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Page 1 of 14 Today’s date: _____ ___ Loan Amount Requested: ________________ Purpose: Purchase Rehabilitation Refinance New Construction Other How did you hear about CPC? WOM Internet Advertising Press Government Agency Other *COMPLETE: THIS APPLICATION| ALL ATTACHED SCHEDULES A, B, C, D, E | PERSONAL FINANCIAL STATEMENT FOR KEY PRINCIPALS AND OWNERS | ENERGY BENCHMARKING PROGRAM AGREEMENT & UTILITY ACCESS AUTHORIZATION FORM. BASIC PROPERTY INFORMATION Project Name: Building Address: City: State: ZIP Code: Section: Block/Lot: County: Property Type: Residential Commercial Mixed Use Ownership: Fee Simple Lease hold Elevator: Y N # Elevators: Number of Floors Above Basement/Grade: Number of Parking Spaces: Number of Vacant Units: Number of Residential Units: Number of Studio Apartments: Number of One-Bedrooms: Number of Two-Bedrooms: Number of Three-Bedrooms: Other Bedroom Apartments: Number of Commercial Units: Type(s) of Commercial Business(es): Total Residential Sq. Feet: Total Commercial Sq. Feet: Year of Construction: Year of Last Renovation: Date of Purchase: Total Current Mortgage: Total Purchase Price: Estimated Cost of Rehab or Construction: Borrower Name State Formed Date Formed Principal’s Name (s) Borrower/Business Address City State Zip Principal Home Address City State Zip Home Phone Business Phone Mobile Phone Fax Email SSN Borrower Fed ID # (EIN/TIN) For Profit Corporation Not-For-Profit Corporation Partnership Sole Proprietor LLC LP

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Page 1: Page 1 14communityp.com/wp-content/uploads/2016/02/CPC-Loan... · 2012. 1. 1. · Low-Rise (1-4 Stories) Garden Style/Townhouse (no common hallways) Primary Occupancy Type: (Select

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Today’s date: _____ ___ Loan Amount Requested: ________________

Purpose: Purchase Rehabilitation Refinance New Construction Other

How did you hear about CPC? WOM Internet Advertising Press Government Agency Other

*COMPLETE: THIS APPLICATION| ALL ATTACHED SCHEDULES A, B, C, D, E | PERSONAL FINANCIAL STATEMENT FOR KEY PRINCIPALSAND OWNERS | ENERGY BENCHMARKING PROGRAM AGREEMENT & UTILITY ACCESS AUTHORIZATION FORM.

BASIC PROPERTY INFORMATION

Project Name: Building Address: City: State: ZIP Code: Section: Block/Lot: County: Property Type: Residential Commercial Mixed Use Ownership: Fee Simple Lease hold Elevator: Y N # Elevators: Number of Floors Above Basement/Grade: Number of Parking Spaces: Number of Vacant Units: Number of Residential Units: Number of Studio Apartments: Number of One-Bedrooms: Number of Two-Bedrooms: Number of Three-Bedrooms: Other Bedroom Apartments: Number of Commercial Units: Type(s) of Commercial Business(es): Total Residential Sq. Feet: Total Commercial Sq. Feet: Year of Construction: Year of Last Renovation: Date of Purchase: Total Current Mortgage: Total Purchase Price: Estimated Cost of Rehab or Construction:

Borrower Name State Formed Date Formed

Principal’s Name (s)

Borrower/Business Address City State Zip

Principal Home Address City State Zip

Home Phone Business Phone Mobile Phone

Fax Email

SSN Borrower Fed ID # (EIN/TIN)

For Profit Corporation Not-For-Profit Corporation Partnership

Sole Proprietor LLC LP

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Type of Construction: Brick Joint Wood Frame Fire Proof Other

Dimensions: Size of Building One Plot Number of Acres

Primary Building Type: (Select one)

Sky-scraper (30+stories) High-Rise (9-29 stories) Mid-Rise (5-8 stories)

Low-Rise (1-4 Stories) Garden Style/Townhouse (no common hallways)

Primary Occupancy Type: (Select one)

Single/couple Family Senior Special Needs Supportive Housing Student

UTILITY PAYMENT

For each of the following, indicate if the primary utility usage is paid for by the tenant or owner: (Select one)

Apt Electricity Tenant Owner

Heating Tenant Owner

Hot Water Tenant Owner

Water Tenant Owner

Cooking Tenant Owner

Laundry Tenant Owner N/A

Cooling* Tenant Owner N/A

*Cooling will be paid by owner if tenant electricity usage in apartments is paid by owner, or if the owner provides centrallydistributed cooling (in most cases a chiller).

