FSA2061INS_24xxxxV01

FSA-2061 Date of Modification (proposal 2)

APPLICATION FOR RELEASE OR CONSENT

INSTRUCTIONS FOR PREPARATION

Purpose: This form is used by borrowers to request agency approval for transactions affecting real estate that serves as security for agency loans, such as partial releases, sale or exchange of security, right of way, lease, and conveyance. This form is not required for releases of real estate security that are a result of a borrower’s graduation or refinance with another lender. This form is also used by borrowers to request agency approval for releases of personal property security without compensation. Depending on the type of request, Part A or Part B is completed by the borrower with agency assistance if needed. The borrower signs in Part C. Part D is completed by the Agency. The authorized Agency officials sign in Part D.
Handbook Reference: 4-FLP, 5-FLP, and 6-FLP	Number of Copies: Original
Signatures Required: Borrower(s)and authorized Agency official.
Distribution of Copies: The Original of the form is retained in the County Office.
Automation-Related Transactions: (Instructions for writers: provide only the information required, i.e. ADPS TC 3K. If no automation actions are required, insert N/A) DLS, FBP

The borrower, with assistance of the agency, completes either Part A, Items 1 – 7 or Part B, Items 1 – 4.

Notes: If the transaction involves the release of real estate security that will result in all FSA debt being paid in full, complete only Part A 1 through 5.

Minor revisions to this document during processing may be initialed and dated as appropriate in lieu of submitting a new FSA-2061.

Item	Instruction
1(a) Borrower Names	Enter the name(s) of the Borrower(s).
1(b) Release	Describe proposed release of FSA’s security interest.
1(c) SNDA	Describe proposed Subordination, Non-Disturbance and Attornment Agreement request.
1(d) Consent	Describe proposed consent request.
2 Description of Property	Enter the description of the security property affected by the proposed request.
3A Name of Lienholder	Enter the name of any lienholder, including FSA in the order of lien priority. This includes all liens existing pre-release or pre-consent.
3B Approximate amount of lien	Enter the approximate amount of the lien.
3C Lien priority	Enter the lien priority of the lien – 1st, 2nd, 3rd, etc.
4 Use	Enter the use to be made of the property covered by the application and to whom the property or property rights will be leased or conveyed.
5 Proceeds	Enter the amount of the proceeds anticipated or the benefit to be gained by this transaction.
6 Proposed use of proceeds	Enter the proposed use of the proceeds anticipated. Enter the FLP loan(s), if applicable, to which funds will be applied.
7 Items for complete application	Include the items listed, as applicable.

Part B – Borrower Request – Personal Property Security – Only For Release Without Compensation –

To be completed by the borrower

Item	Instruction
1(a) Borrower Names	Enter the name(s) of the Borrower(s).
1(b) Release	Describe proposed release of FSA’s security interest.
2 Description of Property	Enter the description of the security property affected by the proposed request as shown on the FSA-2028 (security agreement).
3A Name of Lienholder	Enter the name of any lienholder, including FSA in the order of lien priority. This includes all liens existing pre-release or pre-consent.
3B Approximate amount of lien	Enter the approximate amount of the lien.
3C Lien priority	Enter the lien priority of the lien – 1st, 2nd, 3rd, etc.
4 Items for complete application	Include the items listed, as applicable.

Part C – Certifications and Signatures - To be completed by the borrower

Item	Instruction
1A – C Certifications	Check “YES” or “NO” to each of the three questions.
2 Certification explanation	If “YES” was marked in any of the three certification questions, enter an explanation.
3 Right to Receive Appraisal	Read – If FSA orders an appraisal or completes a written real estate evaluation, the borrower will receive a copy of at no cost.
4 Disclosures	Read – Contains a warning about false statements or misrepresentations.
5A and B Signature and date	Borrower(s) making the request sign their name in 5A and enter the date they sign the form in 5B.

Part D – FSA Approval- To be completed by the agency

Item	Instruction
1 Comment	Provide description to support the recommendation and/or approval of the transaction including compliance with the requirements for approving type of transaction and any of the damages and/or benefits that will result from the transaction.
2A Initial payment	Enter the amount of the initial payment and the distribution of the payment to one of the 5 options listed.
2B Subsequent payments	Enter the amount of any subsequent payment(s) and the distribution of the payment(s) to one of the 5 options listed.
3A or B Recommendation	Check either the “recommend” or the “do NOT recommend” box.
3C Recommending official name	Enter the name of the authorized recommending Agency official (if any).
3(d) Recommending official title	Enter the title of the authorized recommending Agency official (if any).
3E Signature	The authorized recommending Agency official will sign (if any).
3F Date	The date will be entered by the authorized recommending Agency official (if any) when they sign the form.
4A or B Agency decision	Check either the “approve” or the “do NOT approve” box.
4C Reason for denial	Enter the reason for denial of the request.
4D Authorized Agency official name	Enter the name of the authorized Agency official making the decision to either approve or disapprove the release or consent.
4E Authorized Agency official title	Enter the title of the authorized Agency official.
4F Signature	The authorized Agency official will sign.
4G Date	The date will be entered by the authorized Agency official when they sign the form.

Borrowers: Contact the local servicing office if assistance is needed.

Agency officials: Contact the State Office if additional guidance is needed.

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