HUD-2742 Fiscal Data in Support of Claim for Multifamily Mortgage

Fiscal Data in Support of
Claim for Multifamily Mortgage
Insurance Benefits

U.S. Department of Housing
and Urban Development

0MB Approval No. 2502-0418 (exp.07/31/2025)

Office of Housing
Federal Housing Commissioner

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. This agency may not collect this information, and you are not required to
complete this form, unless it displays a currently valid 0MB control number.
The information is collected to obtain required fiscal data for the Department to pay insurance benefits. The information provides the Department with the necessary fiscal data to
audit the claim submission and accurately compute insurance benefits owed to the lender. Payment of such benefits is cited in Statute 12 USC 1713(g) of the National Housing Act.
The information requested does not lend itself to confidentiality.
Comments regarding the accuracy of this burden estimate and any suggestions for reducing this burden can be sent to U.S. Department of Housing and Urban Development, Office of
the Chief Data Officer, R, 451 7th St SW, Room 8210, Washington, DC 20410-5000 or email: [email protected]. Do not send completed forms to this address.

2. Project No.

1. Date this Form Prepared

4. Date to Which Interest
Collected

5. Date of Default

8. Date and Method of Acquisition
(if applicable)

I

IDD

Section I.
Mortgage
Balance
and
Disbursements

3. Project Name and Property Address

7. Date of Election to
Assian or Convev

6. Nature of Default

□□

9. Date Mortgage Assigned or Property
Conveyed to the Secretary

Foreclosure
Deed in LieL

10. Date Receiver Appointed 11. Date Receiver Discharged 12. Employer Identification No.
(if applicable)
(if applicable)

Assigned
conveyed

a. Unpaid Principal Balance of the Mortgage at Date of Default
b. Unpaid Balance of Advances by Mortgagee, Other than Mortgage Proceeds for:
1. Mortgage Insurance Premiums
$
2. Taxes, Ground Rents, Water Rates, etc. (Which are liens prior to the mortgage) $
3. Insurance on the Property
$
C. Reasonable Expenses for Completion and Preservation of the Property

$

$
$

d. Balance of the Principal Face Amount of the Mortgage Not Heretofore Advanced to,
or for the Account of, the Mortgagor and Paid to HUD (Debenture Claim Only)

Escrow
Fund
and
Deductions

$

Total Mortgage Balance and Disbursements
e. Funds in Escrow at Date of Assignment or Conveyance for:

$

1. Mortgage Insurance Premiums
2. Taxes, Ground Rents, Water Rates, etc.
3. Hazard Insurance Premiums
4. Reserve for Replacements

$
$

5. Other

$

$
$

Total in Escrow Fund
f. Net Income Received from the Property from the date of default to the

$

Date of Assignment or Conveyance:
I$

1. Total Collections (Schedule B)

I$

2. Less: Operating Expenses (Schedule C)
g. Receipts from Other Sources after Default Date

Section II.
Certificate
of Claim

h. One Per Cent (1%) of Item a., Above (Assignments only)
Net Claim

$
$
$

a. Foreclosure, Acquisition and Conveyance Cos
b. Reasonable Attorney's Fees Paid (Conveyances Only)
C. Amount Deducted Under Item h. of Section I

$
$
$
$

$
$
Unadjusted Certificate of Claim
$
The amount of unadjusted claim will be increased by mortgage interest computed from the date of last payment to the date the mortgage is assigned
or the property is conveyed, less the amount of debenture interest paid by HUD from the date of default to the date of assignment.
d. Other

Certification:I/We, the undersigned, certify under penalty of perjury that the information provided on this form is true, accurate, and correct. WARNING: Anyone who knowingly submits a false claim
or makes a false statement is subject to criminal and/or civil penalties, including confinement for up to 5 years, fines, and civil and administrative penalties. (18 U.S.C. §§ 287, 1001, 1010, 1012,
1014; 31 U.S.C. §3729, 3802).

Name and Address of Mortgagee (Do not use A.D.P. rubber stamp)

(Debentures if issued will be inscribed exactly as shown herein)
Sinn,.t11r,a nf Mnrtn�n° 0 Offir.i"I nr S,arvir.,ar

xi

Previous editions are obsolete.

Send the original and 1 copy to:
Mortgagee/Servicer
retain 1 copy

Name and Address of Mortgagee's Servicer

Title
U.S. Department of Housing and Urban Development
Multifamily Claims Branch, HWAFRC, Room 6252
451 Seventh Street, S.W.
Washington, D.C. 20410-8000

D MortgageeOfficial
D Servicer
form HUD-2742 (12/09)
ref. Handbook 4110.2