HUD-434 Statement of Taxes

Statement of Taxes
Street Address of Property

Public reporting burden for this collection of information is estimated to average 30 minutes 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 agency
may not conduct or sponsor, and a person is not required to respond to, a collection information unless
that collection displays a valid OMB control number.

Name and Mailing Address of Owner

City

County

Kind of Tax
or Assessment

OMB Approval No. 2502-0418 (exp. 1/31/2015)

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

For Year

State

Tax Year
MM/DD/YYYY MM/DD/YYYY

Project Number

Date(s) Payable
Annual Amount

How Paid?

HUD uses this information to update its records of the mortgagor’s real estate taxes, the location (the
lot and block numbers) of the property, taxes due dates, and penalty dates. The information can be
used to verify the last taxes paid during an audit for insurance benefits. This information is required
by Statute 12 USC 1713(g) and Title II, Section 207(g) of the National Housing Act. The debtors are
protected by the Privacy Act of 1974. There is no sensitive information be collected.
Date Tax Paid If taxes paid
Official to Whom Payable
Penalty Date(s)
in installments,indicate which
installments have been paid.

(Title and Address)

Quarterly
Semi-Annually
Annually
Quarterly
Semi-Annually
Annually
Quarterly
Semi-Annually
Annually
Quarterly
Semi-Annually
Annually
Quarterly
Semi-Annually
Annually
Quarterly
Semi-Annually
Annually
Quarterly
Semi-Annually
Annually
Quarterly
Semi-Annually
Annually
Use this space to give complete information for each kind of tax and penalties which are charged for failure to pay bills before delinquent dates. If no bills are rendered, Property description
describe fully the procedure to determine taxes of assessments charged against a property. Give all additional information obtainable regarding local tax rules and
(as shown on assessment roll)
regulations. Tax bills for each kind of tax, whether paid or unpaid, and tax receipts should be forwarded with this form.

I do hereby certify that the information furnished herein has been obtained from reliable sources, and that it covers all taxes and assessments that are a lien upon or against the above described property.

Signature of Attorney or other person acting for mortgagee Date

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)
Send original and 1 copy to the:

Use as many copies of this form as necessary.

U.S. Department of Housing and Urban Development
Multifamily Claims Branch, HWAFRC
451 7th Street, SW
Washington, D.C. 20410 - 8000

form HUD-434 (12/09)
ref. Handbook 4110.2