Form VA Form 26-8629 VA Form 26-8629 Manufactured Home Loan Claim Under Loan Guaranty

OMB Approved No. 2900-0408
Respondent Burden: 20 minutes

MANUFACTURED HOME LOAN CLAIM UNDER LOAN
GUARANTY

(Manufactured Home Unit Only) Section 3720, Chapter 37, Title 38 U.S.C.)
RESPONDENT BURDEN: We need this information to determine the amount payable under the loan guaranty, title 38 United States Code allows us to collect this
information. We estimate that you will need an average of 20 minutes to review the instructions, find the information, and complete this form. VA cannot conduct or
sponsor a collection of information unless a valid OMB control number is displayed. You are not required to respond to a collection of information if this number is not
displayed. Valid OMB control numbers can be located on the OMB Internet Page at www.whitehouse.gov/omb/library/OMBINV.VA.EPA.html#VA. If desired, you
can call 1-800-827-1000 to get information on where to send comments or suggestions about this form.

SUPPORTING DOCUMENTS REQUIRED
1. Original or copies certified by the holder, of all

4. A copy of the new installment sales contract (if the
resale of the security was financed) or the proceeds
check (if the security was resold for all cash).
5. Copies of all instruments transferring title from the original
veteran-obligor through the owner holding title at
liquidation, with the Social Security number or taxpayer
identification number of each obligor not listed in Items 2A
through 3B shown on the corresponding transfer instrument.

instruments evidencing or securing the indebtedness.
2. If claimant is a transferee, certified copy of instruments
or transfer.
3. Statement of account in duplicate. This should in effect
be a copy of the ledger sheets or equivalent.

INSTRUCTIONS
1. Item 10A - Enter original principal only excluding any
discount or add-on interest.
2. Item 10D - In case of an interest bearing note enter here
(whether or not paid in whole or in part) the total interest
accrued to the date shown in Item 9A. In case of discount
or add-on note enter here the interest earned, computed
by the actuarial method (not rule of 78s), from the date of
loan disbursement to the date in Item 9A.
3. Item 10E - In the case of an interest bearing note enter here
the total amount of interest paid from the date of the loan to
the date in Item 9A. In case of a discount or add-on make no
entry.

4. Item 10F - In case of an interest bearing note enter here
the amount of interest due from the borrower (Item 10D
minus Item 10E). In case of a discount or add-on note
the amount will be the same as Item 10D.
5. Item 11B - Accrued interest from the cutoff date to the
date of resale will be payable at 6%, not to exceed 60
days, for loans closed prior to May 8, 1984. For loans
closed on or after May 8, 1984, accrued interest from the
cutoff date to the date of resale will be payable at
04.75% below the contract rate, not to exceed 90 days.

Pursuant to the regulations issued under Title 38, U.S.C., the undersigned submits claim for payment of the guaranty as set forth below.
1. NAME AND ADDRESS OF CLAIMANT

2A. NAME(S) AND ADDRESS(ES) OF ORIGINAL
VETERAN-OBLIGOR AND CO-OBLIGOR

2B. SOCIAL SECURITY NUMBERS OF
ORIGINAL VETERAN-OBLIGOR AND
CO-OBLIGOR

3A. NAME(S) AND ADDRESS(ES) OF LAST TITLE

3B. SOCIAL SECURITY OR TAXPAYER IDENTIFICATION
NUMBER(S) OF LAST TITLE HOLDER(S)

4. VA LOAN NUMBER

5. HOLDER’S LOAN NUMBER

6. PERCENTAGE OF GUARANTY

7. AMOUNT OF GUARANTY
%

$

8. AMOUNT AND TERMS OF LOAN
A. DATE OF LOAN

B. AMOUNT BORROWED C. DISCOUNT OR
ADD-ON
$
$
G. YEARS

F. AMOUNT OF PAYMENT

9A. APPLICABLE CUT OFF DATE FOR CLAIM
COMPUTATION - 38 CFR 36.4284(a)

E. INTEREST RATE
PERCENT TYPE
SIMPLE
DISCOUNT
%
H. MONTHS

10. STATUS OF ACCOUNT

JUDGEMENT OR
FORECLOSURE
DECREE

FIRST NOTICE OF
SALE PUBLISHED
(Nonjudicial)

NO SECURITY
AVAILABLE - 6 MONTHS
AFTER FIRST UNCURED
DEFAULT

11. FINAL ACCOUNTING ON SECURITY LIQUIDATION

DATE

A. TOTAL INDEBTEDNESS ON DATE OF CLAIM
(Item 10H)

$

$

B. CREDITS TO PRINCIPAL
(Item 13C on reverse)

B. DATE OF SALE
INTEREST
FROM DATE OF CLAIM TO SALE DATE (See Instruction 5)

C. ADJUSTED PRINCIPAL BALANCE
(Item 10A minus Item 10B)
D. ACCRUED INTEREST PAID AND UNPAID OR
EARNED DISCOUNT OR ADD-ON
(See Instruction 2)

