92403.1 Mortgagor's and Architects Certification of Payment

Mortgagor's and Architect's
Certificate of Payment
Date:

Project Number:

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

OMB No. 2502-0602
exp. 05/31/2015

Project Name:

To: the Secretary of Housing and Urban Development:

To induce the Secretary of Housing and Urban Development, acting by and through the Assistant Secretary for Housing-Federal
Housing Commissioner, to initially endorse the instrument in the above-captioned case for mortgage insurance, or initially close
a capital advance under Section 202 or Section 811, and with the intent that said Commissioner may rely on the statements contained
herein as a basis for so doing, the Mortgagor and Architect hereby certify as follows:
As of the date hereof, the Mortgagor has paid to the Architect, in cash, or will pay upon this disbursement of funds, as a payment
on account of the Architect’s fee, the sum of: $
The Architect has received from the mortgagor, in cash, or will receive upon this disbursement of funds, as a payment on account
of the Architect’s fee, the sum of: $
We certify that no portion of the architect’s fee has been or will be returned in any form, either directly or indirectly, to the sponsor,
mortgagor, contractor, any officer, director, stockholder, or partner thereof, or any party(s) to this transaction.

I hereby certify that 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)
Name of Mortgagor:

Name of Architect:

By: (Signature & Date)

By: (Signature & Date)

X

X

Public reporting burden for this collection of information is estimated to average .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. The form is used by mortgagors for funds expended or obligated for construction related items; by mortgagees to request
mortgage insurance for funds so advanced. Furnishing of this information is required to obtain benefits, and failure to provide it may result
in your not receiving your benefits. In accordance with the Paperwork Reduction Act, HUD may not conduct or sponsor, and a person is not
required to respond to, a collection of information unless the collection displays a currently valid OMB control number.

form HUD-92403.1­OHF (1/95)
ref Handbooks 4470.1, 4571.4, & 4571.5