Application Minnesota Housing Rental Rehabilitation Deferred Loan (RRDL) Pilot Program

RRDL Form 1 (11/2011) 1

APPLICANT INFORMATION: Applicant Name:

Co-Applicant Name (if applicable):

Applicant Address (Street, City, State, Zip): , MN

Co-Applicant Address (if different than applicant): , MN

Applicant Contact Name and Telephone No.: Name: Home: ( ) Office: ( ) Cell Phone: ( ) Email:

Co-Applicant Telephone No. (if different than applicant): Name: Home: ( ) Office: ( ) Cell Phone: ( ) Email:

OWNERSHIP/PARTNERSHIP: Partnership/Corporation Name: Partnership/Corporation Address: Telephone Number: ( ) Cell Phone Number: ( ) Email: Legal Status of Ownership Entity: Federal Tax ID No.: (Not Social Security Number) Name of General Partner(s)/Contact Person Telephone No. ( ) ( ) ( ) ( ) DEVELOPMENT TEAM:

Name Address Phone Email Attorney ( ) Architect ( ) General Contractor

( )

Management Co.

( )

Other (specify):

( )

Does an identity of interest exist between ownership and General Contractor? Yes No

Does the above entity manage the property? Yes No

RRDL Form 1 (4/2012) 2

PROPERTY INFORMATION: Property Name: Property Address (Street, City, State, Zip):

County:

Building Addresses (if multiple buildings)

Gross Area of Bldg(s): (non residential - exclude basements, attics, etc.) Sq. ft.

Gross Area of Non-Residential: (commercial, office, parking etc.) Sq. ft.

Purchase Price: $

Current Estimated Market Value (EMV): $

Yr. Built:

# of Buildings:

# of Stories:

Total # of Units:

# of RRDL Units (subject to rent/income restrictions):

Census Tract Number: Type of Site Control: Does Applicant currently control the property/building .................................................................................. Yes No Is the property in compliance with current zoning requirements?.................................................................. Yes No

• ATTACH ZONING LETTER TO APPLICATION Is the property in compliance with current local rental license? ..................................................................... Yes No

• ATTACH A COPY OF THE LICENSE TO APPLICATION Is the property in compliance with current local rental inspections? .............................................................. Yes No

• ATTACH A COPY OF THE CURRENT INSPECTION REPORT TO APPLICATION Has the property received prior Minnesota Housing Funding? Yes No if yes, identify program source and amount: If yes, did you successfully complete compliance period. Yes No Is the property located in a historic district or designated a historic building? Yes No Current Indebtedness on the Property/Building:

Lender: Loan Amount Monthly Payment Term Interest

Rate Balance Maturity Date

$ $ $ $ $ $ $ $ $ Existing Subsidies:

Type of Subsidy Type # of Units

Are any of these funds

subject to long term use

restrictions?

Are the assisted

units at risk of

conversion to market

rents?

Is the contract for federal assistance at risk of expiring in 2 years or less, or is the building

at risk due to physical

deterioration?

Is the federal assistance at risk

of loss due to deterioration of the capacity of

the current ownership/manag

ement entity?

RRDL Form 1 (4/2012) 3

Estimated Annual Income & Expenses A. Housing Income

Unit Type (0BR, 1BR, 2BR, etc.)

# of DU

Monthly Rent (including Tenant Paid Utilities)

Monthly Tenant Rent

Contribution

Subsidy Amount (if apolicable)

Total Annual Contract Rent

(Contract Rent x # DU x 12)

Tenant Paid Utility Allocation (UA)

Total Gross Rent/Month (Tenant Rent

Contribution + Subsidy + US)

RRDL Rent Limit

$ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ $ UNITS: TOTAL GPR: $ 1. Gross Potential Rent a. Rental Housing Potential $ b. Parking/Garage Rent potential $ c. Commercial Rent Potential (specify) $ d. Miscellaneous Rent Potential (specify) $ e. Gross Potential Rent (total lines A1a thru A1d) $ 2. Rental Loss a. Rental Housing Vacancy $ Vacancy Factor 5% x line 1a $ b. Parking/Garage Vacancy $ Vacancy Factor x line 1b $ c. Commercial Vacacny $ Vacancy Factor x line 1c $ d. Miscellaneous Unrealized Income $ e. Employee Rent Credits $ f. Out of Service Units $ g. Rental Concession Adjustments $ h. Bad Debt $ i. Total Rental Loss (total lines A2a thru A2h) $ 3. NET RENTAL COLLECTIONS (Lines A1e – A2i) $

4. Other Income a. Tenant Fees $ b. Other Income $ Laundry Equipment $ Annual Tax Increment Financing (TIF) Receipts $ Other (Specify) $ c. Forfeited Security Deposit $ d. Interest Income $ e. Total Other Income (total lines A4a thru A4d) $ 5. TOTAL REVENUE: (lines A3 + A4e) $

