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2018 Samaritan HouseMontana HOME Annual Rental Certification Checklist In order to complete the Annual Rental Certification, please complete and attach the following documents/documentation: W Annual Certification for Rental Housing form 119 Rent and Occupancy Report I& Rent Schedule Form qOperating Budget for the current year for the project IF Statement of Financial Position for the project PStatement of Cash Flows for the project Ep Statement of Activities If you have changed your Lease in the last 12 months, please attach a copy highlighting the differences If you have changed your Affirmative Fair Housing Marketing Plan in the last 12 months, please / attach a Copy highlighting the differences If you have changed your Tenant Selection Policy in the last 12 months, please attach a copy highlighting the differences Send all of documents to DOCHOME@mt.gov. Please title the email: "Annual Rental Recertification/ (Grantee Name)/ (Project Name)". If you have any questions, please contact the Community Development Division at DOCHOME@mt.gov, or 406-8412770. Montana HOME Investment Partnerships Program Annual Certification for Rental Housing Certification Period January 1, 2016 — December 31, 2016 Project Name Samaritan House Project Address 124 9th Ave W. City, Zip Code Kalispell, MT 59901 Owner Information Original Contract # M9756300117 Original Grantee City of Kalispell Current Owner Samaritan House, Inc. Owner Contact Person Chris Krager, Director Street Address 124 9th Ave W. City, State, Zip Code Kalispell, MT 59901 Phone 257-5801 Email Chris.Kraeer@yahoo.com Date Entity Commenced Ownership of Project 1998 (paid off 8/23/2004) CH DO (Yes or No) Yes Non -Profit Organization (Yes or No) Yes Management Information (If different from Owner Information) Management Company Name Same Management Contact Person Kent McLellan Professional Title Associate Director Street Address 124 9th Ave W. City, State, Zip Code Kalispell, MT 59901 Phone 257-5801 Email Thesamaritanhouse(@vahoo.com Date Company Commenced Management of Project 1998 On -Site Contact Person Kent McLellan On -Site Phone 257-5801 On -Site Contact Email Samhouse124@yahoo.com Montana Department of Commerce Community Development Division Annual HOME Rental Certification Revised 4/17/2017 Rent Schedule Form Project Name: Samaritan House Project Address: 124 9th Ave W. Contract Number: M9756300117 Name of HOME Grantee: City of Kalispell Name of Owner: Effective Date of Proposed Schedule: Name of Preparer: Chris Krager Phone Number of Preparer: 257-5801 Utility Allowances Do tenants pay for utilities at the project? ❑ Yes No If Yes, attach Section 8 Utility Schedule identifying the tenant -paid utilities HOME Unit Mix Indicate the number of total HOME -assisted units by bedroom size for the project. For projects with 5 or more HOME units, at least 20% of the units by each bedroom size must be designated as Low -HOME units- 0 Bed 1 Bed 2 Bed 3 Bed 4 Bed 5 Bed 6 Bed Total Number of HOME Units 14 Number of Low -HOME Units Fixed or Floating HOME Units? El Fixed ❑ Floating HOME Rent Limits Provide the HOME Program rent limits for your project area using the table below. Effective Date of HOME Rent Schedule: 2018 Current HOME Rent Limits 0 Bed 1 1 Bed 1 2 Bed 1 3 Bed 1 4 Bed 1 5 Bed 1 6 Bed Low HOME Rent 564 High HOME Rent 564 Project Based Assistance Does this property receive project -based assistance? ❑ Yes No ***Skip this section if you do not have Project -Based units in your project.*** Through which Program does your project receive assistance? ❑ RD Section 515 ❑ RD Section 538 ❑ Project Based Section 8 ❑ Other: If other, explain: Attach a copy of the letter or rent schedule you received from Rural Development or HUD with the approved rent rates and effective dates for this property. Maximum Low Income Housing Tax Credit Rent Limits (if applicable) ***Skip this section if you do not have LIHTC units in your project.*** Provide the Low Income Housing Tax Credit rent limits for your project and project area. Effective Date of LIHTC rent schedule: LIHTC Rent Limits 0 Bed 1 Bed 2 Bed 3 Bed 4 Bed 5 Bed 6 Bed 30% 40 50% 60% Proposed Net Rent Structure (if anplicable) tenant nays utilities 0 Bed 1 Bed 2 Bed 3 Bed 4 Bed 5 Bed 6 Bed Low Rent Room Low Rent Utilities Total Low Rent High Rent Room High Rent Utilities Total High Rent Proposed Gross Rent Structure (if anplicable) 0 Bed 1 Bed 2 Bed 3 Bed 4 Bed 5 Bed 6 Bed Low Rent Room Low Rent Utilities Total Low Rent High Rent Room High Rent Utilities High Rent Total Signatures Accepted By: Grantee Chief Executive Officer or Elected Official Date: Counter Signature (ex. Property Manager): Printed Name: Title: Date: HOME Program Approval HOME Program Officer: Printed Name: Date: (N/A) z!un pase9-i:)arwd algeo!ldde }! '(AA/ww) jn0-avow 10 ale(] . (AA/ww) ul-avow 10 ale(] - E °Ln (AA/ww) uo!l:)adsul S:)dit aoS-OH ISel 10 a}e a .E 0)i O m Juan ejo l ® i/� t/) i/} th V? t/? t"61 L 'N L � FA I(sopI114n pied-}ueual aoj) a:)uemolld A41mn o = o (Aue jl) junowd Aplsgn Q/ N O;. woo jueue o r O L O '= 3 (AA/ww) uo!-jeol1!aan awoOul Isel 10 ale(] (AA/ww) uo!le:)WI:Pa:) awo:)ul lel;iul }o area —. > m (IWd) awo:)ul ue!paw ea.ay jo luaDJad c ao C `o C° awooul (ssoig) lenuu CC a N �- 1 N/A) (�ueua� Aq pa.1,luap! }!) ployasnoH palges!a E _ N swooapag jo aagwnN p C� ployasnoH 10 az! 3W 0- ba o m_ N o �+ O O N O ++ c W N aweN Isel }ueua - 14), .o Q �- ME 6 I ih Q UISISEGE sasses i!un luaa 3wOH (H) 421H JO (l) mol (iu,LA1 i!,un na�eu�!san-3iglrn�..i �., �- .aagwnN z!un _. b rn �_- \r •9 r a- o- in E 0 0 L iJ c v L 3 c V 0 0 a C � m CL > u c: E O 13 �. m o !x4(1 a E b (N/A) llun paSeg-?'-I@fOjd! a e:)i dde ! ' AA ww In ano o ale (ilA/ww) u!-anolN;a ale(] L — •. E-31 (AA/ww) umpadsul S:)dn ao S-OH Isel 10 ale(] e luaairo N� q o � b rz A �j •N 0 W (sailiiiin pied-;aeua4 jo;) ague :SoiiV,4l!igii O x (Aue-;I) junowd Aplsgn _ N (J 40 Q luau 4ueua i r� .— _} ci C-4 3 (AA/ww) uoile:)iUan awOOul ise-l;o area `1 t- (AA/ww) uoi;eoi;rpaD awo:)ul Ie,j!ul;o a;LCj : v _ IN a, (IWd) awo:)ul ueipaW eaay;o luaO.aad w CA awooul (ssoig) !enuu �- . v N/A) (iueua; Aq paiiluap! j!) plo4asnoH palgeS1a `J �- zT N swoo.ipag;o .IagwnN O o 2 plogasnoH 10 az! O 0 I o r' a.weN Isel ;ueua — o 711 o Jj i!un Waa 3WOH (H) 4S!H ao (1) mOI (n�/A} Iun na eu isaG-3!NOH .IagwnN i!un =- rb ri r ` ®c� Ci `4 r� CA r+ r1 ca! �"'b t�1 rt Rent Schedule Form Project Name: Samaritan House Project Address: 135 9th Ave W. Contract Number: M9756300117 Name of HOME Grantee: City of Kalispell Name of Owner: Effective Date of Proposed Schedule: Name of Preparer: Chris Krager Phone Number of Preparer: 257-5801 RK Utility Allowances Do tenants pay for utilities at the project? El Yes ❑ No If Yes, attach Section 8 Utility Schedule identifying the tenant -paid utilities HOME Unit Mix Indicate the number of total HOME -assisted units by bedroom size for the project. For projects with 5 or more HOME units, at least 20% of the units by each bedroom size must be designated as Low -HOME units- 0 Bed 1 Bed 2 Bed 3 Bed 4 Bed 5 Bed 6 Bed Total Number of HOME Units 4 Number of Low -HOME Units Fixed or Floating HOME Units? O Fixed ❑ Floating HOME Rent Limits Provide the HOME Program rent limits for your project area using the table below. Effective Date of HOME Rent Schedule: 2018 Current HOME Rent Limits 0 Bed 1 1 Bed 2 Bed 3 Bed 4 Bed 5 Bed 6 Bed Low HOME Rent 625 High HOME Rent 668 Project Based Assistance Does this property receive project -based assistance? ❑ Yes 21 No ***Skip this section if you do not have Project -Based units in your project.