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t tub -s U.S. DEPARTMENT OF HOUSING AND URBAN !,,.•; ._ _vr+A.tENT fi0H HUtT USE O!� REQUISITION FOR PARTIAL PAYMENT OF ANNUAL COUTRIBUTIONS HOUSING ASSISTANCE PAYMENTS ? dOGRANI vonenerhurrrG,•: SEC-n0N 23 f SECTIC7y 3 Oats of Requisition 7/27/83 Fiscal Year Ending date --9.Z-3—Q/-8A--- For Quart Ir EIithng 12/3.0./83 NAME AND ADDRESS OF PUBLIC HOUSING AGENCY tlnriudinq 71p Codej ACC Contract C�urnber A-3409 Indian River County Board of County Commissioners Project Number FL29—E132-001 & 002 1840 25th St., Suite S-321, Vero Beach, Fla. 32960 12 -- DEPOSITARY SANK (Name. Addrers and Account Number) Na. of Months in Fiscal Year First Bankers of Indian River County Type of Project; Vero Beach, Fla. 32960, Acct. #98-04000-1 +� ® EXISTING C NEW C} REHAB. L Number of Units Ugder Lease to Eligible Families es of Date of 3-.;quisition b. Estimated Number of Units to be under Lease at End of Requested tluarter c. Averape Monthly Housing Assistance Payment Per Unit at of Hate of Requisition ESTIMATE Rl:QUiRED TOTAL COST DESCRIPTION { ANNUAL 1 INCURRED T L0NRIpU'iIIJNSi TO DATE - tt) PRELIMINARY ADMINISTRATIVE EXPENSE 1. Preliminary Administrative Expense—Prior to ACC (Account 4010) 2. Prsdiminary Administrative Expeme—After ACC (Account 4012) 3. Total Preliminary Administrative Expense (Lines I d 2) NONEXPENDA8LE EQUIPMENT 4. ReplataZment of Nonexpendable Equipment (Account 7520) S. Property Betterments and. Additions (Account 7540) 6. Total Nonexpendable Equipment (Lines 4 d SJ HOUSING ASSISTANCE PAYMENTS 7. Housing Assistance Fayments (Account 4715) ADMINISTRATIVE FEE 8. Total Administrative Fee Approved for Fisch Year 9. Monthly Rate of Administrative Fee (Line 8 divided by number of months in Jised Year) 10. Amount Previously Requisitioned for fiscal year 11. Estimated Additional Amount Required to end of Requested Quarter 12. 'fetal Administrative Fee (Lines 10 d 11) [NOE-PENDENT PUBLIC ACCOUNTANT AUDIT COSTS Isection 3 only) 13. Total Independent Public Accountant Audit Cutts SECURITY AN© UTILITY DEPOSITS (Section 23 oniy) 14. Total Ailowance Approved for Security and Utility Deposits 15. Amount Previously Requisitioned for Fiscal Year 16. Estimated Additional Amount Requirod to End of Requested Quarter 17. Total Security and Utility Deposits (Lines 15& 16) AMOUNT Or TH.'S REQUISITION 18. Total Funds Required to End of Requested Quarter(Lines 3, 6. 7, 12, 13 d 171 19. Total Partial Payments Received for Fiscal Year to Date 20. Partial Payment Requested (Line 13 minus Line 19) 459,972 59,303 2,500 9 152 190 165 ESTIMATED CUMULATiv %DOITIONAL TOTAL ,OST TO END FREQUESTED FUNDS QUARTER REQUIRE'[' tat l (g) . ,sg - . 0 0 0 0 0 0 0 94,050 94,050 0 14,826 14,826 2,500 I 'J METHOD OF PAYMENT INSTIST 2NO 3RD ALMENT INSTALLMENT INSTALLMENT TOTAL 21. Requested Installment Payments 17 37.126 111.376 1 CE3TIFY that housing assistance payments have bean or will be made only with resile, -t to units which: (1) are under tease by Famtiies at the timo- such housing asastance payments are mads excupt as otherwise provided in the Housing AtsistAmm Payments Contracts and (2) the Housing Agency has within one yes► prior to the making of such housing assistance paymanM adequately impgctad or crused to be inspected (including inspection of grounds. and areas for the benefit and use of the Families) to assure that decent, safe and sanitary rousing accommodations are being provided; that all applicable Fre vis ons of the above numbered Contract have been complied with by the Housing Agency; and that this roqu;sition for annual contrbutions has been exam- irwi by me and to the bast of my knowledge and b -fief it is true, correct and complete. ---------_ �rlh i !iu Ring,•. ,- -- lSignaiure and Title of Official Authorized to Certtfv) HUD FIELD QFFICE APPROVAL 25 AUG 31983 5,4 PAci 1,98