B. ANNUAL OPERATING EXPENSES 1. Administrative Expenses a. Advertising and Marketing $

b. Management Fee $ c. Legal $ d. Auditing $ e. Telephone $ f. On-Site management Payroll $ g. Other administration $

RRDL Form 1 (4/2012) 4

h. Total Administration (total lines B1a thru B1g) $ 2. Maintenance Expenses a. Elevator Maintenance/Contract $ b. Exterminating $ c. Rubbish Removal $ d. Other contract Services $ e. Janitor Supplies $ f. Maintenance Supplies $ g. Grounds Maintenance $ h. Snow Removal $ i. Heal & AC Repair Services $ j. General Repair Services $ k. Paint/Decorating Materials $ l. Maintenance & Jan. Payroll $ m. Other Maintenance and Operating $ n. Other: (Specify) $ o. Total Maintenance (Total lines B2a thru B2n) $ 3. Utilities a. Electricity $ b. Water & Sewer $ c. Gas & Oil $ d. Total Utilities (Total lines B3a thru B3c) $ 4. Insurance $

5. Debt Service $

6. Total Management and Operating Expenses (total lines B, 1h, 2o, 3d, 4 & 5) $

7. Reserves and Escrows $ a. Real Estate Taxes $ b. Replacement Reserves $ c. Painting & Dec Reserve $ d. Miscellaneous Reserve $ e. Total Reserves & Escrows (Total lines B7a thru B7d) $ 8. Effective Gross Expenses (lines B6 & B7e) $

9. NET OPERATING INCOME (lines A5 & B8) $

PROPOSED REHABILITATION INFORMATION Description of work: Estimated Cost $ $ $ $ $ $ $ $ $ Total Estimated Cost of Proposed Rehabilitation Work $ Estimated Funding for Project $ $ $ $ $ $ $ $

RRDL Form 1 (4/2012) 5

$ $ Total Estimated Funding for Project $ Estimated Schedule for Project Submittal of the application with all supporting documentation: Inspections: Bids: Construction Start Date: Construction End Date: Relocation Information Will the rehabilitation result in permanent displacement of any current residents? ...................................... Yes No Will the rehabilitation require any temporary relocation of current residents? .............................................. Yes No Narratives: 1. Describe the proposed housing project and use of funds, including: a. Physical attributes of the building (i.e. duplex, three story, elevator, brick, parking); b. Type of housing (i.e. general occupancy, rural development. elderly); c. Site suitability; d. Characteristics of the surrounding adjacent land/neighborhood and the density of the area; e. Support of local markets and utilizes existing infrastructure; f. Proximity to jobs and services.

2. Describe how the proposed improvements will address the needs of the property and the rental population(s) inluding: a. Physical condition of property; b. Scope of project work; c. Enhance, preserve, or extend affordability d. Tenants and local community demand for affordable rental housing of this type, and program requirements.

RRDL Form 1 (4/2012) 6

CERTIFICATIONS: Sign all of the following statements: I (We) hereby certify that the information contained in this application is true, correct and complete. I (We) understand that any misrepresentations and/or fraudulent information made in this application may result in the termination of our application/project by the local administrator and/or Minnesota Housing and may bar me(us) and related parties from future program participation, and report such misrepresentation and fraudulent information to the IRS.

Applicant Signature Applicant Signature Date I/we, the applicant(s) herby certify that I/we have read and understand the conditions, restrictions and compliance requirements associated with the receipt of RRDL funds, as outlined in the Rental Rehabilitation Deferred Loan Pilot Program Guide.

Applicant Signature Applicant Signature Date I/we hereby certify that it is the policy of the undersigned to comply with all existing laws prohibiting discrimination in all aspects of employment due to race, color, creed, sex, age, religion, and national origin, and marital status, sexual orientation, familiar status, public assistance or disability. This shall be accomplished substantially by nondiscrimination in RECRUITING, HIRING, TRAINING, PROMOTING, CONTRACTING, DEMOTION, LAYOFF, and/or TERMINATION.

Applicant Signature EEO Officer Signature Date It is required that more than one comparable bid from a prime general contractor be obtained; each bidder should base his price on the same description of work to be done and on comparable materials. Each bidder must also state that bid prices will be valid for at least 90 days. The Scope of Work from which bids are solicited must be approved by the local administrator, and include correction of all housing and energy standard deficiencies cited by the Housing Quality Inspector, Architect, or Building Code Inspector. The Scope of Work is simply a detailed description of work, materials and costs which may include drawings and specifications. Minnesota Housing will require the applicant to adhere to its tenant assistance policies in providing fair and equitable assistance to tenants at the time the owner makes an application for RRDL funds. The applicant must provide all tenants with an Initial Occupancy Statement by Tenant, Tenant Demographic Profile, Lead Based Paint Notification, Lead Addendum, Government Data Practices Act Disclosure Statement and all applicable notices, which must be completed by each tenant. The tenant information collected will be used in determining the eligibility for the applicant to receive funding under the RRDL program. Failure on the part of tenants to provide the requested information may jeopardize the rehabilitation project.

