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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 /> 3 $ $ <br /> 4 - $ $ <br /> 6 $ $ <br /> 8 $ $ <br /> 9 $ $ <br /> 10 <br /> 12 <br /> 13 $ $ <br /> 15 --- -- $ $ -- <br /> 5 <br />