HUD XXXX Pre Foreclosure Sale Closing Worksheet

OMB Approval No. XXX-XXX

(Expires XX/XX/20XX)

Office of Native American Programs

S ection 184 Program

Pre-Foreclosure Sale Closing Worksheet

1. Section 184 Case Number

2. Holder

2a. Name

2b. Loan Number

2c. Land Type

2d. Contact’s Last Name

2e. First Name

2f. Middle Name

2g. Contact’s Phone Number

2h. Contact’s Email

3. Seller(s)

3a. Seller’s Last Name	3b. First Name	3c. Middle Name
3d. Co-Seller’s Last Name	3e. First Name	3f. Middle Name

4. Property

4a. Street Address

4b. City

4c. State

4d. Zip Code

5. Servicer

5a. Name

5b. Contact’s Last Name

5c. First Name

5d. Middle Name

5e. Contact’s Phone Number

5f. Contact’s Email

5g. Street Address

5h. City

5i. State

5j. Zip Code

6. Purchaser(s)

6a. Purchaser’s Last Name or Tribe/Entity	6b. First Name	6c. Middle Name
6d. Co-Purchaser’s Last Name	6e. First Name	6f. Middle Name

6g. Street Address

6h. City

6i. State

6j. Zip Code

6k. Phone Number

7. Sale

7a. New Type of Financing (e.g., FHA, VA, Conventional, Other)

7b. Date Sales Contract Approved

7c. Sale Commission (%)

8. Sales Calculation Worksheet

Sale Price	$
Less, Sales Commission	$
Other	$
Other	$
Other	$
Consideration to Owner-Occupant Seller	$
Total Amount Payable from Sales Proceeds	$
Net Proceeds to Lender	$
Total Amount Paid to the Seller(s)	$

I, the undersigned, certify under penalty of perjury that the information provided above is true, correct. and accurate. WARNING: Anyone who knowingly submits a false claim or makes a false statement is subject 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, 1014; 31 U.S.C. §3729, 3802).

9. Signatures

9a. Sales’s Agent/Broker’s Last Name

9b. First Name

9c. Middle Name

9d. Sale’s Agent/Broker’s Signature

9e. Date

9f. Holder’s Authorized Official’s Last Name

9g. First Name

9h. Middle Name

9i. Holder’s Authorized Official’s Signature

9j. Date

9k. Closing Agent’s Last Name

9l. First Name

9m. Middle Name

9n. Closing Agent’s Signature

9o. Date

By signing, the Agent/Broker certifies that there are no hidden terms or special understandings with the buyer, seller, appraiser, closing agent, or lender.

Burden Notice: Sections 184 of the Housing and Community Development Act of 1992, as amended, authorizes the Secretary to pay claims to a lender in the event of borrower default and where all reasonable efforts of collection by the lender have been exhausted, which includes loss mitigation involving pre-foreclosure sale of the defaulted borrower’s property. The respondents are defaulted Section 184 borrowers who are attempting to sell their property to avoid foreclosure. Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. Send comments regarding this burden estimate or any other aspect of this collection of information, including suggestions to reduce this burden, to the Reports Management Officer, REE, U.S. Department of Housing and Urban Development, 451 7th Street SW, Room 4176, Washington, DC 20410-5000. When providing comments, please refer to OMB Approval No. 2577-XXXX. HUD may not collect this information, and you are not required to complete this form, unless it displays a valid OMB control number. HUD is authorized to solicit the information requested in the form by virtue of 12 U.S.C. § 1715z-13a and 24 C.F.R. Part 1005. While no assurance of confidentiality is pledged to respondents, HUD generally discloses this data only in response to a Freedom of Information Act request.

Page 2 of 2 Form HUD-5xxxx (02/2024)