HUD 92403 eh Requisition for Disbursement of Section 202 Loan Funds

OMB Approval No. 2502-0187
(Exp. 06/30/2016)

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

Requisition for Disbursement
of Section 202 Loan Funds
No Capital Advance may be disbursed unless a
completed requisition form has been received.

Read Public Burden Statement on back before completing this form
Name, Address & Zip Code of Borrower

Name, Address & Zip Code of Designated Depository (Include bank account number)

Project Name

HUD Accounting Use Only
Fund Symbol

86 x 4115
Project Number

Requisition Number

Voucher Number

Type of Disbursement

Initial

Schedule Date

Progress

Final

Schedule Number

Amount

$

Instructions to the Borrower: Prepare this request in quadruplicate and send the original and two copies to HUD. Clearly identify by description all items which
loan funds are requisitioned. Do not request funds for any item until payment is due. A request covering construction cost mus t show one entry for the total
disbursement requested to meet the net amount due according to the Contractor's Requisition, form HUD-92448 (which must accompany this requesition). The
request for the first payment on account of the Architect's fee must be accompanied by the Mortgagor's and Architect's Certificate, form HUD-92403.1. Requests
for subsequent payments on account of this fee must be made simultaneously with the requests for payment to cover the Contractor's Requisition.

To HUD: The undersigned Borrower hereby requests HUD to disburse funds as provided by the Building Loan Agreement heretofore executed
on the _________________ day of ____________________, 20 ____, as shown in the request for disbursement.
Item Number and Identification
1. Construction per Form HUD-92448
2. Interest from (
) to (
3. Architect's Fee
4.
5.
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.

(A) Amount Claimed

(B) HUD-Approved Amount

$

$

$

$

)

Total Due on This Requisition

To the best of our knowledge, information and belief the sum requested is now payable. The undersigned hereby certifies that all above items have been paid
or will be paid within three days of receipt of the requisitioned funds. We hand you herewith full supporting invoices and/or receipts, as required, covering such items
enumerated for your review. With respect to any items of interest enumerated above, we understand that the disbursement will not include the amount requested
for interest payable to HUD. However, such amounts shall be accredited to our account and it shall constitute a principal obligation. The undersigned certifies that
all prior work, labor and materials to be paid for under this request are satisfactory and are in accordance with the contract.  The undersigned further certifies
that hazard insurance as requested by HUD is in full force and effect upon whatever improvements are now upon the mortgaged premises including but not limited
to materials stored on site for which an advance is being requested. We intend to disburse said sum on or about the____________
__       day of______________20_____.
You are further advised that after the requested disbursement is made, a total sum of $ ____________________ will have been disbursed from loan proceeds and
the total sum of $ ____________________ will have been disbursed from our cash escrow of funds required at initial closing, if any, to complete the project.
(Note: The Borrower's cash escrow must be completely disbursed prior to any disbursement out of the Section 202 loan proceeds.)

Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1011, 1012; 31 U.S.C. 3729, 3802)
Borrower's Name

By (Signature of Authorized Borrower Official)

Date

X
Previous editions are obsolete.

form HUD-92403-EH (1/93)
ref Handbook 4470.1 & 4571.1

Certificate of Approval (for HUD Use Only)
The Above Borrower and Depository are hereby notified that the amounts shown in Column (B) above have been approved for disbursement in accordance with
the provisions of the Building Loan Agreement applicable to this project. Of the above total, $ ____________________ is hereby approved for disbursement from
loan proceeds in accordance with the above application, and this amount, when disbursed, will thereupon constitute principal secured by that certain mortgage
executed by __________________________________________________________________ dated the __________ day of __________________20_____,
,
covering certain property in ___________________________________________ and this certificate does hereby constitute the approval of the Assistant Secretary
for Housing / Federal Housing Commissioner for a loan under Section 202 of the Housing Act of 1959, as amended, and Regulations thereunder for the amount set
forth herein, within the meaning of the aforesaid loan contract, provided; that if the above disbursement constitutes the disbursement to be made under the terms
of said Building Loan Agreement and if any items of construction are still incomplete, this approval is based upon receipt of form HUD-2456 as evidence that the
sum of $ ____________________ has been placed in escrow under the provisions of the “Escrow Deposit Agreement.”
Explanation of Disallowed Amounts

Chief, Mortgage Credit Examiner

Signature of Authorized HUD Official

Date

X
Public reporting burden for this collection of information is estimated to average 30 minutes per response, including the time for rev iewing 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.
This information collection is necessary to ensure that viable projects are developed.  It is important to obtain information for all  applicants to assist HUD in
determining if nonprofit organizations initially funded continue to have the financial and administrative capacity needed to design  a project and that the project
design meets the needs of the residents.  The Department will use this information to determine if the projects meet statutory requirements, ensuring the
continued marketability of the projects.  This information is required in order to obtain benefits.  This information is considered non ­sensitive and no assurance
of confidentiality is provided
This collection of information is used in HUD financed construction of projects.  The information is required  to apply for disbursement  for work completed on
HUD­funded loans under the Section 202 Direct Loan Program for Housing the elderly and handicapped.  The information is used during the  construction period
and at final loan closing to enable the Owner to obtain funds to settle obligations or be reimbursed in a timely manner.  The information  is required to obtain
benefits.  The information collected is considered non­sensitive..

Previous editions are obsolete.

form HUD-92403-EH (1/93)
ref Handbook 4470.1 & 4571.1