Laserfiche WebLink
Attachment D <br />EXHIBIT BÎ1 <br />FORM OF INITIAL INCOME CERTIFICATION <br />TENANT INCOME CERTIFICATION Effective Date: _________________________ <br /> Move-in Date: __________________________ <br /> Initial Certification Recertification (MM/DD/YY): _________________________ <br /> Other _____________________________________ <br />PART I. DEVELOPMENT DATA <br />Property Name: Twin Lakes Family Apartments County: Ramsey BIN #: __________ <br /> Unit Number: ___________ # Bedrooms: _____ <br />Address: ___________________, Roseville, Minnesota <br />PART II. HOUSEHOLD COMPOSITION <br />HH First Name & Relationship to Date of Birth F/T Social Security <br />Middle Initial Head of (MM/DD/YY) Student or Alien Reg. <br />Br # Last Name <br />Household No. <br />(Y or N) <br />1 HEAD <br />2 <br />3 <br />4 <br />5 <br />6 <br />PART III. GROSS ANNUAL INCOME (USE ANNUAL AMOUNTS) <br />HH (A) (B) (C) (D) <br />Br # Employment or Wages Soc. Security / Pensions Public Assistance Other Income <br /> <br /> <br /> <br /> <br />TOTAL $ $ $ $ <br /> Add totals from (A) through (D) above TOTAL INCOME (E): $ <br /> B-1-1 <br />12519391v3 <br /> <br />