OMB Approved no. 2900-0362

Respondent Burden: 1 hour

+-----------------------------------------------------------------------+
| VA DEPARTMENT OF VETERANS AFFAIRS                                     |
+-----------------------------------------------------------------------+
| CLAIM UNDER LOAN GUARANTY                                             |
|                                                                       |
| (Chapter 37, Title 38, U.S.C.)                                        |
+-----------------------------------------------------------------------+
| NOTE: Use this form only in connection with loans guaranteed under    |
| Sections 501, 502, 503, 505 and 507 of the Serviceman's Readjustment  |
| Act of 1944 as amended or Section 3710 (formerly 1810) of the Title   |
| 38, U.S.C. Submit this original form with authorized signature to the |
| appropriate Regional Loan Center.                                     |
|                                                                       |
| [See the Supporting Documents Required Listing and instructions       |
| below.]{.smallcaps}                                                   |
+-----------------------------------------------------------------------+
| RESPONDENT BURDEN: Public reporting burden for this collection of     |
| information is estimated to average 1 hour per response, including    |
| the time for reviewing instructions, searching existing data sources, |
| gathering and maintaining the data needed, and completing and         |
| reviewing the collection of information. Send comments regarding this |
| burden estimate or any other aspect of this collection of             |
| information, including suggestions for reducing this burden to the VA |
| Clearance Officer (723),                                              |
|                                                                       |
| 810 Vermont Ave., NW, Washington DC 20420; and to the Office of       |
| Management and Budget, Paperwork Reduction Project (2900-0362),       |
| Washington, DC 20503.                                                 |
|                                                                       |
| Do not send requests for benefits to these addresses.                 |
+-----------------------------------------------------------------------+
| SUPPORTING DOCUMENTS REQUIRED                                         |
+-----------------------------------------------------------------------+

+-----------------------------------+-----------------------------------+
| > A. A Certified Statement of     | > D. Copies of all deeds          |
| > Account. This should be a copy  | > transferring title from the     |
| > of                              | > original veteran-obligor        |
| >                                 | >                                 |
| > the payment history or          | > through the owner holding title |
| > equivalent from the inception   | > at liquidation. Put the social  |
| > of the loan or at               | > security                        |
| >                                 | >                                 |
| > minimum from the date of        | > number or taxpayer              |
| > default or the date of the      | > identification number of each   |
| > first advance that is claimed   | > obligor not listed              |
| > in Item 12, if it is earlier    | >                                 |
| > than the date of default. A key | > in Items 2A through 2D on the   |
| > for reading the payment history | > corresponding deed.             |
| > must also be included.          | >                                 |
|                                   | > E. Copy of foreclosure document |
| B. Copy of paid receipts/invoices | > showing amount bid at sale when |
| for items claimed in Items 12 and | >                                 |
| 13.                               | > property is not conveyed to VA  |
|                                   | > (e.g. Trustee, Sheriff, or      |
| > C. Bankruptcy docket report or  | > Foreclosure                     |
| > equivalent (if applicable).     | >                                 |
|                                   | > Deed).                          |
+-----------------------------------+-----------------------------------+

+-----------------------------------------------------------------------+
| INSTRUCTIONS: The amounts shown in Item 11 are subject to VA audit.   |
| The amount listed in Item 11H will be increased by an amount equal to |
| the interest on the total eligible indebtedness from the date to      |
| which interest was paid to the date the liquidation was completed (or |
| other date established by VA under applicable regulations).           |
|                                                                       |
| If VA declines to specify an amount as a credit to the debt incident  |
| to a foreclosure sale, the claim is subject to the limitation that    |
| the amount payable shall in no event                                  |
|                                                                       |
| exceed VA's liability under the guaranty. The earliest advance listed |
| in Item 12 should be the partial amount actually advanced when the    |
| escrow account first becomes                                          |
|                                                                       |
| depleted. This will normally occur prior to the Loan Termination date |
| in Item 4, therefore, the amount in 11C should normally be zero if an |
| advance is listed in Item 12.                                         |
+-----------------------------------------------------------------------+
| **PURSUANT TO THE REGULATIONS ISSUED UNDER TITLE 38, U.S.C., THE      |
| UNDERSIGNED**                                                         |
|                                                                       |
| **SUBMITS A CLAIM FOR PAYMENT OF THE GUARANTY, AS SET FORTH BELOW**   |
+-----------------------------------------------------------------------+
| 1\. [Name And Address Of Claimant]{.smallcaps}                        |
+-----------------------------------------------------------------------+

