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SN SERVICING CORPORATION

Check Request/Invoice Coversheet

Entity:     Asset Name:     Asset No.:

Address:  

Broker/Agent Name:        Phone:

Remit to:___________________________________________ Tax ID No.:  _______________________

                                                Vendor Name

______________________________________________________________________________

                                                                               Address, City, State, Zip

Instructions to submitting Broker/Agent:  Fill out this form in its entirety, with the exception of the areas designated for SNP USE ONLY.  Each invoice for which reimbursement is requested must be identified individually.  An original invoice, as well as a copy of the check used to pay same, must be attached for each reimbursement requested.

Utilities

$

$

$

$

Total Utilities                       

$

Maintenance

$

$

$

Total Maintenance              

$

Approved Repairs

$

$

$

$

Total Approved Repairs

$

Other

$

$

$

Total Other

$

TOTAL CHECK AMOUNT

$

I have inspected the work for which the invoices listed above are submitted and found it to be done in a professional and satisfactory manner.

________________________________________    Date:  _____________________

              Listing Agent

SNP USE ONLY

Requested by:______________________________________Date:_______________________

Approved by: ______________________________________Date:_______________________

Special Instructions:_______________________________________________________________

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