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ADFA Form 2012 - Arkansas - state ar

ADFA Form 2012 - Arkansas - state ar-2026

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The document is a Pay Request form for a HOME Project, requiring certification of incurred costs paid to vendors. It includes sections for listing vendor details, invoice numbers, amounts, and a total calculation. The signer certifies that the costs are legitimate and do not duplicate other services. A warning about the legal consequences of false statements is also included.

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Click ‘Get Form’ to open the ADFA Form 2012 in the editor.
Begin by entering your name in the 'PRINT NAME' field under the HOME DISBURSEMENT CERTIFICATION section. This identifies you as the certifying individual.
Fill in the address details of the HOME Project, including street address, city, zip code, and county. Ensure accuracy to avoid any processing delays.
List each vendor or provider in the designated fields along with their corresponding invoice numbers and amounts. Be thorough to ensure all costs are accounted for.
Calculate the total amount and enter it in the 'TOTAL Less Retainage' field. This should match Column F of Form No. 2011 for consistency.
Finally, sign and date the form where indicated by 'Finance Officer / Designee'. This step is crucial for validation.

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