RD 1980-86 Request for Reservation of Funds

Form RD 1980-86
(Rev 12-05)

FORM APPROVED
OMB NO. 0575-0078

UNITED STATES DEPARTMENT OF AGRICULTURE
RURAL DEVELOPMENT
SINGLE FAMILY HOUSING GUARANTEED LOAN PROGRAM (SFHGLP)

REQUEST FOR RESERVATION OF FUNDS
LENDER INFORMATION:
Submitting Lender Name: ________________________________________

Tax I.D. No. _________________________

Address: _____________________________________________________________________________________________

_____________________________________________________________________________________
Lender Contact Person: _________________________________________________________________________________
Contact Phone No. (______)______________________ Ext. ______

Fax No. (______)___________________________

Rural Development Approved Lender (Complete when Submitting Lender (listed above) is not an Rural Development Approved Lender):
Name: ____________________________________________________

Tax I.D. No. _______________________

APPLICANT/PROPERTY INFORMATION:
Reservation Amount Requested: $______________________

Is this a Refinance Loan?

Yes

Applicant and Co-Applicant are both First Time Homebuyers

If Yes, loan being refinanced is a Rural Development Single Family Housing

OR
Number People in Household: ______
Applicant Information

Guaranteed Loan
Direct Loan

Number of Dependents Under Age 18 or Full-time Student: ______

(Please complete, circle, or mark as appropriate)

Co-Applicant Information

(Please complete, circle, or mark as

appropriate)

Name: _________________________________________

Name: _________________________________________

SSN: _________________

SSN: _________________

Date of Birth: ______________

US Citizen:
Yes
No
Permanent Resident/Qualified Alien:
Veteran:
Gender:

Yes
M

No

Ethnicity:

(Check only One Box)

Disabled:

Yes
Yes

Date of Birth: ______________

US Citizen:
Yes
No
Permanent Resident/Qualified Alien:

No
No

F
Hispanic or Latino

Veteran:
Gender:

Yes
M

No

Disabled:

Ethnicity:

(Check only One Box)

Race:

Hispanic or Latino
Not Hispanic or Latino

Asian

Race:

Black or African American

American Indian or Alaska Native

Asian

Black or African American

Native Hawaiian or Other Pacific Islander

Married

No

(Check as many boxes as applicable)

American Indian or Alaska Native

Marital Status:

Yes

No

F

Not Hispanic or Latino
(Check as many boxes as applicable)

Yes

Separated

White

Unmarried

Native Hawaiian or Other Pacific Islander

Marital Status:

Married

Separated

White

Unmarried

Property Address: __________________________________________________________________________________________
City, State, Zip Code: ______________________________________________

County: ________________________

We are processing an application from the above named person(s), and expect to have a complete package to you within 60 days.
Please reserve funds for this loan. We have reviewed the applicant’s income and credit history and have tentatively determined the
applicant(s) has sufficient qualifying income and credit history to proceed with this application.

___________________________________________________
(Authorized Lender Representative/Official)

Date: ___________________________

According to the Paperwork Reduction Act of 1995, an agency may not conduct or sponsor, and a person is not required to respond to, a collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is 0575-0078. The time required to complete this information collection 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.