Fillable NHHFA ATTACHMENT B PART I (New Hampshire Housing)

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NHHFA ATTACHMENT B PART I (New Hampshire Housing)

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The NHHFA ATTACHMENT B PART I (New Hampshire Housing) form is 1 page long and contains:

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  • 5 check-boxes
  • 27 other fields

Country of origin: US
File type: PDF

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Revised: April 19, 2018
NHHFA
ATTACHMENT B
PART I
Date
Project Name
Total Amount Requested
Management Agent
Funding Source
Check appropriate source
Replacement Reserve
Operating
Other restricted account
___________________________
Description of Repairs
DISCLOSURE OF IDENTITY OF INTEREST
Please indicate if this award is being made to a contractor or vendor with an identity of interest.
Yes No
Please describe the relationship:
Signature of Agent
***NHHFA USE ONLY***
Approved by
Declined by
Date
Date
Comment
Failure to submit this form for payment within 90 days of approval will result in denial of payment request. NHHFA will not advance funds for
materials and/or for work not completed.
PART II
(To be completed by Owner/Agent and submitted with backup documentation for payment.)
Payee
Address
City, State ZIP Code
Amount
Check Stub Comment
***NHHFA USE ONLY***
Approved Amount
Loan #
Special Comments or Notes
Approved by:
Signature
Type Name
Date
Revised: April 19, 2018
Instructions:
Owner/Agent will complete Part I and submit to NHHFA for approval
NHHFA Asset Manager will approve or decline and return form to Owner/Agent
If approved and after work has been completed Owner/Agent will complete Part II and submit along with necessary backup
documentation to NHHFA for payment. (Note: All “new” vendors must submit a W9)
NHHFA Asset Manager will review the request for payment. Complete the “Approved Amount”, add any special instructions, sign, date
and forward to M&D Admin Assistant for payment process.
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NHHFA ATTACHMENT B PART I (New Hampshire Housing)

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Completed 30 August 2020

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