HUD-2742 Fiscal Data in Sipport of Claim for Multifamily Mortgage

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

Fiscal Data in Support of
Claim for Multifamily Mortgage
Insurance Benefits

OMB Approval No. 2502-0418 (exp.06/30/2021)

Public reporting burden for this collection of information is estimated to average 30 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 agency may
not collect this information, and you are not required to complete this form, unless it displays a currently valid OMB control number.
The information is collected to obtain required fiscal data for the Department to pay insurance benefits. The information provides the Department with the
necessary fiscal data to audit the claim submission and accurately compute insurance benefits owed to the lender. Payment of such benefits is cited in
Statute 12 USC 1713(g) of the National Housing Act. The information requested does not lend itself to confidentiality.
1. Date this Form Prepared

4. Date to Which Interest
Collected

2. Project No.

5. Date of Default

8. Date and Method of Acquisition
(if applicable)

3. Project Name and Property Address

6. Nature of Default

9. Date Mortgage Assigned or Property
Conveyed to the Secretary

Foreclosure
Deed in Lieu

Section I.
Mortgage
Balance
and
Disbursements

Escrow
Fund
and
Deductions

Section II.
Certificate
of Claim

7. Date of Election to
Assign or Convey

10. Date Receiver Appointed 11. Date Receiver Discharged 12. Employer Identification No.
(if applicable)
(if applicable)

Assigned
Conveyed

a. Unpaid Principal Balance of the Mortgage at Date of Default
b. Unpaid Balance of Advances by Mortgagee, Other than Mortgage Proceeds for:
1. Mortgage Insurance Premiums
2. Taxes, Ground Rents, Water Rates, etc. (Which are liens prior to the mortgage)
3. Insurance on the Property
c. Reasonable Expenses for Completion and Preservation of the Property
d. Balance of the Principal Face Amount of the Mortgage Not Heretofore Advanced to,
or for the Account of, the Mortgagor and Paid to HUD (Debenture Claim Only)
Total Mortgage Balance and Disbursements
e. Funds in Escrow at Date of Assignment or Conveyance for:
1. Mortgage Insurance Premiums
2. Taxes, Ground Rents, Water Rates, etc.
3. Hazard Insurance Premiums
4. Reserve for Replacements
5. Other
Total in Escrow Fund
f. Net Income Received from the Property from the date of default to the
Date of Assignment or Conveyance:
1. Total Collections (Schedule B)
$
2. Less: Operating Expenses (Schedule C)
$
g. Receipts from Other Sources after Default Date
h. One Per Cent (1%) of Item a., Above (Assignments only)
Net Claim
a.
b.
c.
d.

$
$
$
$

$
$
$
$

$
$
$
$
$
$

$
$
$

Foreclosure, Acquisition and Conveyance Cos
Reasonable Attorney's Fees Paid (Conveyances Only)
Amount Deducted Under Item h. of Section I
Other
Unadjusted Certificate of ClaiP

$
$
$
$
$
$
$

The amount of unadjusted claim will be increased by mortgage interest computed from the date of last payment to the date the mortgage is assigned
or the property is conveyed, less the amount of debenture interest paid by HUD from the date of default to the date of assignment.
Certification:“I/We, the undersigned, certify under penalty of perjury that the information provided above is true and correct. WARNING: Anyone who knowingly submits a false claim or makes a false statement is sub
ject to criminal and/or civil penalties, including confinement for up to 5 years, fines, and civil and administrative penalties. (18 U.S.C. §§287, 1001, 1010, 1012; 31 U.S.C. §3729, 3802)”

Name and Address of Mortgagee (Do not use A.D.P. rubber stamp)

Name and Address of Mortgagee's Servicer

(Debentures if issued will be inscribed exactly as shown herein)
Signature of Mortgagee Official or Servicer

Title

X
Send the original and 1 copy to:
Previous editions are obsolete.

Mortgagee/Servicer
retain 1 copy

U.S. Department of Housing and Urban Development
Multifamily Claims Branch, HWAFRC, Room 6252
451 Seventh Street, S.W.
Washington, D.C. 20410-8000

MortgageeOfficial
Servicer
form HUD-2742 (12/09)
ref. Handbook 4110.2