HUD 92033 Certification: No Permanent Relocating of Residents

OMB Control #2502­0592 Exp. (04/30/2014) 

Attachment 4
CERTIFICATION: NO PERMANENT RELOCATION OF RESIDENTS

Project Name: ___________________________________________________
FHA or Contract Number: ____________________________________
I, _________________________________________, do hereby certify that:
(1) I am authorized by __________________________________ to complete this certification; and,
(Name of Owner)

(2) On behalf of the ownership entity, there will be no permanent displacement of residents as a
result of the proposed unit conversion.
Warning: 18 U.S.C. 1001 provides, in part, that whoever knowingly and willingly makes or uses a document or writing
containing any false, fictitious, or fraudulent statement or entry, in any matter within the jurisdiction of any department
or agency of the United States shall be fined not more than $10,000 or imprisoned for not more than 5 years, or both.

Signed by (print or type):
Name
Title
Signature

Date