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EXHIBi7 A <br />REPORT FORM B <br />FACILITY-BASED NON-HOUSING <br />(Property Acquisition. Construction or Rehab) <br />Activity Name: <br />Facility Type: _ <br />Date of ClosinglLease Execution: <br />Date ConstructionlRehab Started: <br />Date Construciion/Rehab Completed: <br />Date Operations Staff Hired: <br />Date Support Services Started: <br />HOPWA Site Expenditures (tn dollars) <br />Acquisition: <br />Rehab/ConversionlRepair: <br />Lease: <br />Operating Costs: <br />other: <br />other: -- <br />TOTAL: <br />is the site owned by a public entity? <br />Is this activity "substantial" rehab? <br />~~ ^~ <br />QYes QNo <br />. ,. <br />S <br />S <br />S <br />S <br />S <br />AvaNable HOPWA Funds <br />Allocated HOPWA Funds: <br />Allocated HOPWA Proc~am Irxome: <br />Total HOPWA funds for Project: <br />Total HOPWA Expended to date: <br />Balance HOPWA Funds to date: <br />Source Of Non-HOPWA Funds <br />Total Non-HOPWA Funds: <br />+~ <br />_~ <br />-S <br />=S <br />Total Available <br />S <br />S <br />~, <br />S <br />Expended To Date <br />S_ <br />~_ <br />NOf1lt-A P.z-~ori form 6 ~~~~~~ 1111~I04 <br />