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~~ <br />~ucatlon Is~ <br />O OFFICE USE ONLY O <br />REQUEST FOR FINAL PAYMENT <br />Date <br />NSP Grant Services Agreement <br />ANR Homes, Inc. (Developer) <br />Property Address: <br />AMOUNT REQUESTED: <br />AMOUNT RETAINED: <br />AMOUNT DISBURSED: <br />PAYABLE TO: <br />ANR Homes, Inc. <br />iDS NUMBER: <br />ESCROW NUMBER: <br />ACCOUNT NUMBER / W.O.#: <br />DEVELOPER <br />The undersigned CONTRACTOR: (1) Certifies that to the best of their knowledge, information and belief, the work summarized on the <br />attached invoice and covered by this Final Payment Request has been completed in accordance with all of the terms and conditions of <br />the NSP Grant Services Agreement; (2) Certifies that they have obtained all required building permits, inspections and approvals for <br />the work covered by this Final Payment Request. <br />Date <br />SOURCE OF FUNDS <br />!~ HOME <br />~~ CALHOME <br />'TAX INCREMENT <br />Ci CDBG <br />TOTAL DISBURSEMENT <br /> <br />AMOUNT <br />Print Name /Title <br />Signature <br />CITY OF SANTA ANA <br />Based on site observations, the undersigned Senior Residential Construction Specialist (BRCS) certifies that to the best of their <br />knowledge, information and belief, the work summarized above and covered by this Final Payment Request has been completed in <br />accordance with the terms and conditions of the NSP Grant Services Agreement.. <br />Date Senior Residential Construction Specialist (Signature) <br />The undersigned certifies that to the best of their knowledge, information and belief, this Final Payment Request has been properly <br />prepared and documented and authorizes the disbursement of funds to cover the amount requested. <br />Date <br />Housing Programs Coordinator (Signature) <br />rccyuirea r+itacnmen[s: rro~ect continuation Sheet, Lien Release, Certificate of Final Inspection, Notice of Completion <br />May 2009 <br />