Form HUD 92466 HUD 92466 Regulatory Agreement Multifamily Housing Projects

1
Request for Endorsement of Credit
Instrument & Certificate of Lender,
Borrower& General Contractor

U.S. Department of Housing
and Urban Development

OMB Approval No. 2502-0598
(Exp. 06/30/2017)

Office of Housing

Public Reporting Burden for this collection of information is estimated to average 0.75 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.
Response to this request for information is required in order to receive the benefits to be derived. 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. While no assurance of confidentiality is pledged to
respondents, HUD generally discloses this data only in response to a Freedom of Information Act request.

Project Name:

Project Number:

Project Address:

Date of Commitment:

Lender:

Borrower:

 Traditional Application Processing (TAP)
 Multifamily Accelerated Processing (MAP)
 Other

 Insurance upon Completion under Section ______
 Refinancing under Section ____ pursuant to Section ____

To the U.S. Department of Housing and Urban Development (HUD):
GENERAL
The entities executing this Request for Endorsement of Credit Instrument (“Request”) are
__________________________________________, Lender under that certain Security Instrument
dated ___________________, 20____; _____________________________________, Borrower
under the Security Instrument; and, in cases involving insurance upon completion,
____________________________________, General Contractor, the entity responsible for
construction or substantial rehabilitation of the Project. The parties hereto understand that the
Security Instrument, the Note, this Request, and any documents submitted with this Request are
considered to be consistent with and shall be interpreted consistently with HUD’s regulations as they
pertain to the Contract of Insurance. The parties hereto agree to be bound by Program Obligations.
(The definition of any capitalized term or word used herein can be found in this Request, the
Regulatory Agreement between Borrower and HUD, the Note, and/or the Security Instrument, except
that the term “Program Obligations” means (1) all applicable statutes and any regulations issued
by the Secretary pursuant thereto that apply to the Project, including all amendments to such statutes
and regulations, as they become effective, except that changes subject to notice and comment
rulemaking shall become effective only upon completion of the rulemaking process, and (2) all
current requirements in HUD handbooks and guides, notices, and mortgagee letters that apply to the
Project, and all future updates, changes and amendments thereto, as they become effective, except
that changes subject to notice and comment rulemaking shall become effective only upon completion
of the rulemaking process, and provided that such future updates, changes and amendments shall
be applicable to the Project only to the extent that they interpret, clarify and implement terms in this
Request rather than add or delete provisions from such document. Handbooks, guides, notices, and
mortgagee letters are available on HUD's official website:
(http://www.hud.gov/offices/adm/hudclips/index.cfm or a successor location to that site).
Previous editions are obsolete;
Replaces form FHA-2455 (02/73)

Request for Endorsement
.

HUD-92455M (Rev. 04/11)

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I. CERTIFICATE OF LENDER
A. LENDER SUBMISSIONS & REPRESENTATIONS
1. Lender submits separately a check to HUD for $____________ covering the first mortgage
insurance premium, together with the other items called for in the Firm Commitment dated
____________, 20___, and in any extensions or amendments thereof. Lender certifies that all
conditions of the Firm Commitment have been fulfilled to date, including any work done prior to
endorsement of the Note that has been approved by HUD, in writing, and all HUD-imposed
conditions have been met with respect to such work.
2. Lender submits separately the appropriate security agreement(s) executed by Borrower covering
all of the Mortgaged Property that, under applicable law, may be subject to a security interest under
the Uniform Commercial Code (“UCC”), whether acquired now or in the future, and all products and
cash proceeds and non-cash proceeds thereof (“UCC Collateral”).
3. Lender submits separately a certified survey of the Mortgaged Property, if required by HUD, and a
title policy as specified in Program Obligations together with evidence that the Mortgaged Property is
properly zoned.
4. Lender agrees that the amount approved for disbursement by HUD shall not be released unless
the current endorsement to the title policy, insuring Lender and HUD, evidences that (a) the lien of
the Security Instrument is prior to all liens and encumbrances that may have attached or defects that
may have arisen subsequent to the recording of the Security Instrument, except such liens or other
matters approved by HUD, including tax liens not delinquent, and (b) the lien of the Security
Instrument is prior to all mechanics’ and materialman’s liens filed of record subsequent to the
recording of the Security Instrument, regardless of whether such liens attached prior to the recording
date.
5. Lender agrees to: (a) obtain the prior written approval and/or consent of HUD in those instances
required in the Security Instrument; (b) furnish HUD with all pleadings, reports and data in those
instances required in the Security Instrument, including but not limited to the physical inspection
report of the Mortgaged Property, except for physical inspections performed by HUD or on behalf of
HUD, and financial reporting data; and (c) furnish HUD with a copy of any application by Lender for
the appointment of a receiver pursuant to the Security Instrument and all related pleadings.
6. Lender agrees to furnish a copy of this Request to any successors and assigns of Lender and
agrees that, in any contract for sale or assignment of the Security Instrument to a successor Lender
(for purposes of servicing the Loan only), the successor Lender will agree to be bound by the
provisions of this Request that relate to the servicing of the Loan.
7. To the best of our knowledge and information, any required repairs have been completed in
accordance with Program Obligations, except for such items approved by HUD for delayed