FUEL TYPE

For each of the following, indicate primary fuel: (Select one) Heating Electric Gas Oil Other ______________________

Hot Water Electric Gas Oil Other ______________________

Cooking Electric Gas Oil Other ______________________

Laundry (Dryers) Electric Gas Oil Other ______________________ N/A

Is oil used as a backup fuel? (Select Yes/No) Yes No

Have you recently undergone a fuel conversion (i.e. oil to gas)? (Select Yes/No) ) Yes No

If yes, when: ____________________________________________________

METERING

Indicate the metering type installed for each. Residential tenant metering (Select one):

Electricity Master Direct Sub-meter N/A

Gas Master Direct Sub-meter N/A

Water Master Direct Sub-meter N/A

Commercial tenant metering (Select one):

Electricity Master Direct Sub-meter N/A

Gas Master Direct Sub-meter N/A

Water Master Direct Sub-meter N/A

Definitions:

“Master” metered means there is a meter serving all the tenant spaces and common areas combined. This meter is maintained by the utility.

“Direct” metered means each tenant space is served by an individual meter maintained by the utility. The common areas are also served by a one or more separate meters.

“Sub-meter” means there is a utility-maintained master meter, and a third party meter has been installed to separate and measure usage among individual tenants.

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SYSTEMS SURVEY

Indicate the type of heating and cooling systems:

Central Plants: □ Steam Boiler – 1 pipe system □ Steam Boiler – 2 pipe system □ Hydronic (Heating Hot Water) Boiler □ Furnace □ District Steam Supply □ Ground Source Heat Pump (Geothermal) □ Chiller □ Chiller-Heater □ Cooling Tower □ Other:___________________

Apartment Units: □ Radiator/Baseboard □ Electric Resistance Baseboard □ PTAC (Packaged Terminal Air Conditioner) □ PTHP (Packaged Terminal Heat Pump) □ Water Source Heat Pump (WSHP) □ Fan Coil Unit □ Window/Wall AC □ Ductless Mini Split System (Heat Pump) □ Unit Heater (Furnace or Boiler) □ Other:________________________

Packaged Air Handling: □ Makeup Air Unit □ Packaged Indoor Unit □ Packaged Rooftop Unit □ Split System

Is there any renewable or on-site generation equipment at your property?

Type Size Solar/PV Cogeneration/CHP Other:

MISCELLANEOUS QUESTIONS

Is water used for landscape irrigation? (Select Yes/No) Yes No Please indicate the number of dishwashers on site: _______________________ Please indicate the number of washer and driers on site: # washing machines: ________ # driers:___________ How many of these machines are located in a common area? _____________________ Does the building have in-unit thermostats? (Select Yes/No) Yes No Will this building be constructed/renovated using modular panels or units? (Select Yes/No) Yes No

If yes, please describe: ____________________________________________________

List any amenities and common spaces below that may account for additional owner-paid utility usage (i.e. parking, garage, community room, gym, cool, commercial kitchen). Indicate if each space is conditioned. Amenity/Space Heated? Cooled? _____________________________ _____________________________ _____________________________ _____________________________ _____________________________

Describe the quantity and type of any commercial tenants (i.e. 1 restaurant, 1 office, 2 retail). Additional Property Notes:

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Existing Mortgage Information (for Subject Property) 1. Mortgagee and Address Outstanding Principal

Balance Interest Rate Account #

Annual Payment Amortization Maturity Date Arrears

Contact Name

Phone Number

2. Mortgagee and Address Outstanding Principal Balance

Interest Rate Account #

Annual tayment Amortization Maturity Date Arrears

Contact Name

Phone Number

Can each existing mortgage(s) be prepaid? Yes No If yes, how much is the prepayment fee? Government Participation (if applicable) *If government financing has been requested for a portion of this loan, please complete the following: Source 1 Name of Agency Name of Program

