Voluntary Suspension Form

OMB Control Number: 3170-0012
Expiration: 06/30/2015

Request for Suspension of
Statement of Record Effective Date
Subdivision Name:
Developer:
ILS Number:

_________________________________________
_________________________________________
______________

Pursuant to 12 CFR 1010.21(b), the developer of the above-referenced subdivision hereby requests
the suspension of the effective date of its statement of record together with all amendments and/or
consolidations filed subsequent to the initial statement of record.
The basis for granting the suspension is:

[INSERT BASIS HERE]
The developer certifies that: (i) the developer does not have any outstanding annual financial
statements required to have been filed pursuant to 12 CFR 1010.212(d) or which are under pending
review with the Bureau; (ii) the developer does not have any outstanding annual reports of activity
required to have been filed pursuant to 12 CFR 1010.310 (including outstanding fees owed under 12
CFR 1010.35) or which are under pending review with the Bureau; or (iii) the developer is not the
subject of an administrative proceeding filed by the Bureau.
The effectiveness of the statement of record is suspended effective with the date of execution by the
developer.
Developer:

_________________________________

By:
_________________________________
Printed name: _________________________________
Title:
_________________________________

Date: _____________

(Corporate Seal)

The Consumer Financial Protection Bureau (CFPB) is authorized to collect this information by 12 CFR 1010. 100 1010.219 and The Interstate Land Sales Full Disclosure Act, 15 U.S.C. 1701, et seq., and requires developers to register
subdivisions or condominiums of 100 or more non-exempt lots or units with CFPB. The developer must give each
purchaser a property report that meets CFPB’s requirements before the purchaser signs the sales contract or agreement
for sale or lease. The property report contains the information purchasers need to make informed land or condominium
unit purchases. Information gathered from Financial Statements, Restrictive Covenants are required to be made
available to prospective purchasers. Most of this information is public information. Information about complainants,
open investigations are not public.
Public reporting burden for this collection of information is estimated at .08 hours 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 agency may not collect this information, and you are not required to complete this form, unless it displays a
currently valid OMB control number. The OMB control number for this form is 3170-0012, and expires on
06/30/2015.
The CFPB will not disclose any personally identifiable information collected except to the extent that it is required to do
so by law and as provided in the Privacy Act Notice below. Additionally, the CFPB will treat the information received
consistent with its confidentiality regulations at 12 C.F.R. Part 1070, et seq. You are not required to submit the
information requested above or provide any identifying information. However, if you do not provide the requested
identifying information, the CFPB may not be able to take action on your request fully.

Notice of Collection Under the Privacy Act of 1974, 5 U.S.C. § 552a -- As Amended
(Privacy Act Notice): The information in the system allows for the submission of information
related to interstate land sales registrations pursuant to the requirements of the Interstate Land Sales
Full Disclosure Act, 90, codified at 15 U.S.C. 170, et seq. Identifying information collected may be
used by and disclosed as permitted by the Privacy Act, 5 U.S.C. § 552a, to employees, contractors,
agents, and others authorized by the Consumer Financial Protection Bureau to receive this
information to assist in related activities. It may also be disclosed:
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to a court, magistrate, or administrative tribunal in the course of a proceeding;
for enforcement, statutory, and regulatory purposes;
to another federal or state agency or regulatory authority;
to a member of Congress; to the Department of Justice, a court, an adjudicative body or
administrative tribunal, or a party in litigation;
to the public, members of the media, federal, state, and local government officials, or other
recipients of public relations materials issued by the CFPB about the activities of the CFPB;
and
pursuant to the CFPB’s published Privacy Act system of records notice, CFPB.012 –
Interstate Land Sales..

The collection of this information is authorized by 12 CFR 1010. 100 - 1010.219 and the Interstate
Land Sales Full Disclosure Act, 15 U.S.C. 1701, et seq.