Previous editions are obsolete;
Replaces form FHA-2455 (02/73)

Request for Endorsement
.

HUD-92455M (Rev. 04/11)

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completion or non-critical deferred repairs as indicated on a separate schedule attached hereto as
Exhibit ___.
8. Impound accounts for taxes, insurance and mortgage insurance premiums have been established
and are adequately funded.
9. Lender agrees (a) to require Borrower to keep the Mortgaged Property insured at all times against
such hazards as Lender and HUD may from time to time require and as set forth in the Security
Instrument, and (b) to notify HUD of any known payments made by an insurer.
10. Lender certifies that all insurance policies on the Project comply with the terms of the Security
Instrument and, where applicable, that those insurance policies have attached thereto a standard
mortgagee clause making the loss payable to Lender, as its interest may appear, and where
applicable, Lender is shown as an additional insured. If Lender determined that any of the
Improvements are located in an area identified by the Federal Emergency Management Agency (or
any successor to that agency) as an area having special flood hazards, Lender certifies that it has
collected a receipt from the insurance company providing flood insurance evidencing payment for the
premium, dated _______,
11. The term “Financing Charge(s),” as used herein shall mean any charge, direct or indirect, for
supplying the Loan to Borrower or servicing the Loan for HUD, Ginnie Mae, a third party investor or
Lender’s own account.
12. If the Security Instrument is assigned to HUD under the Contract of Insurance, HUD shall not be
bound by the requirements of this Request.
13. Lender agrees to promptly review any Borrower’s request to transfer the Project and not
unreasonably withhold Lender’s approval of the transfer. If HUD approves the transfer, Lender
agrees to execute a release and assumption agreement or a security instrument modification
agreement incorporating any new Regulatory Agreement into the existing Security Instrument. It is
understood that Lender’s consent to the transfer will in no way prejudice Lender’s rights under the
Contract of Insurance with HUD.
14. Lender agrees (a) to notify HUD in writing immediately upon learning of any Violation of the
Regulatory Agreement by Borrower, (b) that Violations under the terms of the Regulatory Agreement
may only be treated as a default under the Security Instrument where HUD requests Lender to do so,
and (c) following a Declaration of Default by HUD under the Regulatory Agreement and upon the
request by HUD, Lender, at its option, may declare the entire Indebtedness to be due and payable.
B. FEES AND CHARGES BY LENDER
The charges enumerated on a separate schedule prepared by Lender are attached hereto as Exhibit
____. The charges have been (i) collected in cash or will be so collected not later than the date of
initial endorsement; (ii) will be disbursed from Loan proceeds; or (iii) will be collected or disbursed as
otherwise set forth in Program Obligations.

Previous editions are obsolete;
Replaces form FHA-2455 (02/73)

Request for Endorsement
.

HUD-92455M (Rev. 04/11)

4

C. ESCROWS AND DEPOSITS HELD BY LENDER
1. Borrower has deposited with Lender, or subject to the control and order of Lender in a depository
satisfactory to Lender, in accordance with Program Obligations, the following sums required by the
Firm Commitment: (Check and complete applicable paragraphs.)

(a) Escrow deposit guaranteeing payment for off-site facilities in the amount of
$____________. This deposit is in the form of _____ ___________ (cash or letter of credit). The
Escrow Agreement for Off-Site Facilities is dated __________________, 20__, and is executed by
_________________________.

(b) Lender has received from Borrower a working capital deposit in the form of (cash or letter
of credit)______ _______ in the sum of $_______ ____, which Lender agrees to maintain and
control. Funds in this deposit may be released or allocated for the purposes indicated in the Escrow
Agreement for Working Capital (dated _____________, 20__, and executed by ____________) and
for no other purpose unless Lender obtains the prior written approval of HUD.

