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HOUSING PROGRAM STATEMENT OF EXPENSE WORKSHEET <br /> Billing Party <br /> Bill To: o-e—(In elm <br /> Billing Address: Z01 �q-,p�Q 24 . <br /> City: }pC- State: CA Zip: S2b5 <br /> Site Information <br /> Owner/Facility Name: same A,, Q.bo FA#: D j) <br /> Site/Facility Location: p L . LILe,UO �4 �4 ►-1 PR#: D �J 3 D&&? <br /> Total Costs Summary <br /> Costs Type Amount <br /> Total Staff Time and Activity Charges from EC 5255 Report(1321) <br /> 7S <br /> Title Search Actual Costs (1371) <br /> •DO <br /> Postage Actual Costs(1372) <br /> 2n"k - 5 @ S •5'4 = 2-7-1b <br /> �j 3. ICP <br /> Recorded Documents Actual Costs (1364) <br /> Notice of Abatement Action/Notice of Violation Recorded Document Actual Costs (1374) <br /> Release of Abatement Action/Release of Notice of Violation Recorded Document Actual Costs <br /> (1374) PLO J <br /> Demolition Actual Costs from Contractor Invoice (1380) <br /> Securement Actual Costs from Contractor Invoice (1381) <br /> Other Actual Costs <br /> Total EHD Costs J -30.- ' <br /> Billing Type I <br /> 13 Demand Billing 173 Final Billing Progress Billing Quarter: s Year: o ca <br /> Compilation and Review <br /> Compiled By: Date: 6/2-4> 1</ <br /> Reviewed By: Date: <br /> Revised:5/13/2014 <br />