Contact Person Telephone Number

Amount Requested Purpose Government Financing Status Approved Declined Pending

Source 2 Name of Agency Name of Program

Contact Person Telephone Number

Amount Requested Purpose Government Financing Status Approved Declined Pending

Source 3 Name of Agency Name of Program

Contact Person Telephone Number

Amount Requested Purpose Government Financing Status Approved Declined Pending

Person(s) Responsible for Performing Rehabilitation & Construction Work (e.g. contractor(s), architect, etc.) CONTRACTOR (Name of Contact) Address Telephone Number

ARCHITECT (Name of Contact) Address Telephone Number

BUILDING MANAGER (Name of Contact) Address Telephone Number

References (include 3 business references) Company Name Contact Name Telephone Number Relationship

Have you applied for a loan for this property with any other financial institution? Yes No LIST ALL FINANCIAL INSTITUTIONS WHERE YOU HAVE SUBMITTED AN APPLICATION FOR THE SUBJECT PROPERTY 1. _ 2. _ 3. _

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Financial Statement* THE FOLLOWING IS REQUIRED FOR THE BORROWING ENTITY. ANY PRINCIPAL OWNER OF THE BORROWER HOLDING 10% OR GREATER INTEREST, MUST COMPLETE A PERSONAL FINANCIAL STATEMENT & PAGE 4

NAME OF BORROWING ENTITY DATE

~AN ACCOUNTANT PREPARED OR AUDITED STATEMENT MAY BE SUBMITTED IN LIEU OF THIS STATEMENT, BUT DECLARATION SECTION MUST BE COMPLETED AND SIGNED

ASSETS LIABILITIES CASH ** NOTES PAYABLE TO BANKS REAL ESTATE *** NOTES PAYABLE TO OTHERS SECURITIES **** MORTGAGES ON REAL ESTATE CASH VALUE OF LIFE INS. INSTALLMENT/LINES OF CREDIT OTHER ASSETS OTHER LIABILITIES

TOTAL LIABILITIES TOTAL ASSETS NET WORTH

* Attach copy of last 2 years of tax returns

** Attach current bank statements *** Complete Real Estate Schedule D if needed (Schedule D is an Excel Spreadsheet) ****Attach current statements

Personal Data (Complete only if Borrower & Principal are the same) Employer Employer Address

City State Zip Title/Position

Work Telephone Number Annual Salary Other Income Source of Other

Declarations (Borrowing Entity) Yes No

Are there any outstanding judgments against you?

Have you ever declared bankruptcy?

Are you party to a lawsuit?

Do you have any contingent liabilities? If yes, $ Have you ever been convicted of a felony?

Are you presently delinquent or in default on any loan, mortgage, financial obligation, bond or loan guarantee?

Have you, directly or indirectly, been involved on any loan which resulted in foreclosure, Transfer of title in lieu of foreclosure or judgment?

IF YES TO ANY OF THE ABOVE, PLEASE EXPLAIN BY ATTACHING A SEPARATE SHEET

I/We certify that all information contained on this financial statement is true and correct in every detail and represents the financial condition of the Applicant(s) on the date given below. The undersigned declares that he/she has read and understands the statements above.

Applicant’s Authorized Signature Date

Applicant’s Authorized Signature Date _

Bank Reference Institution Address Account Representative

Account # Telephone Number Institution Address Account Representative

Account # Telephone Number

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ALL PERSONS IN THE BORROWING ENTITY MUST PROVIDE THE FOLLOWING INFORMATION: Principal Owner Soc. Sec # Stockholder # of shares or %

interest Home Address

City State Zip Home Telephone Cellular Telephone

Business Address City State Zip Business Telephone

Are you a US Citizen? Yes No Country of Citizenship Visa Type Date of Expiration Refugee Status Date Received

Permanent Residency # Date of Issue

Principal Owner SSN Stockholder # of shares or % interest

Home Address

City State Zip Home Telephone Cellular Telephone

Business Address City State Zip Business Telephone

Are you a US Citizen? Yes No Country of Citizenship Visa Type Date of Expiration Refugee Status Date Received

Permanent Residency # Date of Issue

SUSTAINABILITY INFORMATION

1. Will you be incorporating any sustainability design elements (or measures to improve energy efficiency) into

your project scope? Yes No

2. If yes, what sustainability elements will be incorporated into your project design and scope? (select all that apply) □ Green Physical Needs Assessment (GPNA) or Energy Audit □ High-efficiency heating system □ On-site renewable energy generation □ Sustainability Certification (i.e. LEED, Enterprise Green Communities, Energy Star, NYSERDA) □ Other: ________________________________________________________________________________

