Free Subsidized Housing - Maryland

Subsidized Housing Income and Expense Questionnaire
FOR 36 MONTHS: FROM __ 2006___ TO ___2008___
OWNER AND ADDRESS OF RECORD NAME AND LOCATION OF PROPERTY

Check Services & Utilities in Rent: Heat ( ) Carpets ( ) Drapes ( ) Washer/Dryer ( ) Tennis ( ) Parking ( ) Switchboard ( )

A/C ( ) Gas ( Swimming Pool ( ) Security ( )
2007 Base Mo. Rent

)

Electricity ( Party Room ( )
2006 Base Mo. Rent

)

Rent Schedules:
# Units Effic. 1 Bedrm. 2 Bedrm. 2 Bedrm./den 3 Bedrm. 3 Bedrm./den Other (list) # of Spaces

2008 Base Mo. Rent

2008 Market Mo. Rent

2007 Market Mo. Rent

2006 Market Mo. Rent

2008 Mo. Rent

2007 Mo. Rent

2006 Mo. Rent

Parking:
Income and Expense Information: Please attach copies of the last three years audited profit and loss statements as filed with the regulatory agency. Mortgage / Sales Information:
1. Is there a current mortgage on this property? Yes _____No_____

2. 3. 4. 5. 6.

If yes, please provide the following data: Name of mortgagee _________________________________ Mortgage amount _________________________________ Market interest rate _________________________________ Subsidized interest rate _________________________________ Original loan / value ratio _________________________________ Original equity investment ($amt ) _________________________________ Term of mortgage _________________________________ Date of first payment _________________________________ Monthly payment _________________________________ Regulatory limit on equity return _________________________________ Mortgage balance (if known) ______________as of_______________ Current dollar amount in residual receipts / surplus cash account _______________ Interest rate _______________ Current dollar amount in reserve for replacement account _______________ Is there an annual trustee fee? If yes, enter amount _______________ Is there an annual mortgage ins. premium? If yes, enter amount _______________ Please provide: Date Purchased______________ Consideration______________

I declare, under the penalties of perjury, that the contents of this form and all the accompanying schedules and statements have been examined by me and are true, correct, and complete to the best of my knowledge, information, and belief. __________________________________ Signature __________________________________ Print/Type Name of Signer ________________________ Title of Signer _______________ Phone Number ______________ Date RP-069 (Rev. 12/03 rs)