All Contract Areas Rev. 4-15-15 All previous versions are obsolete. © BLB Resources, Inc. 2015 All rights reserved.
Certification
FHA Case Number _______________________ Selling Agent ___________________________________
Property Address (include city, state, zip) ____________________________________________________
Purchaser(s) __________________________________________________________________________
Purchaser certifies that he/she IS ______ or IS NOT_______ an Employee, Immediate Family Member,
Management Official, and/or Affiliated Entity of any of the following person(s)/entities:
1. BLB Resources, Inc.
2. Other HUD Asset Managers (AMs)
3. Appraiser for any HUD AM
4. HUD Local Listing Broker (LLB), including
but not limited to branch offices with the
same EIN and/or ownership
5. HUD Field Service Manager (FSM)
6. Buyer’s Selected Closing Agent
7. HUD (except for employees who have no
involvement in the management and oversight of
HUD-owned properties or HUD’s marketing and
management vendors, or a person related by
blood, law, or marriage to such a HUD
employee, IF employee submits an original or
fax copy of form HUD-50001 “HUD
Employee/Relative Home Purchaser
Certification” signed by the Director of the Office
of Single Family Asset Management)
For the purposes of this certification, the following terms are defined:
Immediate Family Members include any person, whether by blood, law, or marriage, who is: (1) a
spouse, domestic partner, child, sibling, or parent of a Management Official of any of the above entities;
or (2) the spouse or domestic partner of children, siblings or parents of the Management Official.
A Management Official is the owner, partner, principal, shareholder, director, officer, employee, agent,
representative, or any individual who directs the daily operations of an entity.
Affiliated Entity is any entity: (1) controlling, controlled by, or under common control with one of the
above entities; or (2) whose Management Officials are an immediate family member of a Management
Official of one of the above entities.
If Purchaser IS an Employee, Immediate Family Member, Management Official, and/or Affiliated Entity of
one of the above person(s)/entities, complete the following fields:
__________________________________________________________________________________
Relationship (e.g. parent, employee, Affiliated Entity, etc.)
__________________________________________________________________________________
Person(s)/Entity with whom Purchaser is related/affiliated (e.g. BLB Resources, Inc. employee;
appraiser for a HUD AM, etc.)
Purchaser, Selling Agent, and Selling Broker acknowledge that purchase of a HUD home by an Employee,
Immediate Family Member, Management Official and/or Affiliated Entity of one of the above
person(s)/entities may be deemed a conflict of interest, and may result in one or more of the following
penalties: 1) cancellation of the purchaser’s contract, 2) forfeiture of the purchaser’s earnest money
deposit, 3) removal of the LLB from the LLB network, and/or 4) loss of Selling Broker’s bidding privileges.
_________________________________________________ ____________________
Purchaser Signature (Required) Date
_________________________________________________ ____________________
Purchaser Signature (Required) Date
_________________________________________________ ____________________
Selling Agent Signature (Required) Date
_________________________________________________ ____________________
Selling Broker Signature (Required) Date