*** Through which Program does your project receive assistance? ❑ RD Section 515 ❑ RD Section 538 ❑ Project Based Section 8 ❑ Other: If other, explain: Attach a copy of the letter or rent schedule you received from Rural Development or HUD with the approved rent rates and effective dates for this property. Maximum Low Income Housing Tax Credit Rent Limits (if applicable) ***Skip this section if you do not have LIHTC units in your project.*** Provide the Low Income Housing Tax Credit rent limits for your project and project area. Effective Date of LIHTC rent schedule: LIHTC Rent Limits ' 0 Bed 1 Bed 2 Bed 3 Bed 4 Bed 5 Bed 6 Bed 30% 40% 50% 60% Proposed Net Rent Structure (if applicable) tenant oays utilities 0 Bed 1 Bed 2 Bed 3 Bed 4 Bed 5 Bed 6 Bed Low Rent Room Low Rent Utilities Total Low Rent High Rent Room High Rent Utilities Total High Rent Proposed Gross Rent Structure (if annlirahlp) 0 Bed 1 Bed 2 Bed 3 Bed 4 Bed 5 Bed 6 Bed Low Rent Room Low Rent Utilities Total Low Rent High Rent Room High Rent Utilities High Rent Total Signatures Accepted By: Grantee Chief Executive Officer or Elected Official Date: Counter Signature (ex. Property Manager): Printed Name: Title: Date: HOME Program Approval HOME Program Officer: Printed Name: Date: �i O Q. O cc m CL ca v 0 M c m C O cu .1 n. E 0 u Ci E 0 s a a 04 �. YYA)1!un paSeg-ia@fOJd algea!ldde }! '(AA/ww) jno-anoW 10 ale(] (AA/ww) ul-anoW 10 a;e4 A fl E 3 ° u (AA/ww) uoipadsul S:)dn ao S-OH ISel Jo area VI wab Tejo y .N 4J o (saillllin pied-;ueua* aol) 33uem.oliv Alli!�i•l 0 (glue }i) }unowd Apisgn cu >.N �A \q^ V , Y' �A V } ;uaH jueua Y ' N N s 3 N (AA/ww) uoi-.eoll!aaA @wO:)ul ;Sel 10 a}e(I (AA/ww) uo!leol1I:W@D awo:)ul leillul 10 a;ea N ©- on (IWH) awo:)ul ue!paW eaay }o lu93aad t 0 ® Q9 awo:)ul (ssoaE)) lenuu �1 a ° J N/Jl) (lueua� Aq paij!luap! j!) plogasnoH palges!Q I I N 4� -T-- N swooapag jo aagwnN w o plogasnoH 10 az! 0 c Ln aweN Isel ;ueua C s, u a� 0 a y J � I!un wag 3WOH (H) ySlH ao (1) nnol 1!.un pa.je.alsaC]-a Wn}i . aaquanN }!uN Til ITI Rent Schedule Form Project Name: Samaritan House Project Address: 145 9th Ave W. Contract Number: M9756300117 Name of HOME Grantee: City of Kalispell Name of Owner: Effective Date of Proposed Schedule: Name of Preparer: Chris Krager Phone Number of Preparer: 257-5801 Utility Allowances Do tenants pay for utilities at the project? 0 Yes ❑ No If Yes, attach Section 8 Utility Schedule identifying the tenant -paid utilities HOME Unit Mix Indicate the number of total HOME -assisted units by bedroom size for the project. For projects with 5 or more HOME units, at least 20% of the units by each bedroom size must be designated as Low -HOME unite 0 Bed 1 Bed 2 Bed 3 Bed 4 Bed 5 Bed 6 Bed Total Number of HOME Units 4 Number of Low -HOME Units Fixed or Floating HOME Units? 21 Fixed ❑ Floating HOME Rent Limits Provide the HOME Program rent limits for your project area using the table below. Effective Date of HOME Rent Schedule: 2018 Current HOME Rent Limits 0 Bed 1 1 Bed 2 Bed 3 Bed 4 Bed 5 Bed 6 Bed Low HOME Rent 625 High HOME Rent 668 Project Based Assistance Does this property receive project -based assistance? ❑ Yes 0 No ***Skip this section if you do not have Project -Based units in your project.*** Through which Program does your project receive assistance? ❑ RD Section 515 ❑ RD Section 538 ❑ Project Based Section 8 ❑ Other: If other, explain: Attach a copy of the letter or rent schedule you received from Rural Development or HUD with the approved rent rates and effective dates for this property. Maximum Low Income Housing Tax Credit Rent Limits (if applicable) ***Skip this section if you do not have LIHTC units in your project.*** Provide the Low Income Housing Tax Credit rent limits for your project and project area. Effective Date of LIHTC rent schedule: LIHTC Rent Limits 0 Bed 1 Bed 2 Bed 3 Bed 4 Bed 5 Bed 6 Bed 30% 40% 50% 60% Proposed Net Rent Structure (if anolicablel tenant nays utilities 0 Bed 1 Bed 2 Bed 3 Bed 4 Bed 5 Bed 6 Bed Low Rent Room Low Rent Utilities Total Low Rent High Rent Room High Rent Utilities Total High Rent Proposed Gross Rent Structure (if annlirahlal 0 Bed 1 Bed 2 Bed 3 Bed 4 Bed 5 Bed 6 Bed Low Rent Room Low Rent Utilities Total Low Rent High Rent Room High Rent Utilities High Rent Total Signatures Accepted By: Grantee Chief Executive Officer or Elected Official Date: Counter Signature (ex. Property Manager): Printed Name: Title: Date: HOME Program Approval HOME Program Officer: Printed Name: Date: S a a c a c m R a s 3 L H O 0 a A � u � C m M ,a V � 0 a, `O a C C o N m DG a 0. E 0 u (N/A) i!un paseQ-info I I t t ► i ► t alge:)lidde}! `(AA/ww) znO-anoW 10 ale(] c (AA/ww) ul-anow.10 ale(] � � VC E (AA/ww) umpadsul SDdn ao S-OH Isel 10 aled � 1 �J juaa lejo '� sl td � Z:�- H . 0 tin .N v> in �n v> v> - n. I^ v> v> I^ in. V). a� (say r t*n nred-�� �� .1 � 1 t r, ,ae�.a� .ot, aZ.�er..olly Al!IB�ii � 0 v 1 (Aue }1) junowy Aplsgn to a: } ivaH lueue s 3 U (AA/ww) uol-.eolj!aaA awo:)u! Isel 10 a;e(i 41. N (AA/ww) uolleolj!:Wa:) awo:)ul le!llul jo ale(] 1 c c (IINb) awoOu! uelpaW eaay }o lua:)J@d y- u, 0 _ awo:)ul (sso.t9) lenuu ®o a� N/A) (iueual A a! o asno a es! qp llua t � p.