VA Form 26-1805-1 Request for Determination of Reasonable Value (Real Esta

Respondent Burden: We need this information to request an appraisal on the property for which VA guarantee of the loan is requested (38
U.S.C. 3710(b)). Title 38, United States Code, allows us to ask for this information. We estimate that you will need an average of 12 minutes to
review the instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid
OMB control number is displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB
control numbers can be located on the OMB Internet Page at www.reginfo.gov/public/do/PRAMain. If desired, you can call 1-800-827-1000
and give your comments or ask for mailing information on where to send your comments.

OMB Control No. 2900-0045
Respondent Burden: 12 minutes
Expiration Date: XX/XX/XXXX

REQUEST FOR DETERMINATION OF REASONABLE VALUE (Real Estate)
1. CASE NUMBER

4. TITLE LIMITATIONS AND RESTRICTIVE COVENANTS:

2. PROPERTY ADDRESS (Include ZIP Code and county)

3. LEGAL DESCRIPTION

6. LOT DIMENSIONS:
X

5A. NAME AND ADDRESS OF FIRM OR PERSON MAKING REQUEST/APPLICATION (Include ZIP Code)

1.

IRREGULAR:

2.

SQ/FT

ACRES:

7. UTILITIES

5B. E-MAIL ADDRESS (TO BE NOTIFIED WHEN APPRAISAL UPLOADED):
9. BUILDING STATUS:

GAS -

WATER -

SEWER -

8.EQUIPMENT:
12A. NO. OF 12B. NO.
BUILDINGS: OF
LIVING
UNITS:

11. FACTORY
FABRICATED?

10. BUILDING TYPE:

16. NAME OF OWNER

17. PROPERTY:

19. NAME OF OCCUPANT:

20. TELEPHONE NO.:

13A. STREET
ACCESS:

13B. STREET
MAINTENANCE:

14C. EXPIRATION DATE: 15. CONSTRUCTION COMPLETED:

14A. CONSTRUCTION WARRANTY
14B. NAME OF WARRANTY PROGRAM:
INCLUDED? (If "Yes," complete Items 14B & 14C)

23. KEYS AT (Address)

ELECTRIC -

18. RENT (If applicable)

24. ORIGINATOR'S IDENT. NO.:

21. NAME OF BROKER:

22. TELEPHONE NO.:

25. SPONSOR'S IDENT. NO.:

26. INSTITUTION'S CASE NO.:

27. PURCHASER'S NAME AND ADDRESS (Complete mailing address, Include ZIP Code)

EQUAL OPPORTUNITY IN HOUSING
NOTE: Federal laws and regulations prohibit discrimination because of
race, color, religion, sex, or national origin in the sale or rental of
residential property. Numerous State statutes and local ordinances also
prohibit such discrimination. In addition, section 805 of the Civil Rights
Act of 1968 prohibits discriminatory practices in connection with the
financing of housing. If VA finds there is noncompliance with any
antidiscrimination laws or regulations, it may discontinue business with
the violator.

28. NEW OR PROPOSED CONSTRUCTION - Complete Items 28A through 28E for new or proposed construction cases only
28B. VA BUILDER
28E. TELEPHONE NO.:
28C. TELEPHONE NO.: 28D. NAME AND ADDRESS
OF WARRANTOR:
ID NO.:
(Include Area Code)
(Include Area Code)

28A. NAME AND ADDRESS OF BUILDER

29. APPLICABLE POINT OF CONTACT (POC)
INFORMATION

30. ANNUAL REAL ESTATE TAXES

32. LEASEHOLD CASES (Complete if applicable)

31. MINERAL RIGHTS RESERVED?

32A. LEASE IS:

32B. EXPIRES (Date)

33B. IS BUYER PURCHASING LOT
SEPARATELY?

34. REFINANCING-AMOUNT
OF PROPOSED LOAN:

35. PROPOSED SALE
CONTRACT ATTACHED?

Name:
Phone:
Email:
33A. SALE PRICE OF PROPERTY

CERTIFICATIONS FOR SUBMISSIONS TO VA

On receipt of "Notice of Value" or upon advice from the Department of Veterans Affairs that a "Notice of Value" will not be issued, we agree to
forward to the appraiser the approved fee which we are holding for this purpose.
36. SIGNATURE OF PERSON AUTHORIZING THIS REQUEST

37. TITLE:

40. DATE OF ASSIGNMENT:

41. NAME OF APPRAISER:

Fax:

38. TELEPHONE NUMBER:
(Include Area Code)

Work:

39. DATE

Email:

WARNING: Section 1010 of title 18, U.S.C. provides: "Whoever for the purpose of . . .influencing such Administration . . .makes, passes, utters or
publishes any statement knowing the same to be false . . .shall be fined not more than $5,000 or imprisoned not more than two years or both."
VA FORM
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26-1805-1