(c) Lender has [collected from Borrower in cash] OR [set aside from the final disbursement of
Loan proceeds] funds totaling [150% of the amount necessary to complete the items of delayed
completion] OR [120% of the amount necessary to complete non-critical, deferred repairs] described
in Paragraph I.A.7, above. The [Escrow Agreement for Incomplete Construction] OR [Escrow
Agreement of Non-critical Deferred Repairs] is attached hereto.
2. Lender submits separately: (Check applicable paragraphs.)


(a) Off-site bond in the amount of $______________.


(b) Evidence to the effect that required off-site utilities and streets will be provided by the
public authorities having jurisdiction or by public utility companies serving the Project.
3. As required by the Firm Commitment (if required, check and complete the applicable paragraph):

Submitted separately is the sponsor’s guarantee to meet an initial operating deficit (dated
_______, 20__, and executed by ________).

Escrow Agreement for Operating Deficit evidencing a (cash, or letter of credit)
_________________ deposit in the amount of $___________, dated ______, 20__, and executed by
_____________.
4. List any other escrows:
5. Beginning with the date on which the first payment toward amortization is required to be made by
the terms of the insured Loan or at such later date as may be agreed to by HUD in writing, Lender
shall require a monthly deposit with Lender or in a depository satisfactory to Lender in accordance
with Program Obligations of the sum required by the HUD Regulatory Agreement constituting a
Previous editions are obsolete;
Replaces form FHA-2455 (02/73)

Request for Endorsement
.

HUD-92455M (Rev. 04/11)

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Reserve for Replacement, which account shall be subject to Lender’s order and from which account
withdrawals may be made only upon the receipt of HUD’s written permission. Lender acknowledges
that the amount of the monthly deposit may be increased or decreased from time to time at the
direction of HUD in accordance with Program Obligations. Such funds shall at all times remain under
the control of Lender or Lender’s designee and shall be held in accounts insured or guaranteed by a
federal agency and in accordance with Program Obligations. Notice of any failure to receive the
required deposits shall be forwarded to HUD within 60 days of the date such deposits are due.
6. In cases where a Residual Receipts account is required with respect to the Loan under the
Regulatory Agreement, Lender shall deposit or place in a depository satisfactory to Lender, in
accordance with Program Obligations, all funds received from Borrower for deposit therein. The
Residual Receipts account will be subject to the control of Lender, and withdrawals may be made
only with the prior written approval of HUD. These funds shall be held in an interest-bearing account
which shall be insured or guaranteed by a federal agency and in accordance with Program
Obligations. Lender agrees to notify HUD in writing of any non-compliance with Program Obligations
with respect to such Residual Receipts account immediately when known to Lender.
D. CERTIFICATIONS, AGREEMENTS, AND ACKNOWLEDGEMENTS
1. Lender certifies and agrees that no financing charges other than charges disclosed herein have
been or shall be made. Until final endorsement for insurance by HUD, all funds collected pursuant to
items (c), (d), or (e) below and not paid over to the permanent lender, plus any funds returned by the
permanent lender, shall be held for the account of Borrower and shall be subject to HUD’s control
and direction in the event of a claim under the Contract of Insurance.
Lender further certifies and agrees that: (Check and complete the following applicable
subparagraphs)
 (a) Lender has not imposed and will not impose a financing charge of any kind directly or
indirectly, other than the initial service charge.
 (b) In addition to the initial service charge, Lender has collected in the form of (cash or letter of
credit) ______________ for the amount of $____________ as a discount or financing charge for the
construction loan. Also, an amount of $___________ has been collected in the form of (cash or
letter of credit) _____________ to cover construction Loan extension fees. In an attached
addendum, Lender has identified the time frames in which the extension fees must be paid.
 (c) Lender intends to retain the permanent loan and has collected a permanent placement fee of
$______________. In addition to the initial service charge and permanent placement fee, Lender
has collected in the form of (cash or letter of credit) __________________ the amount of
$____________ as a discount or financing charge for the permanent loan.
 (d) Lender has a firm commitment from __________________________ to purchase the
Loan when fully disbursed and fully insured at a financing charge or discount of _ __ percent and
Lender has collected in the form of (cash or letter of credit) ______________________ the amount
of $___________ to cover said charge or discount.
Previous editions are obsolete;
Replaces form FHA-2455 (02/73)

Request for Endorsement
.

