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r <br />~ucaH°° Ist <br />CITY OF SANTA ANA <br />Housing 8~ Neighborhood Development <br />20 Civic Center Plaza / 3'~ Floor / P.O. Box 1988 / M-26 !Santa Ana, CA 92702 <br />(714)667-2250 <br />O OFFICE USE ONLY O <br />REQUEST FOR RETENTION FUNDS <br />Date: <br />NSP Grant Services Agreement <br />ANR Homes, Inc. (Developer) <br />Project Address: <br />AMOUNT: <br />PAYABLE TO: ANR Homes, Inc. <br />IDS NUMBER: <br />ESCROW NUMBER: <br />ACCOUNT NUMBER / W.O.#: <br />UtVtLVF'tK <br />The undersigned DEVELOPER certifies that to the best of their knowledge, information and belief, all charges for labor and <br />material incurred and used in construction pursuant to the NSP Grant Services Agreement have been paid in full, and that <br />no liens and/or legitimate claims have been reported. <br />Date <br />SOURCE OFFUNDS <br />-' HOME <br />r CALHOME <br />TAX INCREMENT <br />~; CDBG <br />~~ <br />TOTAL DISBURSEMENT <br /> <br />AMOUNT <br />Print Name /Title <br />nature <br />Date Homeowner (Signature) <br />~i I Y Vr SANTA ANA <br />The undersigned Senior Residential Construction Specialist (BRCS) certifies that to the best of their knowledge, information <br />and belief, the DEVELOPER has complied with the NSP Grant Service Agreement and is entitled to receive the retention <br />funds withheld during construction. <br />Date <br />5ernor Residential Construction Specialist (Signature) <br />The undersigned certifies that to the best of their knowledge, information and belief, this Request for Retention Funds has <br />been properly prepared and documented and authorizes the disbursement of funds in the amount requested. <br />Date <br />Housing Programs Coordinator (Signature) <br />Required Attachments: Unconditional Lien Release <br />May <br />