�.t )pl u Hp IQ d�� � N swoo.tpag jo .tagwnN w 2 0 plogasnoH JO az! 0 o c aweN Isel lueua v O o Q. d J cCID N i!un wail 3WOH (H) AH ao (1) Mol (N/A.) I!un paleu2!saO-aVYnfl aagwnN i!ufl ,t O) 4-1 o Annual Tenant Income Certification/Establishing Tenant Eligibility Establishing Tenant Eligibility [24 CFR 92.203 and 92.252(h)] The owner/management has conducted initial income verification for each HOME household and has the supporting documentation available. ®Yes. ❑No. If no, explain: 2. The owner/management has performed an annual re-examination of HOME -assisted household income. The annual re-examination was conducted within twelve (12) months of the previous verification. This information is indicated on the attached Rental Occupancy Report. ®Yes. ❑No. If no, explain: 3. For each household occupying a unit designated as HOME, the owner/management agent has conducted an initial certification and an annual recertification including full third -party documentation of all income and assets. Wes ❑No. If no, explain: Rent Restrictions [24 CFR 92.252] 4. Each HOME -assisted unit was rent -restricted as prescribed by the HOME Contract and Period of Affordability Agreement. ®Yes. ❑No. If no, explain: 5. No fee(s) other than rent was charged to any HOME tenant for non -optional services or provisions (i.e., water -billing service fees, parking fees, non-refundable security deposit fees, payments for meals, etc.). ®None were charged. ❑Additional fees were charged. Explain: Utility Allowances [24 CFR 92.252(d) and HOME Final Rule] The Owner certifies that the utility allowance is reviewed annually and is calculated by using either the Section 8 Utility Allowance Schedule or the HUD Utility Schedule Model (as applicable), available at https:Hwww.huduser.gov/portal/datasets/husm/uam.html. NOTE: All projects awarded after August 23, 2013 are required to use the HUD Utility Schedule Model. Wes []No. If no, explain: Over -Income Units and 'Next Available Unit' Rule [24 CFR 92.252(i)] 7. If the income of a resident in a HOME project unit increased to an amount that exceeds the limit allowed under HOME Period of Affordability Agreement, the next available unit in the project was rented to a qualified household. ®Yes ONO. If no, explain: Montana Department of Commerce 2 Annual HOME Rental Certification Community Development Division Revised 4/17/2017 8. If the annual income of a resident of a HOME restricted unit in the project increased to an amount that exceeded 80% of the Area Median Income (AMI) at recertification, the household's rent was adjusted to 30% of the household adjusted income (unless Low -Income Housing Tax Credit Program rules apply to the unit). ®Yes ❑No. If no, explain: Vacant Units [24 CFR 92.2520)] 9. If a HOME unit in the project became vacant during the year, reasonable attempts were made to rent that or a comparable unit (for floating HOME units, 'comparable' refers to size, features, and number of bedrooms) to a qualified household and while the unit was vacant, no units of comparable size were rented to an unqualified household. ®Yes []No. If no, explain: Physical Condition [24 CFR 92.251 and 92.504(d)] 10. Each unit and building in the project is, as of date of execution of this certification and for the entire period covered by this certification, suitable for occupancy considering State and local codes, ordinances, requirements, and HUD's Uniform Physical Condition Standards (UPCS) or Housing Quality Standards (HQS) (as applicable), and were inspected accordingly, within the past year. ®Yes ❑No. If no, state nature of violation and describe any corrective action that has been taken or is planned. Lead -Based Paint [24 CFR 35 and 361 11. Each tenant has signed the "Lead Based Paint" form and has been given a copy of the signed form. ❑Yes FlNo, due to one of the following exemption(s): ® None of the buildings or portions of the buildings in the development were constructed prior to January 1, 1978 (See 35.86 "Target Housing".) ❑ All buildings on the property have been certified Lead -based paint free and appropriate test reports and certifications have been or will be provided to Commerce. ❑ All units are 0-bedroom units (See 35.86 "Target Housing" and 0-bedroom dwelling.) ❑ This is a HUD Elderly development and no child of less than 6 years of age resides or is expected to reside in any unit. ❑ The development is designated exclusively for persons with disabilities and no childless than 6 years of age resides or is expected to reside in any unit. ❑ Other reason as follows: (For the above exemptions please see Title 24: Housing and Urban Development, PART 35 — LEAD -BASED PAINT POISONING PREVENTION IN CERTAIN RESIDENTIAL STRUCTURES 35.82 "Scope and Applicability" and 35.86 Definitions, "Housing for the Elderly," "Target Housing," and "0-bedroom dwelling." 12. The property owner has incorporated ongoing lead -based paint maintenance activities into regular building operations, such as visual inspection of lead -based paint annually and at unit turnover; repair of all unstable paint; and repair of encapsulated or enclosed areas that are changed. ❑Yes CRNo. If no, explain if different from the reason(s) given in Item 10 above: Montana Department of Commerce 3 Annual HOME Rental Certification Community Development Division Revised 4/17/2017 Comparable Basis —Tenant Facilities [24 CFR 92.251] 12. The Owner certifies that all tenant facilities (such as recreational facilities, parking areas, washer/dryer hookups, and other appliances) of any building in the project are provided on a comparable basis to all tenants (including HOME -assisted) in the development. Yes ❑No. If no, explain: Lease Agreement [24 CFR 92.253(b)] 13. The lease term for all HOME -assisted units is at least one year and each lease contains all the provisions required by the HOME Program, and does not include any prohibited provisions. Yes ❑No. If no, explain: 14. Has the lease been updated during the last year? ❑Yes; please attach and highlight any changes. ®No. Tenant Selection Criteria [24 CFR 92.253(d)] 15. The owner/management has adopted and utilizes written tenant selection policies that: a. are consistent with the purpose of providing housing for very low-income and low-income families; b. are reasonably related to program eligibility and the applicants' ability to perform the obligations of the lease; c. provide for the selection of tenants from a written waiting list in the chronological order of their application, insofar as is practicable; and, d. requires prompt written notification to any rejected applicant of the grounds for any rejections. ®Yes ❑No. If no, explain: 16. Has the tenant selection criteria been updated in the last year? ❑Yes; please attach and highlight updates. ®No. Termination of Tenancy [24 CFR 92.253(c)] 17. The undersigned certifies that tenants have neither been evicted nor had leases fail to be renewed, except for serious or repeated violations of the terms and conditions of the lease; for violation of applicable Federal, State, or local law; for completion of the tenancy period for transitional housing, or for other good cause. For anyone evicted, proper notice was provided. ®Yes []No. If no, explain: Discrimination Against Section 8/Housing Choice Vouchers [24 CFR 92.253(d)(4)] 18. All HOME restricted units were leased to residents without regard to their status as holders of rental vouchers or certificates that are available under 24 CFR 882, 887, or 92.211. ®Yes Montana Department of Commerce 4 Annual HOME Rental Certification Community Development Division Revised 4/17/2017 ❑No. If no, explain: Affirmative Fair Housing Marketing Plan [24 CFR 92.351] 19. For projects with 5 or more HOME -assisted units, an up-to-date Affirmative Fair Housing Marketing Plan (AFHMP) is on file (and available for viewing by interested parties) at the development. 