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1 <br /> 9 <br /> 2.Public Funds <br /> Da.a" <br /> (1)Other Federal Funds <br /> (2) State/Local Funds $ <br /> (3)Tax Exempt Bond Proceeds $ ,„ _ 0"�g <br /> Total Public Funds 1 + 2 + 3 _. - $ <br /> 3. Private Funds <br /> (1)Private Loans $ '`- <br /> z r_ Fi , "fes+ <br /> (2)Owner Cash Contribution $ �j <br /> — a sxs <br /> $ ; � I$Ni tj: i4 T <br /> (3)Private Grants tiLL y <br /> 4,3_0 <br /> r <br /> Total Private Funds[(1)+(2)+(3)] <br /> 4.Activity Total(or Total this address) ! .*l- -¼. ' ' $ <br /> .a�4i�as .47).1...i_ .,,e?w- a !+f�+ <br /> • <br /> K. Household Characteristic. (Refer to code below where applicable) <br /> Household <br /> #ofHispanic? Assistance Total <br /> % <br /> Unit# Bdrms OccupantMed .. Race Size Type Type Monthly Rent <br /> 2 N/A N/A <br /> 1.Homebuyer Counseling 2.FHA Insured Y/N? 3.First-time homebuyer Y/N? <br /> Homebuyer received(enter code): (For multi address activities.) <br /> (1)No Counseling (3)Post-counseling <br /> (2)Pre-counseling (4)Both <br /> 4.Coming from subsidized housing Y/N? i 5.Lease Purchase YIN? If yes,date of agreement: <br /> (For multi address activities.) <br /> #of Bdrms Occupant Household%of Med Household Race <br /> 0-SRO/Efficiency 1–Tenant 1–0 to 30% 11–White <br /> 1–1 bedroom 2–Owner 2–30+to 50% 12–Black or African American <br /> 2–2 bedrooms 9–Vacant Unit 3–50+to 60% 13–Asian <br /> 3–3 bedrooms I I 4–60+to 80% 14–American Indian or Alaska Native <br /> 4–4 bedrooms 15–Native Hawaiian or Other Pacific Islander <br /> 5–5 or more bedrooms Household Size 16–American Indian or Alaska Native&White <br /> 1–1 person 17–Asian&White <br /> 2–2 persons Household Type 18–Black or African American&White <br /> Assistance Type 3–3 persons 1–Single,non-elderly 19–American Indian or Alaska Native&Black or <br /> l–Section 8 4–4 persons 2–Elderly African American <br /> 2–HOME TBRA 5–5 persons 3–Single parent 20–Other Multi Racial <br /> 3–Other federal,state or 6–6 persons 4–Two parents - I i <br /> . local assistance — 7–7 persons — 5–Other <br /> 4–No assistance 8–8 or more persons Revised(8/06) <br />