3. Are you interested in learning more about CPC’s sustainability initiatives and technical assistance program?

Yes No

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Certification The Undersigned certify the following:

1. We have applied for a mortgage loan from The Community Preservation Corporation. In applying for the loan, I/We completed a loan application containing various information on the purpose of the loan, the amount and source of the down payment, employment and income information, and assets and liabilities. I/We certify that all of the information is true and complete. I/We made no misrepresentations in the loan application or other documents, nor did I/We omit any pertinent information. 2. I/We understand and agree that The Community Preservation Corporation reserves the right to change the mortgage loan review process to a full documentation program. This may include verifying the information provided on the application with the employee and/or the financial institution. 3. I/We fully understand that it is a Federal crime punishable by fine or imprisonment, or both, to knowingly make any false statements when applying for this mortgage, as applicable under the provisions of Title 18, United States Codes, Section 1014. 4. This application shall remain the property of CPC. 5. Prior to closing the loan, the applicant(s) agree(s) to promptly advise CPC of any change contained in this application.

Authorization to Release Information To Whom It May Concern:

1. I/We have applied for a mortgage from The Community Preservation Corporation. As part of the application process, The Community Preservation Corporation may verify information contained in my/our loan application and in other documents required in connection with the loan, either before the loan is closed or as part of its quality control program. 2. I/We authorize you to provide to The Community Preservation Corporation, and to any investor to whom The Community Preservation Corporation may sell my mortgage, any and all information and documentation that they request. Such information includes, but is not limited to, employment history and income; bank, money market, and similar account balances; credit history; and copies of income tax returns. 3. The Community Preservation Corporation or any investor that purchases the mortgage may address this authorization to any party named in the loan application. 4. A copy of this authorization may be accepted as an original. 5. Your prompt reply to The Community Preservation Corporation or the investor that purchased the mortgage is appreciated. __________ (Applicant’s Authorized Signature) Date

__________ (Applicant’s Authorized Signature) Date

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SCHEDULE A

RENT ROLL

Please fill out or attach current Rent Roll for Occupied Properties

Rent Roll Summary Month Year Building Address

Tenant’s Name Apt # #/Rooms* Current Monthly Rent

Lease Exp. Date

Occupied/ Vacant

Tenant Share Amt.

Rent Controlled

Amt.

Rent Stabilized

Amt.

Total # of units

Totals

Commercial Space Vacant Monthly Rental

Amount Floor # Sq. Footage of

Commercial Unit Lease Exp.

Date Yes No

#/months vacant

Yes No #/months vacant

Yes No #/months vacant

Totals

* Number of rooms 2 rooms = studio/0 bedrooms 5 rooms = 3 bedrooms 3 rooms = 1 bedroom 6 rooms = 4 bedrooms 4 rooms = 2 bedrooms

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SCHEDULE B

INCOME OPERATING EXPENSES

Please attach 3 years of Income Operating Expenses or Complete Form for Occupied Properties* TO BE COMPLETED BY APPLICANT

ANNUAL INCOME AND EXPENSES FOR YEAR: BUILDING ADDRESS:

INCOME 3 years back 2 years back 1 year back Trailing 12 to Projected Budget

1. Gross income from apartment rental 2. Gross income from commercial rental 3. Total gross income (lines 1 plus 2) 4. Collection Losses Residential Commercial 5. Effective gross income (lines 3 less 4) EXPENSES 1. Real estate taxes 2. Water and sewer charges 3. Fire Insurance Premium Amount of Coverage 4. Liability Insurance Premium Amount of Coverage 5. Licenses 6. Fuel (Oil type: ) Gallons per year 7. Gas 8. Electricity (not metered to tenants) 9. Trash removal 10. Pest control 11. Maintenance and repairs 12. Cleaning expenses 13. Supplies 14. Elevator maintenance & repair contract 15. Management 16. Superintendent and staff salaries Does superintendent receive free apartment? Yes No ¸Ŝǎ bƻ ¸Ŝǎ bƻ ¸Ŝǎ bƻ ¸Ŝǎ bƻ Supers: _ full-time part-time Porters: _ full-time part-time Handymen: _ full-time _ part-time 17. Payroll taxes 18. Legal 19. Accounting and Auditing 20. Replacement (doesn’t include repair) Ranges and refrigerators Boilers Roof Other 21. Painting 22. Other Expenses TOTAL EXPENSE

* Note Please -- For an occupied property with historical operating expenses, please submit monthly usage and cost for heat (oil or gas), and electricity for the most recent calendar year. Please also submit the most recent annual water usage and cost for the property.

