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EXHIBIT B <br />TENANT INCOME CERTIFICATION Effective Date: <br />Move-in Date: <br />^ Initial Certification ^ Recertification ^ Other (MM/DD/YY): <br />PART I. DEVELOPMENT DATA <br />Property Name: County; BIN #: <br />Address: Unit Number: # Bedrooms: <br />PART II. HOUSEHOLD COMPOSITION <br />HH <br />!3r # <br />Last Nante Pirst Name & Middle <br />Initial Relationship io <br />Head of Household Date of Birth <br />(MM/DD/YY) F/T Student <br />(y or N) Social Security or <br />Alien Reg. No. <br />1 HEAD <br />2 ' <br />3 <br />4 <br />5 <br />6 <br />PART III. GROSS ANNUAL INCOME (USE ANNUAL AMOUNTS) <br />HH <br />Br # (A) <br />Employment or Wages (B) <br />SoC. Security /Pensions (C} <br />Public Assistance (D) <br />Other Incotne <br /> <br /> <br /> <br /> <br />TOTALS $ $ $ $ <br />Add totals from (A) through (D) above TOTAL INCOME (E): $ <br /> PART IV, INCOME FROM ASSETS <br />HH <br />Mbr# (F) <br />Type of Asset (G) <br />C!I (H) <br />Cash Value of Asset (1) <br />Annual Income from Asset <br /> <br /> <br /> <br /> <br /> TOTALS; $ $ <br />Enter Column (H) Total <br />if over $5,000 Passbook Rate <br />$_ _ x 2.00 % ~ (l) Imputed Income <br />$ <br />Enter the greater of the total column I, or 1: imputed income TOTAL INCOME PROM ASSETS (K) $ <br /> (L) Total Annual Household Income from aI] sources [Add (E) + (K)] $ <br />HOUSEHOLD CERTIFICATION & SIGNATURES <br />The information on this form will 6e used to determine maximum income eligibility. I/we have provided for eadt person(s) set forth in Part ]I acceptable verificatia~ of <br />current anticipated annual income. Ihve agree to notify the landlord immediately upon any member of the household moving out of the unit or any new member <br />moving in. IAve agree to notify the landlord immediately upon any member becoming a full-time student. <br />Under penalties of perjury, t/eve certify that the information presented. in this Cenification is w.e and accurate to the best of my/our Irnowledge and belief. The <br />undersigned further understands Chat providing false representations herein constitutes an act of fraud. False, misleading or incomplete information Wray result in the <br />termination of the lease agreement. <br />2029975v 1 B- I <br />