Applicant Signature Applicant Signature Date

APPLICANT CERTIFICATION OF ENVIRONMENTAL ISSUES

Applicant Certification of Environmental Issues 1 of 2 April 2012

Development Name Development Address Year Built The previous uses of the site were and the source of this information is .

Has a Phase I Environmental Study been completed? Yes No Unknown Date of Report:

Summarize any recognized environmental conditions: Is there any underground or aboveground fuel storage tanks present on the subject property? If yes, address the following: # of tanks, capacity, usage, location, age, date of last tank installation/removal and delivery system tightness test, and test results. If there are unused tanks or tanks that were removed and there was a soil test done, attach a copy of the test.

Yes No Unknown

Comments:

Has an asbestos containing materials test been completed? Yes No Unknown Date of Report:

Comments: Is there any friable asbestos within the subject project? Yes No Unknown Attach a copy of ACM test results, and attach a copy of any existing operating and maintenance plan. Has lead hazard testing including lead based paint been completed? Yes No Unknown

Is there the presence of lead or lead hazards within the subject property? Yes No Unknown Date of Report:

Comments: Attach a copy of lead test results, and attach a copy of any operating and maintenance plan. Is there visual evidence of mold growth on any interior surfaces; or are there any known leaks on the building envelope that might contribute to concealed water damage or mold? If yes, where and identify any assessments completed

Yes No Unknown

Comments: Is the subject property adjacent to a Superfund, National Priority or CERCLIS or CERCLA site, or within 3000 feet of a toxic or solid waste landfill? Yes No Unknown

Comments: Are there known or evidence of former methamphetamine (meth) manufacturing labs within the subject property? If yes, provide information: Yes No Unknown

Comments: Is the project located within ¼ mile of a 100 + gallon above ground tank(s); or within ½ mile of a 40,000 + gallon above ground tank(s)? Yes No Unknown

Comments: Is there a major roadway within 1,000 ft., a railroad within 3,000 ft, a civil airport within 5 miles, or a military airport within 15 miles of the subject property? If yes, identify the roadway, railroad or airport and the distance from the subject property.

Yes No Unknown

Comments:

Applicant Certification of Environmental Issues 2 of 2 April 2012

Are the structures or proposed structures at least 10 feet from all gas line and power line easements? Yes No Unknown

Comments: Are there any wells on site? If yes, address the following: the current usage, the location, and whether it has been capped under MN Dept. of Health and local requirements (if well is unused)

Yes No Unknown

Comments: Is any portion of the subject property near any power, television, or microwave towers? Yes No Unknown Comments: If there is a tower on or near the subject property, the tower’s height is and the tower’s distance to the subject property is . Is any portion of the subject property at or below the 100-year flood plain? Yes No Unknown Comments: Is any portion of the subject property within 100 feet of a wetland? Yes No Unknown Comments: If this is a new construction proposal, has there been any recent site preparation or other alteration to the site? If yes, has the project been given clearance from the State Historical Preservation Office (SHPO) that it will not have a significant adverse impact on any known historic preservation in the immediate area?

Yes No Unknown

Comments: I certify, after reasonable inquiry, I have answered all of the above questions truthfully to the best of my knowledge. Subject Property Applicant/Owner Date

Market Qualification Information – RRDL Form 32 1 of 3 4/2011

MARKET QUALIFICATION INFORMATION The following information must be included in submission for market qualification for Rental Rehabilitation Deferred Loan Pilot Program applications: 1. Proposed development information to include the following: Development Name: Address: City: County: Development Information in table below:

Unit Type Number of Units Gross Rent Income *

Affordability Hourly Wage **

Needed – 1 Earner Hourly Wage ***

Needed – 2 Earner 0 Bedroom 1 Bedroom 2 Bedroom 3 Bedroom 4 Bedroom Total

*Multiply Gross Rent by 12 and divide by.3. **Divide Income Affordability by 2080. ***Divide Income Affordability by 4160. Information for items 2 and 3 may be found at www.census.gov

o Directions to 2010 information can be found on surface of home page. 2. City Information

City Population 2010 current City Households 2010 current City Renter Households 2010 current City Rental Units 2010 current City Rental Vacancy Rate 2010 current Average or median rents in the local area: Average travel time to work:

3. Racial/ethnicity characteristics according to 2010 Census –

Number of persons in each group:

White Black American Indian Asian Pacific Islander Other Race Hispanic Origin

4. Rental Units and/or Multifamily Units permitted since 2010 in City:

Permitting information on multifamily units since 2010 is available at: http://socds.huduser.org/permits/index.html .

If city does not report Permit information it will be necessary to contact the municipality for that information.

Market Qualification Information – RRDL Form 32 2 of 3 4/2011

5. Comparable Rental Data: Present the following data for 3 more recent rental developments in city comparable to that proposed.

