SAMS1110 Taxing Authority Profile

Single Family Acquired Asset
Management System (SAMS)

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

Taxing Authority Profile

This Is Not a Request for Tax Bills We are requesting and compiling
information for HUD tax bills. To ensure that the bills are paid on time
and for the proper tax period, please complete this form. Define only
one tax type per form. For additional tax types, please copy this form
and complete. Return immediately to the HUD HOC.

If collecting for more than one tax jurisdiction or tax type, please
indicate if the tax is consolidated in one bill or individually. Please
indicate how bills are accepted (Full/Installments).
Lines (1) through (4) under items 21 thru 27 allow for up to four installments
to be made in a year for a particular type of tax. Please indicate how bills are
accepted: as 1 full payment or in 2, 3, or 4 installments.

Instructions: See instructions on back for required adttachments. Send completed form to HUD HOC, Attention: Director, Home Ownership Center

I. DSAE Screen: Tax Authority's TIN & Name (Items 1 - 7)
1.

2. Tax Authority's TIN

3. Tax Authority's name

4. HOC Area Identifier

5. HOC Area Name

Add New Payee (complete entire form)

a.

Change Existing Payee

or b.

(complete items 2, 3, 7, and any changes)

6. Payee Type

7. Payee NAID (if established Payee)

TA

II. GBNA Screen Tax Authority's Address (Items 8 - 19)
8. Attention (Title Only)

9. Phone Number (Area Code)

10. Street Address

11. City

12. State

13. Zip Code + 4

18. State:

19. Zip Code + 4:

Remittance Information (only if different from above)
14. Name

15. Attention (Title Only)

16. Street Address

17. City

III. TXTP Screen Tax Type & Period (Items 20 - 32)
20. Tax Type (i.e., Real Estate, City, County) Enter only one code.

Enter Dates as mm/dd/yyyy
21. From Period

22. To Period

23. Due Date

24. Penalty Date

1st

2nd

3rd

25. Discount Date

26. Discount Date

27. Discount Date

(1)

(2)

(3)

(4)
28. Tax Year

29. Preparer's Signature (M&M Contractor)

30. Title

31. Date (mm/dd/yyyy)

32. Phone (Area Code)

34. Title

35. Date

36. Phone (Area Code)

38. Title

39. Date

40. Phone (Area Code)

X
IV. For HUD Use Only (Items 33 - 40)
33. Reviewer's Signature (M&M Supervisor/GTR)

X
37. Approver's Signature (HOC Director or designee)

X
Previous editions are obsolete

Page 1 of 2

form SAMS-1110 (05/2002)
ref Handbook 4310.5

Public reporting burden for this collection of information is estimated to average 12 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.
This information enables HUD to record and process financial transactions in its automated Single Family Acquired Asset Management System (SAMS)
to dispose of acquired single-family properties. HUD reimburses M&M Contractors for their services in maintaining, marketing, and selling HUD homes,
and HUD collects funds associated with the sales of these properties. The information enables HUD to create and maintain sound financial management
practices and effective internal controls over the property disposition program. A response is required to obtain or maintain a benefit.

Instructions for Completion of Form SAMS-1110 (Please use typewriter or print in ink)
The File ID No. should be a sequential number assigned by the originator of
the form. Enter today's date in next block.
1. Check One: Indicate whether tax authority is being added, modified,
or deleted.
2. Tax Authority's TIN: Indicate the Tax Identification Number or the
Federal Tax Exemption Number. These numbers have previously been
assigned by the IRS.
3. Tax Authority's Name: Indicate the name of the taxing authority.
4. HOC Area Identifier: Enter the HUD Area identifier (e.g., P1 for
Philadelphia Area 1).
5. HOC Area Name: Enter the HUD HOC Area name (e.g., Philadelphia
Area 1).
7. Tax Authority's NAID: Enter the name/address identifier (NAID) if
established payee.
8. Attn: Indicate the title of the contact person for the taxing authority.
9. Phone Number: Indicate the phone number of the taxing authority.
10-13. Tax Authority's Address: Indicate the address of the taxing
authority.
14-19. Remittance Information: Indicate the remitter name and mailing
address only if different from above.
20. Tax Type: Indicate the type of tax (i.e., RE = Real Estate) using the
codes below.
Tax Type Codes
AG
Agriculture Tax
BD
Bond Tax
BO
Borough Tax
CA
Central Appraisal Ag
CC
Central Coll. Agency
CI
City Tax
CM
Combined Tax
CO
County Tax
CS
City and School Dist
EX
Excise Tax
FI
Fire District
GR
Ground Rent Tax
GV
Government Tax
HS
Hospital Tax
IR
Irrigation District
JC
Jr College Sch Dist
LI
Loan Improvement
LV
Levee Tax
MH
Mobile Home
MN
Minerals Tax
MS
Miscellaneous Tax

Previous editions are obsolete

OT
PA
PL
PP
RD
RE
RF
S1
S2
SA
SH
SR
SW
TO
UT
VI
WF
WM
WS
XX

21-22. From Period/To Period: Actual period covered by a payment. This
may be a calendar year or fiscal year or a part thereof.
23. Due Date: Date that the tax payment is due.
24. Penalty Date: Last payment date on which payment may be rendered
without penalty.
25-27. Discount Dates: Indicates up to three discount dates which may be
allowed for early payment. Please indicate discount date if available.
28. Tax Year: Year relating to the from period/to period dates which
together show a taxing authority's billing cycle.
29-32. Preparer's Signature: Enter legible signature, title, phone number,
and date signed.
33-36. Reviewer's Signature: Enter legible signature, title, phone number,
and date signed.
37-40. Approver's Signature: Enter legible signature, title, phone number,
of the Director, Home Ownership Center or designee and date signed.
If the taxing authority has the capability to accept an automated interface for
requesting bills or payment, please provide the specifications. Please
provide the format the taxing authority requires for the tax bills requested.

Other Tax
Parish Tax
Pilot Tax
Personal Property
Road Tax
Real Estate/Property
Refuse
Subdiv Maint/Escrow
Subdiv Maint/Non-Esc
Special Assessment
School Tax
Shelter Rent Tax
Solid Waste Tax
Town Tax
Utility District Tax
Village (Incorp) Tax
Waste Fee District
Water Meters
Water and Sewer
Exempt from taxes

Page 2 of 2

form SAMS-1110 (05/2002)
ref Handbook 4310.5