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Get AR ADFA Form 2012 1998-2024

Incurred and have been or will be paid to the corresponding vendor / provider. I further certify that the following costs were incurred for the HOME Project located at ______________________________________________________________and do not (ADDRESS) (CITY) (ZIP) (COUNTY) duplicate any other services or materials on this project. Vendor / Provider Invoice No. $ Amount 1 2 3 4 5 6 7 8 9 10 * TOTAL Less Retainage $________________* * This will equal Column F of Form No. 2011 ______________.

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