Comparable 1

Name: Number of Units Monthly Contract Rent

Address: 0 Bedrooms $ City: 1 Bedrooms $ Phone: 2 Bedrooms $ 3 Bedrooms $ 4 Bedrooms $ Total $ Are rents subsidized? Yes No

Comparable 2

Name: Number of Units Monthly Contract Rent

Address: 0 Bedrooms $ City: 1 Bedrooms $ Phone: 2 Bedrooms $ 3 Bedrooms $ 4 Bedrooms $ Total $ Are rents subsidized? Yes No

Comparable 3

Name: Number of Units Monthly Contract Rent

Address: 0 Bedrooms $ City: 1 Bedrooms $ Phone: 2 Bedrooms $ 3 Bedrooms $ 4 Bedrooms $ Total $ Are rents subsidized? Yes No

6. Employment Information:

A. List names of at least 3 to 5 major employers in city or area by type of business, number of employees, types of job for employees, and starting or average hourly or annual wages. Some of this information is available in the Community Profile publication of the Department of Employment and Economic Development for each community. The Profile is available online at http:/www.mnprospector.com/ (click on ’Locating in Minnesota)

Employer Type of Business

# of Employees

Average Hourly Wage Types of Jobs Job Growth

Market Qualification Information – RRDL Form 32 3 of 3 4/2011

Do the hourly wages in the community listed in 6, above; meet the hourly Yes No wages needed in 1, above?

7. Are the wages and household sizes necessary to income qualify appropriate Yes No for the number of bedrooms and unit types proposed in #1 above?

8. Provide a narrative summary detailing the need(s) for the proposed housing based upon targeted population,

demographics, job growth, rental housing vacancy rates, and available services. Clearly demonstrate how the proposed housing specifically meets those needs. For example, describe how the proposal addresses the needs of the local work forces and demonstrate the link between jobs and housing, how employees will access jobs and services, and show that the housing proposed is affordable based on the wage level of job being created or retained.

9. Other supporting information, if any, such as:

• Market studies prepared specifically for proposal. • Submit local housing or market studies, rental surveys, or vacancy surveys, if any. • Regional or local housing plans.

04/2011

INSTRUCTIONS FOR PREPARING AN AFFIRMATIVE FAIR HOUSING MARKETING PLAN

1. Introduction - The Affirmative Fair Housing Marketing Regulations require that each applicant carry out an

affirmative marketing program to attract prospective buyers or tenants of all majority and minority groups in the housing market area regardless of race, creed, color, religion, sex, national, origin, marital status, status with regard to public assistance, disability, sexual orientation, or familial status. The applicant shall describe on this form the activities it proposes to carry out during advance marketing, where applicable, and the initial sales or rent-up period. The affirmative marketing program also should assure that any group(s) of persons normally NOT likely to apply for the housing without special outreach efforts (because of existing neighborhood racial or ethnic patterns, location of housing in the SMSA, or price or other factors), know about the housing, feel welcome to apply and have the opportunity to buy or rent. In addition to the specific advertising activities, please describe activities relating to instructions to staff on fair housing concerns.

2. Part 2 - Applicant and Project Identification. Parts A, B, C and D are self-explanatory. With respect to Part E,

specify approximate starting date of marketing activities to the groups targeted for special outreach and the anticipated date of initial occupancy. Part F is to be completed only if the applicant is not to implement the plan on its own. For Part G, indicate all Minnesota Housing Finance Agency (Minnesota Housing) funding sources.

3. Part 3 - Type of Affirmative Marketing Plan. Applicants for multifamily and subdivision projects are to submit a

Project Plan which describes the marketing program for the particular project or subdivision. Scattered site builders are to submit individual annual plans based on the racial composition of the geographical area. For example, if a builder plans to construct units in both minority and non-minority geographical areas, separate plans shall be submitted for all of the housing proposed for both types.

4. Part 4 - Direction of Marketing Activity. Considering factors such as price or rental of housing, the racial/ethnic

characteristics of the neighborhood in which housing is (or is to be) located, and the population within the housing market area, public transportation routes, etc., indicate which group(s) you believe are least likely to apply without special outreach.

5. Part 5 - Marketing Program. The applicant shall describe the marketing program to be used to attract all

segments of the eligible population, especially those groups designated in Part 4 of the Plan as least likely to apply. The applicant shall state: the type of media to be used, the names of newspapers/call letters of radio or TV stations; the identity of the circulation or audience of the media identified in the Plan, e.g., White (Non-Hispanic), Black (Non-Hispanic), Hispanic, Asian-American/Pacific Islander, American Indian/Alaskan Native; and the size or duration of newspaper advertising or length and frequency of broadcast advertising. Community contacts include individuals or organizations that are well known in the project area or the locality and can influence persons within the groups considered least likely to apply. Such contacts may include, but need not be limited to: neighborhood, minority and women's organizations, churches, labor unions, employers, public and private agencies, and individuals who are associated with these organizations and/or are well-known in the community.

