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[null,"HOME Homebuyer and Homeowner Rehabilitation (HHR) ANNUAL PROGRAM INCOME and RECAPTURED REPORT"]
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[null,"Current HOME grantees are required to report annually on the Program Income/Recaptured proceeds generated by their HOME funds.  "]
[null,"Please complete the following chart for all HOME Program Income Activity for the period of October 1, 2018- September 30, 2019. "]
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[null,"Please submit the report by October 20, 2019 to: DOADOHHHRHCRI@wisconsin.gov"]
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[null,"Activity Number","Program Year/Contract Number","Address Check Came From ","PI/ Recaptured ","Dollar Amount Received"]
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[null,null,null,null,null,{"$f":"SUM(F11:F22)","v":0}]
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["By signing this report, I certify to the best of my knowledge and belief that the report is true, complete, and accurate, and the expenditures, disbursements and cash receipts are for the purposes and objectives set forth in the terms and conditions of the Federal award. I am aware that any false, fictitious, or fraudulent, information, or the omission of any material fact, may subject me to criminal, civil or administrative penalties for fraud, false statements, false claims or otherwise. (U.S. Code Title18, Section 1001 and Title 31, Sections 3729-3730 and 3801-3812)"]
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["Printed Name: ",null,null,"Signature:"]
["Agency Name:"]