RD 3550-09 Initial Escrow Account Disclosure Statement

Form RD 3550-9
(Rev. 10-06)

Form Approved
OMB No. 0575-0172

United States Department of Agriculture
Rural Housing Service

INITIAL ESCROW ACCOUNT DISCLOSURE STATEMENT
Borrower Name and Address

Disclosure Date:

Lender’s Name and Address

Loan No.
Telephone No.

Your mortgage payment for the coming year will be $
will be for principal and interest, and $
Your first monthly mortgage payment for the coming year will be $
will be for principal and interest, and $
in changes to the principal and interest payments during the year.

of which $
will go into your escrow account.
of which $
will go into your escrow account. The terms of your loan may result

This is an estimate of activity in your escrow account during the coming year based on payments anticipated to be made from your
account.

Month/
Payment No.
Starting Balance:

Payments to
Escrow Acct.

Payments from
Escrow Acct.

Escrow Acct.
Balance

Description
$

(Please keep this statement for comparison with the actual activity in your account at the end of the escrow accounting computation year.)
Cushion selected by servicer: $

(Borrower Signature)

(Borrower Signature)

(Date Siged)

(Date Siged)

According to the Paperwork Reduction Act of 1995, no persons are 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 0575-0172. The time required to complete this
information collection is estimated to average 5 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.