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<br />Exhibit D <br />FORM OF REQUISITION <br />Requisition No. r~ <br />• <br />Reference is made to that certain Owner Participation and Loan Agreement, dated <br />as of ~M~ s , 2009 (the "Agreement"), between the Redevelopment Agency of the <br />City of San Leandro, a public body, corporate and politic ("Agency") and Gavril and Lavina <br />Munteanu ("Owner") pursuant to which Agency agreed to provide a loan in the maximum <br />amount of Twenty Five Thousand Three Hundred and Seven Dollars ($25,307). <br />Capitalized terms used and not otherwise defined shall have the meanings set forth in the <br />Agreement. <br />The Owner requests a disbursement of funds in the amount of $ a ~, 307 for <br />payment of reimbursable costs for the Project in accordance with the provisions of the <br />Agreement. The supporting documents (invoices, receipts, billing statements) attached to <br />this requisition are true, complete and correct copies of original documents provided by <br />third parties for work authorized by the Agreement. <br />The disbursement of the amount specified above, when added to all previous <br />disbursements of funds for the Project, will total the sum of $ or7~ of Agency funds <br />provided for the Project. The balance of Loan funds available after disbursement of funds <br />requested pursuant to this Requisition is $ ~~~D7 <br />The undersigned hereby certifies that the statements set forth in this Requisition are <br />true, complete and correct, and that the disbursement of funds requested hereby conforms <br />to the requirements of the Agreement. <br />Dated: J ~ ,5~ , 200 <br />[Authorized agent of the Owner] <br />Approved: <br />Authorized Representative of Agency <br />1172237-2 1 <br />