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Get HUD-51004 1992

(date)(mm/dd/yyyy) _____________________ . Name of Owner By (Authorized Representative) Title Date (mm/dd/yyyy) Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/or civil penalties. (18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802) Previous editions are obsolete form HUD-51004 (3/92) ref. Handbooks 7417.1 & 7450.1 .

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