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DEVELOPMENT INFORMATION <br />Property Address (Street, City, State, Zip): <br />Year Built: # of Bldgs: # Stories: <br /># of Total Units: Units subject to rent/income restrictions: <br />IS THE PROPERTY IN COMPLIANCE WITH CURRENT LAND USE REQUIREMENTS? YES NO <br />IS HOUSING DESIGNED EXCLUSIVELY FOR THE ELDERLY OR PEOPLE WITH DISABILITIES? YES NO <br />Current Indebtedness on the Property/Building: <br />DATE PROPERTY PURCHASED:__________________ MORTGAGE HOLDER____________________________ <br />MONTHLY MORTGAGE PAYMENT:_______________ PRESENT BALANCE_____________________________ <br />INSURANCE AGENT FOR RENTAL PROPERTY:____________________________________________________ <br />MATCHING FUNDS INFORMATION <br />Owner contribution to receive rental rehabilitation grants is required, please list sources and terms of funds: <br />RELOCATION INFORMATION <br />Will the rehabilitation result in permanent displacement of any current residents? Yes No <br />Will the rehabilitation require any temporary relocation of current residents? Yes No <br />ADDITION FUNDING REQUESTS <br />Have you applied for other county, state or foundation funding for the proposed? Yes No <br />If yes, please list funding request and status: <br />Funding Agency Status <br />If no, please explain why: <br />3 <br /> <br />