Laserfiche WebLink
Appendix A <br /> Duplication of Benefits Affidavit("Affidavit") <br /> I/We, affirm the following: <br /> 1. I/We own real property at _ <br /> (City/Town),Indiana(the"Residence")which is located in an areathat was impacted by the floods of 2008. <br /> 2. I/We is/are executing this Affidavit in connection with the rehabilitation of the Residence by <br /> (Organization) through a <br /> homeowner rehabilitation project funded under the Indiana Housing and Community Development Authority's <br /> ("IHCDA's")Weatherization Owner-Occupied Rehabilitation Program(the"Program"). <br /> • 3. In addition, I/We have received or will receive the following amounts and types of assistance from the sources <br /> listed below("Duplicative Assistance")for the rehabilitation of the Residence,structural repair of the Residence or <br /> replacement housing: <br /> a. Insurance(Flood Insurance,Homeowner's,etc.)$ <br /> b. Federal Emergency Management Agency(FEMA) <br /> c. Small Business Administration(SBA)Loan$ <br /> d. The American Red Cross(Red Cross)$ • <br /> e. Other agencies(besides IHCDA)$ <br /> 4. I/We have received no other assistance funds in the for rehabilitation of the Residence, structural repair of the <br /> Residence or replacement housing other than that set forth above in paragraph 4. <br /> 5. 42 U.S.C.5155(a)prohibits federal agencies from providing assistance to any person for"any part of such loss"as <br /> to which he has received financial assistance under any other program or from insurance or any other source(such <br /> as,FEMA,SBA,Insurance,etc.). <br /> 6. I/We understand that the amount of assistance received by I/We from IHCDA must be reduced by the amount of <br /> Duplicative Assistance received or will be received for rehabilitation of the Residence, structural repair of the <br /> Residence or replacement housing, from other sources (such as, FEMA, SBA, the Red Cross, homeowner's <br /> insurance,etc.)for the same purpose. <br /> 7. Therefore, I/We understand that if I/We receive assistance from a source other than IHCDA (such as, FEMA, <br /> SEA,.the Red Cross,homeowner's insurance,etc.)for the rehabilitation of the Residence,structural repair of the <br /> Residence or replacement housing,I/We must repay the assistance received from IHCDA. <br /> 8. I/We certify under State and Federal penalties for perjury and fraud that the information provided above is true and <br /> accurate and acknowledge that repayment of all assistance received by Me/Us from IHCDA, payment of fines <br /> and/or imprisonment may be required in the event that I/We provide false,incomplete or misleading information in <br /> this Affidavit or during the rest of this process. <br /> Property Owner <br /> Signature of Property Owner Date <br /> Property Owner <br /> Signature of Property Owner Date <br /> CDBG-D CITY OF SOUTH BEND DR2OR-018-003 <br /> Recapture Page 24 of 24 <br />