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�oioo7s37 Owner Narne and Address: EXHIBIT D REQUISITION �'ORM Pursuant to, and in accordance with, the provisions of the Section 1602 Subaward Agreement, dated , 2010 (the "Agreement"), between the Nebraska Investment Finance Authority (the "Authority"), and Westridge CROWN, LLC (the "Owner"), the Owner hereby requests the Authority to disburse to the �wner the sum of $ . IT TS HERESY CERTIFIED THAT: 1) None of the items for which disbursement is rec{uesied has formed the basis for any disbursement heretafore made under the Agreement; 2) The Owner has no notice of, and is not atherwise aware nf, any mechartics', materialmen's, laborers', suppliers', vendors' or other liens or rights in respect thereof which should, in accordance wiih the Agreement, be satis�ed or discharged before this disbursement is made; 3) This disbursement does not include any amount which the Owner is entitled tn retain pursuant to any contract nr agreern�nt pro�viding for the retention by the Owner of a portion of the pxice paid thereunder; 4) No Event of Default is continuing under ihe Agreernent; and 5) Attached hereto are each of the following: a) Attachment 1: An itemization of bilis and inrroices to be paid with thc requested disburs�ment together with copies of all such bills and invnices; b) Attachment 2: A Contractnr's Sworn Statement together with supporting znechanics lien waivers signed by Owner's Contractor (Nate: a Contractor's Sworn Statement and supporting mechanics lien waivers shall not be required prior to the initial disbursement of 1602 funds). c) Attachment 3: An AIA inspectron report signed by a licensed architect in support of the draw request indicating that all work and rnaterials to be paid for with the disbursement have heen furnishcd in accordance with the Plans and Specifications; WESTRIDGE CROWN, LLC By: Housing Flus, LLC, its managing member Date: Name, Title 4846-6923-1367.3