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Ill. REHABILITATION PROPOSED <br /> Briefly describe the proposed work and purpose <br /> Exterior: <br /> Interior: <br /> Site Work: <br /> (A detailed Scope of Work document with construction bids is required prior to final <br /> approval to substantiate eligible costs. In addition, a visual inspection of the site will be <br /> required to ensure that the improvements have been completed as noted in the <br /> application and scope of work). <br /> As a result of the rehabilitation,Will you be creating any new jobs? Yes No <br /> If yes,how rnan3r? <br /> IV. FINANCIAL INSTITUTION INFORMATION <br /> Tame: <br /> Addresss: <br /> Contact: Rhone: <br /> Business Owner's Signature Date <br /> Business Owner's Signature Date <br /> Note: The participating bank has the right to require additional documentation prior <br /> to consideration and approval of the request. <br /> Q:\Econornic DevelapmenABusine$s Retention ProgramsWan application form.doc <br /> 2 <br />