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SCHEDULE C TRADE COST BREAKDOWN

TO BE COMPLETED BY APPLICANT OR ATTACH STANDARD AIA COST BREAKDOWN FOR RENOVATION OR NEW CONSTRUCTION

ITEM NO. DESCRIPTION OF WORK SCHEDULED VALUE

1 Sitework

2 Demolition & Shoring

3 Concrete-Non Foundation

4 Foundation

5 Masonry

6 Metalwork

7 Rough Carpentry

8 Finish Carpentry

9 Roof/Insulation

10 Windows/Glazing

11 Doors & Hardware

12 Drywall & Plastering

13 Flooring

14 Specialties – Sprinkler

15 Elevators

16 HVAC

17 Plumbing

18 Electrical

19 Other _

Total

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SCHEDULE D

REAL ESTATE SCHEDULE

TO BE COMPLETED BY APPLICANT

All Borrowers and Borrower Principals (see definitions below) must complete and deliver to the lender a separate Real Estate Schedule. The Real Estate Schedule should be in spreadsheet format. The CPC Real Estate Schedule format (see "Step 1" tab) is strongly preferred. If an alternate Real Estate Schedule format is delivered, each property listed in the schedule should include a data point for each of the fields in the "Field Name" section to the right. In addition, each Borrower and Borrower Principal must certify the accuracy of each item on the Real Estate Schedule and deliver an executed certification (see "Step 2" tab), or note any exceptions. Borrower means any individual or entity that will execute the promissory Note evidencing the loan requested. Borrower Principal means any individual or entity that directly or indirectly controls the Borrower, including 1. Any person or entity signing the guaranty, regardless of equity, ownership percentage or position within the borrowing entity 2. Any GP of a general partnership or limited partnership 3. Any managing member or non-member manager of an LLC 4. Any person or entity (limited partner, member or shareholder) with a collective equity interest in the borrower equal to or exceeding 25 percent 5. Any joint venture partner of a joint venture 6. The settlor (grantor) of a living trust 7. Any beneficiary with a 25 percent or more interest in a testamentary (irrevocable) trust 8. Any beneficiary with a 25 percent or more interest in an Illinois land trust Each Borrower and Borrower Principal must list all real estate projects for which it has an ownership interest as a Borrower Principal. If a Borrower or Borrower Principal has more than fifteen real estate projects, add additional rows to the Real Estate Schedule to capture all real estate projects. Please consult the lender if you have any questions concerning this schedule.

The schedule should be completed as follows:

Excel Column

Field Name

Instructions

Column B Property Name Enter the property name Column C Street Address Enter the street address where the property is located

Column D City Enter the city where the property is located

Column E State Enter the state where the property is located Column F Status Select an option from the drop down menu

Column G Asset Type Select an option from the drop down menu

Column H Units Enter the total number of residential units at the property

Column I Year Built Enter the year the property was built

Column J Occupancy % Enter the most current occupancy figures expressed as a percentage for the property. "Occupancy" means leased and physically in place

Column K Acquisition Date (yr) Enter the acquisition date of the property Column L Ownership Role Enter the Borrower or Borrower Principal's legal ownership role in the property (i.e. LP, GP

etc) Column M Ownership Interest Enter the percentage ownership the Borrower or Borrower Principal has in each identified

property Column N Lender Enter the lender on the lien

Column O Loan Type Select an option from the drop down menu Column P Maturity Date Enter the date the debt will be maturing Column Q Outstanding Loan Amount Enter the unpaid principal balance Column R Annual Debt Service Enter the annual debt service payments (principal and interest)

Column S Interest Only or Amortizing Debt Service

Select an option from the drop down menu that reflects whether debt service payments are currently amortizing or interest only

Column T Effective Gross Income Enter the total annual effective/gross income for the property

Column U Total Operating Expenses Enter the total annual operating expenses for the property including all real estate taxes, insurance, management fees, etc

Column V NOI List the annual net cash flow or net operating income for the property before debt service payments. Also insert the 12-month period over "identify period" after the "NOI" heading

Column W Total DCR List the total Debt Coverage Ratio Column X Current Market Value Enter the current fair market value of the property and the date of such valuation over "identify

period" after the "Current Market Value" heading Column Y Cap Rate Enter the cap rate for that particular mortgage on the corresponding property

