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Housing Benefit Form <br /> ( Make copies of this page if necessary to report on units addressed .) <br /> Unit # Owner (0) Name of Owner Name of Occupant Street Address Total Cost Total CDBG Date Rehab Replace- <br /> # of <br /> or (street, city and zip) of Rehab or Funds Invested Completed (Yes or ment Bed- <br /> Renter (R) (if replacement, new address) Replacement No) (Yes or rooms <br /> No) <br /> Occupied <br /> N/A _— -- -- -- — $ <br /> 2 <br /> 7 $ $ <br /> 10 <br /> 11 $ $ <br /> 12 <br /> i <br /> 13 $ $ <br /> 14 I $ $ <br /> I <br /> 15 5 <br /> i <br />