Investment Voucher Certification Form Page 2
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2NM MFA - Investment Voucher Form
Part IV: Description of Donation
Name of Project or organization which donation was made to_
Total amount of donation (monetary value):_____________________ Date(s) donation(s) made:_____________________
Brief description:__________________________________________________________________________________
Proof attached:
Check
Invoice
Appraisal
Affidavit
Part V: Notarized Statement (completed by donor)
I have examined the above application and attachments and that all matters stated therein are, to the best of my
knowledge, information and belief, true, correct and complete. I am the authorized representative of the entity
and as such am authorized to make the statement of affirmation contained herein.
____________________________________________
Date:______________________________
Print
____________________________________________
Sign
)
State of New Mexico
)ss.
)
County of__________________City of_____________________
This instrument acknowledged before me this_____ day of _______________, 20__,
by______________________________as_____________________________________
of____________________________________________________________________
______________________________
My Commission expires_______________________
Notary Public
______________________________
Notary Public
Part VI: Statement of Receipt (completed by Project Sponsor)
I have examined this application in its entirety and believe it to be an accurate description of the contribution
actually received to support the development of Affordable Housing and approved by the NM MFA.
____________________________________________
Date:______________________________
Print
____________________________________________
Sign
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