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daily-use autos,tools,wedding rings,etc.Also excluded are Term life insurance e7 J 10 6 8 5 � <br /> policies, special equipment for use by the handicapped,and assets of an active <br /> business. <br /> RESIDENT'S STATEMENT: I/we understand that the above information is being collected to determine my/our eligibility <br /> for residency. I/we authorize the owner/manager to verify all information provided on this Application/Certification and <br /> my/our signature is our consent to obtain such verification. I/we certify that I/we have revealed all assets currently held or <br /> previously disposed of and that I/we have no other assets than those listed on this form(other than personal property). I/we <br /> further certify that the statements made in this Application/Certification are true and complete to the best of my/our knowledge <br /> and belief and are aware that false statements are punishable under Federal law. <br /> Signature of Head of Household: Date: <br /> Effective Date: <br /> Signature of Spouse or Co-Tenant: Date: <br /> Effective Date: <br /> BORROWER'S STATEMENT: Based on the representations herein and upon the proof and documentation obtained,the <br /> household named in Section 1 of this Application/Certification is eligible under the provisions of Section 42 and Section 142 <br /> of the Internal Revenue Code,as amended,to live in a Dwelling Unit in the development. Based on the representations herein <br /> and upon the proofs and documentation obtained, the household constitutes a [check applicable boxes]: <br /> ❑ Low Income Tenant;❑ Qualified LIHTC Tenant;❑ Moderate Income Tenant whose anticipated annual income for the <br /> next 12 months does not exceed$ (Qualifying Owner Income). <br /> Signature of Owner or Owner's Authorized Representative: <br /> Date: Effective Date: <br /> B-1-3 <br />