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1 CITY OF MODESTO Commercial, Industrial and Multi-Family Deferral Application Application Type Check all that apply: CFF Deferral Water Connection Deferral Wastewater Capacity Deferral A. Applicant Information Full Name: Date: Last First M.I. Relationship to Owner: Physical Address: Street Apartment/Unit # City State ZIP Code Mailing Address (if different than above): Street Apartment/Unit # City State ZIP Code Phone: ( ) Work: ( ) Fax: ( ) Email : B. Project Information Parcel Number(s): Site Address: Street Address Apartment/Suite Number City State Zip Name of Project: Type of Project: Warning: Furnishing false information on a loan application is a crime! U.S. Code Title 18, Section 1001 makes it unlawful for anyone to knowingly or willfully conceal a material fact, make any materially false, fictitious or fraudulent statement or make or use any false, fictitious or fraudulent writing or document. Violation of this section may be punishable by fine or imprisonment for not more than five years, or both. I/We certify that the statements contained in the above schedules are true and accurate statements to the best of the applicant’s knowledge and belief. Signature: Date: Print Name: Title: Phone: ( ) ---PAGE BREAK--- 2 DEFERRAL PROCEDURES Document Checklist: Upon approval, complete and return all of a the following: Deferral Agreement signed and notarized by Applicant Map Exhibit detailing property location Cashier’s Check made out to City of Modesto for $250.00 (Administrative Fee) Cashier’s Check made out to City of Modesto for $500.00 (Title Report) Remit to: IFP Administrator City of Modesto - Infrastructure Finance Program Administration 1010 Tenth Street, Suite 3300 PO Box 642 Modesto, CA 95353 (209) 577-5211 Approval Process: 1. Applicants will be notified in writing of approval status. 2. A Deferral of Capital Facilities Fees, Water Connection and/or Wastewater Capacity Fees and Notice of Lien will be drafted by the City and forwarded to Applicant for review, signature and notarization. Summary of Terms & Conditions Applicant shall pay twenty percent (20%) of total fees due at the time of building permit issuance as determined by the Agreement. Applicant shall pay remaining eighty percent (80%) balance of total fees plus interest in five annual installments as determined by Agreement. Installments shall be paid annually starting the date the Agreement is executed. The remaining unpaid balance of fees, including interest, shall immediately become due and payable on the sale, transfer, or refinancing of the Property. Any additional covenants per the Agreement 3. Upon approval, the Deferral of Capital Facilities Fees, Water Connection and/or Wastewater Capacity Fees and Notice of Lien will be executed by the City and forwarded to the Stanislaus County Recorders Office for recordation. An original copy will be forwarded to Applicant. 4. In all cases, the unpaid balance of the Deferred Fees will be subject to interest and collection charges. The annual interest rate shall be a fixed rate equal to the Wall Street Journal Prime Rate at the time the Deferral of Capital Facilities Fees, Water Connection and/or Wastewater Capacity Fees and Notice of Lien is executed. 5. The terms and conditions of the deferral shall be set forth in an agreement which shall also provide that the unpaid balance of the Deferred Fees shall be due and payable on the sale or the transfer to the property. 6. For those projects where a mitigated negative declaration or an Environmental Impact Report (EIR) has been certified, no deferral shall be allowed to the extent that one or more of the mitigation measures consists of payment of said fees or construction or installation of a public improvement, the cost of which, subject to funding availability, may be eligible for reimbursement of fees.