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<br />C-1 <br />[Exhibit C to Declaration of Covenants and Restrictions] <br />Exhibit C <br />Form of Certificate of Continuing Program Compliance <br /> <br />Certificate of <br />Continuing Program Compliance <br /> <br />Date: ___________________ <br />The following information with respect to the Project located at _______________, St. Anthony, <br />Minnesota (the “Project”), is being provided by SA SENIOR LIVING LLC, a Minnesota limited liability <br />company (“Declarant”) to the City of St. Anthony, Minnesota, a Minnesota statutory city (the “City”) and <br />the Housing and Redevelopment Authority of the City of St. Anthony, Minnesota, a public body corporate <br />and politic organized and existing under the laws of the State of Minnesota (the “Authority”), pursuant to <br />that certain Declaration of Covenants and Restrictions (Affordable Housing) dated ________________ <br />___, 20___ (the “Declaration”), with respect to the Project: <br />(A) The total number of Affordable Units which are available for occupancy is 7 [or <br />5% of total units]. The total number of these units occupied is _________________. <br />(B) The total number of units occupied by “Qualifying Tenants,” as the term is defined <br />in the Declaration (for a total of 7 units [or 5% of total units]) is ____________ (may use the Table <br />below or attach a rent roll) <br />___________ _________________ _________________ <br /> <br /> <br />Unit <br />Number Name of Tenant <br />Number of <br />Persons <br />Residing in <br />the Unit <br />Number of <br />Bedrooms <br />Total Adjusted <br />Gross Income <br />Date of Initial <br />Occupancy Rent <br /> <br />1 <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br />139