"Annual Project Activity Report Template" - North Carolina

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Annual Project Activity Report for Year
20__
Project Name:
TC#
Project Type: (check only one)
Family
Elderly (62 or older)
Elderly (55 or older)
Project Address:
Special Needs
Other:
City:
State:
Zip:
County:
Construction Type: (check all that apply)
New
Rehab
Owner Information
Ownership Entity Name:
Name of First Position Lender:
Owner Address:
Name of Syndicator:
City:
State:
Zip:
Contact Person:
Utilities Paid by Residents: (check all that apply)
Electricity
Trash Collection
Gas/Oil
Water/Sewer
Phone:
E-mail:
Supportive Services Required? (per application):
Tax ID Number:
Type: (SSN or FIN)
Yes
No
Ownership Entity Type: (Non-Profit or For-Profit)
Recertication Waiver Granted by the IRS?
Yes
No
Date of Waiver:
Management Agent Information
Agent Name:
Affordable Housing Products Received From NCHFA:
(check all that apply)
Agent Address:
Federal Tax Credit
State Tax Credit
HOME Loan
HTF Loan
Other
City:
State:
Zip:
Other Non-Agency Funding Sources (check all that apply):
Agent Contact:
Conventional Loan
Bond Financing
RHS Loan
Local HOME
City Loan
Other:
Phone:
E-mail:
Tax Credit Allocation
Amount of Allocation:
Year of Allocation:
Site Manager:
Phone:
Number of Extended Use Years (post 1989 allocations):
Project Profile
Project Minimum Set-Aside (from Application and 8609)
Special Restrictions:
(check only one)
20/50
40/60
15/40
Was 2/7/94 special rent election taken?
Additional Set-Aside (from Application) (indicate the
(1987-1989 allocations only-N/A for all subsequent years)
number of units and percent of median income)
Yes
No
N/A
Units at
%
of County Median Income
Has a "rent floor" been established in accordance with
IRS Procedure 94.57?
Target Elected at Time of Allocation vs Actual as of 12/31
Yes
No
Elected
Actual
Date Project met its minimum set-aside:
Total Low-Income Units:
Total Project Units:
Identify first tax year owner claimed credits on this project:
Total Residential Buildings:
Utility Allowance
Project Based Subsidy:
Effective Date of Most Recent Utility Survey:
(check below)
# of Units Source:
Allowance type used project wide: (check one)
Yes
No
PHA
RHS
HUD
Private
The undersigned hereby certifies that the information presented herein on this Project Activity Report and the attached
Building Activity Reports is true and correct to the best of his or her knowedge and belief.
Signature:___________________________
Name:_________________________
Title:_____________
Date:_______
This report is not considered complete unless it includes a separate Building Activity Report for each building. Further, the Owner's
Certificate of Continuing Program Compliance is not considered complete without the submission of the Annual Project Activity Report.
See instructions if any questions about the data requested.
Revised: 12/14/05
Annual Project Activity Report for Year
20__
Project Name:
TC#
Project Type: (check only one)
Family
Elderly (62 or older)
Elderly (55 or older)
Project Address:
Special Needs
Other:
City:
State:
Zip:
County:
Construction Type: (check all that apply)
New
Rehab
Owner Information
Ownership Entity Name:
Name of First Position Lender:
Owner Address:
Name of Syndicator:
City:
State:
Zip:
Contact Person:
Utilities Paid by Residents: (check all that apply)
Electricity
Trash Collection
Gas/Oil
Water/Sewer
Phone:
E-mail:
Supportive Services Required? (per application):
Tax ID Number:
Type: (SSN or FIN)
Yes
No
Ownership Entity Type: (Non-Profit or For-Profit)
Recertication Waiver Granted by the IRS?
Yes
No
Date of Waiver:
Management Agent Information
Agent Name:
Affordable Housing Products Received From NCHFA:
(check all that apply)
Agent Address:
Federal Tax Credit
State Tax Credit
HOME Loan
HTF Loan
Other
City:
State:
Zip:
Other Non-Agency Funding Sources (check all that apply):
Agent Contact:
Conventional Loan
Bond Financing
RHS Loan
Local HOME
City Loan
Other:
Phone:
E-mail:
Tax Credit Allocation
Amount of Allocation:
Year of Allocation:
Site Manager:
Phone:
Number of Extended Use Years (post 1989 allocations):
Project Profile
Project Minimum Set-Aside (from Application and 8609)
Special Restrictions:
(check only one)
20/50
40/60
15/40
Was 2/7/94 special rent election taken?
Additional Set-Aside (from Application) (indicate the
(1987-1989 allocations only-N/A for all subsequent years)
number of units and percent of median income)
Yes
No
N/A
Units at
%
of County Median Income
Has a "rent floor" been established in accordance with
IRS Procedure 94.57?
Target Elected at Time of Allocation vs Actual as of 12/31
Yes
No
Elected
Actual
Date Project met its minimum set-aside:
Total Low-Income Units:
Total Project Units:
Identify first tax year owner claimed credits on this project:
Total Residential Buildings:
Utility Allowance
Project Based Subsidy:
Effective Date of Most Recent Utility Survey:
(check below)
# of Units Source:
Allowance type used project wide: (check one)
Yes
No
PHA
RHS
HUD
Private
The undersigned hereby certifies that the information presented herein on this Project Activity Report and the attached
Building Activity Reports is true and correct to the best of his or her knowedge and belief.
Signature:___________________________
Name:_________________________
Title:_____________
Date:_______
This report is not considered complete unless it includes a separate Building Activity Report for each building. Further, the Owner's
Certificate of Continuing Program Compliance is not considered complete without the submission of the Annual Project Activity Report.
See instructions if any questions about the data requested.
Revised: 12/14/05
Annual Building Activity Report For Year
20___
Project Name:
TC#
BIN#
Building Profile
Unit Mix at Time of Allocation vs Actual as of 12/31
Unit Size Total, Low-Income, and Market as of 12/31
Elected
Actual
Total
Market
Employee
Low-Income
Total Low-Income Units:
Efficiency Units
Building Address:
Building Placed In Service Date:
Total Market-Rate Units:
1 Bedroom Units
Total Office/Employee Units:
2 Bedroom Units
Total Units In Building:
3 Bedroom Units
Minimum Set-Aside (this building per 8609) (check one)
Additional Building Set-Aside (this building) (indicate below)
4 Bedroom Units
20/50
40/60
15/40
________
Units at
___________%
of County Median Income
A
B
C
D
E
F
G
H
I
J
K
L
M
N
O
P
Q
R
S
T
U
V
W
X
Y
Z
Number
Unit
Event
Event
Move
Name of Head of Household
HOH
HOH
HOH
Head of
Unit
Number
Gross
Maximum
Displaced
Student
HOH Marital
Assistance
Total Housing
Unit
of
Square
Date
Type
In
First
Date of
Ethnicity
Race
Status
Type
of
Annual
Income
Tenant
Type
Utility
Mandatory Expense
Housing
DHHS
by Katrina
Status
Household
Assistance
Number
Bedrooms
Feet
mm/dd/yy (See Instr.)
Date
Last Name
Initial
Birth
(See Instr.) (See Instr.)
Gender
(S,M,D)
Occupants
Income
Limit
Rent
Amount
(See Instr.) Allowance
Fees
(Q+T+U=) Expense (See Instr.) (See Instr.) (See Instr.)
(LI, MKT, EMP)
Prepared By:
Telephone Number:
Date:
Page_________ of ___________
Revised: 12/14/05
Complete a separate form for each building. See instructions if any questions about the data requested.
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