Column Z Value Per Unit Enter the value per unit for that particular property

Column AA Comments Enter any additional notes or clarification about any of the fields populated

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CPC Real Estate Schedule Form Borrower or Borrower Principal Name: Date

Populated: Date of NOI:

Property Info Ownership Debt: Enter any property indebtedness by breaking out each lien and the associated terms in one of the two rows provided

Cash Flow Valuation

#

Property Name

Address

City

State

Status

Asset Type

Units

Year Built

Current

Occupancy %

Acquisition Date (yr)

ABC Company's Ownership

Role

ABC Company's Ownership

Interest

Lender

Loan Type

Maturity Date

Outstanding Loan

Amount

Annual Debt

Service

Interest Only or Amortizing Debt

Service

Effective

Gross Income

Total

Operating Expenses

NOI

01/01/2012

Total DCR

Current

Market Value 01/01/2012

Cap Rate

Value per

Unit

Total LTV

1. ABC Property 123 Main St Mclean Va Stabilized Multifamily (conventional) 100 2000 100% 2005 GP 1.00% ABC Bank Fixed 1/1/2015 $ 8,000,000 $ 800,000 Amortizing $ 1,400,000 $ 400,000 $ 1,000,000 1.00 $ 10,000,000 10.0% $ 100,000 100% DEF Bank Variable 1/1/2016 $ 2,000,000 $ 200,000 Interest Only

2. - - - -

3. - - - -

4. - - - -

5. - - - -

6. - - - -

7. - - - -

8. - - - -

9. - - - -

10. - - - -

11. - - - -

12. - - - -

13. - - - -

14. - - - -

15. - - - -

Total

Weighted Average

Min

Max

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SCHEDULE E

ENERGY AND BUILDING PERFORMANCE

ENERGY PERFORMANCE SURVEY TO BE COMPLETED BY: team architect, MEP engineer, sustainability consultant, energy modeler, or CPC’s supervising engineer

In effort to continually improve the economics of the properties we finance, The Community Preservation Corporation (CPC) is collecting information on how your project is expected to perform post-construction, paying particular attention to the projected cost for owner and tenant paid utilities. Return this from along with any relevant supporting documentation*.

*Supporting documentation could include energy audits, energy model, narrative describing project/systems, and/or information on comparable projects.

BUILDING INFORMATION

Project Name: Building Address: City: State: ZIP Code: Residential Sqft: Commercial Sqft: Other Sqft: Dwelling Units: Rooms: Commercial Units: UTILITY EXPENSES

For each of the following, indicate the cost for both owner and tenant paid utilities: For new construction and substantial renovation (those with changes to the heating systems or thermal properties of a building) indicate the projected, annual costs for each utility.

Owner Paid Total Dollars Per Year

Tenant Paid Total Dollars Per Year

Electric Gas Oil Water/Sewer FUEL TYPE

For each of the following, indicate primary fuel: (Select one) Space Heating Electric Gas Oil Other ______________________

Hot Water Electric Gas Oil Other ______________________

SYSTEM INFORMATION

Space Heating Central Plant In-unit Other ______________________

Hot Water Central Plant In-unit Other ______________________

ELECTRIC GENERATION

Will there be/are there any renewable or on-site generation equipment at your property?

Type Size Solar/PV Cogeneration/CHP Other:

MISCELLANEOUS QUESTIONS

Please list any intended sustainability certifications (i.e. Enterprise Green Communities, LEED, ENERGY STAR, NYSERDA MPP or new construction low rise):

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In effort to continually improve the economics of the properties we finance, The Community Preservation Corporation (CPC) is collecting information on how your project is expected to perform post-construction, paying particular attention to the projected cost for owner and tenant paid utilities. Return this from along with any relevant supporting documentation*.

*Supporting documentation could include energy audits, energy model, narrative describing project/systems, and/or information on comparable projects.

Please list any awarded sustainability incentives or grants (i.e. NYSERD, WAP, National Grid):

Additional Property Notes:

DESIGN PROFESSIONAL VERIFICATION By signing this document, I certify the following: The information provided in this document is true and correct to the best of my knowledge Signature: _________________________ Phone: _____________________________

Name (print): _______________________ E-mail: _____________________________

Title: ______________________________ Organization: _______________________