19Yes. Indicate the date of the last update: ❑No. If no, explain: 20. The AFHMP has been reviewed by the Owner and has been found to be effective in soliciting persons. Wes ❑No. If no, explain: 21. Is a Fair Housing poster on display at the project location? Wes. Location: ❑No. If no, explain: 22. If the affirmative marketing requirements were not met, the Owner has attached a plan of corrective actions to be taken to implement the AFHMP. Yes []No. If no, explain: 23. Has the AFHMP been updated as required every five (5) years? ®Yes; please attach copy of the updated plan. []No. Fair Housing and Reasonable Accommodations/Accessibility 24. The owner has and is complying with all federal, state, and local laws relating to fair housing and equal opportunity, including but not limited to the following: a. The Federal Fair Housing Act and the Montana Fair Housing Act; b. Age Discrimination Act of 1975; c. Section 504 of the Rehabilitation Act of 1973; d. Americans With Disabilities Act of 1990 (ADA); e. Title VI Civil Rights Act —1964; f. Section 3 of the Housing and Urban Development Act of 1968; and Wes []No. If no, explain: Change in Management/Ownership 25. The management of the project during this Certification Period has been continuous and ongoing by the same entity since the last annual certification. INYes, no change. []No (there has been a change). If "No," the HOME Program must be or have been notified in writing within 30 days of the change. Montana Department of Commerce 5 Annual HOME Rental Certification Community Development Division Revised 4/17/2017 Record Keeping 26. The Owner will maintain required records for five years after the end of the affordability period, and has policies in place to keep these records accordingly. (Required records include documentation related to tenant income verifications, unit rents, affirmative marketing, and property standards.) ®Yes ❑No. If no, explain: 27. All resident data for the project has been completed on the Rental Occupancy Report, a copy of which is attached to this form. Wes ❑No. If no, explain: Montana Department of Commerce Community Development Division Annual HOME Rental Certification Revised 4/17/2017 Other Compliance Requirements 28. Does the project have any other government funding and/or income, rent or leasing restrictions, other than MT HOME funds and its requirements? IgNo. ❑Yes. Describe: The undersigned, having entered into a loan or grant agreement pursuant to the applicable provisions of the "HOME Investment Partnership Act" ("HOME"), does hereby certify that the housing project is in continuing compliance with the requirements of the HOME Program and any other applicable compliance requirement. This Certification and any attachments are made UNDER PENALTY OF PERJURY. Responsible Entity: Gra Signature Printed Name Title Date Owner or Manager Signature Printed Name Me-L e,11 a4A._ Title _ `'5so c(6 e- Z l t-"0-C4&4— Date to 1 /q jig HOME Program Signature Printed Name Title Date Montana Department of Commerce 7 Annual HOME Rental Certification Community Development Division Revised 4/17/2017 Allowance for U.S. Department of Housing OMB Approval No. 2577-0169 and Urban Development (exp 4130/2018) Tenant -Furnished Utilities Office of Public and Indian Housing and Other Services Locality Region 10: Flathead, Lake, Lincoln and Sanders counties Unit Type Low-rise Older Multi -Family (Low Rise) Effective 11/01/2017 Utility or Service Monthly Dollar Allowances 0 BR 1 BR 2 BR 3 BR 4 BR 5 BR Heating a. Natural Gas 30 40 53 65 79 90 b. Electric 34 44 59 73 88 101 c. Bottle Gas 82 107 143 177 213 244 Cr. Oil 81 106 141 174 210 241 Cooking a. Natural Gas 4- 5 6 8 10 10 b.. Electric 6 7 10 12 15 16 c. Bottle Gas 10 13 17 21 26 28 Other Electricity 20 25 34 42 52 56 Air Conditioning 4 5 6 7 9 10 Water Heating a. Natural Gas 4 6 8 10 12 1.3 b. Electric 7 9 13 16 19 21 c. Bottle Gas 12 16 21 26 32 35 d. Oil 11 14 19 24 29 32 Water 28 32 35 40 42 46 Sewer 33 38 43 50 54 60 Trash Collection 17 17 17 17 17 17 Range/Microwave 4 5 5 5 5 5 Refrigerator 4 4 4 5 5 5 Other — specify i- I I Project Address 124 9 h Ave W. Owner pays utilities Project Address 135 9b Ave W. Tenant pays utilities: Project Address 145 9`h Ave W. Tenant pays utilities: Heating " b" cooking "b" Other electricity Water heating " b" Water Range/microwave Refrigerator Heating "a" cooking "a" Other electricity Water heating "a" Water Range/microwave Refrigerator � rl rl 'I N � ti ff .1 N N er W rl .Pi H ti .y N .y 1 z z ¢ a ¢ � n ^ n � �p p 9 O ry ¢ ay < p r i v 'z" u ee yem Qo aum°pin ev Q�n WW �� �N^�' mN �2n ti tO� `O .mom z Z O 1- H o C F Z Z o 1. 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H a H Z H �] H Z G4 a a H a la H a a H a a H a a H a a H a a H dP P�4' dP 3 dr Wa dP dP a w3 dP ',i dP a P S ow PSG dP '3 dP Q�'i dP S a c0n�t0D� M>t0oa m>os cm ttoo A mwj%D M %D mwjtW o a J aJ 4.) 4-1 a a a z 0 0 U U U U U a 2 U U v ri ++ v Q w 0 x m m • E -1 1) r1 W U N rt D tHn W W Gnu c�? 0 0 124-9"` Ave. W. Kalisppell, MT 59901 4tT6-257-5801 Thank you for your interest in renting an apartment at The Samaritan House, INC. Enclosed you will find a rental application and price list. All apartments require a security deposit equal to the amount charged for rent. The deposit is payable at move -in. rental prices are as follows: 124 9t' Ave. west: Studio transitional apartments $230 month (Without bathroom) Studio transitional apartments $250 month (With bathroom) 135 9a' Ave. west: 1 bedroom loft apartment $385 month (Utilities not included in rent) Has electric heat 140 9t' Ave. west: 1 bedroom apartment $420 month Studio apartment $365 month (Utilities included) 145 9t' Ave. west: 1 bedroom loft apartment $385 month (Utilities not included) Has gas heat All apartments are non-smoking! All rentals are required to sign a rental agreement. Please attach proof of income, identification (picture ID and social security cards). We cannot process any application without these items. EQUA HOUSM 10:07 AM 10/29/18 Accrual Basis Samaritan House Profit & Loss Budget vs. Actual January through December 2017 Jan - Dec 17 Budget $ Over Budget % of Budget Ordinary Income/Expense Income 301 • Room Rentals 30101 • Room Rentals - B1 94,019.00 97,780.00 -3,761.00 96.2% 30102 • Room Rentals - B2 31,855.65 34,340.00 -2,484.35 92.8% 30103 • Room Rentals - B3 16,800.00 16,440.00 360.00 102.2% 30104 • Room Rentals - B4 17,360.00 18,540.00 -1,180.00 93.6% 301 • Room Rentals - Other 3,726.00 Total 301 • Room Rentals 163,760.65 167,100.00 -3,339.35 98.0% 303 • Laundry Machine Income 2,478.25 4,950.00 -2,471.75 50.1 % 311 • Donations 311.1 • Donations from Newsletter 8,315.00 12,850.00 -4,535.00 64.7% 311.2 • Donations - Advertising 2,605.50 2,000.00 605.50 130.3% 311 • Donations - Other 208,734.32 186,679.00 22,055.32 111.8% Total 311 • Donations 219,654.82 201,529.00 18,125.82 109.0% 313 • Fundraising event income 80,009.13 70,000.00 10,009.13 114.3% 320 • Investment income 16,659.36 6,000.00 10,669.36 277.7% 322 - Interest income - bank 11.83 10.00 1.83 118.3% 323 • Dividend Income - Endowment 5,328.20 1,700.00 3,628.20 313.4% 325 • Grant income 11,500.00 77,005.00 -65,505.00 14.9% 326 • Veteran's Program 47,110.84 87,272.00 -40,161.16 54.0% 330 • United Way Income 4,664.00 6,780.00 -2,116.00 68.8% 399 • Miscellaneous income 2,512.34 500.00 2,012.34 502.5% Total Income 553,689.42 622,846.00 -69,156.58 88.9% Expense 401 • Telephone 40101 • Staff Phones 5,388.08 7,000.00 -1,611.92 77.0% 40102 • Client Services 1,941.16 2,500.00 -558.84 77.6% 40103 • Armory Telephones 2,330.28 3,000.00 -669.72 77.7% Total 401 • Telephone 9,659.52 12,500.00 -2,840.48 77.3% 402 • Utilities 40201 • Utilities - Building 1 12,502.30 13,018.00 -515.70 96.0% 40202 • Utilities - Building 2 19,393.18 22,809.00 -3,415.82 85.0% 40203 • Utilities - Building 3 93.60 500.00 -406.40 18.7% 40204 • Utilities - Building 4A-D 1,621.18 2,000.00 -378.82 81.1% 40205 • Utilities - Armory 13,070.80 13,673.00 -602.20 95.6% Total 402 • Utilities 46,681.06 52,000.00 -5,318.94 89.8% 409 • Depreciation 56,995.28 56,640.00 355.28 100.6% 411 • Insurance 24,503.00 24,445.00 58.00 100.2% 412 • Custodial supplies 1,017.03 1,228.00 -210.97 82.8% 414 • Property Fees 414.1 • Property Fees - Residential 7,584.29 7,457.00 127.29 101.7% 414.2 • Property Fees -Armory 1,694.04 1,749.00 -54.96 96.9% 414 • Property Fees - Other 799.00 Total 414 • Property Fees 10,077.33 9,206.00 871.33 109.5% 416 • Miscellaneous expense 6,573.65 6,000.00 573.65 109.6°% 420 • Supplies 737.00 800.00 -63.00 92.1 % 421 • Maintenance/Repairs 421.1 • Maint. / Repairs - Residence 24,537.22 23,790.00 747.22 103.1% 421.2 • Maint./Repairs -Armory 8,202.29 6,710.00 1,492.29 122.2% 421 • Maintenance/Repairs - Other 322.00 Total 421 • Maintenance/Repairs 33,061.51 30,500.00 2,561.51 108.4% Page 1 10:07 AM 10/29/18 Accrual Basis Samaritan House Profit & Loss Budget vs. Actual January through December 2017 Jan - Dec 17 Budget 430 • Professional services 7,200.00 6,500.00 461 • Food 3,451.70 8,975.00 462 • Lunchroom supplies 1,101.35 1,060.00 471 • Laundry supplies 74.94 122.00 501 • Vehicle expenses 8,767.28 5,000.00 573 • Payroll taxes 27,114.61 30,526.00 581 • Insurance - workers compensatio 4,642.36 6,150.00 600 • Administrator salary 62,210.72 59,610.72 602 • Staff Salaries 244,861.52 262,730.00 603 - Health Insurance Expense 0.00 6,000.00 605 • Staff Training 0.00 300.00 607 • Public relations 2,084.87 3,812.00 609 • Office supplies 9,456.57 12,000.00 610 • Office Hardware 1,067.97 612 • Dues & subscriptions 1,168.00 1,326.00 614 • Bank charges 50.00 55.00 618 • Rent refunds 0.00 260.00 620 • Meals 424.95 250.00 622 • Travel & Lodging 668.57 1,500.00 625 • Wages expense 1,907.00 641 • Interest expense 8,306.42 8,307.00 66900 • Reconciliation Discrepancies -0.08 680 • Fundraising expense 22,216.99 15,654.00 Total Expense 596,080.12 623,456.72 Net Ordinary Income -42,390.70 -610.72 Other Income/Expense Other Income 720 - Unrealized Gain or Loss on Inve 43,434.30 Total Other Income 43,434.30 Net Other Income 43,434.30 0.00 Net Income 1,043.60 -610.72 $ Over Budget % of Budget 700.00 110.8% -5,523.30 38.5% 41.35 103.9% -47.06 61.4% 3,767.28 175.3% -3,411.39 88.8% -1,507.64 75.5% 2,600.00 104.4% -17,868.48 93.2% -6,000.00 0.0% -300.00 0.0% -1,727.13 54.7% -2,643.43 78.8% -158.00 88.1 % -5.00 90.9% -260.00 0.0% 174.95 170.0% -831.43 44.6% -0.58 100.0% 6,561.99 141.9% -27,376.60 95.6% 41,779.98 6,941.1 % 43,434.30 100.0% 1,654.32 -170.9% Page 2 10:03 AM 10/29/18 Samaritan House Statement of Cash Flows January through December 2017 Jan - Dec 17 OPERATING ACTIVITIES Net Income 1,043.60 Adjustments to reconcile Net Income to net cash provided by operations: 110 • Accounts receivable 731.00 112 • Grants Receivable 7,328.00 113 • Cookbook Inventory 70.00 115.3 • Rural Development Reserve Acct. -11.83 125.1 • Endowment Fund -16,621.33 125.2 • Board Directed Investments -48,433.19 125.27 • WFCU -9.37 125.29 • Park Side Credit Union -357.97 149 • Prepaid insurance 464.00 2000 • Accounts Payable -8,181.00 230 • Property Tax Payable 435.74 210 • Wages Payable 1,907.00 214 • P/R Tax payable - SWT 86.00 215 • P/R Tax payable - SUI -91.81 217 • Payroll taxes payable 133.00 222 • Garnishments 206.31 225 • Damage Deposits Payable 725.00 226 • Prepaid Rents -2,275.00 Net cash provided by Operating Activities -62,851.85 INVESTING ACTIVITIES 165.2 • Equipment -Armory -1,030.25 172.1 • Accumulated Depr. Bldg-Residenc 16,389.27 172.2 • Accumulated Depr.- Bldg Armory 36,472.56 172.3 • Accumulated Depr. Equip. Res 4,133.45 Net cash provided by Investing Activities 55,965.03 FINANCING ACTIVITIES 243 • Note Payable - RHS-USDA -8,469.58 Net cash provided by Financing Activities-8,469.58 Net cash increase for period-15,356.40 Cash at beginning of period 147,359.26 Cash at end of period 132,002.86 Page 1 Note to all applicants/respondents: This form was developed with Nuance, the official HUD software for the creation of HUD forms. HUD has made available instructions for downloading a free installation of a Nuance reader that allows the user to fill-in and save this form in Nuance. Please see http://t)ortal.hud.gov/hudportal/documents/huddoc?id=nuancereaderinstall pdf for the instructions. Using Nuance software is the only means of completing this form. Affirmative Fair Housing U.S. DepaMnent of Housing OMB Approval No. 2529-0013 MarketingPlan AFHMP - and Urban Development (exp.12/31/2016) Multifamily Housing Office of Fair Housing and Equal Opportunity la. Project Name & Address (including City, County, State & Zip Code) wut T a�4 `ti r 5 ib. Project Contract Number 1c. No. of Units /yl 5 7 S-b 3 =7 1d. Census Tract e. HousinalExcanded Housina Markat Aroa Market Area: d Housing Market Area: It Managing Agent Name, Address (including City, County, State & Zip Code), Telephone Number S Email Address L/,r►�.� - ��/�,I e 1� .. 1114/ q d ,� ,. i f . �.�/i/.9T1_0 J �/ /i.J , _ _� I 7 g. Application/Owner/Developer Name, Address (including City, County, State & Zip Code), Telephone Number $ EmalWdress I � ut�rraw drrse IaY ?