SPECIFIC POWER OF ATTORNEY FORM
(I)(We), the undersigned, (am)(are) the claimant(s) entitled
to be paid by the Disbursements Branch of the United States
Department of Housing and Urban Development (HUD), Washington, DC
20410, in the amount of ______________________ , generated by the
termination of FHA mortgage insurance on
FHA Case Number _____________________ , on property located at:
_____________________________________________________
_____________________________________________________
(I)(We) understand that a U.S. Treasury check which is payable
to the undersigned in this amount would ordinarily be sent to
(me)(us) at (my)(our) home address of:
______________________________________________
_____________________________________________, however (I)
(We) hereby authorize and direct HUD to deliver the U.S. Treasury
check in payment of this claim to _______________________________
located at ____________________________________________________ .
It is understood that HUD will honor this Specific Power of
Attorney only when submitted with the form HUD-27050-B and item 4
of the form HUD-27050-B shows the Third Party Tracer's address.
It is expressly understood that this Specific Power of Attorney
does not authorize or empower anyone other then the undersigned to
affix (my)(our) signature(s) to the check.
Signed, this _____________ day of __________________ , 19______
Signature __________________________________ Date _____________
Signature __________________________________ Date _____________
State of ____________________________________________
County of ___________________________________________
On the _______ day of _____________ , 19___, Before me, a Notary
Public, in and for said county, personally came and appeared
_____________________ , and ________________________ , personally known
to me to be the same person(s) described in and who executed the
above power of attorney and acknowledged the signing thereof to be
(his)(their) voluntary act and deed for the uses and purposes
therein mentioned.
__________________________________________________ (SEAL)
Notary
My commission expires: