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EXHIBIT B-12 <br /> 99 106858 <br /> CERTIFICATE OF ANNUAL HOUSEHOLD INCOME FROM FAMILY ASSETS <br /> I/we willfully state and swear that: (1)my/our Net Family Assets(as defined in 24 CFR 813.102) <br /> do not exceed$5,000.00 and(2)the annual income from my/our Net Family Assets is$ <br /> I/we understand that this Certification is a sworn statement to be used to determine income eligibility <br /> pursuant to Treasury Regulation Section 1.42-5(b)(1)(vii)(the "Requirement")and that income eligibility <br /> is a substantial and material obligation of our tenancy. <br /> Under penalties of perjury,I/we declare that the information provided above is,to the best of my/our <br /> knowledge and belief,true, correct and complete. <br /> Signature <br /> Print Name and Unit No. <br /> Date <br /> Signature <br /> Print Name and Unit No. <br /> Date <br /> Pursuant to Section 4.03 of Revenue Procedure 94-65, 1994-41 I.R.B. 10,and as a designated representative <br /> of the owner of , I have no reason to <br /> conclude that the above tenant(s) annual income from Net Family Assets is higher than the income <br /> represented above,and therefore it is not necessary to obtain other documentation to satisfy the Requirement. <br /> Signature <br /> Title <br /> Date <br /> B-12-1 <br />