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pdfOMB Approval No. 2502-0141 (Exp. 11/30/2017)
U.S. Department of Housing
and Urban Development
Office of Housing
Federal Housing Commissioner
Application for
Mortgage Insurance
Public reporting burden for this collection of information is estimated to average 4 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. 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 collection of information is necessary for HUD to analyze specific information including financial data, cost data, and drawings an specifications before determining whether a cooperative or condominium project mortgage should be insured. This information is necessary on the application for mortgage insurance and is required to obtain benefits. This information is considered non-sensitive; no assurance of confidentiality is provided.
Project Name:
Mortgage Amount:
Date:
Project Number:
Cooperative Housing
Section 213
SAMA
Feasibility
Firm
A. Location and Description of Property
1. Street Nos.
2. Street
3. Municipality
7. Type of Project
4. Census Tract
8. No. Stories
Elevator
Detached
Row (T.H.)
10.
9.a. Basement Floor
Slab on
Grade
12. No. of Bldgs.
Full
Bsmt.
Partial
Bsmt.
13. List of Accessory Bldgs. and Area
Site Information
Crawl
Space
Structural
Slab
Slab on
Grade
13.a. List Recreation Facilities and Area
Building Information
14. Dimensions:
16. Yr. Built
ft. by
6. State and Zip Code
9. Foundation
Walkup
Semi-Detached
11. Number of Units
Revenue
Non-Rev.
Proposed
Existing
5. County
ft. or
16.a.
Manufactured Housing
Modules
sq. ft.
15. Zoning: (If recently changed, submit evidence)
16.b. Exterior Finish
17. Structural System
Conventionally Built
Components
17.a. Floor System
18. Heating-A/C
System
B. Information Concerning Land or Property
19. Date
Acquired
25. Utilities—
Water
20. Purchase
Price
21. Additional Costs
Paid or Accrued
22. If Leasehold
Ground Rent
23. Total Cost
$
$
$
$
Public
Community
Sewers
26. Unusual Site Features —
Cuts
Fills
Poor Drainge
Other (Specify)
24. Relationship-Business, Personal or
Other Between Seller and Sponsor
Rock Formations
High Water Table
Erosion
Retaining Walls
None
C. Unit Composition and Charges
27. No.
Units
Unit
Type
No.
Rms.
Liv. Area
(Sq. Ft.)
Composition of Unit
Contemplated
Down Payment
$
Unit Charge
Per Month
$
Total Monthly
Charge**
Total
Annual
$
28.
Total Estimated Charges for All Family Units
$
$
29. No. Parking Spaces:
Attended
Self Park
Open Spaces
@$
per month
Covered Spaces
@$
per month
Area-Ground Level
Sq. Ft. @ $
per sq. ft./mo.
Other Levels
Sq. Ft. @ $
per sq. ft./mo.
30. Commercial
31.
Total Estimated Accessory Income at 100% Occupancy
Cooperative only.
Previous editions are obsolete.
Page 1 of 6
Submit an original and two copies
$
$
form HUD-93201 (08/22/2017)
32. Gross Floor Area-
33. Net Rentable Residential Area-
34. Net Rentable Commercial Area-
Sq. Ft.
Sq. Ft.
Sq. Ft.
Non-Revenue Producing Space
35.
Type of Employee
No. Rms.
Composition of Unit
Location of Unit in Project
D. Equipment and Services Included in Charges: (Check Appropriate Items)
36. Equipment:
Ranges-Original (Gas or Electric)
37. Services:
Gas:
Heat
Disposal
Ranges-Replace. (Gas or Electric)
Dishwasher
Refrig.-Original (Gas or Electric)
Carpet
Refrig.-Original (Gas or Electric)
Drapes
Air Conditioning (Equip. Only)
Kitchen Exhaust Fan
Elec:
Hot Water
Cooking
Air Conditioning
Heat
Hot Water
Cooking
Air Conditioning
Lights, etc., in Unit
Other Fuel:
Heat
c. Annual Payment $
Hot Water
Water
Other _________________________________________
Other _____________________________________
Grounds Maint.
F. Annual Fixed Charges
E. Estimate of Annual Common Expense
Cooperative only.
Previous editions are obsolete.
Non-Prepayable
b. Principal Balance $
d. Remaining Term ________ Years
Laundry Facilities
Administrative
1. Apartment Resale Expense $ _____________
2. Management
3. Other
4.
Total Administrative
Operating
5. Elevator Main. Exp.
6. Fuel (Heating and Domestic Hot Water)
7. Lighting & Misc. Power
8. Water
9. Gas
10. Garb. & Trash Removal
11. Payroll
12. Other
13.
Total Operating
Maintenance
14. Decorating
15. Repairs
16. Exterminating
17. Insurance
18. Ground Expense
19. Other
20.
