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3. Private Funds <br /> (1) Private Loans $ <br /> (2) Owner Cash Contribution $ <br /> (3) Private Grants $ <br /> Total Private Funds $ <br /> 4. Activity Total or Total Address $ <br /> I. Beneficiaries. (Refer to code below where applicable) <br /> Household <br /> Unit #of Hispanic Assistance Total <br /> # Bdrms Occupant %o Med ? Race Size Type Type Monthly <br /> Y/N Rent <br /> J. Lead Paint <br /> (1)Applicable Lead Paint Requirement: (Please select one) <br /> O Housing constructed before 1978 (If you check this box please see question#2) <br /> O Exempt: Housing constructed 1978 or later <br /> O Otherwise Exempt <br /> (2) Lead Hazard Remediation Actions (Only if Housing was constructed before 1978) <br /> O Lead Safe Work Practices (24 CFR 35.930 (b)) <br /> O Interim Controls or Standard Practices (24 CFR 35.930 (c)) <br /> O Abatement(24 CFR 35.930 (d)) <br /> FHA Insured (Y/N)? <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 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 16—American Indian or Alaska Native&White <br /> Household Size Household Type 17—Asian&White <br /> 1 —1 person 1 —Single,non-elderly 18—Black or African American&White <br /> Assistance Type 2—2 persons 2—Elderly 19—American Indian or Alaska Native&Black or African <br /> 1 —Section 8 3—3 persons 3—Single parent American <br /> 2—HOME TBRA 4—4 persons 4—Two parents 20—Other Multi Racial <br /> 3—Other federal,state 5—5 persons 5—Other <br /> or local assistance 6—6 persons <br /> 4—No assistance 7—7 persons <br /> 8—8 or more persons <br /> Exhibit D <br /> HCS-17-42-1701-198 <br /> City of Everett <br /> Page 3 of 6 <br />