14-18 Exhibit-Application for Discharge Site Remediation Funds from HDSRF.pdf

LOAN APPLICANTS, ANSWER QUESTIONS 8 THROUGH 11: N/A - seeking grant funding only 8. Indicate the length of term, up to ten years, you desire for this loan. (Note that this term must be coterminous with all additional project financing.) ___________ Years 9. Indicate if your municipality will need Local Finance Board Approval to participate in this program (i.e. are you within your legal debt limit?) ........................................................................................................ Yes No If “Yes,” please state reason below. 10. If you currently hold a tax sale certificate or have acquired the site through foreclosure, do you intend to sell the remediated property and return it to your tax rolls within the next two years?................. Yes No 11. If you answered yes to question 10, indicate whether you would like a moratorium on principal and interest payments up to a maximum of two years. ................................................................. Yes No If “Yes,” I request a payment moratorium of ____________ years 12. Provide additional comments in the space below. Certification: By their signature below, the undersigned, a duly authorized representative of the above unit of local government, hereby certifies on behalf of the local government that the information contained herein is true, complete and correct in all respects as of the date hereof. Signature: Date: Name (print): Title: HDSRF Application Part VI Page 2 of 2 Version 1.3 12/11/13