Form HUD-93232-A Supplement to Subscription Agreement for Cooperative Man

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

Supplement to Subscription
Agreement for Cooperative
Management-Type Applicants
Section 213 and 221(D)(3)

OMB Approval No. 2502-0058
(Exp. 7/31/2010)
Project Number

__________________

Case Number

__________________

Instructions: Submit original with (1) Credit Report, (2) Form HUD-92004F, (3) Form HUD-92004G, to the HUD Field Office.
See page 3 for Public Burden and Privacy Act Statements.
Applicant

Age

Married

Single

Co-subscriber

Married

Divorced

The information concerning minority group categories is requested solely for the purpose 1.
of determining compliance with Federal civil rights law, and your responses will not affect
2.
consideration of your application. By providing this information you will assist us in
3.
ensuring that this program is administered in a nondiscriminatory manner.

Age

Single

Divorced

White, not of Hispanic Origin
Black, not of Hispanic Origin
American Indian or Alaskan Native

Present Address

Property Address

Home Phone

Business Phone

4.
5.
6.

Asian or Pacific Islander
Hispanic
Male
Female

Names, Ages and Relationship of Others Who Will Occupy the Dwelling

Present Landlord Name (If applicant is a home owner, fill in only applicable items.)Present Landlord Address

Number of Rooms Occupied

Rental Charge

Occupancy Since

Lease Expires

Previous Landlord Name

Previous Landlord Address

By (Signature of Mortgagee Official)

(Title of Mortgagee Official)

A. Subscriber's Statement

B. Required Cash Investment and Monthly Payment

The following statements are submitted for obtaining credit in connection
with:
A member of a cooperative organized under
Section
213
Section
221(d)(3)
Other
Section
________________

1. Total investment required
$ ____________________
2. Amount paid
$ ____________________
3. Balance due
$ ____________________
Amount indicated in Item 3 will be paid fromthe following source:

____________________________________________________________
4. Estimated monthly charge for applicant's unit $ ____________________
C. Employment Status: (Attach Additional Statement if More than Two Wage Earners)
1. Subscriber
2. Co-Subscriber
Employer's Name

Employer's Name

Employer's Address

Employer's Address

Type of Business

Type of Business

Position Occupied

Position Occupied

Name and Title of Supervisor

Name and Title of Supervisor

Number of Years in Present Employment*

Number of Years in Present Employment*

*Note: If less than two (2) years, attach rider giving same details with respect to prior employment status.

Replaces FHA 3232A which may be used until supply is exhausted.

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form HUD-93232-A (12/80)

D. Annual Income

E. Annual Fixed Charges (Past 12 Months)

Base pay for applicant
$ ____________________
(Based upon current rate of earnings, except
earnings from commissions or fees, which should
be reported on the basis of the past 12 months.)

Federal and State income tax
Premium on life insurance
Social Security & Retirement contributions
Payment on installment accounts
Mortgage or Contract Payments on Other Real
Estate from Schedule I
Payments on other loans
Total Income

Overtime or other employment earnings

$ ____________________

Base pay of co-subscriber

$ ____________________

Overtime or other employment earnings

$ ____________________

Net income from real estate, from Schedule I
$ ____________________
Income from other sources: (List sources and amounts)
______________________________________ $ ____________________
______________________________________ $ ____________________
______________________________________ $ ____________________
______________________________________ $ ____________________
Total Income

$ ____________________

$ ____________________
$ ____________________
$ ____________________
$ ____________________
$ ____________________
$ ____________________
$ ____________________

F. Approximate Housing Expense (Past 12 Months)
(a) Mortgage payment or rent
(b) Taxes and insurance
(c) Heat
(d) Water, gas, electricity
(e) Maintenance
Total Housing Expense

$ ____________________
$ ____________________
$ ____________________
$ ____________________
$ ____________________
$ ____________________

G. Life Insurance (On Applicant)

H. Financial Statement

(1) Total in Force $ _____________ Cash Value $ ____________________

A combined statement may be made for applicants who are Husband and Wife.
In other cases a separate statement must be filed for each subscriber on Form
____________________ . An applicant who derives his/her principal income
from his/her own business must attach a current balance sheet and operating
statement of the business.

