Fillable At Risk Extension Request for Extension of Time

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At Risk Extension Request for Extension of Time

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The At Risk Extension Request for Extension of Time form is 2 pages long and contains:

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  • 0 check-boxes
  • 15 other fields

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File type: PDF

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At Risk Extension
Request for Extension of Time
Due To Critical Circumstances
Reverse Mortgage Servicing Department
P.O. Box 40724
Lansing, MI 48901
Phone (866) 446-0026
Fax (866) 447-2022
www.reversedepartment.com
Page 1 of 2 repmt-req_ti_004_202105
Instructions
This application is not valid for borrowers with properties located in New York. Please contact the Default
Assistance Department at 866-446-0026 for an applicable application.
If you have a HUD-insured HECM reverse mortgage loan, in order to determine if you are eligible for an extension of
time to delay the initiation or completion of foreclosure due to unpaid property charges such as property taxes or
home insurance, please fill out and return this form.
Your request must also include applicable supporting
documentation to provide evidence as to your claim. If viewing this form online, save to your computer and complete
the form. Print out and sign. Return all pages to one of the following contact points listed below.
By mail
By email
Scan to an image or PDF file and upload to
www.reversedepartment.com
or email to
AtRiskExtensions@reversedepartment.com.
By fax
Fax to
866-447-2022
Reverse Mortgage Servicing Department
P.O. Box 40724
Lansing, MI 48901
Request for Extension of Time and Certification of Critical Circumstances
NOTICE: The U.S. Department of Housing & Urban Development (HUD) has the sole and exclusive discretion to
determine whether you are eligible for an At Risk extension. Although you must disclose the nature of your critical
circumstances, we are not requesting detailed medical information from you.
Borrower Name _____________________________________ Date ________________________
Property Address _____________________________________ HECM Loan No: _______________________
_____________________________________
I have critical circumstances and request relief from foreclosure for the reason below: (Check one)
___ A terminal illness
___ A long-term physical disability
___ Family member with a terminal illness receiving care at the property address shown above
___ Other (please describe)
YOU MUST CAREFULLY READ AND SIGN THE CERTIFICATION AND ACKNOWLEDGMENT ON THE NEXT PAGE.
At Risk Extension
Request for Extension of Time
Due To Critical Circumstances
Reverse Mortgage Servicing Department
P.O. Box 40724
Lansing, MI 48901
Phone (866) 446-0026
Fax (866) 447-2022
www.reversedepartment.com
Page 2 of 2 repmt-req_ti_003_202005
Certification and Acknowledgment
I certify, acknowledge and agree to the following:
1. The youngest living HECM borrower is at least 80 years of age.
2. If I am required to provide additional information or documentation, I will timely respond to all
requests and timely submit such information or documentation.
3. I understand and consent to Celink disclosing and sharing my information, and information about
any foreclosure alternative I receive, with any owner, investor, guarantor (including HUD) or servicer
of any loan, or any subordinate lien holder (if applicable), along with their agents or authorized
representatives (authorized parties).
4. All of the information stated in this Certification is true. I understand that knowingly submitting false
information may violate federal and other applicable laws. I also understand that accuracy of my
statements may be reviewed by and relied on by Celink or any of the authorized parties.
5. By providing my telephone phone number, I consent to being contacted via voice call, text message, or
pre-recorded message by the Servicer or its authorized third party through an automated dialing system
regarding my account at any telephone number, including mobile telephone number, I have provided.
6. I understand that by signing this Certification, I am agreeing to toll (extend) any statute of
limitations applicable to an action to foreclose on the deed of trust or mortgage securing my HECM
loan by Celink, or any owner, investor, guarantor (including HUD) or services of my loan, or any
subordinate lien holder (if applicable) along with their agents or authorized representatives. The
applicable statue of limitations will be tolled effective as of the date of the original due and payable
event giving rise to my need for the extension requested by this Certification and will be tolled until
this extension expires (and it is not renewed by HUD) or my HECM loan becomes due and payable
by another default event in the future.
I understand this information is required by HUD to evidence any At Risk extension request.
Borrower Signature
Date
Co-Borrower Signature (if applicable)
Date
*FOR USE BY AN ATTORNEY-IN-FACT ONLY (if applicable)
*POA document must be attached hereto, unless already provided and approved by Reverse Mortgage
Servicing Department.
as Attorney-in-Fact for
Printed Name of Attorney-in-Fact
Printed Name of Borrower
Signature of Attorney-in-Fact
Date
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At Risk Extension Request for Extension of Time

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Completed 24 September 2021

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