HUD-92455M (Rev. 04/11)

6

 (e) This Project shall be financed with (tax-exempt or taxable) __________ bonds. Therefore,
Lender has collected in the form of (cash or letter of credit) ________________ the amount of
$___________ and has distributed or shall distribute from Loan proceeds the amount of
$______________ to cover the costs of issuance. A statement is attached as Exhibit __ itemizing
these costs with an explanation of the necessity of each cost and the source of the funds.
 (f) The Loan is a unitary loan under which the Lender intends to retain the Loan for both the
construction and permanent loan terms. Lender has collected a unitary loan placement fee of
$___________. In addition to the initial service charge and the unitary loan placement fee, Lender
has collected in the form of (cash or letter of credit) __________ the amount of $_________ as a
discount or financing charge for the unitary loan.
 (g) Additional financing charges or discount of $_____________ are to be collected under
Exhibit ___ attached hereto for the purpose shown in (b), (c), (d), (e), or (f). (Strike inapplicable
letters) The arrangement for the collection of additional financing charges or discount must follow
Program Obligations and use forms prescribed by HUD.
 (h) The Note rate includes a servicing fee payable to Lender monthly during the life of the Loan
(“Servicing Fees”). In addition, the Lender may impose reasonable and customary administrative
fees and charges (including but not limited to, reimbursements for out-of-pocket expenses) for
handling and investing the cash held in the Reserve for Replacement, the Residual Receipts
account, if applicable, and any other interest-bearing escrows related to the Project and for
processing, reviewing and approving other matters, as more fully set forth in Program Obligations
(“Administrative Fees”). Borrower is entitled to earn interest on the Reserve for Replacement and
Residual Receipts accounts, as more fully set forth in Program Obligations. Lender shall not invest
escrow account monies in interest-bearing account unless interest earned is added to and included in
the relevant escrow account, and unless the net income is paid or credited to the account of
Borrower. Net income is defined as the earnings remaining after the following expenses are
deducted: (i) any Servicing Fees, and (ii) any Administrative Fees.
 (i) The Loan to be made to Borrower will be financed through funds being provided by a thirdparty investor through the issuance to the investor of permanent participation certificates pursuant to
a participation agreement between Lender and the investor, with respect to which agreement Lender
has agreed to repay the investor at a stated interest rate according to a fixed payment schedule.
 (j) The Loan to be made to Borrower will be financed through funds being provided by a thirdparty investor through the issuance to the investor of construction and permanent fully-modified,
pass-through, mortgage-backed securities, guaranteed as to principal and interest by Ginnie Mae.
2. Lender certifies and agrees that, except for (a) Loan advances made in accordance with Program
Obligations, (b) notes executed pursuant to D.1(g) above, or (c) Lender advances made pursuant to
the Security Instrument, Lender does not have outstanding and shall not make loans or advances to
Borrower, any of the sponsors, the general contractor, or the architect for any purpose connected
directly or indirectly with this Project without prior written approval of HUD and that Lender has not
made or offered, and shall not make or offer, any guarantees, pledges, reservations of sums to
Previous editions are obsolete;
Replaces form FHA-2455 (02/73)

Request for Endorsement
.

HUD-92455M (Rev. 04/11)

7
become due or other inducements to any entity or person to make loans or advances which Lender
would be prohibited from making under the terms of this paragraph.
3. Lender certifies that Lender has not made and shall not make payment of any kickback or fee or
other consideration, directly or indirectly, to any person who has received payment or other
consideration from any other person in connection with this Loan transaction, including the purchase
or sale of the Mortgaged Property, except for compensation paid or to be paid, if any, for the actual
performance of services and approved by HUD.
4. Lender certifies that in any case where a letter of credit has been accepted instead of cash,
(a) such unconditional and irrevocable letter of credit is in accordance with Program Obligations and
has been issued by (1) another banking institution; or (2) Lender, subject to receiving HUD’s written
permission prior to initial endorsement; and (b) Lender has not made and shall not make any
inducements as described in Section D.2 above to procure issuance of letters of credit. Lender also
agrees that if demand under the letter of credit is not immediately met, Lender shall forthwith provide
cash equivalent to the undrawn balance thereunder without recourse to Borrower and without regard
to Lender’s ability to recover such amount from any other entity or person who securitized the letter
of credit.
5. (a) For Loans funded with the proceeds of state or local bonds, Ginnie Mae mortgage-backed
securities, or other bond obligations as defined by HUD, any of which contain a prepayment lock-out
and/or prepayment premium provision, Lender agrees, in the event of a default during the term of the
prepayment lock-out and/or prepayment premium (i.e., prior to the date on which prepayments may
be made with a prepayment premium of one percent or less), to follow those procedures set forth in
Program Obligations.
(b) After commencement of amortization, Lender agrees to notify HUD of the delinquency when a
payment is not received by the fifteenth (15th) day of the month in which it is due.
6. (a) Lender certifies to HUD that the following are the only identities of interest, as defined in
Program Obligations, between Lender and Borrower, any Principal of Borrower, Contractor, any
subcontractor, or the seller of the land:

(b) Lender agrees that it shall disclose to HUD any future identities of interest, as defined in
Program Obligations, during the construction period or prior to final endorsement.
7. Lender certifies to HUD that no identity of interest, as defined in Program Obligations, exists
between Lender and the counsel to Borrower and that no portion of the amounts included in the Loan
for Borrower’s attorneys has been paid to Lender or its employees.
8. Lender certifies to HUD that all funds, escrows, accounts and deposits specified in this Request
and any and all other funds held by or at the order of Lender in connection with the Loan transaction

Previous editions are obsolete;
Replaces form FHA-2455 (02/73)

Request for Endorsement
.

HUD-92455M (Rev. 04/11)

8
covered by this Request shall be funds held pursuant to Program Obligations and any applicable
escrow agreements.
9. Lender certifies that all HUD form closing documents submitted to HUD in connection with this
transaction (with the exception of the Opinion by Counsel to Borrower and the accompanying
Certification by Borrower) conform to those documents Lender obtained from HUD and such
documents have not been changed or modified in any manner except as suitably identified and
approved by HUD as evidenced by the attached memorandum. It is understood that changes and
modifications do not include filling in blanks, attaching exhibits or riders, deleting inapplicable
provisions or making changes authorized by Program Obligations. Lender further certifies that all
closing documents submitted to and accepted by HUD at closing in connection with this transaction
are listed in the attached memorandum.
10. Lender acknowledges, based upon its reasonable due diligence, that Borrower has obtained the
necessary governmental certificates, permits, licenses, qualifications and approvals of Governmental
Authorities to own and operate the Mortgaged Property and to carry out all of the transactions
required by the Loan Documents and to comply with applicable federal statutes and regulations of
HUD in effect on the date of the Firm Commitment. Lender also acknowledges that appropriate
actions have been taken by and necessary filings have been made with those Governmental
Authorities all as disclosed by Borrower in Exhibit ___, attached hereto.
11. [INTENTIONALLY OMITTED]
12. Lender certifies that it has made reasonable inquiry and has discovered no liens or
encumbrances against the Mortgaged Property that are not reflected as exceptions to coverage in
the title policy.
13. Lender certifies that the Loan does not violate the usury laws or laws regulating the use or
forbearance of money of the Property Jurisdiction.
14. Lender agrees that, if there is a sale or transfer of all or a partial interest in the Note (other than a
sale or transfer of a participation or other beneficial interest, e.g., a transfer of any interest of a Ginnie
Mae MBS Security, or the creation of a security interest) or a change of the Loan servicer, Lender
shall be responsible for ensuring that Borrower is given Notice of the sale, transfer and/or change.

Previous editions are obsolete;
Replaces form FHA-2455 (02/73)

Request for Endorsement
.

HUD-92455M (Rev. 04/11)

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Lender hereby certifies that the statements and representations of fact contained in this instrument
and all documents submitted and executed by Lender in connection with this transaction are, to the
best of Lender’s knowledge, true, accurate, and complete. This instrument has been made,
presented, and delivered for the purpose of influencing an official action of HUD in insuring the Loan,
and may be relied upon by HUD as a true statement of the facts contained therein.

Date

Lender

By

Previous editions are obsolete;
Replaces form FHA-2455 (02/73)

Request for Endorsement
.

HUD-92455M (Rev. 04/11)

10
II. CERTIFICATE OF BORROWER
A. The undersigned Borrower certifies to HUD:
1.
Borrower has read the foregoing Certifications of Lender, and to the best of its
knowledge and belief considers it correct.
2.
All funds escrowed with Lender, as set forth in the Certifications of Lender, may be held
by Lender for the purposes indicated therein, or in an Event of Default and with HUD’s permission
may be applied to the Indebtedness.
3.
No Fixtures or Personalty acquired for the Project have been purchased using a
conditional sale contract or other form of delayed payment
B.

