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TENANT INCOME CE>ItMMCA''ION 200512600 <br />• <br />❑ Initial Cad cation ❑ RecerrifMtioa © Otk � <br />Effective Dale: <br />Move-ia Dates / / <br />YYlf1) <br />HOUSIMOLD CERTIFICATION & SIGNATURES <br />The w6r mation on this form will be usa to determine maximum income eligibility. Uwe have provided for each person(s) set forth in Part ll acceptable verification of <br />current anticipated annual income. Uwe agree to notify the landlord immediately upon my member of the household moving out of the unit or any new member moving in. <br />IL 'we agree to notify the landlord immediately upon any member bwerning a full -time student. <br />Under penalties or perjury, Uwe ccrtify that the information preseraod in this Certification is true and accurate to the best of my /our knowledge and belief. The undersigned <br />further understands that providing false representations herein comatutes an act of fraud False, misleading or incomplete information may result in the termination of the <br />lease agreement. <br />;signature <br />Signature <br />(mo) <br />(D"I <br />Signature (Date) <br />Signature <br />Date) <br />