**Reserve Withdrawal Request**

TO: USDA Rural Development FROM:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ (BORROWER NAME)

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_ DATE OF REQUEST:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Amount Requested: \$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
Vendor/Payee:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Description of Work/Need for Funds:
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Attached are \_\_\_\_\_\_\_ Bids OR \_\_\_\_\_\_\_ Justification if
only 1 bid submitted or Emergency Repair**

O & M Account Balance:
\$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_(Including 2%, any
Certificates of Deposit, savings, etc.)

Reserve Account Balance \$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

RE Tax Account Balance: \$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Security Deposit Acct. Balance:
\$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Are there sufficient funds in the operating account for this request?
YES NO

And, was this a planned operating expense in the approved budget? YES NO

***If you answered YES to either question, reserve request should not be
submitted without prior discussion with Area Office.***

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Signature of Complex Representative**

\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*

**(For Rural Development Use Only)**

Date Received: \_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

**Your reserve request has been approved, as follows:**

\$\_\_\_\_\_\_\_\_\_\_\_\_\_ This amount is an authorized expenditure
and repayment by increasing the reserve payment level is not required;
however, the period of deposits are extended until the required deposit
level is achieved.

\$\_\_\_\_\_\_\_\_\_\_\_\_\_ This amount is an annual recurring type of
expense and must be restored in the reserve account according to the
terms and conditions contained in your servicing workout plan with USDA
Rural Development.

**Your reserve request is denied.** A formal rejection letter with
appeal rights is being sent under separate cover.

This is your Authorization to proceed with work. When work is completed,
please forward a check/withdrawal slip

with Invoice for countersignature.

\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_
\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_

Rural Development Approval Official Date

\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*\*

A check/withdrawal slip in the amount of
\$\_\_\_\_\_\_\_\_\_\_\_\_\_\_\_has been countersigned and is enclosed.

\_\_\_\_\_\_\_\_\_ (Initials of RD countersigning official) Date:
\_\_\_\_\_\_\_\_

(See Instructions on reverse side of this page)

**[INSTRUCTIONS FOR COMPLETING RRH GUIDE 56]{.underline}**

1)  Borrower submits request to Area Office for reserve funds
    **[prior]{.underline}** to any work being done by completing the top
    portion of this guide. Note: post approvals of reserve funds can
    only be approved in emergency situations.

2)  Rural Development Delegated Official will review request and approve
    or reject within 5 working days of receipt.

3)  If approved, when work is completed the borrower will submit
    check/withdrawal slip with invoice to Area Office for
    countersignature along with a copy of the previously approved
    Request for Reserve Funds (RRH Guide 56).

4)  Area Office will review and countersign check/withdrawal slip and
    return promptly to borrower.