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200109053 <br />Signature (Date) Signature (Date) <br />PART V. DETERMINATION OF INCOME ELIGIBILITY <br />TOTAL ANNUAL HOUSEHOLD INCOME <br />RECERTIFICATION ONLY: <br />FROM ALL SOURCES: <br />Household Meets <br />Current Income Limit x 140 %: <br />From (L) on previous page <br />$ <br />Income Restriction <br />1 <br />at: <br />$ <br />❑ 60% ❑ 50% <br />Household Income exceeds 140% at <br />❑ 40% ❑ 30% <br />recertification: <br />Current Income Limit per Family Size: <br />❑ % <br />❑ Yes ❑ No <br />Household Income at Move -in: $ Household Size at Move -in: <br />PART V1. RENT <br />Tenant paid Rent $ Rent Assistance: <br />$ <br />Utility Allowance $ Other non - optional charges: <br />D ROSS RERFOR UNIT: Unit Meets Rent Restriction at: <br />(Tenant paid rent plus Utili llowance & <br />60% 50% <br />other non - optional charges) $ <br />40% 30% — <br />Maximum Rent Limit for this unit: $ <br />PART VII. STUDENT STATUS <br />*Student Explanation: <br />ARE ALL OCCUPANTS FULL -TIME STUDENTS? If yes, enter student explanation* <br />1 AFDC /TANF assistance <br />❑ Yes ❑ No (also attach documentation) <br />2 JTPA Program, or equivalent <br />3 Single parent/dependent child <br />4 Married/Joint tax return <br />Enter <br />1-4 <br />PART VIII. PROGRAM TYPE <br />Mark the program(s) listed below (a. thru e.) for which this household's unit will be counted toward the property's occupancy requirements. <br />Under each program marked, indicate the household's income status as established by this certification /recertification. <br />a. Tax Credit ❑ b HOME ❑ c. Tax Exempt ❑ d. AHDP ❑ <br />e. ❑ <br />(Name of Program) <br />See Part V above. Income Status Income Status Income Status <br />❑ < 50% AMGI ❑ 50% AMGI ❑ 50% AMGI <br />Income Status <br />❑ < 60% AMGI ❑ 60% AMGI ❑ 80% AMGI <br />❑ <br />❑ < 80% AMGI ❑ 80% AMGI ❑ OI" <br />❑ <br />❑ OI" ❑ OI" <br />❑ OI" <br />"Upon recertification, household was determined over - income (OI) according to eligibility requirements of the program(s) marked above. <br />SIGNATURE OF OWNER/REPRESENTATIVE <br />Based on the representations herein and upon the proofs and documentation required to be submitted, the individual(s) named in Part II of this Tenant Income Certification <br />is /are eligible under the provisions of Section 42 and Section 142 of the Internal Revenue Code, as amended, and the Regulatory Agreement and Declaration of Restrictive <br />01- 351904.01 B -2 <br />