(2) Less amount of loans on Policies

$ ____________________

(3) Net cash surrender value

$ ____________________

Statement Date

Assets

Liabilities

Cash Accounts (List) Where Deposited
1. Checking account
______________________________________ $ ____________________
2. Savings account
______________________________________ $ ____________________
3. U.S. Savings Bonds
$ ____________________
4. Stocks and other Bonds
$ ____________________
5. Deposit under subscription agreement
$ ____________________
6. Other important assets (List or attach schedule)
______________________________________
____________________
______________________________________
____________________

Accounts payable (except installment accounts)
Installment account payable, automobile
Monthly payment $ _________________
Other installment accounts payable
Monthly payment $ _________________
Notes payable balance due
Repayment terms for __________ months
at $ ________________ per month.
Other liabilities
Repayment terms for __________ months
at $ ________________ per month.

$ ____________________
$ ____________________
$ ____________________
$ ____________________

$ ____________________

I. Real Estate Owned (If more than one property is owned attach separate schedule)
Type and Address of Property

Name and Address of Mortgagee

Estimated Resale Value
Income

Indebtedness

Annual Payment Principal
and Interest

Estimated Annual Gross
Income (a)

Estimated Annual Operating
Expense Including Taxes (b)

Estimated Annual Net
(a minus b)

$

$

$

$

$

$

J. Personal References*
Name and Address

Name and Address

Name and Address

Name and Address

*This information is not needed for FHA credit examination purposes but for the information of representatives of the cooperative.
Replaces FHA 3232A which may be used until supply is exhausted.

Page 2 of 3

form HUD-93232-A (12/80)

To the best of my/our knowledge, all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate.
Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802)
(Do not sign the following certification until the Statement has been completed)
This Statement (including the reverse side hereof) is made by the undersigned for the purpose of obtaining the benefits of a mortgage loan to be or which may
be insured under the provisions of the National Housing Act, and the undersigned hereby represents that to the best of his knowledge and belief, the statements,
information, and descriptions contained herein are in all respects true, correct, and complete. The Commissioner and mortgagee may verify the statements
contained herein by communicating with any of the persons or institutions named in this statement.
Subscriber

Co-Subscriber

Public Reporting Burden for this collection of information is estimated to average 0.25 hours 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 information
is required to obtain benefits. HUD may not collect this information, and you are not required to complete this form, unless it displays a currently valid
OMB Control Number.
Section 213 and 221(d)(3) of the National Housing Act, as amended, authorizes the Secretary of the Department of Housing and Urban Development to
insure mortgages covering property held by a non-profit housing cooperation. The information is used by HUD to determine the capacity of the borrower
corporation and the infividual members to meet the statutory requirement for repayment. The Department requires the information to review the applicant’s
financial and credit history. If the information is not collected HUD would not be able to determine the capability of the borrower corporation or the
individual members to repay the insured mortgages. The information is considered confidential. While no assurances of confidentiality is pledged to
respondents, HUD generally discloses this data only in response to a Freedom of Information request.
Privacy Act Notice - The United States Department of Housing and Urban Development, Federal Housing Administration, is authorized to solicit the
information requested in this form by virtue of Title 12, United States Code, Section 1701 et seq., and regulations promulgated thereunder at Title 12, Code
of Federal Regulations. The information requested in this is to be used by the Department in determining whether you qualify. It will not be disclosed or
released outside the United Stated Department of Housing and Urban Development without your consent, except as required or permitted by law.

Replaces FHA 3232A which may be used until supply is exhausted.

Page 3 of 3

form HUD-93232-A (12/80)