Form VA Form 26-1874 VA Form 26-1874 Claim Under Loan Guaranty

OMB Control No. 2900-0362
Respondent Burden: 1 Hour

CLAIM UNDER LOAN GUARANTY
(Chapter 37, Title 38, U.S.C.)

NOTE: Use this form only in connection with loans guaranteed under Sections 501, 502, 503, 505, and 507 of the Servicemen’s Readjustment Act
of 1944 as amended or Section 3710 of Title 38, U.S.C. Submit this form in duplicate (2). Signature required on original only. SEE BELOW FOR
DOCUMENTS REQUIRED AND INSTRUCTIONS.
Privacy Act Notice: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of 1974 or Title
38, Code of Federal Regulations 1.576 for routine uses (i.e., to a member of Congress inquiring on behalf of a veteran) as identified in the VA system of records,
55VA26, Loan Guaranty Home, Condominium and Manufactured Home Loan Applicant Records, Specially Adapted Housing Applicant Records and Vendee Loan
Applicant Records - VA, and published in the Federal Register. Your obligation to respond is required to obtain or retain benefits under 38 CFR 36.4321.
Respondent Burden: We need this information to determine the amount payable under the loan guaranty. Title 38, United States Code, allows us to ask for this
information. We estimate that you will need an average of 1 hour to review the instructions, find the information, and complete this form. VA cannot conduct or
sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not
displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.whitehouse.gov/omb/library/OMBINV.VA.EPA..html#VA. If desired, you
can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.
SUPPORTING DOCUMENTS REQUIRED

A. A Certified Statement of Account. This should be a copy of the
ledger history or equivalent from the inception of the loan or at
minimum from the date of default or the date of the first advance that
is claimed in Item 12, if it is earlier than the date of default. A key for
reading the ledger must also be included.

D. Copies of all deeds transferring title from the original
veteran-obligor through the owner holding title at liquidation. Put the
Social Security number or taxpayer identification number of each
obligor not listed in Items 2A through 2D on the corresponding deed.

B. Copy of paid receipts/invoices for items claimed in Items 12 and 13.

E. Copy of foreclosure document showing amount bid at sale when
property is not conveyed to VA (e.g. Trustee, Sheriff, or Foreclosure
Deed).

C. Bankruptcy docket report or equivalent (if applicable).
INSTRUCTIONS: The amounts shown in Item 11 are subject to VA audit. The amount listed in Item 11H will be increased by an amount equal to the interest on the
total eligible indebtedness from the date to which interest was paid to the date liquidation was completed (or other date established by VA under applicable
regulations). If VA declines to specify an amount as a credit to the debt incident to a foreclosure sale, the claim is subject to the limitation that the amount payable shall
in no event exceed VA’s liability under the guaranty. The earliest advance listed in Item 12 should be the partial amount actually advanced when the escrow account
first becomes depleted. This will normally occur prior to the loan termination date in Item 4, therefore, the amount in Item 11C should normally be zero if an advance is
listed in Item 12.

PURSUANT TO THE REGULATIONS ISSUED UNDER TITLE 38, U.S.C., THE UNDERSIGNED
SUBMITS A CLAIM FOR PAYMENT OF THE GUARANTY, AS SET FORTH BELOW
1. NAME AND ADDRESS OF CLAIMANT

2A. NAME(S) AND ADDRESS(ES) OF ORIGINAL VETERAN-OBLIGOR AND CO-OBLIGOR

2B. SOCIAL SECURITY OR TAXPAYER
IDENTIFICATION NUMBER(S) OF ORIGINAL
VETERAN-OBLIGOR AND CO-OBLIGOR

2C. NAME(S) AND ADDRESS(ES) OF LAST TITLE HOLDER(S)

2D. SOCIAL SECURITY OR TAXPAYER
IDENTIFICATION NUMBER(S) OF LAST
TITLE HOLDER(S)

3A. VA LOAN NO.

3B. HOLDER’S LOAN NO.

4. DATE OF LOAN TERMINATION
A. SALE DATE

B. VOLUNTARY CONVEYANCE DATE
DEED RECORDED

5. PAYMENTS
A. AMOUNT OF EACH PAYMENT (P&I)

$

B. TOTAL PAYMENTS RECEIVED

C. AMOUNT APPLIED TO INTEREST

$
A. AMOUNT

$

$

6. PREPAYMENT(S) TO PRINCIPAL (Include no-bid avoidance writeoffs)
B. DATE
A. AMOUNT

$
$
$
$

B. DATE

$
$
$
$

7. ORIGINAL LOAN AMOUNT

$
VA FORM
MAR 2005

D. AMOUNT APPLIED TO PRINCIPAL

8. PERCENT OF GUARANTY

9. DATE INTEREST COLLECTED TO

10. DATE OF FIRST UNCURED
DEFAULT

%

26-1874

EXISTING STOCKS OF VA FORM 26-1874, FEB 2002,
WILL BE USED.

(Continued on Reverse)

11. STATUS OF LOAN ACCOUNT
A. PRINCIPAL BALANCE OF DATE INTEREST WAS LAST PAID BY THE OBLIGOR

$

B. ADVANCES PRIOR TO DATE IN ITEM 4 (Itemize in Item 12)

+$

C. BALANCE IN T & I ACCOUNT ON DATE IN ITEM 4 (If negative, enter "0")

-$

D. SUBTOTAL

$

E. ADVANCES PAID AFTER DATE IN ITEM 4 (Itemize in Item 12)

+$

F. LIQUIDATION EXPENSES (Itemize in Item 13)

+$

G. MISCELLANEOUS CREDITS (Rents, Insurance refund, any remaining subsidy buydown
funds, etc.) (Attach an itemized listing of all miscellaneous credits)

-$

H. TOTAL AMOUNT CLAIMED (VA will increase amount claimed by amount of interest due
from date interest is collected from borrower to interest cutoff date, sale date, or confirmation
of sale) (See instructions)

$

I. PROCEEDS OF LIQUIDATION
OR SPECIFIED AMOUNT
(Check applicable box and give amount)

$

12. ITEMIZED ADVANCES
(Submit copies of paid receipts; attach separate listing if necessary)
A. DATE

B. PURPOSE

C. AMOUNT

(Whichever is greater)

13. ITEMIZED LIQUIDATION EXPENSES
(Submit copies of paid receipts; attach separate listing if necessary)
A. DATE

B. PURPOSE

C. AMOUNT

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

$

The undersigned hereby certifies that the information contained herein is true, accurate and complete, that this is a correct and valid claim, and that
payment therefore has not been received. The undersigned further certifies that it is the owner of the loan identified in Item 3A and that the
Certificate of Guaranty or Endorsement of Guaranty issued by the Secretary of Veterans Affairs in respect to such loan will be surrendered or
cancelled in accordance with 38 CFR 36.4333 upon full payment of this claim. If the undersigned fails or is unable to comply with the requirements
of 38 CFR 36.4333 upon full payment of this claim, it agrees to indemnify the Department of Veterans Affairs to the extent of any loss which may
be sustained by reason of such failure or inability.
14. NAME AND TELEPHONE NUMBER OF OFFICIAL WHOSE SIGNATURE APPEARS BELOW

15. OFFICIAL SIGNATURE AND TITLE

16. DATE

PENALTY: Federal statutes provide severe penalties for any fraud, intentional misrepresentation, or criminal connivance or conspiracy in making any claim upon or
against the Government of the United States, or any department or officer thereof, and obtaining or aiding to obtain the payment or approval of such claim.
VA FORM 26-1874, MAR 2005