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EXHIBIT D <br /> U.S. Department of Housing and Urban Development <br /> Office of Community Planning and Development <br /> Homeowner Rehab Set Up and Completion Form <br /> HOME Program (For single and multi-address activities) <br /> Check the appropriate box: Name and Phone Number of Person Completing Form: <br /> ❑ Original Submission 0 Change Owner's <br /> Address <br /> 0 Ownership Transfer ❑ Revision <br /> A. General Information <br /> 1. Name of 2. IDIS Activity ID Number: 3. Activity Name: <br /> Participant: <br /> Set Up Activity: <br /> B. Objective and Outcome. <br /> 1. Objective (enter code): 2. Outcome (enter code): <br /> (1) Create suitable living environment (1)Availability/accessibility <br /> (2) Provide decent affordable housing (2)Affordability <br /> (3) Create economic opportunities (3) Sustainability <br /> C. Special Characteristics. <br /> 1. Activity Location 2. Will this activity be <br /> Type "Y" next to any that apply carried out by a faith- <br /> (1) CDBG Strategy Area (5) Brownfield redevelopment area based organization <br /> (2)_ Local target area (6)_Conversion of nonresidential to (Y/N)? <br /> (3)_ Presidentially declared major (7)_Colonia (for AZ, CA, NM, TX) <br /> disaster area residential use <br /> (4) Historic preservation area <br /> D. Activity Information. <br /> 1. Homebuyer's Name (option): 2. Street: <br /> 3. City: 4. 5. Zip 6. County Activity Estimates: <br /> State: Code: Code: 7. HOME Units: <br /> 8. HOME Cost: $ <br /> 10. Multi-Address (Y/N)? 11. Loan Guarantee (Y/N)? <br /> E. Contractor. (For multi-address activities only) <br /> 1. Contractor Type (Enter code): 2. Contractor's Name: <br /> (1) Individual (4) Not-for-Profit 3. Contractor's Street Address: <br /> (2) Partnership (5) Publicly Owned <br /> (3) Corporation (6) Other 4. City: 5. State: 6. Zip Code: <br /> Exhibit D <br /> HCS-16-42-1601-198 <br /> City of Everett <br /> Page 1 of 6 <br />