Previous Participation Certification (Form Hud-2530) printable pdf download

U.S. Department of Housing

U.S. Department of Agriculture

OMB Approval No. 2502-0118

Previous Participation

(exp. 9/30/2009)

and Urban Development

Farmers Home Administration

Certification

Office of Housing/Federal Housing Commissioner

Part I To be completed by Principals of Multifamily Projects. See Instructions

For HUD HQ/FmHA use only

Reason for Submitting Certification

1. Agency Name and City where the application is filed

2. Project Name, Project Number, City and Zip Code contained in the application

3. Loan or Contract Amount

4. Number of Units or Beds

5. Section of Act

6. Type of Project (check one)

Existing

Rehabilitation

Proposed (New)

List of All Proposed Principal Participants

7. Names and Addresses of All Known Principals and Affiliates (people, businesses & organizations)

8. Role of Each

9. Expected % Owner

10. Social Security or IRS

proposing to participate in the project described above. (list names alphabetically; last, first, middle initial)

Principal in Project

ship Interest in Project

Employer Number

Certifications: I (meaning the individual who

by me on the certification.

one year, but does not include any offense

5. I am not a principal participant in an assisted

signs as well as the corporations, partnerships

a. No mortgage on a project listed by me has

classified as a misdemeanor under the

or insured project as of this date on which

or other parties listed above who certify) hereby

ever been in default, assigned to the

laws of a State and punishable by

construction has stopped for a period in

apply to HUD or USDA-FmHA, as the case may

Government

foreclosed,

nor

has

imprisonment of two years or less);

excess of 20 days or which has been

be, for approval to participate as a principal in

mortgage relief by the mortgagee been

f. I have not been suspended, debarred or

substantially completed for more than 90

the role and project listed above based upon my

given;

otherwise restricted by any Department or

days and documents for closing, including

following previous participation record and this

b. I have not experienced defaults or non-

Agency of the Federal Government or of a

final cost certification have not been filed with

Certification.

compliances

under

any

Conventional

State Government from doing business

HUD or FmHA.

I certify that all the statements made by me

Contract or Turnkey Contract of Sale in

with such Department or Agency.

6. To my knowledge I have not been found by

are true, complete and correct to the best of my

connection with a public housing project;

g. I have not defaulted on an obligation

HUD or FmHA to be in noncompliance with

knowledge and belief and are made in good

c. To the best of my knowledge, there are no

covered by a surety or performance bond

any applicable civil rights laws.

faith, including the data contained in Schedule A

unresolved findings raised as a result of

and have not been the subject of a claim

7. I am not a Member of Congress or a

and Exhibits signed by me and attached to this

HUD audits, management reviews or other

under an employee fidelity bond.

Resident

Commissioner

nor

otherwise

form. Warning: HUD will prosecute false claims

Governmental

investigations

concerning

3. All the names of the parties, known to me to

prohibited or limited by law from contracting

and statements. Conviction may result in

me or my projects;

be principals in this project(s) in which I

with the Government of the United States of

criminal and/ or civil penalties. (18 U.S.C. 1001,

d. There has not been a suspension or

propose to participate, are listed above.

America.

1010, 1012; 31 U.S.C. 3729, 3802)

termination of payments under any HUD

4. I am not a HUD/FmHA employee or a

8. Statements above (if any) to which I cannot

I further certify that:

assistance contract in which I have had a

member

HUD/FmHA

employee's

certify have been deleted by striking through

1. Schedule A contains a listing of every

legal or beneficial interest;

immediate household as defined in Standards

the words with a pen. I have initialed each

assisted or insured project of HUD, USDA-

e. I have not been convicted of a felony and

of Ethical Conduct for Employees of the

deletion (if any) and have attached a true and

FmHA and State and local government

am not presently, to my knowledge, the

Executive Branch in 5 C.F.R. Part 2635 (57

accurate signed statement (if applicable) to

housing finance agencies in which I have

subject

complaint

indictment

FR 35006) and HUD's Standard of Conduct in

explain the facts and circumstances which I

been or am now a principal.

charging a felony. (A felony is defined as

24 C.F.R. Part 0 and USDA's Standard of

think helps to qualify me as a responsible

2. For the period beginning 10 years prior to the

any offense punishable by imprisonment for

Conduct in 7 C.F.R. Part 0 Subpart B.

principal for participation in this project.

date of this certification, and except as shown

a term exceeding

Typed or Printed Name of Principal

Signature of Principal

Certification Date (mm/dd/yyyy)

Area Code and Telephone No.

This form was prepared by (Please print name)

Area Code and Telephone No.

Previous editions are obsolete

Page 1 of 2

ref Handbook 4065.1 form HUD-2530 (5/2001)

Previous Participation Certification (Form Hud-2530)

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