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Attachment D <br />PART V. DETERMINATION OF INCOME ELIGIBILITY <br /> <br /> <br />TOTAL ANNUAL HOUSEHOLD Household Meets RECERTIFICATION ONLY: <br />$ <br />INCOME FROM ALL SOURCES Income Restriction <br />From Item (L) on page 1 at: Current Income Limit x 140% <br /> 60% 50% <br /> 40% 30% $____________________________ <br />Current Income Limit per __% Household income exceeds 140% at <br />Family Size: $ recertification: <br /> Yes No <br />Household Income at Move-in $_____________ <br />Household Size at Move-in: ______ <br /> <br />PART VI. RENT <br /> <br />Tenant Paid Rent $ _________________ Rent Assistance: $ ______________________ <br />Utility Allowance $ _________________ Other non-optional charges: $ ________________ <br /> <br /> <br />GROSS RENT FOR UNIT: <br />$ <br />Tenant paid rent plus Utility <br />Unit Meets Rent Restriction at: <br />Allowance and other non-optional <br /> <br />charges <br /> 60% 50% 40% 30% ___% <br /> <br />Maximum Rent Limit for this unit: $ __________ <br />PART VII. STUDENT STATUS <br /> <br />ARE ALL OCCUPANTS FULL-If yes, enter student explanation** Student explanation: <br />TIME STUDENTS? <br />(also attach documentation) 1. TANF assistance <br /> <br /> 2. Job training program <br />Enter <br /> <br /> yes no <br /> 3. Single parent/dependent child <br />1-4 <br />4. Married/joint return* <br /> <br />*Exception for married/joint return is the only exception available for units necessary to qualify tax-exempt bonds. <br /> B-1-3 <br />12519391v3 <br /> <br />