Collateral Information Questionnaire
Date completed:
Property Address:
Prepared by:
The purpose of this questionnaire is to provide additional factual information regarding physical attributes, occupancy agreements and operational characteristics of the property for use in the appraisal and underwriting processes. The primary elements supported with the profile include:

Please answer each question explaining any "Yes" answers below:
Yes
1. Does the property contain commercial income that accounts for more than 25% of the annual gross potential income? If YES then please explain:
2. Does the property have public-provided water and sewer? If NO then please explain:
3. Does the property rent space units where liquor, beer or wine is served to customers and consumed on-site? If YES then please explain:
4. Does the property show evidence of having been converted from its initial intended and permitted use - such as from a house or from a motel? If YES then please explain:
5. Does the property include land parcels that do not share a common lot line (that are not contiguous)? If YES then please explain:
6. Does the property contain aluminum wiring?
  a) Is there aluminum wiring running from the electrical sub-panel to the major appliances (stove, refrigerator, air conditioner)?
  b) If answered "yes" to question (a), is the appliance plugged into a properly wired, code compliant 220 volt outlet?; If "no", is the appliance plugged into a properly lugged standard 115 volt outlet?
  c) Is there aluminum wiring going to all other receptacles other than the major appliances?
  d) If answered "yes" to question (c), are the receptacles pigtailed with retrofitted copper and fastened with a lug-nut?
  e) Is there knob & tube wiring present?
7. Does the property operate with seasonal occupancy? If YES then please explain:
8. Does the property operate as furnished housing (Furniture provided by the landlord)? If so, identify the units and their bedroom count mix. If YES then please explain:
9. Is the property subject to rent control restrictions either by public law or under any other agreement (HAP contract)? If YES then please explain:

Borrower will need to obtain a Collateral Assignment from HUD prior to or near the time of rate lock. Lender will require legal review of the HAP contract and Collateral Assignment from HUD.
10. Does the property have subsidized rental (Section 8) occupancy? If so, all Section 8 leases & addenda are required with submission of loan package. If YES then please explain:
11. Does the property have tenancy restrictions or conditions attached to the property based upon zoning, permit, HUD, municipality or other enablement agreements that set aside tenancy allocations? If YES then please explain:
12. Does the property have rooming house tenancy (i.e. - where initial lease occupancy terms are less than six months and/or rent paid more frequently than monthly)? If YES then please explain:
13. Has the property in the past 12 months offered: 1) rent concessions, or 2) orther rent abatement techniques? If YES then please explain:
14. Has the borrower been made aware of any prior testing of the property for any of the following: (A) radon; (B) asbestos; (C) lead hazards; (D) chemical contamination of the soil or ground water; (E) underground subsidence risk; or (F) performance of a Phase 1 Environmental Study? If YES then please explain:
15. Is the property heated by oil supplied by an underground oil tank, or are any unused underground tanks present? If YES then please explain:
16. Is the property within 1/8 mile of any facility that generates or handles materials that could be considered toxic or hazardous in nature: e.g. dry cleaner, service station, oil change facility, etc.? If YES then please explain:
17. Is the property a Mobile Home Park with less than 15 pads and has more than 25% park owned models or more than 10% Recreational Vehicles? If YES then please explain:
18. Is the property a Mobile Home Park with onsite waste management / septic or well? If YES then please explain:

If onsite waste management - Lender will require current permits with no violations from the local authority (Lender reserves the right to obtain a third party consultant at borrower's expense to review the documentation). If septic or well - Lender requires satisfactory well and/or septic inspection from a licensed inspector (Borrower can order).
19. Is the property within a Zone 3 or 4 as defined by the FEMA Seismic Zone Map?
  a) Is the property built on or next to a hill with a slope exceeding a 30 degree angle? if YES, then property is INELIGIBLE.
  b) Is the loan amount requested greater than $1,500,000.00 with a joint LTV greater than 55% with any one of the following characteristics: 1) Basic structural system other than wood frame, 2) Tuck-under parking grater than 30.00% of the footprint of the building, 3) Subterranean parking built prior to 1980 or having a solid/sheer wall equating less than 30% of the perimeter, or 4) Soft Story where more than 50% of the structure is built above a retail store with a large store display? If YES, then a PL is needed. After submitting this form, you will be asked to fill out a Seismic Questionnaire.
Borrower/Guarantor Signature Date
YYYY-mm-dd
Broker Signature Date