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FLORIDA HOUSING HOME Program <br /> Tenant Based Rental Assistance <br /> FINANCE CORPORATION Payment Request Form <br /> This form shall be used in requesting a drawdovl►n. . 1lllatl completed form to : <br /> of funds for Tenant Based Rental Assistance . , F� l Florida Housing Finance Corporation <br /> in all appropriate blanks and type or print cloady. Attns Heather Boyd <br /> This form is due by the ISth of the morin, � 27 N . Bror ough St . , Suite 5000 <br /> Tillahas eel FL 32301 - 1329 <br /> Name and Address of Grantee Date of <br /> Name : Request for the month <br /> Address : IDIS Number. <br /> City : State <br /> Zip : _ <br /> WIME <br /> Type <br /> 63 v <br /> Payment <br /> 1 = Initial <br /> Social Security Amount 2=Ongoing <br /> Number Tenant Name , Re uested 3= Final <br /> Commitment Amount <br /> Previous Disbursements (not including administration fee) <br /> Disbursement Request <br /> Balance (not including administration fee) <br /> 10 % Administration Request <br /> Total Request <br /> Name of Authorized Signatory Title <br /> Florida Housing Finance Corporation Page 1 Attachment B (Rev. 09/06) <br />