Type of Unit being type Unit.
Type of Unit. Singe, Semi-detached, condo town, freehold town, row house, duplex, condo apartment Total ($) requested in this report: Total ($) IAH Loans advanced to date: Service Manager Region: Date of Report: I hereby confirm that the above mentioned Purchasers and Units comply with all provisions and eligibility requirements set out in the Homeownership Component of the Service Manager Administration Agreement and the Program Guidelines. Name Title Signature Date APPENDIX “D” IAH HOMEOWNERSHIP ANNUAL REPORT Cumulative Report On Homeownership Loans Advanced by the Service Manager AIMS Reference No. Purchaser Name IAH Loan Amount Mortgage Registration No. Date Security Registered on Title Closing Date Project Status TOTAL With respect to any sale of an Eligible Unit, cessation of occupancy by debtor or repayment of an IAH Loan AIMS Reference No. Eligible Unit Address Original Purchase Price Resale / Fair Market Value IAH Loan Amount Total Amount Repaid Date Repayment Received Date of Closing Reason for Repayment TOTAL With respect to withdrawals from the Revolving Loan Fund and redeployment of Revolving Loan Funds AIMS Reference No Purchaser Name Client Type Eligible Unit Address Type of Unit Purchase Price Loan Amount Closing Date Date Security Registered on Title TOTAL Balance ($) of the RLF as of Last Report [date]: Legend for Reporting Requirements Balance ($) of the RLF as of Current Report [date]:
Type of Unit. Singe, Semi-detached, Condo Town, Freehold Town, Row House, Duplex, Condo
Type of Unit. Rate per Unit ( 1 ) Number of Units Provided this Reporting Period ( 2 ) Total Funds Earned this Reporting Period ( 3 ) Prior Report Period Year to Date Funds Earned ( 4 ) Total Year to Date Funds Earned ( 5 ) TOTAL ADHS USE ONLY THIS SECTION FOR ADHS ACCOUNTING USE ONLY 7. CONTRACTOR CERTIFICATIONI certify that this report has been examined by me, and to the best of my knowledge and belief, the reported expenditures and fixed price information is valid, based upon our official accounting records (book of account) and consistent with the terms of the contract. It is also understood that the contract payments are calculated by the Department of Health Services based upon information provided in this report. AUTHORIZED CONTRACTOR'S SIGNATURE/TITLE/DATE ADHS PROGRAM COORDINATOR CERTIFICATION: Performance satisfactory for payment Performance unsatisfactory, withhold payment No payment due Total Expenditures or total Fixed Price Adj (if required): Less: Year to date payments Adj (if required): Net payment due: Index PCA AY Amount PROGRAM COORDINATOR SIGNATURE/DATE Page 27 of 30 ADHS/BFS/F-110 (Rev. 3/2002) WHITE-ADHS ACCOUNTING* PINK-ADHS ACCOUNTING COPY * CANARY-ADHS PROGRAM COPY * GOLDENROD-CONTRACTOR'S COPY Exhibit C CONTRACT NO: CTR055477