Total Maintenance
21. Replacement Reserve (0.0060 or 0.0040 x) Total
structures from Line 50
22. Total Common Expense (Except Taxes)
Taxes
23. Real Estate Est. Assessed
Val. $ ________________ at
$ __________ per $1000- $ _____________
24. Personal Prop. Est. Assessed
Val. $ ________________ at
$ __________ per $1000- $ _____________
25. Empl. Payroll Tax
26. Other
27. Other
28.
Total Taxes
29. Total Common Expense
38. Special Assessments:
a.
Prepayable
$ _____________
_____________
$ _____________
$ _____________
_____________
_____________
_____________
_____________
_____________
_____________
_____________
$ _____________
$ _____________
_____________
_____________
_____________
_____________
_____________
$ _____________
30. Interest Plus Curtail ___%
(Call Insuring Office for Rate)
31. Mortgage Insurance
$ _____________
$ _____________
G.Net Common Expense & Fixed Charges
35. Tot. Gross Ann. Exp. & Fixed Chgs
36. Estimate of Accessory
Rental Income
$ _____________
37. Less Vacancy (_ %)
$ _____________
38. Effective Accessory Rental Income
39. Total Ann. Net Common Expense & Fixed
Charge (after deducting common income)
40. Fixed Monthly Net Common Expense &
Fixed Charge
41. Total Monthly Net Common Expense & Fixed
Charger per SF
42. Total Monthly Net Common Expense & Fixed
Charger Per Room (_ Rooms)
$ _____________
$ _____________
$ _____________
$ _____________
$ _____________
$ _____________
$ _____________
$ _____________
_____________
_____________
_____________
$ _____________
$ _____________
Page 2 of 6
Submit an original and two copies
form HUD-93201 (08/22/2017)
H. Estimated Replacement Cost
43. Unusual Land Improvements
$ ____________
44. Other Land Improvements
$ ____________
45. Total Land Improvements
Carrying Charges & Financing
62. Int. ____________ Mos.
Structures
46. Main Buildings
at %
on $ _________________
$ _____________
$ ____________
$ ____________
63. Taxes
____________
64. Insurance
____________
47. Accessory Buildings
____________
65. FHA Exam. Fee (0.3%)
____________
48. Garages
____________
____________
49. All other buildings
____________
66. FHA Inspec. Fee (0.5%)
67. Financing Fee (
%)
50.
Total Structures
51. General Requirements
$ _____________
68. Other Fees (
$ _____________
69. FNMA or FNMA Fee (
70. Title & Recording
Fees
52. Builder's Gen. Oh. (
____________
%)
____________
%)
%) $ ____________
(
%)
____________
71.
54. Arch. Fee-Design (
%)
____________
Legal Organization & Marketing
55. Arch. Fee-Supvr.
%)
53. Builder's Profit
Total Carrying Chgs. & Financing
____________
72. Legal
56. Bond Premium
____________
73. Organization
57. Other Fees
____________
74. Marketing
(
____________
____________
58.
Total Fees
59. Tot. for all Imprmts. (Lines 45,50,51+58)
$ ____________
____________
____________
$ _____________
75.
$ _____________
76. Other
77. Total Est. Development Cost
(Lines 59, 72, 76, 77)
78. Land (Est. Market Price of Site)
__________ sq. ft. at $ __________ per sq. ft.$
79. Total Estimated Replacement Cost
of Project (Add 78 & 79)
__________ sq. ft. at $ __________ per sq. ft.$
60. Cost Per Gross Sq. Ft.
$ _____________
61. Estimated Construction Time
________ Months
$ _____________
Total Legal, Organ. & Mktg.
$ _____________
$ _____________
$ _____________
_____________
$ _____________
_____________
I. Estimated Expenses Not Included in Carrying Charges or Common Expense
Type No. 1
Type No. 2
Type No. 3
Type No. 4
Type No. 5
Real Estate Taxes,
Individual Per Month
$
$
$
$
$
Insurance, if Paid
Individually Per Month
$
$
$
$
$
Estimated Personal Benefit Expenses To Be Paid Individually By Residents
Heating
Electricity
Water
Gas
Decorating
Repairs
Other
Total Annual Personal
Benefit Expense
$
$
$
$
$
Total Monthly Personal
Benefits Expense
$
$
$
$
$
Cooperative only.
Previous editions are obsolete.
