Reserve for Replacement / Operations Management

Contact Information

First Name
Last Name
Email
Phone

Request Type

Instructions

Instructions: Indicate the Fund for the request and provide the information for each section as requested.

Owners/Agents must also submit the following with this form:

A narrative providing a detailed description of the work performed or to be performed;
Copies of paid invoices if the withdrawal request is for reimbursement for work that has been performed;
If a bid exceeds $25,000 than copies of bids may required. Please refer to HUD Handbook 4350.1 Chapter detailed guidance;
Mortgagor Certification (refer to HUD Handbook 4350.1, REV-1); and,
A list of appliances and/or major components that will be replaced along with a notation of whether or not the replacement items will be energy efficient products. If replacement items are not energy efficient products, the owner/agent must provide a justification.

Property Information

Has your Signatory Authority changed?

Held by KHC?

Project Number

Project Name

Address 1

Address 2

City

State

Zip Code

Mortgagee Information

Loan Number

Mortgagee Name

Address 1

Address 2

City

State

Zip Code

Request Specifics

Reserve for Replacements Fund

Residual Receipts Fund

This is your authority to adjust the reserve requirements accordingly. This authority is revocable upon written notice from HUD.

A change in the monthly RFR deposit from $

to $

effective

A suspension of deposits to the reserve from

A suspension of deposits to the reserve so long as a balance of $

is maintained.

A reimbursement request for goods, materials, equipment or appliances purchase.

An advance of RFR funds for goods, materials, equipment or appliances to be purchased.

A loan advance of $

from RFR or RR. To be repaid from

An inspection made on the date of

revealed satisfactory replacement and/or installation.

An inspection will be made on the next visit to the property. Satisfactory replacement and/or installation will be determined at that time.

Current account balance: $

as of

Request to release the following amounts from the reserve:

Purpose	Amount
	$
	$
	$
	$
	$
	$
Total	$

To: (Mortgagor/Managing Agent) (*This is where the check will be mailed)

Mortgagor Name

Address 1

Address 2

City

State

Zip Code

Operating Reserve Minimum Balance Certification

Minimum account balance

Current account balance

Amount of draw request

Ending account balance

Comments (Optional)

Attach Documents

Submitted by:

Email:

Title: