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Form SHIP AR/2009 <br />67-37.008(3)(f), F.A.C. <br />Effective Date: 11/2009 <br />Number of Households/Units Produced <br />Strategy <br />List Unincorporated <br />and Each <br />Municipality <br />ELI <br />VLI <br />Low <br />Mod <br />Total <br />Purchase Assistance <br />with Rehab <br />Unincorporated Co. <br />Total <br />1 <br />Unincorporated Co. <br />1 <br />1 <br />Totals: <br />Characteristics/Age (Head of Household) <br />1 <br />Description <br />List Unincorporated <br />and Each <br />Municipality <br />0 <br />- 25 <br />26 <br />- 40 <br />41 <br />- 61 <br />62+ <br />Total <br />Purchase Assistance <br />with Rehab <br />Unincorporated Co. <br />1 <br />1 <br />1 <br />Totals: <br />Family Size <br />1 <br />Description <br />List Unincorporated <br />and Each <br />Municipality <br />1 <br />Person <br />2- 4 <br />People <br />5 + <br />People <br />Total <br />Purchase Assistance <br />with Rehab <br />Unincorporated Co. <br />1 <br />Purchase Assistance <br />with Rehab <br />Unincorporated Co. <br />1 <br />Totals: <br />Race (Head of Household) <br />1 <br />1 <br />1 <br />Description <br />List Unincorporated <br />and Each <br />Municipality <br />White <br />Black <br />Hisp- <br />anic <br />Asian <br />Amer - <br />Indian <br />other <br />Total <br />Purchase Assistance <br />with Rehab <br />Unincorporated Co. <br />1 <br />1 <br />1 <br />Totals: <br />Special Needs (Any Member of Househo d) <br />1 <br />Description <br />List Unincorporated <br />and Each <br />Municipality <br />Farm <br />Worker <br />Devel. <br />Dis- <br />abied <br />Home- <br />lei <br />Elderly <br />Special <br />Needs <br />Special <br />Needs <br />Total <br />Purchase Assistance <br />with Rehab <br />Unincorporated Co. <br />1 <br />1 <br />Totals: <br />1 <br />Special Target Groups for Funds Expended (i.e. teachers, nurses, law enforcement, <br />fire fighters, etc.) Set Aside <br />Description <br />Special Target <br />Group <br />Expended Funds <br />Total;#<of <br />Expended Units <br />1 <br />Form 4 <br />Page 3 <br />73 <br />