(I) (We), the undersigned. (am) (are) the claimants entitled to be paid by the Distributive Shares Branch of the United States Department of Housing and Urban Development (HUD), Washington DC 20410, a distributive share in the amount of _________, generated by the termination of FHA insurance on FHA case number _____________________, on a 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 the payment of this claim to:

___________________________ located at ____________________________.

It is expressly understood that this

Power of Attorney does not authorize nor empower anyone other than the undersigned to affix (my) (our) signature(s) to the check.

Signed, this ______day of _______,20____

Witness Signature

Witness Signature

On this _____ day of ______________, 20____ personally appeared before me;

______________________________________ the person or persons signing this Power of Attorney and acknowledge to me they have executed this instrument as their own act of deed.



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