IN WITNESS WHEREOF, the parties hereto have hereunto caused these presents to be executed on their behalf
and their corporate seals affixed the day and year first above written.
Party of the First Part:
Date
(Seller)
By
Title:
Title:
Party of the Second Part:
Date
(Lender)
By
Title:
Title:
Party of the Third Part:
Date
(Agent)
By
Title:
Title:
INSTRUCTIONS
REQUEST FOR INSPECTION - If partial disbursement of escrowed funds is desired, VA or FHA, whichever agency made
the previous inspections, shall be notified when construction of each scheduled item is completed and ready for inspection.
BASIS OF DISBURSEMENT - Escrowed funds may be disbursed on the basis of 90 percent of the amounts set forth for
any scheduled item of the work upon notification by VA that the work in the scheduled item has been acceptably
complete. The amount equal to the withheld 10 percent may be disbursed after the acceptable completion of all the work
and when the other requirements and conditions of the Escrow Agreement are fully met. VA reserves the right to refuse, or
to delay, acceptance of any work which is subject to damage in executing other work by delay in completing such other
work.
PRIVACY ACT NOTICE: These agencies will not disclose information collected on this form to any source other than what has been authorized under the
Privacy Act of 1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (for example: authorized release of information to Congress when
requested for statstical purposes) identified in the VA system of records, 55VA26, Loan Guaranty Home, Condominium and Manufactured Loan Applicant
Records, Specially Adapted Housing Applicant Records, and Vendee Loan Applicant Records - VA, published in the Federal Register. Your obligation to
respond is required in order to process the request for postponed exterior onsite improvements.
RESPONDENT BURDEN: This information is needed to help the veteran purchaser obtain occupancy of a home prior to the completion of exterior on-site
improvements. Title 38, U.S.C., 3710(b)5, authorizes collection of this information. We estimate that you will need an average of 30 minutes to review the
instructions, find the information, and complete this form. VA cannot conduct or sponsor a collection of information unless a valid OMB control number is
displayed. You are not required to respond to a collection of information if this number is not displayed. Valid OMB control numbers can be located on the
OMB webpage at If desired, you can call 1-800-827-1000 to get information on where
to send comments or suggestions about this form.