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UNDER $5,000 ASSET CERTMCATIUN For households whose egg net assets do not exceed $5,000. Complete only air ,form per household; include assets of children. Household Name: Unit #: Development Name: Crays Complete an that apply for 1 through 4: 1. Mylour assets include: A0 Cash Int. Annual Value! Rate Income S $ s s S $ s $ s $ s s s s S s S S S S 200512606 Source (A) (B) (A'B) Source Cash lot. Annual Vales Rate Income Savings Account. $ $ Checking Account Cash on Hand $ $ Safety Deposit Box Certificates of Deposit S $ Money market funds Stocks $ $ Bonds IRA Accounts $ $ 401 K Accounts Keogh Accounts $ S Trust Funds Equity in real ratite $ $ Land Contracts Lump Stmt Receipts $ $ Capital investments Life Insurance Policies (Occluding Term): otter Retireaneat/Pe ision Fonds not named above: $ S personal property held as an investment ": $ $ otter (list): PLEASE NOTE. Cauja fiords (a.g., Retirement, Pension, Tout) may or may not be (fully) accessible to Ym Include only those amounts which,�p 'Cash value is defined as market value mftraa the cost of convating the asst to cash, such as broker's fees, settlenent costs, outstanding loam, early withdrawal penalties, eta. "Personal property held as an investment may include, but is not limited to, gem or coin collations. art, antique cars, etc. Do not include necessary personal property such as, but not necessarily limited to, household furniture, daily -use autos, clothing, assets of an active business, or special equipment for use by the disabled. 2. ❑ Within the past two (2) years, Uwe have sold or given away assets (including cash., real estate, etc.) for more than 51,000 below their fair market value (FMV). Those amounts $ arc included above and are equal to a total of S ($ the difference between FMV and the amount received, for each asset on which this occurred). 3. ❑ 1/we have ga sold or given, away assets (including cash, real estate, etc.) for less than fair market value during the past two (2) years. 4, ❑ I/we do not have any assets at this time: The net family assets (as deflaed in 24 CFR 813.102) above do not exceed S5000 and the annual income from the net family assets is S This amount is included in total gross annual income. Under penalty of perjury, liwe certify that the information presented in this certification is true and accurate to the best of myiour knowledge. The undersigned further understand(s) that providing false representations hcreim constitutes an act of fraud. False, misleading or incomplete information may result in the termination of a lease agreement. 4;splicant;Tenant Date Applicant Tcnant Date (Updated 12104