DI-381 Claim for Relocation Payments - Residential - Schedule D

DI-381 (03-2019)
Department of the Interior

OMB Control Number: 1084-0010
Expiration Date: 12/31/2021

Schedule D
Down Payment and Incidental Expenses – Residential
(Under Sec. 204 (b) P.L. 91-646, as amended)

Section 1 – To Be Completed By Claimant
1. NAME:

2. PROJECT/TRACT:

3. PRICE PAID FOR REPLACEMENT DWELLING:

$ __________________

4. DOWN PAYMENT ACTUALLY PAID FOR REPLACEMENT DWELLING:

$ __________________

5. INCIDENTAL EXPENSES: (Attach a copy of the closing statement and/or other documentation in support of the amounts claimed)
49CFR24.401(e)
ITEM

AMOUNT
CLAIMED

FOR AGENCY
USE ONLY

ITEM

AMOUNT
CLAIMED

FOR AGENCY
USE ONLY

LEGAL, CLOSING, AND
RELATED COSTS

$ __________

______________

ESCROW FEE

$ __________

______________

TITLE SEARCH FEE

$ __________

______________

TRANSFER TAXES

$ __________

______________

NOTARY FEE

$ __________

______________

$ __________

______________

RECORDING FEES

$ __________

______________

LOAN ORIGINATION OR
ASSUMPTION FEES (that do
not represent prepaid interest)

SURVEY COSTS

$ __________

______________

CERTIFICATION FEE

$ __________

______________

LENDER’S APPRAISAL FEE

$ __________

______________

HOME INSPECTION FEE

$ __________

______________

LENDER’S APPLICATION FEE $ __________

______________

TERMITE INSPECTION FEE

$ __________

______________

CREDIT REPORT FEE

$ __________

______________

$ __________

______________

OWNER’S AND MORTGAGEE’S $ __________
EVIDENCE OF TITLE

______________

COST OF POINTS
FOR MORTGAGE
OTHER (LIST) ___________

$ __________

______________

_______________________

$ __________

______________

_______________________

$ __________

______________

TOTAL

0.00
$ __________

0.00
______________

6. RENTAL ASSISTANCE PAYMENT PREVIOUSLY RECEIVED: (if any)
7. DOWN PAYMENT ADVANCED: (if any)

$ __________________

$ __________________

8.
SIGNATURE: ___________________________________________ SIGNATURE:
DATE: ___________________________________________

DATE:

___________________________________________
___________________________________________

9. REMARKS:

DI-381 Schedule D - Page 1 of 2

DI-381 (03-2019)
Department of the Interior

OMB Control Number: 1084-0010
Expiration Date: 12/31/2021

Section 2 – To Be Completed By Agency
COMPUTATION OF AMOUNT OF DOWN PAYMENT
PRICE OF A COMPARABLE DWELLING:

$ _______________

DOWN PAYMENT REQUIRED FOR
CONVENTIONAL MORTGAGE ON
COMPARABLE DWELLING:

$ _______________

PRICE PAID FOR REPLACEMENT DWELLING: $ _______________

TOTAL DOWN PAYMENT: (The lesser
of the difference between the
down payment for comparable plus
incidental costs or the down payment
actually paid plus incidental costs)

$ _______________

RENTAL ASSISTANCE
PREVIOUSLY RECEIVED:

$ ________________

DOWN PAYMENT ACTUALLY PAID
ON REPLACEMENT DWELLING:

$ _______________

DOWN PAYMENT ADVANCED:

$ ________________

INCIDENTAL COSTS:

$ _______________

TOTAL AMOUNT DUE:

$ ________________

PAYMENT

AMOUNT

SIGNATURE

TITLE

DATE

RECOMMENDED:

_________________

________________________________________

_________________

______________

APPROVED:

_________________

________________________________________

_________________

______________

FBMS INVOICE NO.:_________________

DI-381 Schedule D - Page 2 of 2