& /4tv_ '6W "'n0'JJ' 1 h. Entity Responsible for Marketing (check all that apply) PVT Owner ❑ Agent Other (specify) Position, Name (if known), Address ( including City, County, State & Zip Code), Telephone Number & Email Address r 1:4w 11. To whom should a / pproval and other correspondence concerning this AFHMP be sent? Indicate Name, A dress ncluding City, Cmse a clp %.oae/, i siepnone numoer a e-man Aaaress. day 9P-4 2a. AffirmaAre Fair Housing Marketing Plan Plan Type IPlease Select Plan Type Date of the First Approved AFHMP:Now-,--, Reason(s) for current update: I FKly Zmal- 2b. HUD -Approved Occupancy of the PfWect (check all that apply) gIderly family -Mixed (Elderly/Disabled) 9-ftabled 2c. Date of Initial Occupancy 2d. Advertising Start Date 1 $ Advertising must begin at least 90 days prior to initial or renewed occupancy for new construction and substantial rehabilitation projects. Date advertising began or will begin For existing projects, select below the reason advertising will be used: -4, Previous editions are obsolete Page 1 of 8 Form HUD-935.2A (12/2011) 3a. DemcarapNcs of Project and Housing Market Area Com ete and submitWorksheet 1. 3b. Targeted Marketing Activity Based on your completed Worksheet 1, indicate which demographic group(s) in the housing market area is/are least likely to apply for the housing without special outreach efforts. (check all that apply) ❑ Wh,b ❑ American Indian orAlaska Native Asian ® Black or African American ER Native Hawaiian or Other Pacific Islander P Hispanic or Latino ❑ Persons with Disabilities ❑ Families with Children [-]Other ethnic group, religion, etc. (specify) 4a. Residency Preference Is the owner requesting a residency preference? If yes, complete questions 1 through 5. Please Select Yes or No If no, proceed to Block 4b. (1) Type IPlease Select Type (2) Is the residency preference area: The same as the AFHMP housing/expanded housing market area as identified in Block le? IPlease Select Yes or No The same as the residency preference area of the local PHA in whose jurisdiction the project is located? I Please Select Yes or No (3) What is the geographic area for the residency preference? (4) (5) IAr�_• _- 11_ _ ....aa w •na 1vaw11 wi uarmy a R7aluanuy pruieren Ger now oo you plan ro penoammy evaluate your residency preference to ensure that it is in accordance with the non-discrimination and equal opportunity requirements in 24 CFR 5.105(a)? Complete and submit Worksheet 2 when requesting a residency preference (see also 24 CFR 5.655(c)(1)) for residency preference requirements. The requirements in 24 CFR 5.655(c)(1) will be used by HUD as guidelines for evaluating residency preferences consistent with the applicable HUD program requirements. See also HUD Occupancy Handbook (4350.3) Chapter 4, Section 4.6 for additional guidance on preferences. 4b. Proposed Marketing Activities: Community Contacts 4c. Proposed Marketing Activities: Methods of Advertising Complete and submit Worksheet 3 to describe your use of community Complete and submit Worksheet 4 to describe your contacts to market the project to those least likely to apply. proposed methods of advertising that will be used to market to those least likely to apply. Attach copies of { advertisements, radio and television scripts, Internet Aur PO `f/14 /UFO l v; V d3te/160 '1f " , advertisements, websites, and brochures, etc. Previous editions are obsolete Page 2 of 8 Form HUD-935.2A (12/2n111 5a. Fair Housing Poster The Fair Housing Poster must be prominently displayed in all offices in which sale or rental activity takes place (24 CFR 200.620(e)). Check below all locations where the Poster will be displayed. r— M Rental Office M Real Estate Office Model Unit Other (specify) I 5b. Affirmative Fair Housing Marketing Plan The AFHMP must be available for public inspection at the sales or rental office (24 CFR 200.625). Check below all locations where the AFHMP will be made available. &Rental Office Real Estate Office Model Unit Other (specify) Sc. Project Site Sign Project Site Signs, if any, must display in a conspicuous position the HUD approved Equal Housing Opportunity logo, slogan, or statement (24 CFR 200.620(f)). Check below all locations where the Project Site Sign will be displayed. Please submit photos of Project signs. ® Rental OlfiaeReal Estate Office Model Unit Entrance to Project Other (specify) The size of the Project Site Sign will be �� x The Equal Housing Opportunity logo or slogan or statement will be x F ; -1..-,.."......:...,.,.,.,.,.,"",-,..''..-I......'',"",.11''I'll .... . . ..... ..... ...... .... 6. Evaluation of Marketing Activities Explain the evaluation process you will use to determine whether your marketing activities have been successful in attracting individuals least likely to apply, how often you will make this determination, and how you will make decisions about future marketing based on the evaluation process. Out C`l�Qr r/ �jPif/Q� Q5 Ca ff� 1p locj 4ov, GIiLS �� uT (ovic NOW l �J-i►�co o le s�I���. Previous editions are obsolete Page 3 of 8 Form HUD-935.2A (12/2011) 7a. Marketing Staff What staff positions areMil be responsible for affirmative marketing? c�Pt �Or 4,p1n (io,r ftff Training and Assessment AFHMP (1) Has staff been trained on the AFHMP? Please Select tes r No (2) Has staff been instructed in writing and ray on non-discrimination and fair housing policies as required by 24 CFR 200.620(c)? jPIease Sele a or No (3) If yes, who provides instruction on Me AFHMP and Fair Housina Act. and hnw frPrniPntly? (4) Do you periodically assess staff skills on the use of the AFHMP and the application of the Fair Housing Act? Please SelectiM or No (5) If yes, how and how o en? 7c. Tenant Selection Training/Staff (1) Has staff been trained on tenant selection in accordance with the project's occupancy policy, including any residency preferences? Please Selects a or No --1 (2) What staff positions are/will be responsible for tenant selection? n At�r (sr 7d. Staff Instruction/Training: Describe AFHM/Fair Housing Act staff training, already provided or to be provided, to whom it wasAMII be provided, content of training, and the dates of past and anticipated training. Please include copies of any AFHM/Fair Housina staff training matPrink - e tier -Lit r140,4� - Previous editions are obsolete Page 4 of 8 Form HUD-935.2A (12/2011) 8. Additional Considerations Is there anything else you would like to tell us about your AFHMP to help ensure that your program is marketed to those least likely to apply for housing in your project? Please attach additional sheets, 'as needed. 4wvvlar,I LA 444�& S �I�cF, �1�d� aM�C /00- /HCOAt2� �b4S//� Q% �Y6C �o be. U3 Ae q P r�s5 �r7 ley lP�>�j l� Fl l� Cokv� , �► ute 'pkiVI (4 5 ro AiTf4 il t2 1'ke iW 50(er ;r 0, fur GO c areaT, 4� . 