52427 Actual Development Cost Certificate

Actual Development Cost Certificate

U.S. Department of Housing

OMB Approval No. 2577-0157

(exp. 1/31/2017)

and Urban Development

Office of Public and Indian Housing

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. Response to this collection of information is mandatory to obtain a benefit or to retain a benefit. The information requested does not lend itself to confidentiality. HUD may not conduct or sponsor, and person is not required to respond to a collection of information unless it displays a currently valid OMB control number.

Name of Public Housing Agency (PHA)

Annual Contributions Contract Number

Project Number

The PHA hereby certifies to the Department of Housing and Urban Development as follows:

1. That the total amount of the Development Cost (herein called the “Actual Development Cost”) of the Project is

$

, which amount is shown in detail on the attached Statement of Actual Development Cost;

2. That all development work in connection with the Project has been completed;

3. That the entire Development Cost or liabilities therefor incurred by the PHA have been fully paid;

4. That there are no undischarged mechanics’, laborers’, contractors’, or material-men’s liens against such Project on file in any public office where the same should be filed in order to be valid against such Project; and

5. That the time in which such liens could be filed has expired.

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)

Submitted By

Name of Official Authorized to Sign for PHA

Title

Signature

Date (mm/dd/yyyy)

For HUD Use Only

Recommended Name of Authorized Official

for Approval By

Title

Signature

Date (mm/dd/yyyy)

Approved By

Name of Authorized Official

Title

Signature

Date (mm/dd/yyyy)

Previous editions are obsolete

form HUD-52427 (1/2014)