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TO: <br />tit: -4i <br />Name Be Addrou <br />Applice et/T enant Name <br />Apphpaut(fenaatName <br />I hereby authorize repose of my user infomuNon <br />Sigwtlure of Applicant/Teuant <br />gignatuse ofAppHcant/Tcnant <br />GENERAL ASSET VERIFICATION <br />Unit M kil'aseignad) <br />Social Security Number <br />Soaid Security Number <br />Data <br />Date <br />200512606 <br />Th. individual(a) tweed directly above is an applicrntlitanank of a hons�g program that reclutr °a verification of income. The infmmmtion provided will remain confidential <br />amt will be used solely for the purpose of detataniming eliprl city for occupancy. Your pro mptresponaa is t xucdal and greatly appntaalad <br />projeatOwnorlManagemont Agent <br />Return Form To: <br />1. Type of Asset (s) (e.g; Stocks, $ ands, Mated Fund+. UL44 Life lnsuranca) <br />Validafion Date <br />2. Life Insurance: Whole life YES 0 NO <br />Term Life YES ❑ NO <br />s <br />3. Current Asset Cash/Surrender Value: <br />S <br />4. Face Value (Market Value): <br />Owned: at Z � Per unit <br />S. NwnberofUnits: (e.g.skaras) <br />$ <br />6. ckoss Anneal Dividends/Int —A Rate: <br />(If varies, ploaae use average dividands/interestrate, or the rate at the close ofbusiness yesterday) <br />7. Costs incurred to Sell the asset <br />YES © VO ❑ <br />K. Do they have access to this account: YES ❑ NO <br />9, Currently `Nithdnwing on this account' <br />10. Amount ofAnnaityPaYment <br />11. Real F4tate: Cash Value: 5 <br />$ipaturc <br />,'4,; ac H <br />YES 0 v0 Cl Amount S <br />Market Value (Assessed or Apptwsed Value) $ _ <br />A,c,, -age Assessment Rnun <br />Printed \ame &c Tide irate <br />and ASdre.cE <br />r aX ;i <br />0 <br />W:