Form Hud-3111 - Mortgagee'S Certification And Application For Interest Reduction Payments - U.s. Department Of Housing And Urban Development

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U.S. Department of Housing

OMB Approval No. 2502-0445

Mortgagee's Certification and Application

(Exp. 10/31/2009)

and Urban Development

for Interest Reduction Payments

Office of Housing

Federal Housing Commissioner

(Section 236–Non-Insured Mortgages)

Instructions: See Public burden statement on back of form. Submit original and one copy to addressee shown below. Retain one copy. Additional instructions are shown on the reverse.

For HUD

Voucher Number

Schedule Number

Use Only

1. Payee (Name, Address and ZIP Code of Mortgagee or Servicer)

Amounts claimed cover all payments for the month

To: Director, General and Program Accounting

Office of Finance and Accounting

_____________________ , due on first day of:

Department of Housing and Urban Development

Washington, D.C. 20410

_______________________

_________

Attention: Diversified Payments Division

Month

Year (yyyy)

3. Contract Year (yyyy)

4. Number of Changes in Billed Amount

5. Annual Contract Amount

this Contract Year (Including this billing)

Current Contract

$ ________________________

From ___________________________

Total Interest Reduction Payments Received this

Contract Year to Date (Do not include this billing)

$ ________________________

To____________________________

Balance Payable This Contract Year

$ ________________________

6. Unit and Room Composition of Project

7. Estimated Mortgage Amount Applicable to

8. Disbursed Proceeds Applicable to

Subsidized Units

_____________

Rooms

___________

Subsidized Rooms

$ ________________________

Subsidized Rooms

$ _________________________

Unsubsidized Units

_____________

Rooms

___________

Unsubsidized Rooms

$ ________________________

Unsubsidized Rooms

$ _________________________

Total

_____________

___________

Total

$ ________________________

Total

$ _________________________

Yes

No (If answer is Yes, give "a" and "b")

Yes

No (If answer is Yes, give "a" and "b")

9. Has amortization started?

10. Has permanent financing been arranged?

(a) Date Started (mm/dd/yyyy)____________________________________________

(a) Effective Date (mm/dd/yyyy) ____________________________________

(b) Monthly Payment to Principal and Interest

$ ______________________________

(b) Effective Bond Interest Rate _____________________ %

Est. Mtge. Amt.

Disb. Proceeds

Mtge.

Note/Bond

Interest

Hand-

Project

Applicable

Term

Fees &

Reduction

ling

Total

Name and Address of Mortgagor

Number

To Sub. Rooms

(Years)

Mtge. Rate

Charges

Payment

Charge

Payment Due

11.

12.

13.

14.

15.

16.

17.

18.

19.

20.

Certification: The undersigned hereby certifies to the best of his knowledge and belief that (a) each interest reduction payment included in this billing has been calculated in accordance with the provisions

of the Interest Reduction Contract; (b) all certifications required under the Interest Reduction Contract have been obtained; (c) the amount of this billing is true and correct and has not been previously

claimed or paid; (d) credits, when applicable for previous payments made by HUD have been given; (e) supporting detail records and work sheets together with a copy of this billing are being held

in the mortgagee's files; and (f) upon request of any authorized official of the Department of Housing and Urban Development or of the Comptroller General of the United States, it will furnished or make

available for audit all aforementioned documents as required by the Interest Reduction Contract.

Title of Certifying Payee Official

Signature

Date (mm/dd/yyyy)

Warning: 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)

form HUD-3111 (10/78)

Page 1 of 2

Replaces form FHA-3111 and previous editions which are obsolete