9. Review and Update By signing this form, the applicant/respondent agrees to implement its AFHMP, and to review and update its AFHMP in accordance with the instructions to item 9 of this form in order to ensure continued compliance with HUD's Affirmative Fair Housing Marketing Regulations (see 24 CFR Part 200, Subpart M). I hereby certify that all the information stated herein, as well as any information provided in the accompaniment herewith, is true and accurate. Warning: HUD will prosecute false claims and statements. Conviction may result in criminal and/Qr civil penalties. (See 18 U.S.C. 1001, 1010, 1012; 31 U.S.C. 3729, 3802). n // _ , nature of person su ame ompany �et,(4,e h(T-e r For HUD -Office of Housing Use Only Reviewing Official: For HUD -Office of Fair Housing and Equal Opportunity Use Only Approval Disapproval Signature & Date (corn/dd/yyyy) Signature & Date (mm/dd/yyyy) Name Name (type (type or or print) print) Title Title Previous editions are obsolete Page 5 of 8 Form HUD-935.2A (12/2011) Public reporting burden for this collection of information is estimated to average six (6) hours per initial response, and four (4) hours for updated plans, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. This agency may not collect this information, and you are not required to complete this form, unless it displays a currently valid Office of Management and Budget (OMB) control number. Purpose of Form: All applicants for participation in FHA subsidized and unsubsidized multifamily housing programs with five or more units (see 24 CFR 200.615) must complete this Affirmative Fair Housing Marketing Plan (AFHMP) form as specified in 24 CFR 200.625, and in accordance with the requirements in 24 CFR 200.620. The purpose of this AFHMP is to help applicants offer equal housing opportunities regardless of race, color, national origin, religion. sex, familial status, or disability. The AFHMP helps owners/agents (respondents) effectively market the availability of housing opportunities to individuals of both minority and non -minority groups that are least likely to apply for occupancy. Affirmative fair housing marketing and planning should be part of all new construction, substantial rehabilitation, and existing project marketing and advertising activities. An AFHM program, as specified in this Plan, shall be in effect for each multifamily project throughout the life of the mortgage (24 CFR 200.620(a)). The AFHMP, once approved by HUD, must be made available for public inspection at the sales or rental offices of the respondent (24 CFR 200.625) and may not be revised without HUD approval. This form contains no questions of a confidential nature. Applicability. The form and worksheets must be completed and submitted by all FHA subsidized and unsubsidized multifamily housing program applicants. INSTRUCTIONS: Send completed form and worksheets to your local HUD Office, Attention: Director, Office of Housing Part 1: Applicant/Respondent and Project Identification. Blocks 1 a, 1 b, 1 c, 1 g, 1 h, and 1 i are self- explanatory. Block 1 d- Respondents may obtain the Census tract number from the U.S. Census Bureau (http://factfinder2.census.gov/main.html) when completing Worksheet One. Block 1e- Respondents should identify both the housing market area and the expanded housing market area for their multifamily housing projects. Use abbreviations if necessary. A housing market area is the area from which a multifamily housing project owner/agent may reasonably expect to draw a substantial number of its tenants. This could be a county or Metropolitan Division. The U.S. Census Bureau provides a range of levels to draw from. An expanded housing market area is a larger geographic area, such as a Metropolitan Division or a Metropolitan Statistical Area, which may provide additional demographic diversity in terms of race, color, national origin, religion, sex, familial status, or disability. Block 1f- The applicant should complete this block only if a Managing Agent (the agent cannot be the applicant) is implementing the AFHMP. Part 2: Type of AFHMP Block 2a- Respondents should indicate the status of the AFHMP, i.e., initial or updated, as well as the date of the first approved AFHMP. Respondents should also provide the reason (s) for the current update, whether the update is based on the five-year review or due to significant changes in project or local demographics (See instructions for Part 9). Block 2b- Respondents should identify all groups HUD has approved for occupancy in the subject project, in accordance with the contract, grant, etc. Block 2c- Respondents should specify the date the project was/will be first occupied. Block 2d- For new construction and substantial rehabilitation projects, advertising must begin at least 90 days prior to initial occupancy. In the case of existing projects, respondents should indicate whether the advertising will be used to fill existing vacancies, to place individuals on the projects waiting list, or to re -open a closed waiting list. Please indicate how many people are on the waiting list when advertising begins. Previous editions are obsolete Page 6 of 8 Form HUD 935.2A (12/2011) Part 3 Demographics and Marketing Area. "Least likely to apply" means that there is an Identifiable presence of a specific demographic group in the housing market area, but members of that group are not likely to apply for the housing without targeted outreach, including marketing materials in other languages for limited English proficient individuals, and alternative formats for persons with disabilities. Reasons for not applying may include, but are not limited to, insufficient information about housing opportunities, language barriers, or transportation impediments. Block 3a - Using Worksheet 1, the respondent should indicate the demographic composition of the project's residents, current project applicant data, census tract, housing market area, and expanded housing market area. The applicable housing market area and expanded housing market area should be indicated in Block 1e. Compare groups within rows/across columns on Worksheet 1 to identify any under -represented group(s) relative to the surrounding housing market area and expanded housing market area, i.e., those group(s) "least likely to apply" for the housing without targeted outreach and marketing. If there is a particular group or subgroup with members of a protected class that has an identifiable presence in the housing market area, but is not included in Worksheet 1, please specify under "Other." Respondents should use the most current demographic data from the U.S. Census or another official source such as a local government planning office. Please indicate the source of your data in Part 8 of this form. Block 3b - Using the information from the completed Worksheet 1, respondents should identify the demographic group(s) least likely to apply for the housing without special outreach efforts by checking all that apply. Part 4 - Marketing Program and Residency Preference (if any). Block 4a - A residency preference is a preference for admission of persons who reside or work In a specified geographic area (see 24 CFR 5.655(c)(1)(ii)). Respondents should indicate whether a residency preference is being utilized, and if so, respondents should specify if it is new, revised, or continuing. If a respondent wishes to utilize a residency preference, it must state the preference area (and