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existing buildings must complete the attached OPRHP Building-Structure Inventory Form.)

SECTION D(To be completed by all applicants.)

I certify that the information provided herein is true to the best of my knowledge.

Applicant/Project Sponsor Name                                                                                              Authorized Representative’s Name                                                                                      Representative’s Title                                                                                      Signature of Applicant’s Representative

Date    

HFA Form 1510/14

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