+-----------------------------------------------+----------------------+
| 2A. [Name(s) And Address(es) Of Original      | 2B. [Social Security |
| Veteran-Obligor And Co-Obligor]{.smallcaps}   | Or                   |
|                                               | T                    |
|                                               | axpayer]{.smallcaps} |
|                                               |                      |
|                                               | [Identification      |
|                                               | Number(s) Of         |
|                                               | O                    |
|                                               | riginal]{.smallcaps} |
|                                               |                      |
|                                               | [Veteran-Obligor And |
|                                               | Co-                  |
|                                               | Obligor]{.smallcaps} |
+-----------------------------------------------+----------------------+
| 2C. [Name And Address(es) Of The Last Title   | 2D. [Social Security |
| Holder(s)]{.smallcaps}                        | Or                   |
|                                               | T                    |
|                                               | axpayer]{.smallcaps} |
|                                               |                      |
|                                               | [Identification      |
|                                               | Number(s) Of         |
|                                               | Last]{.smallcaps}    |
|                                               |                      |
|                                               | [Title               |
|                                               | Ho                   |
|                                               | lder(s)]{.smallcaps} |
+-----------------------------------------------+----------------------+

  --------------------- --------------------- --------------------------------
  3A. [VA Loan          3B. [Holder's Loan    4\. [Date Of Loan
  Number]{.smallcaps}   Number]{.smallcaps}   Termination]{.smallcaps}

  --------------------- --------------------- --------------------------------

+----------------+--------------------+-----------+------------------+
|                |                    | A. [Sale  | B. [Voluntary    |
|                |                    | Date]{.s  | Conveya          |
|                |                    | mallcaps} | nce]{.smallcaps} |
|                |                    |           |                  |
|                |                    |           | [Date Deed       |
|                |                    |           | Recor            |
|                |                    |           | ded]{.smallcaps} |
+----------------+--------------------+-----------+------------------+

  -----------------------------------------------------------------------
  5\. PAYMENTS

  -----------------------------------------------------------------------

+-----------------+-----------------+---------------+------------------+
| A. [Amount Of   | [B. Total       | [C. Amount    | [D. Amount       |
| Each Payment    | Payments        | Applied To    | Applied To       |
| (P&             | Receiv          | Interest      | Princi           |
| I)]{.smallcaps} | ed]{.smallcaps} | ]{.smallcaps} | pal]{.smallcaps} |
|                 |                 |               |                  |
| **\$**          | **[\$           | **[\$]{       | **[\             |
|                 | ]{.smallcaps}** | .smallcaps}** | $]{.smallcaps}** |
+-----------------+-----------------+---------------+------------------+

  -----------------------------------------------------------------------
  6\. PREPAYMENT(S) TO PRINCIPAL *(Include no-bid avoidance
  write-off(s))*

  -----------------------------------------------------------------------

+-----------------+-----------------+-----------------+-----------------+
| **A.            | **B.            | **A.            | **B.            |
| [Amount         | [Date           | [Amount         | [Date           |
| ]{.smallcaps}** | ]{.smallcaps}** | ]{.smallcaps}** | ]{.smallcaps}** |
+-----------------+-----------------+-----------------+-----------------+
| **\$**          |                 | **\$**          |                 |
+-----------------+-----------------+-----------------+-----------------+
| **\$**          |                 | **\$**          |                 |
+-----------------+-----------------+-----------------+-----------------+
| **\$**          |                 | **\$**          |                 |
+-----------------+-----------------+-----------------+-----------------+
| **\$**          |                 | **\$**          |                 |
+-----------------+-----------------+-----------------+-----------------+
| 7\. [Original   | 8\. [Percent Of | 9\. [Date       | 10\. [Date Of   |
| Loan            | Guaran          | Interest        | First Uncured   |
| Amou            | ty]{.smallcaps} | Collected       | Defau           |
| nt]{.smallcaps} |                 | To]{.smallcaps} | lt]{.smallcaps} |
|                 |                 |                 |                 |
| **\$**          |                 |                 |                 |
+-----------------+-----------------+-----------------+-----------------+

+------+---------------------------------------------------------------+
| VA   | 26-1874 (Revision Pending)                                    |
| FORM |                                                               |
|      |                                                               |
| JULY |                                                               |
| 2001 |                                                               |
+------+---------------------------------------------------------------+

