Form Hud-40104 - Property Transfer Form - Hope 3 / Single Family Homes Program
ADVERTISEMENT
1
2HOPE 3
U.S. Department of Housing
OMB Approval No. 2506-0128
/ Single Family Homes Program
and Urban Development
(exp. 8/31/2003)
Property Transfer Form
Office of Community Planning
and Development
This information is required by 24 CFR Part 572, to obtain benefits under the HOPE 3
of Information Technology, U.S. Department of Housing and Urban Development,
Washington, D.C. 20410-3600. Do not send this completed form to either of these
Program authorized by the National Affordable Housing Act of 1990, as amended.
addressees.
Information collected pursuant to the requirements will be reviewed and analyzed by
HUD may not conduct or sponsor, and a person is not required to respond to, a collection
HUD staff at the Field Office and Headquarters level to determine compliance with
information unless that collecton displays a valid OMB control number.
statutory requirements for eligibility, and compliance with national objectives.
Information on activities and expenditure of grant funds is public information and is
Public Reporting Burden for this collection of information is estimated to average 0.25
generally available for disclosure. Recipients are responsible for ensuring confidentiality
hours per response, including the time for reviewing instructions, searching existing data
when public disclosure is not required. Recipients may assure additional confidentiality
sources, gathering and maintaining the data needed, and completing and reviewing the
where doing so would not be inconsistent with the requirements of the Freedom of
collection of information. Send comments regarding this burden estimate or any other
aspect of this collection of information, including suggestions for reducing this burden,
Information Act and the Privacy Act.
to the Reports Management Officer, Paperwork Reduction Project (2506-0128), Office
Submit this form within 15 days of the property transfer to: HOPE 3 Program,
U.S. Department of Housing and Urban Development
L’Enfant Plaza Station, PO Box 23997,
Washington, DC 20026
Part A. Recipient Information
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
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
1. LOCCS Pgrm. Area: 2. Property No: (12 digits)
3.
= Original Submission
1
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
HOP3
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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
= Revision
2
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 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9
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 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. Recipient Organization's Name :
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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 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 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
5. Grant No:
4a. Recipient Organization's TIN :
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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
Part B. Property Information
Fill in all information.
1. Name of Homebuyer(s):
First Name:
Initial: Last Name:
2. Status of Rehabilitation:
Completed: Rehabilitation is complete
Mr.
Mrs.
Ms.
1.
and unit meets the higher of local housing
code or HUD Section 8 Housing Quality
First Name:
Initial: Last Name:
Standards (HQS)
Mr.
Mrs.
Ms.
Not Completed: Rehabilitation is not
3. a. Property Street Address:
3b. Unit No:
2.
complete, but unit meets applicable health
and safety standards.
Not Applicable: Rehabilitation is not
3c. City:
3d. State:
3e. Zip Code:
3.
necessary and unit meets the higher of
local housing code or HUD Section 8
HQS without rehabilitation.
4a. Type of Ownership: (mark one) 5. Recipient Acquisition & Transfer:
6. Homebuyer Direct Acquisition:
If the recipient owns or acquires the property and then transfers it to
If the property is acquired by the
Fee Simple
1
the homebuyer, complete the following: (mm/dd/yy)
homebuyer directly, enter the
Lease Purchase
2
5a. Date of Acquisition by
5b. Date of Transfer from the recipient
date of acquisition by the
the recipient or donation
to the Homebuyer: (mm/dd/yy)
Other:
9
(specify below)
homebuyer: (mm/dd/yy)
to/by the recipient
(mm/dd/yy)
5c.
For Transfer by Lease/Purchase:
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(1) Beginning Date of Lease:
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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
4b. Type of Property: (mark one)
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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
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 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
(2) Anticipated Date of Sale:
Single Family
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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
1
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 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 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 3 4 5 6 7 8 9 0 1 2
1 2 3 4 5 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0 1 2
Property
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 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 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 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 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 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0
(not condominium)
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 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 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 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 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 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 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 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 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0
Condominium
2
Unit
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 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 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 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 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 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0
Cooperative
3
Unit
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 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 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 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 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 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0
Other:
9
(specify below)
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 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 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 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 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 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 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 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 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 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 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 6 7 8 9 0 1 2 3 4 5 6 7 8 9 0
Part C. Unit & Household Characteristics
Mark only one box in each numbered group.
Unit Characteristics:
1. Number of Bedrooms:
Efficiency
2 Bedrooms
4 Bedrooms
0
2
4
1 Bedroom
3 Bedrooms
5 Bedrooms or More
1
3
5
Household Characteristics:
1. Family Income:
2.Race/Ethnicity of Head of Household:
3. No. of Persons in Household: 4. Type of Household:
1a. Monthly Adjusted Income:
1
5
1
Single Parent (non-elderly)
1
White (non-Hispanic)
4
Hispanic
$
2
6
2
Two Parents (non-elderly)
2
Black (non-Hispanic)
5
Asian & Pacific Islander
1b. Percent of Area Median:
3
7
3
Elderly
3
Native American or Alaskan native
50% and below
4
8 or more
1
9
Other: (specify)
51% to 80%
2
form HUD-40104 (7/94)
page 1 of 3
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