Instructions: 
In accordance with Section 1602 of the American Recovery and Reinvestment Act of 2009, Public Law 111-5 (“Section 1602”), the information in this Application for Section 1602 Form 8609/Certification by Owner (the “Application”) will be used to complete the Section 1602 Form 8609 (“Form 8609”), which will not be filed with the Internal Revenue Service but will be filed with the Minnesota Housing Finance Agency (“Minnesota Housing”).  All information provided by you in this Application must be consistent with your Section 1602 application and with the Attorney’s Opinion and the Final CPA Cost Certification prepared in connection with this Application.  Only Minnesota Housing or, as applicable, an authorized Suballocator may issue a Form 8609.  No other entity shall issue a Form 8609.

The United States Department of the Treasury has directed that Minnesota Housing (or the Suballocator, if applicable) complete boxes A, B, C, D, and E, and lines 5 and 6 in Part I of Form 8609 and that the borrower of Section 1602 funds complete lines 7, 8b, 9b, 10a, 10c, and 10d in Part II of Form 8609.  The remaining lines are applicable to low-income housing tax credits only and should be left blank.

Certification
As the owner of the above-referenced development (the “Development”), I hereby make application for the issuance of a Section 1602 Form 8609 and certify the following:

1.	Project Information

Minnesota Housing HTC # (s)      

Name of Development      

Address (Do Not Use P.O. Box)      

City	     	County	     	Zip	     

2.	Eligible Basis (from Exhibit A)

	Building 1	$     	Building 2	$     	Building 3	$     	Building 4 	$     

I understand that it is my sole responsibility to fully understand how Section 1602 and Section 42 of the Internal Revenue Code of 1986, as amended (“Section 42”), and the regulations and rules promulgated thereunder, apply to the Development.  I understand that final determinations of how Section 1602 and Section 42 apply to the Development can only be made by the United States Department of the Treasury.

I hereby state that all the applicable design standards and design features, including all requirements or special conditions of selection of the Development, have been incorporated into the construction of the building(s) in the Development.

I hereby state that the Development is in compliance with all Minnesota Housing Section 1602 program requirements and conditions of selection and any additional or special conditions described in the Minnesota Housing Award and Acceptance Letter, Carryover Agreement, HTC Procedural Manual, Section 1602, or Section 42, and that the above information and any other information provided during the 8609 application process is 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) to the Development have been disclosed to Minnesota Housing.

Ownership Entity (partnership):     
Ownership Address:     
City, State, Zip:       
General Partner:     
Authorized Signatory for General Partner:     
Ownership Entity Federal Tax ID #:       
Email Address:       	Phone Number:       	FAX Number:     

Non-Profit Corporation General Partner (if applicable):     
Authorized Signatory For Nonprofit Corporation General Partner:     
Email Address:       	Phone Number:       	FAX Number:     

Acknowledged, agreed and accepted:	OWNER

	     
	(Name of Entity)
	     
	(Legal Description of Entity and State of Authorization)

By:	___________________________________
	(Signature)
	_     __________________________________
	(Typed or Printed Name)

Its:	     

Dated:	     

STATE OF 	)
	)	ss.
COUNTY OF	)

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

_________________________________________
Notary Public