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FLORIDA HOUSING HOME Program <br /> Tenant Based Rental Assistance <br /> FINANCE CORPORATION Payment Request Form <br /> This form shall be used in requesting a drawdown Mail completed form to : <br /> of funds for Tenant Based Rental Assistance . Fill Florida Housing Finance Corporation <br /> in all appropriate blanks and type or print clearly . Attn : Heather Boyd <br /> This form is due by the 18th of the month . 227 N . Bronough St . , Suite 5000 <br /> Tallahassee , FL 32301 - 1329 <br /> Name and Address of Grantee Date of <br /> Name : Request for the month <br /> Address : IDIS Number : <br /> City : State <br /> Zip : _ <br /> Type <br /> Payment <br /> 1 = Initial <br /> Social Security Amount 2 = Ongoing <br /> Number Tenant Name Requested 3 = Final <br /> Commitment Amount <br /> Previous Disbursements (not including $ 5 , 000 advance or admin ) <br /> Disbursement Request <br /> Balance (commitment amount minus disbursements ) <br /> 10 % Administration Request <br /> Total Request <br /> Name of Authorized Signatory Title <br /> Florida Housing Finance Corporation Page 1 Attachment B (Rev . 09/05 ) <br />