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EXHIBIT C <br /> FORM OF WRITTEN REQUEST <br /> STATEMENT NO. REQUESTING DISBURSEMENT OF FUNDS FROM <br /> THE DISBURSEMENT ACCOUNT OF THE PROJECT FUND PURSUANT TO <br /> SECTION 3.4 OF THE LOAN AGREEMENT DATED AS OF APRIL 1, 2020 <br /> BETWEEN CITY OF SOUTH BEND <br /> AND MAH CEDAR GLEN, LP <br /> Pursuant to Section 3.4 of the Loan Agreement (the "Agreement") between the City of <br /> South Bend (the "Issuer") and MAH Cedar Glen, LP (the"Borrower") dated as of April 1, 2020, <br /> the undersigned Authorized Borrower Representative hereby requests and authorizes The <br /> Huntington National Bank, as trustee (the "Trustee"), as depository of the Project Fund created <br /> by the Indenture, to pay the costs of the items listed on the copy of the HUD Disbursement <br /> Request to the Senior Lender that is attached hereto as Attachment 1. <br /> This statement constitutes the approval of the Borrower of each disbursement hereby <br /> requested and authorized. <br /> This day of , 20 . <br /> Authorized Borrower Representative <br /> C-1 <br />