Form Hud-40103 - Property Set Up Form - U.s. Department Of Housing And Urban Developmen

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VRS / LOCCS
U.S. Department of Housing
OMB Approval No. 2506-0128
(exp. 08/31/2003)
and Urban Development
HOPE 3
/ Single Family Homes Program
Office of Community Planning
and Development
Property Set Up Form
If a property contains more than one unit, complete a set up form for
Immediately after the call, send this completed form to:
each unit. All units in a multi-unit property must be set up in a single
HOPE 3 Program,
call unless all units in the property, except the homebuyer's unit, will
U.S. Department of Housing and Urban Development
be rental units. Part A must be called in to HUD to set up or increase
L'Enfant Plaza Station, PO Box 23997
property amounts.
Washington, DC 20026
Part A. Recipient Information
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1. LOCCS Pgrm. Area:
2. Property No: (12 digits)
3.
= Original Submission
1
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HOP3
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= Revision
2
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1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5
4. Voice Response No. (5 digits, hyphen, 5 more ) : 6. Recipient Organization's Name (lead recipient only) :
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1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 1 2 3 4 5
5. Grant No:
6a. Recipient Organization's TIN :
7. HOPE 3 Funds Reserved for this Property:
Part B. Property Information
Fill in all information.
1. Property Street Address:
1b. Unit No:
1c. City:
1d. State:
1e. Zip Code:
1f. County Code:
2. Source of Property: (mark one)
3. Building Size: (mark one)
4. Appraised Value (if known):
3a.Check this box
$
1 unit
FHA
Local
1
1
6
if the property will
include rental units:
2 units
2
FmHA
PHA
2
7
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1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6
3 units
VA
IHA
3
3
8
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1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6
4 units
4
RTC
Other:
4
9
(specify)
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1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6
Number of
more than 4-unit bldg
State
5
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6
5
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rental units
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Number of units
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in building
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in the building
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1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6
Part C. Estimated HOPE 3 Grant or Match Costs*
Enter "0" if none.
(A)
(B)
Type
HOPE 3 Grant Funds
Matching Funds or In-Kind Contributions
Acquisition
1.
Rehabilitation
2.
Other Property Costs
3.
Totals
4.
*
Do not include any "Program Costs" as shown on the Implementation Grant Payment Voucher. Show only Property Costs.
(18 U.S.C. 1001, 1010, 1012; 31
Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties.
U.S.C. 3729, 3802)
Signature, Name, & Phone Number (including area code) of the Person who completed this form:
Date of Request :
X
Privacy Statement: Public Law 97-255, Financial Integrity Act, 31 U.S.C. 3512, authorizes the Department of Housing and Urban Development (HUD) to collect all the information
(except the Tax Identification Number (TIN)) which will be used by HUD to protect disbursement data from fraudulent actions. The Housing and Community Development Act of
1987, 42 U.S.C. 3543, authorizes HUD to collect the TIN. The data are used to ensure that individuals who no longer require access to Line of Credit Control System (LOCCS)
have their access capability promptly deleted. Provision of the SSN is mandatory. HUD uses it as a unique identifier for safeguarding LOCCS from unauthorized access. Failure
to provide the information requested may delay the processing of your approval for access to LOCCS. This information will not be otherwise disclosed or released outside of HUD,
except as permitted or required by law.
form HUD-40103 (7/94)
page 1 of 2

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