5 STAR PLUS NEW CONSTRUCTION

ENERGY REBATE FORM

(HER-51 Invoice)

This form must be fully completed and signed by the homeowner. Please read the instructions on the
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following page. Incomplete forms will delay processing. The social security number is required for tax
purposes. Reimbursements and rebates are subject to funding availability. This is a one-time rebate per
family and per home. The homeowner must send the completed form with all required documents to
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AHFC, P.O. Box 101020, Anchorage, AK 99510-1020; Attn: R2D2 to participate in the Home Energy
Rebate program for 5 Star Plus New Construction. U

Homeowner Information

1. Homeowner Legal Name U                          

2. Homeowner Social Security# U (required, or will not be processed)
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3. Property Address/Legal Desc. U                          

4. Mailing Address U                          
5. City U           
6. State AK
U Zip Code                                        
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7. Phone Numbers (907) U                          

8. E-mail Address (optional)                               
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9. Rebate Amount $7,500

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10. AHFC Loan Yes____ No____

I certify that I am the original owner of the above-referenced property, that the home was purchased on or
after April 5, 2008 (or completed on or after April 5, 2008, if owner-built), that I have occupied this
property for less than 12 months from the date of purchase (or completion, if owner-built) and that this is
my primary residence. I further certify that the attached copies of the required documentation support my
rebate request. Attached are the required copies of my:

a) Recorded AHFC Form PUR-101,

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b) Recorded AHFC Form PUR-102 or Certificate of Occupancy, from an approved municipality,

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c) Builder’s Alaska contractor’s license with a Residential Contractor Endorsement, (not required
for an owner-built house for his or her own use),
d) Recorded title transfer deed or deed of trust,
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e) 5 Star Plus energy rating.

Check one:
I am certifying as the home purchaser ____ I am certifying as the owner-builder____

Homeowner’s Signature Date

HER-51
12/2/2008
5 STAR PLUS NEW CONSTRUCTION ENERGY REBATE INSTRUCTIONS
(HER-51 Invoice)

PLEASE READ THESE TWO PAGES OF INSTRUCTIONS CAREFULLY. Incomplete forms and
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documents may result in the rebate being delayed or denied. Only one rebate is allowed per family or per
home. The rebate amount is $7,500.00. The program is subject to funding availability. Individuals or
dwellings which have participated, or are participating, in the Weatherization assistance program after
May 1, 2008 are ineligible for the 5 Star Plus New Construction Home Energy Rebate program.
Participation in both the Weatherization Program and the Home Energy Rebate Program is not allowed.

REQUIREMENTS:

• The rebate applies to newly-built & completed 5 Star Plus homes:

o purchased on or after April 5, 2008 and
o not more than 1 year old at time of first sale.
• The rebate applies to owner-built newly constructed 5 Star Plus homes:
o completed on or after April 5, 2008 and
o not occupied for more than 1 year from the date of completion.
• The rebate is available only for an owner-occupied home used as a primary residence.
• The rebate is available only to the original owner.
• The cost of the energy rating is not reimbursed.

To be eligible for the $7,500 rebate on the purchase of a newly built 5 Star Plus home, the
homeowner must provide the following:

a) A copy of the signed and recorded AHFC Form PUR-101, which certifies the home’s compliance
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with the Building Energy Efficiency Standard, and

b) A copy of the signed and recorded AHFC Form PUR-102, which certifies the home’s compliance
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with Minimum Construction Standards, or a Certificate of Occupancy (CO), from an approved

municipality or borough whose building code has been determined to meet or exceed AHFC
Property Financing Requirements, and
c) A copy of the builder’s Alaska contractor’s license with a “Residential Contractor Endorsement,”
and
d) A copy of the recorded title transfer deed or deed of trust demonstrating ownership, and
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e) A copy of the 5 Star Plus energy rating performed by an AkWarm certified energy rater.

Item c) is not required for an owner-builder who has constructed a newly built 5 Star Plus
home for his or her own use.

Notarized documents are not the same as recorded documents. To find out how to record a
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document, contact the state recorder’s office or go to: www.dnr.state.ak.us/ssd/reoff/search.cfm

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(Instructions continued on next page)

HER-51
12/2/2008
1. NAME/SOCIAL SECURITY NUMBER: Enter the name and social security number of the
homeowner signing the certifying statement and applying for the rebate. Enter one name only. The
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social security number is required as the payments will be reported to the IRS, and a 1099 form will
be issued by AHFC as required by the IRS. AHFC recommends consulting a tax professional on the
taxability of the rebate.

2. PROPERTY AND MAILING ADDRESS: The property address line is for the street address or the
legal description (lot, block, and subdivision) of the property being rated and should correspond to the
proof of ownership. The mailing address is where the rebate check will be mailed.

3. PROOF OF OWNERSHIP: This rebate is available only for an owner-occupied home used as year-
round residence. The homeowner must attach proof of ownership in the form of a copy of a recorded
title transfer deed or deed of trust, which matches the address on the energy rating certificate.

4. PHONE NUMBERS AND E-MAIL: Enter the numbers where the homeowner can be reached
between the hours of 8:00 a.m. and 5:00 p.m. if we have questions while processing the rebate. An e-
mail address is not required, but may be helpful.

5. CERTIFYING STATEMENT: The homeowner must sign and date the certifying statement in order
for this rebate to be processed. The person signing the rebate form should be the owner whose name
appears on the recorded title transfer deed. This certification is required to prevent fraud.

6. REQUIRED DOCUMENTS: Provide all information and documents listed on the form.
Homeowners submitting incomplete forms and documents will be notified by certified mail. If
missing items are not provided within 30 days, the form and documents will be returned to the
homeowner. The homeowner will then need to re-submit the completed forms and required
documents.

TIMELINE: The homeowner has 12 months from the date of purchase (or completion, if owner-built) to
submit the energy rating and this completed form with required documents for a rebate. AHFC has 60
days to process the rebate request. The homeowner is responsible for mailing all required forms and
documents to AHFC.

Questions on the 5 Star Plus New Construction Energy Rebate program? In Anchorage, call Alaska
Housing Finance Corporation at 330-8183, or if you are located outside the Anchorage area, call 1-800-
478-2432 and ask for the rebate program manager. You may also find answers to your questions at our
website: www.ahfc.us/energy.
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HER-51
12/2/2008