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Other (specify) <br />Signatures: <br />Housing Authority of South Bend <br />Pent or Type Name of PHA <br />Jacelyn R. Phillips Section $ Manager <br />Pent or Type Name and TNe of Signatory <br />Date (mmlddlyyyy) <br />Mail Payments to: <br />City of South Bend Redevelopment Commisssion <br />Print or Type Name or Owner <br />Signature _ to <br />cram <br />Print or Type Name and Title of Signatory <br />Date(mmlddlyyyy) <br />Name <br />Address (street, city, State, Zip) <br />Previous editions are obsolete Page .3 of 12 torte HUD -52641 (08/2009) <br />ref Handbook 7420.8 <br />�© <br />®y <br />a <br />XXXXXXX <br />�s <br />e <br />e <br />ae <br />•. .I <br />• <br />•: <br />Other (specify) <br />Signatures: <br />Housing Authority of South Bend <br />Pent or Type Name of PHA <br />Jacelyn R. Phillips Section $ Manager <br />Pent or Type Name and TNe of Signatory <br />Date (mmlddlyyyy) <br />Mail Payments to: <br />City of South Bend Redevelopment Commisssion <br />Print or Type Name or Owner <br />Signature _ to <br />cram <br />Print or Type Name and Title of Signatory <br />Date(mmlddlyyyy) <br />Name <br />Address (street, city, State, Zip) <br />Previous editions are obsolete Page .3 of 12 torte HUD -52641 (08/2009) <br />ref Handbook 7420.8 <br />