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D. Annual Income

E. Annual Fixed Charges (Past 12 Months)

Base pay for applicant

$ ____________________

Federal and State income tax

$ ____________________

(Based upon current rate of earnings, except

Premium on life insurance

$ ____________________

earnings from commissions or fees, which should

Social Security & Retirement contributions

$ ____________________

be reported on the basis of the past 12 months.)

Payment on installment accounts

$ ____________________

Overtime or other employment earnings

$ ____________________

Mortgage or Contract Payments on Other Real

Base pay of co-subscriber

$ ____________________

Estate from Schedule I

$ ____________________

Payments on other loans

$ ____________________

Overtime or other employment earnings

$ ____________________

Total Income

$ ____________________

Net income from real estate, from Schedule I

$ ____________________

Income from other sources: (List sources and amounts)

F. Approximate Housing Expense (Past 12 Months)

______________________________________ $ ____________________

(a) Mortgage payment or rent

$ ____________________

______________________________________ $ ____________________

(b) Taxes and insurance

$ ____________________

______________________________________ $ ____________________

(d) Water, gas, electricity

$ ____________________

______________________________________ $ ____________________

(e) Maintenance

$ ____________________

Total Income

$ ____________________

Total Housing Expense

$ ____________________

G. Life Insurance (On Applicant)

H. Financial Statement

A combined statement may be made for applicants who are Husband and Wife.

(1) Total in Force $ _____________ Cash Value $ ____________________

In other cases a separate statement must be filed for each subscriber on Form

(2) Less amount of loans on Policies

$ ____________________

____________________ . An applicant who derives his/her principal income

from his/her own business must attach a current balance sheet and operating

(3) Net cash surrender value

$ ____________________

statement of the business.

Statement Date

Assets

Liabilities

Cash Accounts (List) Where Deposited

Accounts payable (except installment accounts) $ ____________________

1. Checking account

Installment account payable, automobile

$ ____________________

______________________________________ $ ____________________

Monthly payment

$ _________________

2. Savings account

Other installment accounts payable

$ ____________________

______________________________________ $ ____________________

Monthly payment

$ _________________

3. U.S. Savings Bonds

$ ____________________

Notes payable balance due

$ ____________________

4. Stocks and other Bonds

$ ____________________

Repayment terms for __________ months

5. Deposit under subscription agreement

$ ____________________

at $ ________________ per month.

6. Other important assets (List or attach schedule)

Other liabilities

$ ____________________

______________________________________

____________________

Repayment terms for __________ months

______________________________________

____________________

at $ ________________ per month.

I. Real Estate Owned (If more than one property is owned attach separate schedule)

Type and Address of Property

Name and Address of Mortgagee

Estimated Resale Value

Indebtedness

Annual Payment Principal

Estimated Annual Gross

Estimated Annual Operating

Estimated Annual Net

Income

and Interest

Income (a)

Expense Including Taxes (b)

(a minus b)

J. Personal References*

Name and Address

*This information is not needed for FHA credit examination purposes but for the information of representatives of the cooperative.

Replaces FHA 3232A which may be used until supply is exhausted.

Page 2 of 3

form HUD-93232-A (12/80)

Form Hud-93232-A - Supplement To Subscription Agreement For Cooperative Management-Type Applicants Page 2

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