Part I. Initial Property Set-Up Section	 NSP1	  NSP 3	

For each property eligible for funding under the Minnesota Housing Neighborhood Stabilization Program (NSP) the following information must be provided to the Minnesota Housing. Submit Part I and Part II of this form accompanied by the “Sub-recipient Approval” form, signed and dated.		     	
		MHFA  Contract #	
		 CRV-NSP Set-Aside	

Sub-recipient Name and Administrator Contact Information	
                     /                           	     	     	
Sub-recipient Name/Administrator Name &Contact information 	Phone Number	Email Address	

Property Address:	(NSP1 Only)	 High Need Zip Code	 High Need County
     	
Property Address	
     	     	     	     	
City	State	Zip	County	

National Objective:   LMMH or  LMMA   	
If LMMA provide      % percentage of households in defined target area at or below 120%AMI.  Provide the census tract(s) and block group(s) information in the spaces provided below.	
Census Tract       and Block Group       (provide when LMMA applies)	
Census Tract       and Block Group       (provide when LMMA applies)	
Census Tract       and Block Group       (provide when LMMA applies)	
Attach additional Census Tract/Block Group if applicable.

Activity (NSP-CDBG): (Select all that apply)
	Financing Mechanisms
	Acquisition
	Disposition
	Relocation
	Direct Homeownership Assistance
	Rehabilitation		Acquisition/Rehab – Homeownership
	Acquisition
	Disposition		SF
	Relocation		MF
	Rehabilitation		Acquisition/Rehab – Rental
	Acquisition
	Disposition		SF
	Relocation		MF
	Rehabilitation	
	Land Banking
	Acquisition
	Disposition

	Demolition
	Clearance		Redevelopment
	Acquisition
	Disposition		SF
	New Construction		MF
	Public Facilities and improvements		Redevelopment - Rental
	Acquisition
	Disposition		SF
	New Construction		MF
	Public Facilities and improvements	

Property Status: (select all that apply)
 Foreclosed	 Abandoned	 Blighted	 Non-Residential	 Vacant Lot – Date Structure Removed      	

Source of Property:
 Tax Forfeiture	 Bank Foreclosed	 Bank Abandoned	 Privately Owned	 Publicly Owned	 Shortsale Foreclosure	

Occupancy:
Occupied?  	  Yes	  No	By Renter?	  Yes	  No	

URA Seller Notice to Seller/Owner:
URA Seller Notification Delivered? 	 yes     no	

URA Requirements to Tenant:
Was there a bona fide tenant in the property at time of foreclosure?
 yes     no	If yes, do you or the successor in interest have documentation that complies with NSP’s 90 day tenant notice?
 yes     no	If no, you must assume the responsibilities for any penalties that may be required
 yes     no	

 Environmental Review complete, does not require published notice and request for release of funds	
 Environmental Review complete, does require published notice and request for release of funds	
 Request for Release of Funds approval received	

Proposed Reuse:
 Single Family (1 to 4 units)	      # of units  (1 - 4 units)	 Homeownership 	 Rental	
Household at or below 50% AMI  yes     no	     # of Households at or below 50% AMI	

 Multifamily (Greater than 4 units)(# of units      )	 Homeownership
 Rental	      # of Households at or below 50% AMI 	

 Public Facilities 	Are you using NSP funds for the demolition only?
	 yes     no	If not please explain. 
     	Land Banking Only:
Interim Use     	

Proposed Property Budget/Total Property Costs	Budget	NSP Funds Obligated	
	Acquisition/Purchase Price	     	     	
	Rehab	     	     	
	Demo	     	     	
	Redevelopment/New Construction	     	     	
	Soft Costs	     	     	
	Other Costs	     	     	
Total 	$0.00	$0.00	

Submit Part I and Part II of this form accompanied by the “Subrecipient Approval” form, signed and dated

Complete Part II of this form when project resold to homebuyer or entity and/or its National Objective was met.  Complete report is due within 30 days of the disposition closing date.

Part II.  Property Close Out (Complete when project resold to homebuyer or entity and/or its National Objective was met)	

NSP Cumulative Total Obligations to Date (for property:
	Program Funds	Program Income	Grand
Total	
NSP Cumulative Total Obligations at completion.	     	     	$0.00	
Activity (select all that apply):
Complete Only for Home-Buyer Driven Transactions	
 Financing Mechanisms              	 DPA	 Rehab	Date acquired      	            Date Rehab completed      	
Dates apply to Sub-recipient Actions	
 Acquisition/Rehab	Date acquired      	Date Rehab completed      	
 Demolition	Date acquired      	Date Demolition completed      	
 Land Banking	Date property entered Land Bank      	Date removed      	
 Redevelopment	Date acquired      	Date Redevelopment completed      	

Environmental Clean Up Required  Yes   No	Lead Abatement  Yes   No	Green Standards  Yes   No	

Acquisition Information:
Purchase Price      	Date of Final Offer      	
Appraised Value      	Date of Appraisal      	
After Improved Appraised Value       	 N/A 	Date of After Improved Appraisal      	
Purchase Price Discount Percentage      % (subrecipient acquisition closing)	Date of Acquisition Closing        (sub-recipient acquisition closing)	

Disposition Information:
Sales price to homebuyer      	Date of Final Closing (Property close-out date)      	
First Mortgage Amount      	MN Housing First Mortgage   Yes    No	
Program Income Generated:  yes    no	Amount of PI (Program Income) at time of Sale:      	

 Downpayment Assistance (DPA) (soft seconds, including buydowns, DPA, price reduction)	
 Grant   Loan  Deferred   Loan Interest Rate      %   Loan term in months      	
 Rehabilitation
          Grant   Loan   Deferred    Loan Interest Rate      %   Loan term in months      	
Future expected income:	 Rental Income	 Loan Satisfaction	 Contract for Deed Payment	

Buyer Driven Activities
 Downpayment Assistance (DPA)	 Rehabilitation	
DPA Sources:	Amount:	Rehabilitation Sources:	Amount:	
MHFA NSP Funds:	     	MHFA NSP Funds	     	
HUD NSP Funds:	     	HUD NSP Funds:	     	
Other:	     	Other:	     	
Other:	     	Other:	     	
Total DPA:	$0.00	Total Rehabilitation:	$0.00	

City/County Driven Activities
Final Development Costs	NSP Funds Obligated This Period	#1
MHFA
NSP Funds	#2
MHFA
NSP Program
Income	#3
Other Funds*
Source of funds and amounts	Total
1+2+3	
Acquisition/Purchase Price	     	     	     	     	     	$0.00	
Rehab	     	     	     	     	     	$0.00	
Demo	     	     	     	     	     	$0.00	
Redevelopment/New Construction	     	     	     	     	     	$0.00	
Soft Costs	     	     	     	     	     	$0.00	
Other Costs	     	     	     	     	     	$0.00	
Total	$0.00	$0.00	$0.00		$0.00	$0.00	
*Other funds may include HUD NSP funds and/or other leverage funds

Interim Financing Loan Amount
Interim Financing Loan Amount $     	Interest Rate      %	Loan Term       (in months)	

Value/Affordability Gap
 Value Gap	 Affordability Gap	
Value Gap Sources:	Amount:	Affordability Gap Sources:	Amount:	
MHFA NSP Funds:	     	MHFA NSP Funds:	     	
HUD NSP Funds:	     	HUD NSP Funds:	     	
Other:	     	Other:	     	
Other:	     	Other:	     	
Total Value Gap Contributions:	$0.00	Total Affordability Gap Contributions:	$0.00	

Final Use or Change of Use:  
   Final Use          Change of Use 	From what use     			
National Objective met:                              	  LMMH                             LMMA			
 Single Family (1 to 4 units)	      # of units  (1 - 4 units)	 Homeownership 	 Rental	
Household at or below 30% AMI  yes     no	     # of Households at or below 30% AMI	
Household at or below 50% AMI  yes     no	     # of Households at or below 50% AMI	
 Multifamily (Greater than 4 units)(# of units      )	 Homeownership
 Rental	      # of Households at or below 30% AMI 
      # of Households at or below 50% AMI 	
 Public Facility 	 yes     no	Describe public facility. 
     	Land Banking:  When do you plan to change use?      (year final use is anticipated)	

Homeownership Housing and Household Characteristics
 Owner Occupied	Livable space        (sq.ft)	

Gross Household Income (Annual) $     

# of persons to live in the home      	 Lease to Own (PITI)	Monthly Payment      	
	 Contract for Deed (PITI)	Taxes & Insurance      	
	 Mortgage Payment (PITI)	Total Payment        $0.00	
		Monthly Debt payment      	

Head of Household Race:
 White
 Black or African American
 Native Hawaiian or other Pacific Islander
 Asian
 American Indian or Native Alaskan	Head of Household Ethnicity:
 Hispanic or Latino
 Not Hispanic or Latino

 Female Headed Household	
 Attach HUD 1 Settlement Statement (acquisition)
 Attach HUD 1 Settlement Statement (disposition)		

Rental Housing and Household Characteristics
 Attach Utility Allowance Chart
 Attach Lease Agreement
 Attach HUD-1 Settlement Statement (acquisition)
 Attach HUD-1 Settlement Statement (disposition)	

# of required NSP units per NSP investment	Unit #	Lease Dates From & To	# of Bedrooms	Livable Space	Monthly Rent	Utility Allowance	Gross Household Income (Annual)	# of persons in household	Race 
(W = White; 
B = Black or African American;
I = American Indian or Alaska Native;
N = Native Hawaiian or Other Pacific Islander; 
A= Asian)	Hispanic
or Latino
(Y = yes; 
N = no)	Female Headed 
(Y = yes;
N = no)	
     	   	     
     	     	     	     	     	     	     	 	 	 	
     	   	     
     	     	     	     	     	     	     	 	 	 	
     	   	     
     	     	     	     	     	     	     	 	 	 	

Submit Part I and Part II of this form accompanied by the “Sub-recipient Approval” form, signed and date