provide a map delineating the precise area) and state the reason for having such a preference. The respondent must ensure that the preference is in accordance with the non- discrimination and equal opportunity requirements in 24 CFR 5.105(a) (see 24 CFR 5.655(c)(1)). Respondents should use Worksheet 2 to show how the percentage of the eligible population living or working in the residency preference area compares to that of residents of the project, project applicant data, census tract, housing market area, and expanded housing market area. The percentages would be the same as shown on completed Worksheet 1. Block 4b - Using Worksheet 3, respondents should describe their use of community contacts to help market the project to those least likely to apply. This table should include the name of a contact person, his/her address, telephone number, previous experience working with the target population(s), the approximate date contact was/will be initiated, and the specific role the community contact will play in assisting with affirmative fair housing marketing or outreach. Block 4c - Using Worksheet 4, respondents should describe their proposed method(s) of advertising to market to those least likely to apply. This gable should identify each media option, the reason for choosing this media, and the language of the advertisement. Alternative format(s) that will be used to reach persons with disabilities, and logo(s) that will appear on the various materials (as well as their size) should be described. Please attach a copy of the advertising or marketing material. Part 5 — Availability of the Fair Housing Poster, AFHMP, and Project Site Sign. Block 5a - The Fair Housing Poster must be prominently displayed in all offices in which sale or rental activity takes place (24 CFR 200.620(e)). Respondents should indicate all locations where the Fair Housing Poster will be displayed. Block 5b -The AFHMP must be available for public inspection at the sales or rental office (24 CFR 200.625). Check all of the locations where the AFHMP will be available. Block 5c -The Project Site Sign must display in a conspicuous position the HUD -approved Equal Housing Opportunity logo, slogan, or statement (24 CFR 200.620(% Respondents should indicate where the Project Site Sign will be displayed, as well as the size of the Sign and the size of the logo, slogan, or statement. Please submit photographs of project site signs. Previous editions are obsolete Page 7 of 8 Form HUD-935.2A (1212011) Part 6 - Evaluation of Marketing Activities. Part 9 - Review and Update. Respondents should explain the evaluation process to be used to determine if they have been successful in attracting those individuals identified as least likely to apply. Respondents should also explain how they will make decisions about future marketing activities based on the evaluations. Part 7- Marketing Staff and Training. Block 7a -Respondents should identify staff positions that are/will be responsible for affirmative marketing. Block 7b - Respondents should indicate whether staff has been trained on the AFHMP and Fair Housing Act. Please indicate who provides the training and how frequently. In addition, respondents should specify whether they periodically assess staff members' skills in using the AFHMP and in applying the Fair Housing Act. They should state how often they assess employee skills and how they conduct the assessment. Block 7c - Respondents should indicate whether staff has been trained on tenant selection in accordance with the project's occupancy policy, including residency preferences (if any). Respondents should also identify those staff positions that are/will be responsible for tenant selection. Block 7d - Respondents should include copies of any written materials related to staff training, and identify the dates of past and anticipated training. Part 8 - Additional Considerations. Respondents should describe their efforts not previously mentioned that were/are planned to attract those individuals least likely to apply for the subject housing. By signing the respondent assumes responsibility for implementing the AFHMP. Respondents must review their AFHMP every five years or when the local Community Development jurisdiction's Consolidated Plan is updated, or when there are significant changes in the demographics of the project or the local housing market area. When reviewing the plan, the respondent should consider the current demographics of the housing market area to determine if there have been demographic changes in the population in terms of race, color, national origin, religion, sex, familial status, or disability. The respondent will then determine if the population least to likely to apply for the housing is still the population identified in the AFHMP, whether the advertising and publicity cited in the current AFHMP are still appropriate, or whether advertising sources should be modified or expanded. Even if the demographics of the housing market area have not changed, the respondent should determine if the outreach currently being performed is reaching those it is intended to reach as measured by project occupancy and applicant data. If not, the AFHMP should be updated. The revised AFHMP must be submitted to HUD for approval. HUD may review whether the affirmative marketing is actually being performed in accordance with the AFHMP. If based on their review, respondents determine the AFHMP does not need to be revised, they should maintain a file documenting what was reviewed, what was found as a result of the review, and why no changes were required. HUD may review this documentation. Notification of Intent to Begin Marketing. No later than 90 days prior to the initiation of rental marketing activities, the respondent must submit notification of intent to begin marketing. The notification is required by the AFHMP Compliance Regulations (24 CFR 108.15). The Notification is submitted to the Office of Housing in the HUD Office servicing the locality in which the proposed housing will be located. Upon receipt of the Notification of Intent to Begin Marketing from the applicant, the monitoring office will review any previously approved plan and may schedule a pre -occupancy conference. Such conference will be held prior to initiation of sales/rental marketing activities. At this conference, the previously approved AFHMP will be reviewed with the applicant to determine if the plan, and/or its proposed implementation, requires modification prior to initiation of marketing in order to achieve the objectives of the AFHM regulation and the plan. OMB approval of the AFHMP includes approval of this notification procedure as part of the AFHMP. The burden hours for such notification are included in the total designated for this AFHMP form. Previous editions are obsolete Page 8of8 Form HUD-935.2A (12/2011)