Form Hud-92541 - Builder'S Certification Page 2

Download a blank fillable Form Hud-92541 - Builder'S Certification in PDF format just by clicking the "DOWNLOAD PDF" button.

Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.

Complete Form Hud-92541 - Builder'S Certification with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.

Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.

HUD Label Number(s):

Builder or Builder's Agent: I hereby certify that the site analysis information above is true and accurate to the best of my knowledge and belief and that the plans and

specifications were designed to mitigate any foreseeable hazards or adverse conditions. On all properties eligible for maximum LTV financing, I further certify that I

have personally reviewed the plans, specifications, and site information submitted herewith . Based upon my review, I hereby certify that such plans, specifications

comply with the applicable building codes specified above as well as complying with the HUD construction requirements listed above. An "X" marked in the blank

by each numbered item indicates that provisions from the marked code apply.

9a.

Name of Builder's Company or Builder's Agent (type or print)

10 a. Name & Title of Builder or Builder's Agent (type or print)

b. Street Address

b. Signature of Builder or Builder's Agent Date

Date

c. City, State, & Zip Code

c. Telephone Number (include area code)

Affirmative Fair Housing Marketing Plan (AFHMP) Did you sell five (5) or more houses in the last twelve (12) months or do you intend to

YES

sell five (5) or more houses within the next twelve (12) months with HUD mortgage insurance?

If "Yes," check either a, b, c, or d below.

a. I am a signatory in good standing to a Voluntary Affirmative Marketing Agreement (VAMA).

b. I have an AFHMP which HUD approved on (mm/dd/yyyy)

to market this house.

c. I have a contract with

d. I certify that I will comply with the following: (a) Carry out an affirmative program to attract all minority and majority groups to the housing for initial sale

or rental. Such a program shall typically involve publicizing to minority persons the availability of housing opportunities regardless of race, color, religion,

sex, handicap, familial status or national origin, through the type of media customarily utilized by the applicants; (b) Maintain a nondiscrimination hiring

policy in recruiting from both minority and majority groups; (c) Instruct all employees and agents in writing and orally in the policy of nondiscrimination and

fair housing; (d) conspicuously display the Fair Housing Poster in all Sales Offices, include the Equal Housing Opportunity logo, slogan and statement in all

printed material used in connection with sales, and post in a prominent position at the project site a sign which displays the Equal Opportunity logo, slogan or

statement, as listed in 24 CFR 200.620 and appendix to subpart M to part 200. I understand that I am obliged to develop and maintain records on these

activities, and to make them available to HUD upon request.

Builder: I hereby certify that the site analysis information is true and accurate to the best of my knowledge and belief. On all properties eligible for maximum LTV

financing, I further certify that the plans and specifications submitted herewith have been reviewed by the individual signing above and that the individual has the

knowledge and experience necessary to determine whether such plans and specifications comply with the HUD/FHA requirements set forth at 24 CFR 200.926d and with

other applicable HUD requirements as determined in accordance with 24 CFR 200.926(d)(1) and ( 2). Any subsequent changes to these plans and specifications shall

comply with the aforementioned requirements. Upon sale or conveyance of the property, the undersigned will promptly furnish to lender a Warranty of Completion of

Construction, form HUD-92544 on all properties eligible for maximum LTV financing.

12 a. Name of Builder's Company (type or print)

13 a. Name & Title of Builder (type or print)

b. Street Address

b. Signature of Builder

Date

c. City, State, & Zip Code

c. Telephone Number (include area code)

Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1 0 10 , 1012; 31 U.S.C. 3729, 3802).

This form must be complete and legible and must be reproduced to include all three pages.

Public reporting burden for this collection of information is estimated to average 15 minutes per response, including the time for reviewing instructions, searching existing data

sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may not collect this information, and you are not

required to complete this form, unless it displays a currently valid OMB control number.

Executive Order 11988 and HUD environmental regulations (24 CFR Part 51) require builders who build newly constructed properties s to ensure that the property is not affected

by: flood hazards, noise, runway clear zones, explosive/flammable materials storage hazards, toxic waste hazards, and other foreseeable hazards that may affect the site. HUD

requires this information to determine whether the site/location factors would adversely affect the dwelling or homeowner. A response is required whenever a builder builds new

properties. Confidentiality is not applicable.

Previous Editions are Obsolete

Page 2 of 3

Handbook 4145.1 form HUD-92541 (10/2012)