Additionally, the undersigned certifies that:

1. Borrower has received the sum of $ ____________________, constituting the full principal
amount of the Loan for this Project.
2. Construction or repairs is/are complete, except as otherwise noted in the Certifications of
Lender, and is in accordance with the drawings and specifications or list of repairs required by HUD.
The Security Instrument is a good and valid first lien; the Mortgaged Property is free and clear of all
liens other than that of the Security Instrument or such inferior liens as have been approved by HUD;
and all outstanding unpaid obligations contracted by or on behalf of Borrower, directly or indirectly, in
connection with the Loan transaction, the acquisition of the Mortgaged Property, and the
construction, substantial rehabilitation or repair of the Project are listed below:
(a) HUD-approved notes (copies attached) $
(b) Due General Contractor

$

(c) Other

$

(NOTE: If the space provided is inadequate to list all unpaid obligations, insert the total in each
category and attach itemizations. If there are no outstanding obligations, so state.)
3. Except for any amounts due on notes listed in item II.B.2 above, the undersigned agrees to
pay the foregoing obligations in cash and to furnish HUD with receipts, or other evidence of payment
satisfactory to HUD, within 45 days following the date hereof.
4. Borrower represents and warrants to Lender and HUD that no UCC filings have been made
against Borrower, the Project or the Project Assets prior to the initial/final endorsement of the Note by
HUD, and Borrower has taken and shall take no action which would give rise to such UCC filings,
except for any UCC filings in connection with the acquisition of any Personalty (as listed below), that
has been approved in writing by HUD.

Previous editions are obsolete;
Replaces form FHA-2455 (02/73)

Request for Endorsement
.

HUD-92455M (Rev. 04/11)

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_________________________________
_________________________________
_________________________________

The Borrower affirms that the statements and representations of fact by Borrower contained in this
instrument and all documents are, to the best of Borrower’s knowledge, true, accurate, and complete.
This instrument has been made, presented, and delivered for the purpose of influencing an official
action of HUD in insuring the Loan, and may be relied upon by HUD as a true statement of the facts
contained therein.
Date

Borrower

By

Previous editions are obsolete;
Replaces form FHA-2455 (02/73)

Request for Endorsement
.

HUD-92455M (Rev. 04/11)

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III. CERTIFICATE OF GENERAL CONTRACTOR

A. The undersigned general contractor certifies to HUD:
1.

The construction is in accordance with the Drawings and Specifications approved by

HUD.
2.
All outstanding unpaid obligations contracted by or on behalf of the undersigned in
connection with the Construction Contract are listed below:
_________________________________________

$_____________________________

_________________________________________

$_____________________________

_________________________________________

$_____________________________

_________________________________________

$_____________________________

_________________________________________

$_____________________________

_________________________________________

$_____________________________

(NOTE: If the space provided is inadequate to list all unpaid obligations, insert the total in each
category and attach itemizations. If there are no outstanding obligations, indicate “none.”)
B. Except for unfinished work funded by an escrow or escrows approved by HUD, the undersigned
agrees to pay the foregoing obligations, and to furnish HUD receipts or other evidence satisfactory to
HUD, within 15 days following receipt of payment from Borrower.

Previous editions are obsolete;
Replaces form FHA-2455 (02/73)

Request for Endorsement
.

HUD-92455M (Rev. 04/11)

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The General Contractor affirms that the statements and representations of fact by General
Contractor contained in this instrument and all supporting documentation thereto are, to the best of
General Contractor’s knowledge, true, accurate, and complete. This instrument has been made,
presented, and delivered for the purpose of influencing an official action of HUD in insuring the Loan,
and may be relied upon by HUD as a true statement of the facts contained therein.
Name of Entity: __________________________________
By:

/s/ _____________________________
Printed Name, Title: _____________________________

Dated: _____________________________
By:

/s/ _____________________________
Printed Name, Title: _____________________________
Dated: _____________________________

Warning
Any person who knowingly presents a false, fictitious, or fraudulent statement or
claim in a matter within the jurisdiction of the U.S. Department of Housing and
Urban Development is subject to criminal penalties, civil liability, and
administrative sanctions.

Previous editions are obsolete;
Replaces form FHA-2455 (02/73)

Request for Endorsement
.

HUD-92455M (Rev. 04/11)