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ATRUE COPY Form SHIP AR/2009 <br />CERTIFICATION ON LAST PAGE 67-37.008(3)0, F.A.C. <br />J.R. SMITH, CLERK Effective Date: 11/2009 <br />Demographics (Any Member of Household) <br />Totals: <br />2 1 3 <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 />Expended Funds <br />$299,268.00 <br />Strategy . : , <br />List Unincorporated <br />:Zip .: <br />Devel.; <br />....... .. .. ,. A <br />;.` .. <br />Code <br />`,Funds"' Already <br />SW <br />and -Each. :: <br />Farm <br />3Dis= <br />Haynes, <br />3445 1st Place <br />Vero Beach <br />32968 <br />$22,947.00 <br />Description • ' <br />� ,Municipaiity , ., <br />Worker. <br />abled <br />` less-. e <br />. Elderly. <br />Other . <br />. other <br />Total <br />Purchase Assistance <br />Indian River County <br />Chimere <br />Purchase <br />Hyatt, <br />0 <br />with Rehab <br />32960 <br />$28,640.45 <br />Purchase <br />Acosta, <br />2066 Waterside Lane <br />Purchase Assistance <br />Indian River County <br />$17,560.00 <br />Assistance with <br />Roberto & <br />1 <br />1 <br />with Impact Fee <br />Impact Fee Loan <br />Rubby <br />Loan <br />Rehabilitation <br />Indian River County <br />1 <br />1 <br />2 <br />Totals: <br />2 1 3 <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 />Expended Funds <br />$299,268.00 <br />Strategy . : , <br />Full, Name � : ''Address ;.: : ` ` .-:•'..:':: City ; . :. :. <br />:Zip .: <br />Expended -. FY if Unit - <br />....... .. .. ,. A <br />;.` .. <br />Code <br />`,Funds"' Already <br />SW <br />Counted-' <br />Purchase <br />Haynes, <br />3445 1st Place <br />Vero Beach <br />32968 <br />$22,947.00 <br />Assistance with <br />Elvony & <br />Purchase <br />Smith, <br />3466 1st Street <br />Vero Beach <br />32966 <br />Rehab <br />White, Brian <br />Assistance with <br />Chimere <br />Purchase <br />Hyatt, <br />636 9th Place <br />Vero Beach <br />32960 <br />$28,640.45 <br />Assistance with I Kathleen <br />Rehab <br />Purchase <br />Pursel, Katelyn <br />1426 25th Avenue <br />Vero Beach <br />32962 <br />$23,978.82 <br />Assistance with <br />SW <br />Rehab <br />Purchase <br />Smith, <br />3466 1st Street <br />Vero Beach <br />32966 <br />$19,648.95 <br />Assistance with <br />Chimere <br />Rehab <br />Purchase <br />Acosta, <br />2066 Waterside Lane <br />Vero Beach <br />32962 <br />$17,560.00 <br />Assistance with <br />Roberto & <br />SW <br />Impact Fee Loan <br />Rubby <br />Page 6 <br />