Page 3 of 6
Submit an original and two copies
form HUD-93201 (08/22/2017)
J. Total Requirements For Settlement
K. Estimated Annual Operating Statement
1. Development Cost
$ ________________
2. Land Indebtedness (or Cash required for
land acquisition)
$ ________________
3. Subtotal (Line 1 + Line 2)
$ ________________
4. Mortgage Amount
$ ____________
5. Fees paid by other than cash
$ ____________
2. Garage Rent
________________
3. Commercial Income
________________
4. Other (Specify)
________________
___________________________________________________________
$ ________________
7. Cash Invest. Required (Line 3 - Line 6)
$ ________________
8. Initial Operating Deficit
$ ________________
9. Anticipated Discount
$ ________________
$ ________________
5. Estimated Gross Income Assuming
100% Occupancy
$ ________________
6. Less Vacancies Assumed(
%) on garages
$ ____________
(
%) on other
Non-dwelling Income ____________________
7. Total Vacancy Deduction
$ ________________
8. Total Estimated Gross Income After
Vacancy Deduction
$ ________________
9. Annual Expense & Fixed Charges
Total Expense per annum
$ ____________
Total fixed charges per annum $ ____________
11. Add Off-site construction costs $ ________________
12. Total Estimated Cash Requirement
(Lines 7 + 8 + 9 + 10 + 11)
$ ________________
___________________________________________________________
6. Line 4 + Line 5
10. Working Capital
1. Dwelling Change (From Schedule C)
$ ________________
10. Total Annual Expense and Fixed Charges
________________
11. Excess of Income Over All Charges
$ ________________
L. Attachments: (Required Exhibits)
1.
Location Map
8.
Sketch Plan of Site
2.
Evidence of Site Control (option or purchase) and Legal Description of
Property
9.
Personal Financial & Credit Statement of Sponsors
10.
Form HUD-2530 Previous Participation Certification
3.
Form HUD-92010 Equal Employment Opportunity Certification
11.
Survey
4.
Photographs of Improvements on Site & Adjacent Site
12.
Evidence of Architect E&O Insurance Coverage
5.
Architectural - Exhibits - Final
Architectural Exhibits - Preliminary
13.
Copy of Owners and Architects Agreement
14.
Form FHA-2328 Contractor's and/or Mortgagor's Cost Breakdown
6.
7.
15.
M. Names, Addresses and Telephone Numbers of the Following: (Indicate Cash Investment from each Sponsor)
1. Sponsor(s)
2. General Contractor
3. Architect
4. Sponsor's Attorney
For HUD Use Only
Date Rec.
Amount
Code
Schedule
Rec. By
Cooperative only.
Previous editions are obsolete.
Page 4 of 6
Submit an original and two copies
form HUD-93201 (08/22/2017)
Sponsor Certification
To: Federal Housing Commissioner:
SAMA
Feasibility
Firm
I request a loan in the principal amount of $ _____________________ to be insured under the provision of Section __________ of
the National Housing Act, said loan to be secured by a first mortgage on the property hereinafter described.
As the principal sponsor of the proposed mortgagor, I certify that I am familiar with the provisions of the Regulations of the Federal
Housing Commissioner under the above identified Section of the National Housing Act and that to the best of my knowledge and belief
the mortgagor has complied, or will be able to comply with all of the requirements thereof which are prerequisite to insurance of the
mortgage under such Section.
I further certify that to the best of my knowledge and belief no information or data contained herein or in the exhibits or attachments
listed herein are in any way false or incorrect and that they are truly descriptive of the project or property which is intended as the security
for the proposed mortgage and that the proposed construction will not violate zoning ordinances or restrictions of record.
I agree with the Department of Housing and Urban Development, Federal Housing Administration, that pursuant to the requirements
of Title VII of the Civil Rights Act of 1968, Title VI of the Civil Rights Act of 1964, Executive Order 11063, and Departmental
regulations, (a) neither he nor anyone authorized to act for him will decline to sell, rent or otherwise make available any of the property
or housing in the multifamily project to a prospective purchaser or tenant because of race, color, religion, or national origin, (b) I will
comply with federal, state and local laws and ordinances prohibiting discrimination, (c) I will affirmatively market this project to attract
buyers or tenants of all minority and majority groups, and (d) my failure or refusal to comply with the requirements of either (a), (b) or
(c) shall be a proper basis for the Commissioner-Secretary to reject requests for future business with which the sponsor is identified or
to take any other corrective action deemed as necessary.
The type of firm commitment eventually to be requested, is checked below, I have read and understand the applicable form of
Commitment for insurance and the FHA forms referred to therein.
Sponsor's Signature and Date
X
Proposed Mortgagee's Signature and Date
Proposed Mortgagee's Address:
X
Cooperative only.
Previous editions are obsolete.
Page 5 of 6
Submit an original and two copies
form HUD-93201 (08/22/2017)
I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and
accurate.
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)
X Signature and Date
Cooperative only.
Previous editions are obsolete.
Page 6 of 6
Submit an original and two copies
form HUD-93201 (08/22/2017)
| File Type | application/pdf |
| File Modified | 2017-08-22 |
| File Created | 2013-10-31 |