Local Government Verification Of Contribution
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1LOCAL GOVERNMENT VERIFICATION OF CONTRIBUTION – LOAN FORM
Name of Development: __________________________________________________________________________________
Development Location: _________________________________________________________________________________
(At a minimum, provide the address number, street name and city, and/or provide the street name, closest designated intersection and either the
city (if located within a city) or county (if located in the unincorporated area of the county). If the Development consists of Scattered Sites, the
Development Location stated above must reflect the Scattered Site where the Development Location Point is located.)
On or before the Application Deadline, the City/County of ________________________________, committed
(Name of City or County)
$________________ (which may be used as a Non-Corporation Funding Proposal in the Application if it meets the
(loan amount)
required criteria) in the form of a reduced interest rate loan to the Applicant for its use solely for assisting the
proposed Development referenced above.
The net present value of the above-referenced loan, based on its payment stream, inclusive of a reduced interest rate
and the designated discount rate (as stated in the applicable RFA) is: $____________________.
No consideration or promise of consideration has been given with respect to the loan. For purposes of the foregoing,
the promise of providing affordable housing does not constitute consideration. The commitment for this loan is
effective as of the Application Deadline referenced above, and is provided specifically with respect to the proposed
Development.
CERTIFICATION
I certify that the foregoing information is true and correct and that this commitment is effective at least through the
date required in the applicable RFA.
___________________________________________ ______________________________________________
Signature
Print or Type Name
_____________________________________________
Print or Type Title
This certification must be signed by the chief appointed official (staff) responsible for such approvals, Mayor, City Manager,
County Manager /Administrator/Coordinator, Chairperson of the City Council/Commission or Chairperson of the Board of
County Commissioners. If the contribution is from a Land Authority organized pursuant to Chapter 380.0663, Florida Statutes,
this certification must be signed by the Chair of the Land Authority. One of the authorized persons named above may sign this
form for certification of state, federal or Local Government funds initially obtained by or derived from a Local Government that
is directly administered by an intermediary such as a housing finance authority, a community reinvestment corporation, or a state-
certified Community Housing Development Organization (CHDO). Other signatories are not acceptable. The Applicant will not
receive credit for this contribution if the certification is improperly signed. To be considered for points, the amount of the
contribution stated on this form must be a precise dollar amount and cannot include words such as estimated, up to, maximum of,
not to exceed, etc.
If the Application is not eligible for automatic points, this contribution will not be considered if the certification contains
corrections or ‘white-out’ or if the certification is altered or retyped. The certification may be photocopied.
Please note: This form may be modified by Florida Housing Finance Corporation per Section 67-60.005, F.A.C.
(Form Rev. 01-14)
RFA ___________
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