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<br />200809274 <br /> <br />.018968 <br /> <br />CLARIFICATION RECORD <br /> <br />Applicant/Resident Name: <br /> <br />Date: <br /> <br />D Initial Certification <br />D Recertification (Annual or Interim) <br /> <br />Datc of Expected Move-In: <br /> <br />Effective Date: <br /> <br />Means of Clarification: <br /> <br />D Phone Conversation <br />D Person-to-Person Conversation <br />D Other: <br /> <br />(Please state) <br /> <br />Date of Clarification: <br /> <br />Time: <br /> <br />Contact Name: <br /> <br />Position: <br /> <br />Company/Organization: <br /> <br />Phone: <br /> <br />Summary Clarification Requested: <br /> <br />Explanation or Clarification Given: <br /> <br />Signature of Contact <br /> <br />Printed Name <br /> <br />Date <br /> <br />Signature of Owner's Representative <br /> <br />Printed Name <br /> <br />Date <br /> <br />(Updated (] ]107) <br />