6. Part 6 - Future Marketing Activities. State how you intend to continue your affirmative marketing efforts to

maintain attained goals or correct any current occupancy concerns. 7. Part 7 - Experience and Staff Instructions. a. Indicate whether the applicant has previous experience in marketing housing to group(s) identified as least

likely to apply for the housing. b. Describe the instructions and training given to sales/rental staff. This guidance to staff must include

information regarding federal, state and local fair housing laws and this Affirmative Fair Housing Marketing Plan. Copies of any written materials should be submitted with the Plan, if such materials are available.

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8. Part 8 - Additional Considerations. In this section, describe other efforts not mentioned previously which are

planned to attract persons in either those groups already identified in Part 4 of the Plan as least likely to apply for the housing or in groups not previously identified in the Plan. Such efforts may include outreach activities to female-headed households.

9. Part 9 - Current Occupancy or Anticipated Occupancy for New Projects. For existing developments, list your

current occupancy (by Head of Household) broken down in the categories provided. For new projects, list the numbers you anticipate will occupy the units.

10. Part 10 - Signatures. The applicant's authorized agent signs the Affirmative Fair Housing Marketing Plan at the

bottom and dates it. By signing the Plan, the applicant assumes full responsibility for its implementation. The Agency may at any time monitor the implementation of the Plan and request modification in its format or content, where the Agency deems necessary.

11. Notice of Intent to Begin Marketing. At least 90 days before the start of sales or rental marketing activities the

applicant with an approved Affirmative Fair Housing Marketing Plan shall submit notice of intent to begin marketing, if applicable. This notice is submitted either orally or in writing to the FHEO Division of Minnesota Housing.

04/2011

Supplemental Instructions for Preparing Minnesota Housing’s

Affirmative Fair Housing Marketing Plan (AFHMP) NOTE: It is preferred the AFHMP is typed. Legible printing in ink may be accepted. Original signatures required (i.e., no copies or facsimiles). Clarification is sometimes needed for certain sections when completing the AFHMP. Below is an explanation of what is really wanted for certain sections of the AFHMP that are often responded to incorrectly or not at all.

What’s Really Wanted? 3. Type of Marketing Plan More than likely you are completing an AFHMP for a multifamily housing development (i.e., an apartment

complex). You should check Project Plan. If you are doing a scattered site development (involves single family units), then you would check Annual Plan.

4. Direction of Marketing Activity Indicate only the people least likely to apply currently residing in the marketing area. 5a. Marketing Program - Commercial Media If advertisements are used, remember to indicate the size of the ad(s) and how long the ad will run. If advertising

through television or radio, indicate the length of the advertisement. 5b. Marketing Plan - Brochures, Signs, and HUD’s Fair Housing Poster 2. MHFA financed developments are to have a site identification sign that includes the Equal Opportunity Housing

logo and/or statement along with the development’s name and rental information telephone number. 5c. Community contacts ALL information requested is to be provided. 7a. Experience and Staff Instruction Management agents or owners are to list any marketing activity they have done regarding marketing to the

groups identified in #4 as least likely to apply without special outreach efforts. The kinds of marketing might include: ∗ distributing brochures or flyers at grocery stores, housing fairs, community organizations, etc. advertising

the availability of the housing, ∗ identifying by name and city location other developments owned or managed by the management agent or

owner also indicating which of the populations reside at that development (e.g., XYZ Management Company has successfully marketed housing to African Americans and Asians at You Can Live Here Apartments, St. Cloud, MN; and has marketed housing to American Indians in Bemidji for Bemidji Town homes).

If an owner or management agent has no experience marketing housing to the groups identified as least likely to apply in #4 than indicate none. None is an acceptable response if that’s the case.

7b. Experience and Staff Instruction List all training staff who will receive and who provides the training to the staff on state, federal, and local fair

housing laws as well as the AFHMP (e.g. XYZ Management Company staff attend annually fair housing training sponsored by HUD, or, staff attends the fair housing workshop offered at the annual conference sponsored by MINNESOTA HOUSING, Multi-Housing Association, et. al., etc.).

Attach a copy of the instructions to staff regarding fair housing.

04/2011

8. Use this space to provide additional information, or helps to explain or clarify information given previously on the AFHMP. (E.g., XYZ Management Company has a current waiting list (that is updated annually) for 20 families for the 24 unit You Can Live Here Apartments, St. Cloud, therefore has no immediate need to advertise. Enclosed is a copy of the waiting list.

9. Anticipated or Actual Resident Demographics By head of household indicate who presently occupies the development or to the best guess, who will occupy the

development as a result of the marketing efforts made. The total number should not exceed the total number of units minus any units that are vacant at the time the AFHMP is being completed. This means if there are 30 units in the development and all 30 units are occupied, the total number for white, black or African American, Asian, American Indians, and Hispanics residents should total 30. Numbers for people with disabilities (disabled), single-headed households, and persons on public assistance will be a subset of the total number of the residents identified previously. This means they may be counted more than once. For example, you may have an Asian resident receiving public assistance that also has a disability.

04/2011

MINNESOTA HOUSING FINANCE AGENCY

AFFIRMATIVE FAIR HOUSING MARKETING PLAN

1. INTRODUCTION State and Federal Affirmative Fair Housing Marketing Regulations require that each applicant subject to these Regulations carry out an Affirmative Marketing Program to attract prospective buyers or tenants of all minority and non-minority groups to the housing that the applicant is providing. These groups include Whites (Non-Hispanic) and members of minority groups: Blacks (Non-Hispanic), American Indians/Alaskan Natives, Hispanics and Asian/Pacific Islanders in the Standard Metropolitan Statistical Areas (SMSA) or housing market area who may be subject to housing discrimination on the basis of race, color, creed, religion, sex, national origin, marital status, status with regard to public assistance, disability, sexual orientation, or familial status.

2. APPLICATION AND PROJECT IDENTIFICATION: A. NAME OF APPLICANTS

B. PROJECT OR APPLICATION NUMBER

NUMBER OF UNITS (Indicate family, elderly, etc.)

ADDRESS (Include City, State and ZIP Code)

PRICE OR RENTAL RANGE OF UNITS: FROM $ TO $

TELEPHONE NUMBER

D. FOR MULTIFAMILY HOUSING ONLY: ELDERLY NON-ELDERLY

C. PROJECT NAME

E. APPROXIMATE STARTING DATES ADVERTISING OCCUPANCY

F. NAME OF MANAGING/SALES AGENT

LOCATION / ADDRESS (Include City, State and ZIP Code)

ADDRESS (Include City, State and ZIP Code)

COUNTY

G. MINNESOTA HOUSING PROGRAM (s) USED TO FINANCE

3. TYPE OF AFFIRMATIVE MARKETING PLAN Project Plan Annual Plan (for single family scattered site units)

NOTE: A separate Annual Plan must be developed for each area in which the housing is to be built.

Minority Area White (non-minority) Area Mixed Area (with % minority residents)

4. DIRECTION OF MARKETING ACTIVITY Indicate below which group(s) in the housing market area are least likely to apply for the housing because of its location and other factors without special outreach efforts.

White African American American Indian or Hispanic Asian or (Non-Hispanic) (Non-Hispanic) Alaskan Native Pacific Islander

Persons with Disabilities Families with Children *Failure to complete each section will delay approval of the AFHMP.

04/2011

5. MARKETING PROGRAM A. COMMERCIAL MEDIA

Check the media to be used to advertise the availability of this housing.

Newspaper(s)/Publication(s) Radio TV Billboard(s) Other (Specify)

NAME OF NEWSPAPER, RADIO OR TV STATION

RACIAL/ETHNIC IDENTIFICATION OF READERS/AUDIENCE

SIZE/DURATION OF ADVERTISING

B. BROCHURES, SIGNS AND HUD'S FAIR HOUSING POSTER: (1) Will brochures, leaflets, or handouts be used to advertise? Yes No. If yes, attach a copy or submit when available. (2) For project site sign, indicate sign size x ; Logotype size x . (3) HUD's Fair Housing Poster must be conspicuously displayed wherever sales/rentals and showings take place. Fair Housing Posters will be displayed in the Sales/Rental Office(s); Real Estate Office(s); Model Unit(s); Other (Specify)

C. COMMUNITY CONTACTS To further inform the group(s) least likely to apply about the availability of the housing, the applicant agrees to establish and maintain contact with the groups/organizations listed below that are located in the housing market area or SMSA. If more space is needed, attach an additional sheet. Notify Minnesota Housing of any changes in this list. Attach a copy of correspondence to be mailed to these groups/organizations. (Provide all requested information.)

NAME OF GROUP/ORGANIZATION RACIAL/ETHNIC IDENTIFICATION

APPROXIMATE DATE OF CONTACT OR PROPOSED CONTACT

PERSON CONTACTED OR

TO BE CONTACTED

ADDRESS AND TELEPHONE NUMBER METHOD OF CONTACT

INDICATE SPECIFIC FUNCTION OF GROUP/ORGANIZATION WILL UNDERTAKE IN IMPLEMENTING THE MARKETING PROGRAM

04/2011

6. FUTURE MARKETING ACTIVITIES (Rental Units Only)

Check the block(s) that best describe future marketing activities to fill vacancies as they occur after the project has been initially occupied.

Newspapers/Publications Radio TV Brochures/Leaflets/Handouts Site Signs

Community Contacts Others (Specify)

7. EXPERIENCE AND STAFF INSTRUCTIONS A. Indicate any experience in marketing housing to the group(s) identified as least likely to apply. (See page 1, number 4).

B. Indicate training to be provided to staff on federal, state and local fair housing laws and regulations, as well as this

Affirmative Fair Housing Marketing Plan. Attach a copy of the instructions to staff regarding fair housing.

8. ADDITIONAL CONSIDERATIONS:

9. ANTICIPATED OR ACTUAL RESIDENT DEMOGRAPHICS Please list the number of persons (by head of household). Use real numbers not percentages that you anticipate will occupy or presently occupy the units as a result of your affirmative marketing efforts. The total number by Ethnic Group(s) cannot exceed the total number of units occupied. White Blacks Asians American Indians Hispanics Disabled Single-Headed Households Persons on Public Assistance

10. SIGNATURES By signing this form, the applicant agrees, after appropriate consultation with Minnesota Housing, to change any part of the plan covering a project to assure continued compliance with affirmative fair housing marketing regulations. SIGNATURE OF PERSON SUBMITTING PLAN NAME (TYPE OR PRINT) TITLE AND COMPANY DATE

MINNESOTA HOUSING USE ONLY APPROVAL BY DISAPPROVAL BY SIGNATURE SIGNATURE

NAME (TYPE OR PRINT) NAME (TYPE OR PRINT)

TITLE TITLE

DATE DATE

Equal Employment Opportunity Policy Statement

Minnesota Housing Finance Agency (Minnesota Housing) is committed to equal housing and equal employment opportunity. Anyone that does business with Minnesota Housing will be required to share this commitment. 04/2012

Equal Opportunity Housing and Equal Opportunity Employment

SECTION I: DEVELOPMENT INFORMATION MHFA Development ID: Development Name: Development Address: Total No. of Units: Dollar Amount of Rehab: $ Dollar Amount of Project $ SECTION II. PROPERTY OWNER INFORMATION Property Owner Name Phone No.: Minority Property Owner? No Yes, please enter racial/ethnic code: SECTION III. DEVELOPMENT TEAM INFORMATION Equal Opportunity Officer Name: Phone No.: General Contractor Name: Phone No.: Minority General Contractor? No Yes, please enter racial/ethnic code: SECTION IV: RACIAL/ETHNIC CODES 1. Black or African American 4. Native Hawaiian or Other Pacific Islander 2. Asian 5. Hispanic or Latino 3. American Indian or Alaskan Native SECTION V. POLICY STATEMENT I hereby certify that it is the policy of the undersigned to comply with all existing laws prohibiting discrimination in all aspects of employment due to race, color, creed, sex, age, religion, national origin, marital status, receipt of public assistance or disability. This shall be accomplished substantially by the following actions: Nondiscrimination in RECRUITING, HIRING, TRAINING, PROMOTING, SUBCONTRACTING, DEMOTION, LAYOFF, and/or TERMINATION. Whenever possible, we will also take affirmative action to include in our workforce minorities, females, and those who are disabled.

Property Owner or General Contractor Signature (entity completing form) Date

Equal Opportunity Officer Signature Date

CONFLICT OF INTEREST INTERVIEW FORM MHFA Rental Rehabilitation Deferred Loan Program

Applicant’s name (printed): Have you or any member of your household or company been, during the last 12 months, been an:

Employee Consultant Officer Elected official Appointed official

of the:

State Name Agency: ____________________________________ Local government/its agents Name Position: ____________________________________ Managing/consulting agency Name Agency: ____________________________________

or, do you or have you had:

immediate family ties or a business relationship with any of the above named persons? If yes, describe: Note: If a conflict exists, it may be possible for the grantee and it’s agents to request an exception to the conflict from the funding agency. Signature of Applicant: __________________________________________________________________ Date: _______________________ Conflict Interview Form05.doc

C:\Users\KellyM\Desktop\Disclaimer.doc\MarieT 7/17/2012

Lakes and Pines CAC, Inc. 1700 Maple Avenue East, Mora, MN 55051

An Equal Opportunity Employer / Contractor

General Disclaimer ♦ Under federal and state laws, your right to privacy is protected. You are asked to supply private

information concerning you and your family and household. You are not legally required to provide this information. Without this information, Lakes and Pines may not be able to determine if the household is eligible for certain programs.

♦ The reason for this information is to have on file your family's participation in programs. These records

help Lakes and Pines in applying for funds. ♦ You have the right to see your file at any time. ♦ You have the right to request changes in your file if mistakes are found. ♦ You have the right to ask Lakes and Pines to no longer keep information about your family. ♦ Lakes and Pines will provide copies of your file at your expense. Lakes and Pines may limit review of

your file to once every 6 months. If new information is added, you may review your file more often. ♦ Any information you feel is incorrect will be left out of your file until you are sure it is correct. ♦ If summary reports are made which include information from your file, the reports will not identify

individuals or families. ♦ Please complete all sections of the forms. Under the law, you may not receive certain benefits at the same

time. Do not check a source of income or aid which is in conflict with sources you actually receive. ♦ I have read or have had read to me the above statements. I understand the purpose of the information

which Lakes and Pines will keep in its files. ♦ I will allow you to release information to other programs of the Lakes and Pines Agency. ♦ Also, I will allow Lakes and Pines to share this information with: state and local welfare agencies;

community based organizations; local and state public and private human service agencies; The MN Department of Commerce; MN Department of Employment & Economic Development; MN Department of Human Services; MN Department of Education; The United States Department of Labor; The U. S. Department of Health and Human Services; The U. S. Department of Housing and Urban Development; The U. S. Department of Agriculture; U. S. Department of Energy; MN Department of Corrections; MN Housing Finance Agency; MN Department of Health; and the state and local educational programs, as allowed by law. I will also allow Lakes and Pines to share information to other agencies as stated on the Program Disclaimer.

