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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- # 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 /> Occupied No) <br /> i <br /> 1 <br /> i <br /> N/A ---- � $ <br /> 2 <br /> I <br /> i <br /> 5 � $ $ <br /> P <br /> _ <br /> 9 i $ $ <br /> i <br /> to $ $ <br /> i <br /> i <br /> 12 - - - 7 $ <br /> i <br /> 14 $ --- $ <br /> 5 <br />