Form Hud-92458 - Rent Schedule Low Rent Housing - 2005 Page 2

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Part G – Information on Mortgagor Entity

Name of Entity

Type of Entity

Individual

General Partnership

Joint Tenancy/Tenants in Common

Other (specify)

Corporation

Limited Partnership

Trust

List all Principals Comprising Mortgagor Entity: provide name and title of each principal. Use extra sheets, if needed. If mortgagor is a:

• corporation, list: (1) all officers; (2) all directors; and (3) each stockholder having a 10% or more interest.

• partnership, list: (1) all general partners; and (2) limited partners having a 25% or more interest in the partnership.

• trust, list: (1) all managers, directors or trustees and (2) each beneficiary having at least a 10% beneficial interest in the trust.

Name and Title

Part H – Owner Certification

To the best of my knowledge, all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate.

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)

Name and Title

Authorized Official's Signature

Date (mm/dd/yyyy)

Part I – HUD/Lender Approval

Addendum Number

Branch Chief/Lender Official Signature

HAP Contract Number

Date (mm/dd/yyyy)

Exhibit Number

Director, Housing Management Division Signature

Loan Servicer Signature

Date (mm/dd/yyyy)