$0
$0
$0
$0
$0
$0
$0

Total Expenses

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

Total Reserve Deposits

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

Adjusted NOI

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

Total Debt Service

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

Operating Cash Flow

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

$0

Comments:
x
x
x

Application for Section 236 Preservation Transaction:
Applicant's Certification of Financial Exhibits
DATA ENTRY FIELDS:
Name of person executing document:
Title of person executing document:
Role of person executing document in the applicant
entity:
Legal name of applicant entity:
Phone Number of Individual Signing:
Name of Section 236 project
Current FHA number of 236 project

enter name here
enter title here
enter role here
0
enter phone number here
0
0

Application for Section 236 Preservation Transaction:
Applicant's Certification of Financial Exhibits
I, enter name here, as enter title here, in my capacity as the enter role here of 0 (the 'Applicant') make the following
representations and certifications to the United States Department of Housing and Urban Development ('HUD') on behalf of
the Owner in conjunction with the attached Financial Exhibits which are part of the application (the 'Application') of Applicant
for approval of a transaction (the 'Transaction') for the project known as: 0 (the 'Project') having the following FHA project
number: 0.
I represent and certify that I have all requisite authority to execute this Certification and to bind the Applicant.
On behalf of the Applicant I represent and certify as follows:
1. The Applicant understands that HUD will rely upon this certification in evaluating the Application.
2. The Applicant has read and understands all published HUD guidance that is relevant to the proposed preservation
transaction.

3. The Owner has been advised that it should conduct such due diligence as it determines is necessary including but not limited
to consulting legal counsel in order to ensure that all statements contained in these certifications are true and complete.
4. The information contained in the Sources and Uses Statement, Pro Forma Stabilized Cash Flow Statement, and 10 Year Cash
Flow Projection (collectively, the 'Financial Exhibits') is accurate, complete, and not misleading.
5. Except as fully disclosed in the Application, the Applicant has not received, has not applied for, and is not pursuing, any
funding (including tax credit funding) with respect to the Project and/or the Transaction.
6. Each form of "HUD Assistance” that is available to or is anticipated for the Project and/or the Transaction is fully disclosed in
the Financial Exhibits. “HUD Assistance” means any contract, grant, loan, cooperative agreement or other form of assistance,
including the insurance or guarantee of a loan or mortgage, that is provided under a program administered by the Department
of Housing and Urban Development for use in, or in connection with, the Project and/or the Transaction.
7. Each form of "Other Governmental Assistance” that is available to or is anticipated for the Project and/or the Transaction is
fully disclosed in the Financial Exhibits. “Other Governmental Assistance” means any loan, grant, guarantee, insurance,
payment, rebate, subsidy, credit, tax benefit, or any other form of direct or indirect assistance from the Federal government, a
State, or a unit of general local government, or any agency or instrumentality thereof, other than HUD Assistance.
8. The Applicant agrees to update the Financial Exhibits and to provide an updated Certification of Financial Exhibits in the
event that (A) there is any increase in estimated (or actual) total sources of funds; (B) any new form of HUD Assistance is
received or is applied for with regard to the Project and/or the Transaction; (C) any new form of Other Governmental
Assistance is received or is applied for with regard to the Project and/or the Transaction; or (D) there is any reduction in
estimated (or actual) total uses of funds. The Applicant acknowledges that this is a continuing requirement until the
Transaction has been closed, all assocated rehabilitation has been completed, and all associated financing transactions have
been completed.
9. Each use restriction, associated with any actual or proposed form of HUD Assistance or Other Governmental Assistance, is
fully disclosed in the Application, including the length of such use restriction and the key compliance requirements under such
use restriction.
10. The estimates presented in the Financial Exhibits were prepared not more than six months prior to the date that appears
below my signature.
Warning: HUD will prosecute false claims and statements. Conviction may result in criminal or civil penalties (18 USC
Sections 1001, 1010, 1012; 31 USC Sections 3729, 3802)

Authorized Signature __________________________________________________
Date: __________________________________________
By: enter name here
Of: 0
Its: enter role here
Phone Number of Individual Signing: enter phone number here

Application for Section 236 Preservation:
Applicant's Overall Certification
I, enter name here, as enter title here, in my capacity as the enter role here of 0 (the 'Applicant') make the following
representations and certifications to the United States Department of Housing and Urban Development ('HUD') on behalf of
the Owner in conjunction with the attached application (the 'Application') of Applicant for approval of a transaction for the
project known as: 0 (FHA project number 0).
I represent and certify that I have all requisite authority to execute this Certification and to bind the Applicant.
On behalf of the Applicant I represent and certify as follows:
1. The Applicant understands that HUD will rely upon this certification in evaluating the Application.
2. The Applicant has read and understands all published HUD guidance that is relevant to the proposed preservation
transaction.
3. The Owner has been advised that it should conduct such due diligence as it determines is necessary including but not
limited to consulting legal counsel in order to ensure that all statements contained in these certifications are true and
complete.
4. The information contained in the Application is accurate, complete, and not misleading.
5. Neither the Applicant, the proposed management agent of the Project, nor any Affiliates of the Applicant and the
management agent of the Project, are currently debarred or suspended from participation in
any federal program.
6. Neither the Applicant, the proposed management agent of the Project, nor any Affiliate of the Owner or management
agent, is subject to a Limited Denial of Participation.
7. There is no litigation or other claim pending or threatened against the Applicant or the Project other
than those listed herein:
No litigation
8. The Applicant has not received, applied for, and is not pursuing, any other funding with respect to the Project
(including, without limitation Low Income Housing Tax Credit funding); except as fully disclosed in the Application.
9. No judgment lien in favor of the government of the United States of America or any agency or instrumentality
thereof exists against the Project or any portion thereof.
10. Neither the Applicant nor any Affiliate of the Applicant has a delinquent federal debt.
Warning: HUD will prosecute false claims and statements. Conviction may result in
criminal or civil penalties (18 USC Sections 1001, 1001; 31 USC Sections 3729, 3802)

Authorized Signature __________________________________________________
Date: __________________________________________
By: enter name here
Of: 0
Its: enter role here
Phone Number of Individual Signing: enter phone number here