C. LIQUIDATION EXPENSES FROM
SCHEDULE A, ITEM 16 ON REVERSE

E. INTEREST PAID (Item 13B on reverse)
(See Instruction 3)

E. TOTAL

D. ADVANCES (Not in Item 10G)
(See Item 15 on reverse)

$

F. LESS BALANCE IN T & I ACCOUNT Insurance REFUNDS,
AND OTHER CREDITS (Omit if included in Item 10B)

F. BALANCE OF INTEREST DUE OR
EARNED DISCOUNT OR ADD-ON
(See Instruction 4)

G. TOTAL INDEBTEDNESS ON DATE OF SECURITY
LIQUIDATION

G. CHARGES TO PRINCIPAL
(Item 15 on reverse)

H. GROSS PROCEEDS OF LIQUIDATION

H. TOTAL INDEBTEDNESS
(Sum of Items 10C, 10F, and 10G)

I. BALANCE (Item 11G minus 11H)
I

% (ITEM 6) OF 10H

$

12. AMOUNT CLAIMED (The smallest of Item 7, Item 10I, or Item 11I)
VA FORM
MAR 2005

26-8629

ADD-ON

9B. CUT OFF DATE FOR CLAIM BASED ON (Check one)
REPOSSESSE
D
SECURITY

A. ORIGINAL
PRINCIPAL
AMOUNT AS

D. FACE AMOUNT OF
LOAN INSTRUMENT
$

EXISTING STOCK OF VA FORM 26-8629, MAY 2002,
WILL BE USED.

$

STATEMENT OF ACCOUNT
INSTRUCTIONS: (1) Complete in detail and include the amounts shown in Item 10 on front of this form. (2) Total payments received will be shown in both Items 13A
and 13C where discount or add-on note is used. (3) Items 13B and 13F will not be completed if discount add-on note is used.
13. PAYMENTS
A. TOTAL PAYMENTS RECEIVED

E. DATE OF FIRST UNCURED DEFAULT

D. PREPAYMENTS TO PRINCIPAL
AMOUNT

$
B. AMOUNT APPLIED TO INTEREST

DATE
F. AMOUNT OF INTEREST COLLECTED TO DATE

$

$
C. AMOUNT APPLIED TO PRINCIPAL
$

$

14. TAX AND INSURANCE ACCOUNT
AMOUNT

BALANCE IN TAX AND INSURANCE ACCOUNT (If maintained) (This amount must be included in Item 10B, if this sum is
legally applicable to debt as of claim computation cut-off date; if not include in Item 11F)

$

15. ADVANCES
(Advances made before cut-off date in Item 9 will be shown in Item 10G; those made after will be shown in Item 11D)
AMOUNT OF ADVANCE
(A)

DATE MADE
(B)

PURPOSE
(C)

$

$

$

$

16. SCHEDULE A - LIQUIDATION EXPENSES
ITEM
A.

$

AMOUNT

ITEM

AMOUNT
F.

B

G

C.

H.

D.

I.

E.

J.

K. TOTAL

$

$
AMOUNT

17. INSURANCE REFUNDS OR OTHER CREDITS UNDER 38 CFR 36.4283(H)(5) (Show amount in Item 11F)

$

PRIVACY ACT INFORMATION: VA will not disclose information collected on this form to any source other than what has been authorized under the Privacy Act of
1974 or Title 38, Code of Federal Regulations 1.576 for routine uses (e.g., to a member of Congress inquiring on behalf of a veteran) as identified in the VA system of
records, 55VA26, Loan Guaranty Home, Condominium and Manufactured Home Loan Applicant Records, Specially Adapted Housing Applicant Records, and Vendee
Loan Applicant Records - VA, and published in the Federal Register. Your obligation to respond is mandatory under 38 CFR 36.4215 and 36.4284.
CERTIFICATION: The undersigned hereby certifies that the information contained herein is true and accurate, 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 8 and that the Certificate of Guaranty or Endorsement
of Guaranty issued by the Secretary of Veterans Affairs in respect to such loan will be surrendered or canceled in accordance with 38 CFR 36.4218 upon full payment of
this claim. If the undersigned fails or is unable to comply with the requirements of 38 CFR 36.4218 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.
18. ATTEST (Signature of Secretary)

20. DATE

21. OFFICIAL SIGNATURE AND TITLE

19. CLAIMANT