Check the box that reflects the appropriate version of this submission: 

 Reflects Owner Estimated Information                              
 Reflects Final CPA Certified Information 

Instructions: The information in this application will be used to complete the Carryover Agreement. All information must be consistent with your application (Multifamily Workbook), the Attorney's Opinion Letter and the CPA Certification.

As the owner of the referenced development, I hereby make application to the Minnesota Housing Finance Agency (Minnesota Housing) for a carryover allocation of 2016 Housing Tax Credits (Carryover), as indicated above, and certify the following:

1.	Project Information:

Minnesota Housing HTC #:	     	
Name of Development:	     	
Street Address of Development:	     	
Development City:	     	
Development County:	     	
Development Zip Code:	     	

2.	As of (check one):

  December 31, 2016

  As of a date not later than one year after the date the Carryover is made. (Application information is Owner-estimated at this time pursuant to §42(h)(1)(E)(ii). The submission deadline of final CPA certification documents to Minnesota Housing is May 1, 2017,)

A.	Carryover Basis:							$     

B.	Reasonably Expected Basis:						$     

C.	Percent Expended (2A must be more than 10 percent of 2B):		     %
Each building for which this application is being made is a qualified building as defined in §42(h)(1)(E)(ii) of the Code, and each building will be placed in service by December 31, 2018.

3.	Enclosed is the Carryover Allocation Fee equal to 3.5 percent of the annual tax credit reserved by Minnesota Housing.

A.	Annual Tax Credit Reserved (do not exceed reservation amount):	$     

B.	Carryover Allocation Fee (3.5 percent of amount in 3A. Do not include in this amount any fees for “additional tax credits” requested by this application.):				$     

C.	Late Fee ($1,000 plus $200 for each calendar day from original due date):		
$     
	
4.	Request for Additional Tax Credits at time of Carryover:

NOTE: Do not send fees at this time for “additional tax credits” requested by this application. Minnesota Housing will contact you regarding any additional fees to be paid.

Based on the revised application for tax credits (Multifamily Workbook) and supporting documentation, the above development qualifies for additional credits. I request that the following additional 2016 tax credits be allocated with this project’s Carryover:

A.	Additional Tax Credits Requested:					$     

For Minnesota Housing Use Only:
B.	Additional Tax Credits Approved for Allocation:			$     
C.	Additional Carryover Fee Due (3.5 percent of 4B):			$     

I understand that Minnesota Housing's determination that the 10 percent carryover test has been met is not necessarily binding on the Internal Revenue Service (IRS) and does not constitute a representation or warranty by Minnesota Housing to the owner or investors that the requirement has been met or will be met or that all basis items have been properly included for federal tax purposes, and that the burden of compliance is the responsibility of the owner/taxpayer.

Important Note: A project that either (1) fails to submit the above-referenced “final certification” materials by the established deadlines or (2) fails to successfully meet the carryover requirement that the Owner incur more than 10 percent of the reasonably expected basis on the project on or before the established deadlines, will lose its entire allocation of 2016 tax credits. The allocation will be treated as if it had not been made, and the credits will be considered returned to the State of Minnesota and will be reissued to qualified tax credit developments according to Minnesota Housing’s procedures. It is the sole responsibility of the owner/applicant to make sure that the appropriate required documents are submitted to Minnesota Housing by the established deadlines.

Name of Ownership Entity:	     	
Address of Ownership Entity:	     	
Authorized Signatory for Ownership Entity:	_____	
Ownership Entity Federal Employer I.D. Number:	     	
Ownership Entity Phone Number:	     	
Ownership Entity Fax Number:	     	

Name(s) of General Partner(s) of Ownership Entity:	     	
Authorized Signatory for General Partner(s):	     	
Name of Nonprofit General Partner (if applicable):	     	
Authorized Signatory for Nonprofit General Partner:	     	

I hereby state that the information contained on this form and all other forms, attachments and exhibits to my housing tax credit Carryover application package submitted to Minnesota Housing are true and correct to the best of my knowledge and belief.

I hereby certify that the full extent of all federal, state and local subsidies that apply (or are expected to apply) have been disclosed to Minnesota Housing.

Owner:

     	
Name of Entity	

     	
Legal Description of Entity and State of Authorization	

By:	
Signature	

     	
Title	

Its:       	
Name of Entity	

     	
Dated	

STATE OF 	)
	)ss.
COUNTY OF      	)

	Subscribed and sworn to before me, a notary public, this       day of     , 20     , by      ,       of ,      ,      , on behalf of said       .

Notary Public