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~ucatton 2si <br /> <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: <br />O OFFICE USE ONLY D <br />SOURCE OF FUNDS AMOUNT <br />G HOME _~~__~__..,. <br />CALHQME <br />TAX INCREMENT <br />CDBG <br />TpTAt DISBURSEMENT <br />IDS NUMBER: <br />ESCROW NUMBER: <br />ACCOUNT NUMBER / W.O.# <br />DEVELOPER <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 />Date <br />Print Name !Title <br />Signature <br />Homeowner (Signature) <br />CITY OF 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 Senior 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 Housing Programs Coordinator (Signature) <br />rcegwrea Httacnments: unconditional Lien Release <br />May <br />