| DISTRIBUTIVE SHARE-MORTGAGE INSURANCE REFUND THIRD PARTY TRACER INFORMATION |
Tracer Name Scott Holbert
Address 316 Watermelon Hill Rd
Street Apt No.
Eastover SC 29044
City State Zip
Contact Name Scott Telephone Number 803 556 4238
CLAIMANT INFORMATION
FHA Case Number (10 digits) ------------------------------------------------------ Important!!! Do not omit.
NAME
First Middle Initial Last Name
Additional Names
______________
Address _____________ ___ _
Street Apt No.
______________ __
City State Zip
Telephone Number ___________ _ ____
Include Area Code
Property Address __________ __
Street Apt No.
City State Zip
Date Title Date Sold Date Mortgage
Acquired ____________ If Applicable ___________ Was Paid Off ______________
_______________________________________________________________
The Department of Housing and Urban Development is not a party to any financial agreement betweenthe tracer and the claimant. MORTGAGORS:I/We, hereby certify that (I/We) never received a distributiveshare or premium refund from HUD in connection with this FHA INSURED MORTGAGE. (I/We) consentto the above Tracer submitting this form on (my/our) behalf._______________________________________________________________
SIGNATURE(S)
of Mortgagor(s) -DATE _________________
-DATE _________________
Forward "Form" to
Department of Housing & Urban Development
Distributive Shares Branch,
P.O. Box 23699
Washington, D.C. 20026-3699
