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m/o n u m e nt Fairview Bridge Replacement and Street Improvements: Relocation Plan <br />DMLUNG <br />YAWIng Addre": <br />City. sL ZIP <br />Carbon Copy Address: <br />city. 5t. ZIP' <br />(Dwelling Type (Iisi4). <br />aecirooras <br />Athr)UtPuby6bxa9e <br />Approx SQFt <br />Kitchen <br />Basemen) <br />Bathmorns <br />Lmnglfamily room& <br />Gaage <br />Garage spares <br />Diningrmom <br />OthedExtra <br />CO-Wspwtri <br />DawofFice <br />Total physical and <br />Parking Spaces <br />Total toms: <br />canYntreemsto mow; <br />Numbwafcws <br />Coed ECOW ❑WaillYYlndow ❑Hed Pump ❑7Evap iSnemp Hare <br />kiting OFAU EReffienl :7HMWatw DSpaceHtr ❑solar ❑HestPurnp <br />+eking Condition: ❑ Good ❑ Fair 0 Poor <br />ightorhood Condition ❑ Good ❑ Fair ❑ Poor <br />renilies <br />TENANT <br />Rentlerms: ❑ Mondl•fdonlh ❑ Lea9e4mon4rsleft <br />❑ Rent reduced in exchange for service ❑ Unitturnished by tenant <br />Monthly contract rent: $ Socunty deposit 5 <br />Landlordfmanager narnOph: <br />❑ Wrdten rental agreement available? ❑ Rant receipts available? <br />❑ Reoeiving Bevan 8 or other housing assistance? <br />Caseworker n arnelph. <br />Monthly tenant portion of rent $ <br />Annual farnitylchild care expenwsto allow work: $ <br />Annual non-rsimhursed medical expenses; 5 <br />Anauat non-roimb. handicapped assistance expenses S <br />Utilities paid by tenant: Pets: <br />❑ Gas: S <br />❑ Bectic: 5 Energy source: GasEectr Cil ❑they I <br />0 Water: Cooking dove: ❑ ❑ ❑ <br />❑ Sewer: Water Heater: ❑ ❑ Q <br />❑ Trash: S Space Heat ❑ ❑ 0 <br />❑ NONE Air Conditioning. ❑ ❑ ❑ <br />HOUSEHOLD <br />❑ Primary►esidence of all 000upantO (lfnot, explain in notes) <br />❑ Can someone readknderstand English? M not, language <br />Rawrf thnrcily: ❑ American IndiardAlaskan ❑ As an <br />© Ell acld*f Gan -American ❑ HawaiianlPacffic Islander <br />❑ HispaniclLatino ❑ While ❑ Other ❑ Mixed <br />Subsuibe to ❑ Land phone ❑ TV service ❑ Internet <br />❑ Home -based business? (describe In notes) <br />❑ Rent rooms in dwelling? (describe in notes) <br />❑ On fixed income or public assistance (desaiba in 0owpants) <br />❑ Disabled occupants? (deaxibe modificatonedneedsin Occupants) <br />Repiacementsks srxcjalneeds (mark and describe in "a) <br />❑ Employmentaocess ❑ Stropping <br />❑ Public transport ❑ Religious <br />❑ Medical fadtiteslservices ❑ 5ociallpublicserwces <br />❑ School needs ❑ Re:ative*thnic <br />❑ Cirrldcare ❑ Other sped at needs <br />❑ At ocmpantsio move to the same dwelling? (if not, explain in notes) <br />Replacement dwellingpreferenoe El Rent ❑ %y <br />Can relocate from: ❑ Neighborhood ❑ City ❑ County ❑ State <br />Prate -red relocation areas <br />HOMEOWNER <br />Lbt size (sq 11): Dale purchased: Age (yrs) <br />❑ Own dear, no man vans ❑ Negative equi q of stories <br />1st Loan Infonrtatlon 2nd Loan Infarmabon <br />Lender. <br />Lender <br />Loan Type (list 5) <br />Loan Type {Iisl5]- <br />Current % Rate <br />Current % Rate. <br />Prinapal6alanoe: $ <br />Principal Balance: $ <br />Original Date. <br />Original Data. <br />Remaining months: <br />Remaining months: <br />Monthly P&I payment <br />Monthly Peg payment <br />Pad space: 0 Rent ❑ Own Coady ❑ Rent ❑ Own <br />Pad rent $ MakolModel. <br />Coach length (R) Year: <br />Coach urrd th (tt}. Deco I # <br />City Council 39 — 32 4/5/2022 <br />