CERTIFICATION OF SOURCES AND USES
12/2014
This form is completed to certify the actual cost of a property’s construction and development and is to be
returned to VHDA with the Application for IRS Form 8609.
OWNER CERTIFICATION
The owner hereby certifies the following:
1. In connection with the Application for IRS Form 8609 for the above-named development I have
obtained and attached an Independent Auditor’s Report and Schedule of Final Costs. I have
disclosed all costs and all uses of funding to the person or firm preparing such Report and Schedule
including all kickbacks, rebates, adjustments, discounts or gifts of value made or to be made to the
general contractor, architect or any corporation, trust, partnership, joint venture, or other legal or
business entity in which the aforementioned entities, or any of their members, stockholders, officers,
directors, beneficiaries, or partners hold any interest.
2. I have disclosed all of the development’s funding sources and uses, as well as its total financing,
and will disclose any future changes in funding to VHDA in a timely manner.
3. I have provided VHDA with the final Partnership Agreement or other ownership agreement (as
amended).
_____________________________ ___________________________________________
Date Owner
By: _______________________________________
Title:_______________________________________
SYNDICATION/INVESTOR CERTIFICATION
The limited partner/investor member hereby certifies the following:
1. The Final Partnership Agreement or other ownership agreement (as amended) attached to this
Certification is in full force and effect and has not been changed, altered, amended or modified.
2. There are no agreements among the limited partner/investor member, general partner/managing
member and the Owner other than as set forth in the Partnership Agreement, including exhibits,
and the limited partner/investor member is not obligated to make any contribution to the Owner or
to the General Partner or its affiliates which is not included in the Partnership Agreement, including
exhibits.
3. In connection with the Owner’s Application for IRS Form 8609, we have reviewed the Owner’s
Certification above and the Independent Auditor’s Report and Cost Certification. We believe this
information to be complete and accurate.
_____________________________ ___________________________________________
Date Limited Partner/Investor Member
By: _______________________________________
Title:_______________________________________