♦ My signature means that all the information on my application is true and correct. ♦ I understand that I have the right to appeal if my application is denied.

(OVER)

C:\Users\KellyM\Desktop\Disclaimer.doc\MarieT 7/17/2012

DATA USES INCLUSION REQUIREMENTS

I. Program Information

A. Why We Are Asking For It: To help us decide whether you are eligible for the program and what other services you may need. B. How We Plan To Use It: We may use it to prepare required reports, conduct audits, review eligibility and to find out how the program is helping you. C. With Whom We May Share This Information: With staff, allowed by law, who need it to do their jobs in: The MN Department of Commerce; MN Department of Employment & Economic Development; MN Department of Human Services; MN Department of Education; The United States Department of Labor; The U. S. Department of Health and Human Services; The U. S. Department of Housing and Urban Development; The U. S. Department of Agriculture; U. S. Department of Energy; MN Department of Corrections; MN Housing Finance Agency; MN Department of Health. We may also share it with community based agencies, local and state human service agencies, educational programs and other agencies which help you. D. If You Do Not Provide This Information: You are not required by law to provide this information. If you choose not to provide this information, we may not know whether you are eligible for the program and may not be able to help you. Providing false information can lead to removal from the program.

II. Wage Detail Files We may also use information from wage records kept by the Minnesota Department of Employment & Economic Development or other applicable state departments to help us evaluate the program.

III. Social Security Numbers You do not have to provide a Social Security Number to be eligible for our programs. Federal Privacy Act and Freedom of Information Act dictates the use of the Social Security Number. We may use it for computer matches, program reviews and improvements, and audits.

IV. Revocation of Release Form

The individual may revoke the consent to release private data at any time by writing to Lakes & Pines C.A.C. The revocation goes into effect on the date it is available to Lakes & Pines C.A.C. It will not affect information released prior to receipt of the revocation.

V. Expiration of Release This release will remain in effect throughout your enrollment for the program for which you are currently enrolled or revocation of the release. Signature of Applicant:___________________________________________ Date:________________________ Signature of Lakes & Pines Representative:_________________________________________ Date:________________________

Office and TDD • 320/679-1800 • 1-800-832-6082 Special Accommodations for people with disabilities upon request

Borrower’s Certification and Authorization

The undersigned certify the following: I/We have applied for a mortgage loan funded by Minnesota Housing Finance Agency (MHFA). In applying for the loan, I/we completed a loan application containing a variety of information on the purpose of the loan, my/our employment verification, income verification, asset verification, and liability verification. Authorization to Release Information: To whom it may concern:

1. I/We applied for a mortgage loan from Minnesota Housing Finance Agency (MHFA). As part of the application process, MHFA and the administrator of the loan, Lakes & Pines CAC, Inc., may verify information contained in my/our loan application and in other documents required in connection with the loan, before the loan is closed or as part of its quality control program.

2. I/We authorize you to provide MHFA/Lakes & Pines CAC, Inc. any and all information they request. Such information may include, but is not limited to, employment income, bank money market and similar account balances, and copies of income tax returns.

3. MHFA/Lakes & Pines CAC, Inc. may address this authorization to any party named in the loan application.

4. A copy of this authorization may be accepted as an original.

_____________________________________________________________________________ Borrower’s Signature Date Social Security Number _____________________________________________________________________________ Borrower’s Signature Date Social Security Number

*This release will expire sixty (60) days from date of signature.

Minnesota Housing Finance Agency Rental Rehabilitation Deferred Loan Program

IMPORTANT PRIVACY NOTICE READ THIS BEFORE FILLING OUT THE APPLICATION

We are asking that you provide the information on the application form to determine if you are eligible to participate in the rehabilitation program. Your name, address, and the amount of assistance you receive are considered public data under the Minnesota Data Practices Act. Other information that you provide to the housing rehabilitation program about you and your household is considered private data. We will use your private data only when it is required for administration and management of the program. Persons or agencies with whom this information may be shared includes: Staff and other persons involved in program administration Auditors who perform required audits of this program Authorized personnel from Minnesota Housing Finance Agency (MHFA) or other

local, State, and Federal agencies providing funding assistance for your loan Those persons who you authorized to see it Law enforcement personnel, in the case of suspected fraud, or other enforcement

authorities as required We cannot release private data to anyone or use the private data in any other way unless you give us permission, in writing, by completing a consent form that we will provide. Please keep in mind, however, that data must be released if required by a court order and in addition, your private data must be released if required by law that authorizes or requires such release of data. Signature of Applicant: _______________________________________ Date: ____________

Signature of Co-Applicant: ____________________________________ Date: ____________ Minnesota Law gives you important rights in regard to information maintained about you. These include:

• The right to see and obtain copies of the data maintained on you and your household • The right to be told the contents and meaning of the data • The right to challenge the accuracy and completeness of the data