Form Approved
OMB No. 0575-0172
Form RD 3550-9
(Rev. 10-06)
United States Department of Agriculture
Rural Housing Service
INITIAL ESCROW ACCOUNT DISCLOSURE STATEMENT
Disclosure Date:
Lender's Name and AddressBorrower Name and Address
Loan No.
Telephone No.
of which $
will be for principal and interest, and $
will go into your escrow account.
of which $
Your first monthly mortgage payment for the coming year will be $
will go into your escrow account The terms of your loan may result
will be for principal and interest, and $
in changes to the principal and interest payments during the year.
This is an estimate of activity in your escrow account during the coming year based on payments anticipated to be made from your
account.
Escrow Acct.
Balance
Payments from
Escrow Acct.
Month/
Payment No.
Description
Starting Balance:
$
(Please keep this statement for comparison with the actual activity in your account at the end of the escrow accounting computation year.)
Cushion selected by servicer: $
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control
number. The valid OMB control number for this information collection is 0575-0172. The time required to complete this information collection is estimated
to average 5 minutes 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.
Payments to
Escrow Acct.
Your mortgage payment for the coming year will be $
(Borrower Signature) (Borrower Signature)
(Date Signed) (Date Signed)
