HUD-50125-A Single Close 184A Applicant Acknowledgement

OMB Approval No.
(exp. )

SINGLE CLOSE 184A APPLICANT ACKNOWLEDGEMENT
I/We, the undersigned, do hereby acknowledge and understand that at the time of loan closing of the HUD 184A
Guaranteed Construction/Permanent Loan, for which I/we have applied to ____________________________________
________________________________ (lender), all the proceeds designated for the construction in the amount of
$_______________ (received form the borrower/loan proceeds), are to be placed in an interest bearing escrow account. If
there are remaining construction funds in the Construction Escrow Account after the Final Release is processed,
________________________________ (lender) must apply those funds in accordance with the 184A Program Guidelines.
I/We hereby request that _________________________________________ (lender), after final inspection is
satisfactorily complete and the final release has been processed, apply the net income (interest) earned by the Construction
Escrow Account accordingly:
Pay the net interest income directly to me/us.
Apply the net interest income directly to the mortgage principal balance for an equal amount of principal
reduction.
Other: ___________________________________________________________________
This account is not, nor shall it be treated as an escrow for the paying of real estate taxes, insurance premiums,
delinquent notes, ground rents, or assessments.
I/We further acknowledge, that if required to protect the priority of the Security Instrument, that
___________________________________(lender) may retain the holdback, for a period not to exceed 35 days (or the time
period required by law to file a lien, whichever is longer), to ensure compliance with state lien waiver laws or other state
requirements. A copy of the final inspection report and Final Release Notice will be provided to me/us.
I/We further understand that the Appraiser and Inspector’s obligation is to assist the lender in determining the
eligibility of the property for HUD loan guarantee purposes only and that I/we are responsible to determine the soundness of
the property before and after construction, including value, cost estimates and the ability of the contractor to complete the
construction in a satisfactory workman like manner in compliance with all accepted exhibits and local codes and ordinances.
_____________________________________________
Borrower Signature

___________________________
Date

_____________________________________________
Borrower Signature

___________________________
Date

Privacy Act Statement. This statement is provided pursuant to the Privacy Act of 1974, 5 USC § 552a. The authority for collecting
personally identifiable information (PII) in the Regulatory Consistency Communication Board (RCCB) Electronic Feedback Form is
based in Section 313 of Public Law 112-95.
Form HUD-50125-A (date)

OMB Approval No.
(exp. )

Public reporting burden for this collection of information is estimated to average .15 hours per response, including the time for
reviewing instructions, searching existing data sources, gather and maintaining the data needed, and completing and reviewing the
collection of information. HUD 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 is required in order for an eligible homebuyer to obtain a benefit and for HUD to administer the Loan Guarantee
Program for low-income Native Americans, Alaska Natives, and native Hawaiians (24 CFR Parts1000 and 6000). The requested
information is necessary to determine the income and credit worthiness of low income homebuyers. If HUD did not collect this
information, it would prevent HUD from guaranteeing mortgages to eligible homebuyers. While no assurances of confidentiality are
pledged to respondents, HUD generally discloses this data only in response to a Freedom of Information request.

Form HUD-50125-A (date)