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EXHIBIT C <br />TO <br />SUBGRANT AGREEMENT <br />(VILLAGE AT LITTLE CANADA RAMSEY HRA GRANT) <br />DISBURSEMENT REQUEST FORM <br />(Village at Little Canada Project) <br />Number <br />Date <br />The undersigned, pursuant to that certain Subgrant Agreement dated <br />, 2006, and between The Village at Little Canada LLC (the "Grantee ") <br />and the City of Little Canada, Minnesota (the "City ") (the "Agreement "), hereby certifies <br />and requests as follows: <br />1. The Grantee requests the following amounts from the City to pay or reimburse the <br />following persons from the Subgrant funds under the Agreement: <br />Name and Address of Payee Amount <br />a. $ <br />b. $ <br />c. $ <br />d. <br />TOTAL $ <br />9 <br />