Federal Home Loan Bank of Des Moines
Western Office

AHP Project Name:

AHP Project Number:

Affordable Housing Program (AHP)

Modification Request Form

Member Name: / Sponsor name:
Project status: Active project Completed project

Basic Project Modifications

Indicate project information to be changed:

From: / To:
Project Name
Address
Member
Project Sponsor
Other

Provide a detailed explanation of the proposed changes. Attach additional pages if necessary.

AHP Scoring Criteria Modification

Indicate AHP scoring criteria element(s) to be changed:

Donated Property / From to
Non-Profit Sponsorship / From to
Empowerment / From to
Homeless / From to
First District Priority / From to
Second District Priority / From to
Targeting / From to
Effectiveness / From to
Community Stability / From to

Provide a detailed explanation of the proposed changes. Attach additional pages if necessary.

The following items are attached:

Projects that are active/not complete must update all tabs of the AHP workbook.

Projects that are complete must update the Rent Schedule and Pro forma tabs of the AHP workbook.

All parties hereby certify that the undersigned are authorized to make, and makes, the following acknowledgments and certifications: (1) All statements and information provided herein or herewith are true and accurate; (2) If any such statement or information is materially untrue or inaccurate then the Member and/or Sponsor may be required to repay the full AHP Subsidy amount to the Federal Home Loan Bank of Des Moines (the “Des Moines Bank”); (3) the Member and Sponsor acknowledge and understand their continuing obligations regarding the above-listed project as outlined in the executed AHP Regulatory Agreement and approved AHP application and as further described in the AHP regulations (12 CFR Part 1291 et seq.) and the policies of the Federal Housing Finance Agency (the “FHFA”) and/or the Des Moines Bank; and (4) the Member and Sponsor acknowledge that if the above-listed project fails to comply with the AHP requirements, the Member and Sponsor may, in some circumstances, be required to repay the AHP, plus interest if appropriate, pursuant to the executed AHP Regulatory Agreement, the approved AHP application, the AHP regulations, and/or the policies of the FHFA or the Des Moines Bank.

Agreed to and Accepted - Member

Dated: By

Name:

Title:

For:

Agreed to and Accepted - Member

Dated: By

Name:

Title:

For:

Agreed to and Accepted - Sponsor

Dated: By:

Name:

Title:

For:

Modification Request FormRevised June 1, 2015

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