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Form SHIP AR/2009 <br /> 67-37.008(3)0,F.A.C. <br /> Effective Date: 11/2009 <br /> umber of Households/Units Produced <br /> List Unincorporated — — - -- -- - <br /> and Each.. <br /> Strategy , Municipality; ELI VLI Lome Mod Total <br /> Totals: � � p <br /> Characteristics/Age (Head of Household) <br /> List Unincorporated <br /> and Each <br /> Description Municipality 0 -25 26 -40 41 -61 62+ Total <br /> Totals: 0 <br /> Family Size <br /> List Unincorporated <br /> and Each .l 2-4 5 + <br /> Description � �_.. Municipality Person People � People `Total <br /> „I otals: 0 <br /> Race (Head of Household) <br /> FL_ <br /> tUnincorporateand Each Hisp- Amer-DescriptionMunicipality White Black anic Asian Indian Other Total <br /> _.__ Totals: 0 <br /> _,pecial Needs (Any Member of Household) <br /> List Unincorporated bevel. <br /> and Each Fanyi Dis- Home- Special Special <br /> Description Municipality Worker abled less Elderly Needs Needs Total <br /> Totals: 0 <br /> Special Target Groups for Funds Expended (i.e. teachers, nurses, law enforcement, <br /> fire fighters, etc.) Set Aside <br /> Special Target Total#of <br /> Description" Group :Expended Funds Expended Units <br /> Form 4 <br /> Page 4 <br /> 71 <br />