  -----------------------------------------------------------------------
  11\. STATUS OF LOAN ACCOUNT

  -----------------------------------------------------------------------

+----------------------------------------------------+-----------------+
| A. [Principal Balance On Date Interest Was Last    | \$              |
| Paid By The Obligor]{.smallcaps}                   |                 |
+----------------------------------------------------+-----------------+
| B. [Advances Prior To The Date In Item             | +\$             |
| 4]{.smallcaps} (*Itemize in Item 12*)              |                 |
+----------------------------------------------------+-----------------+
| C. [Balance In T&I Account On Date In              | -\$             |
| Item]{.smallcaps} 4 (*If negative enter "0"*)      |                 |
+----------------------------------------------------+-----------------+
| D. [Subtotal]{.smallcaps}                          | \$              |
+----------------------------------------------------+-----------------+
| E. [Advances Paid After Date In Item               | +\$             |
| 4]{.smallcaps} (*Itemize in Item 12*)              |                 |
+----------------------------------------------------+-----------------+
| F. [Liquidation Expenses]{.smallcaps} (*Itemize in | +\$             |
| Item 13*)                                          |                 |
+----------------------------------------------------+-----------------+
| [G. Miscellaneous Credits]{.smallcaps} (*Rents,    | -\$             |
| Insurance refund, any remaining subsidy buydown    |                 |
| funds, etc.) (Attach an*                           |                 |
|                                                    |                 |
| *itemized listing of all miscellaneous credits.)*  |                 |
+----------------------------------------------------+-----------------+
| [H. Total Amount Claimed]{.smallcaps} (*VA will    | \$              |
| increase amount claimed by amount of interest due  |                 |
| from date interest is collected*                   |                 |
|                                                    |                 |
| *from borrower to interest cutoff date, sale date, |                 |
| or confirmation of sale) ( See instructions*)      |                 |
+----------------------------------------------------+-----------------+
| I. [Proceeds Of Liquidation]{.smallcaps} [Or       | \$              |
| Specified Amount]{.smallcaps} (*Whichever is       |                 |
| greater*)                                          |                 |
|                                                    |                 |
| (*Check applicable box and give amount*)           |                 |
+----------------------------------------------------+-----------------+

  ----------------------------------- -----------------------------------
  12\. ITEMIZED ADVANCES              13\. ITEMIZED LIQUIDATION EXPENSES

  ----------------------------------- -----------------------------------

  -------------------- ----------------------- ---------------------- -------------------- ----------------------- ----------------------
  A.                   B.                      C.                     A.                   B.                      C.
  [Date]{.smallcaps}   [Purpose]{.smallcaps}   [Amount]{.smallcaps}   [Date]{.smallcaps}   [Purpose]{.smallcaps}   [Amount]{.smallcaps}

                                               \$                                                                  \$

                                               \$                                                                  \$

                                               \$                                                                  \$

                                               \$                                                                  \$

                                               \$                                                                  \$

                                               \$                                                                  \$

                                               \$                                                                  \$

                                               \$                                                                  \$

                                               \$                                                                  \$

                                               \$                                                                  \$

                                               \$                                                                  \$

                                               \$                                                                  \$

                                               \$                                                                  \$

                                               \$                                                                  \$
  -------------------- ----------------------- ---------------------- -------------------- ----------------------- ----------------------

  -----------------------------------------------------------------------
  The undersigned hereby certifies that the information contained herein
  is true, accurate and complete, that this is a correct and valid claim,
  and that payment therefore has not been received. The undersigned
  further certifies that it is the owner of the loan identified in Item
  3A and that the Certificate of Guaranty or Endorsement of Guaranty
  issued by the Secretary of Veteran Affairs in respect to such loan will
  be surrendered or cancelled in accordance with 38 CFR 36.4333 upon full
  payment of this claim. If the undersigned fails or is unable to comply
  with the requirements of 38 CFR 36.4333 upon full payment of this
  claim, it agrees to indemnify the Department of Veterans Affairs to the
  extent of any loss which may be sustained by reason of such failure or
  inability

  14\. [Name And Telephone Number Of Official Whose Signature Appears
  Below]{.smallcaps}
  -----------------------------------------------------------------------

  --------------------------------------------- -------------------------
  15\. [Official Signature And                  16\. [Date]{.smallcaps}
  Title]{.smallcaps}                            

  --------------------------------------------- -------------------------

+------+---------------------------------------------------------------+
| PENA |                                                               |
| LTY: |                                                               |
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| ai   |                                                               |
| ding |                                                               |
| to   |                                                               |
| ob   |                                                               |
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| the  |                                                               |
| pay  |                                                               |
| ment |                                                               |
| or   |                                                               |
| appr |                                                               |
| oval |                                                               |
| of   |                                                               |
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| cl   |                                                               |
| aim. |                                                               |
+------+---------------------------------------------------------------+
| VA   | 26-1874 (Revision Pending)                                    |
| FORM |                                                               |
|      |                                                               |
| JULY |                                                               |
| 2001 |                                                               |
+------+---------------------------------------------------------------+