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Signature (Date) Signature (Date) Signature (Date) Signature (Date) PART V. DETERMINATION OE INCOME ELIGIBILITY TO"1'AL ANNUAL HOUSEHOLD Household Meets RECERTIFICATION ONLY: INCOME FROM ALL SOURCES $ Income Restriction From Item (L) on page 1 at: Current Income Limit x 140% ^ 60% ^ 50% ^ 40% ^ 30% $ Current Income Limit per Family Size: $ ^ _% Household income exceeds 140%at recertification: Household Incocne at Move-in $ ^ Yes ^ No Household Size at Move-in: PA1t'C V1. RENT Tenant Paid Rent $ Rent Assistance: $ Utility Allowance $ Other non-options] charges: $ GROSS RENT FOR UNIT: 'tenant paid rent plus Utility Unit Meets Rent Restriction at: Allowance and other non-optional $ .charges) ^ 60% ^ 50% ^ 40% ^ 30% ^ ~% Maximum Rent Limit. for this unit: $ PART VII. STUDENT STATUS ARE ALL OCCUPANTS FULL-TIME If yes, enter student. explanation** Student cxplanatian: STUDENTS? (also attach documentation) 1. TANF assistance 2" Job training program ^ yes ^ no Enter 3. Single parent/dependent child 1-4 4. Married/joint return* *Exception 4 for married/joint return is the only exception available for units necessary to qualify tax-exempt bonds. PART VIII. PROGRAM TYPE Mark [he program(s) listed below (a. through e.) for which this household's unit will be Counted toward the property's occupancy requirements. Under each program marked, indicate the household's income status as established by this certification/reeertification a. Tax Credit ^ b. HOME ^ c. Tax Exempt ^ d. AHDP ^ e. ^ (Name of Program) See Part V above. Income Status Income Status Income Status Income Status ^ <_ 50%AMGI ^ 50%AMGI ^ 5 50%AMGI ^ _.. ^ < 60% AMGI ^ 60%AMGI ^ < 80%AMGI ^ ^ <_ 80%AMGI ^ 80%AMGI ^ <_ 01 ** ^ < Ol ** ^ <_ Oi ** ^ OI ** ** Upon recertification, household was determined over income (OI} according to eligibility requirements of the program(s) marked above. SIGNATURE Off' OWNER / R)vPRESENTATIVE 2029975v1 B-2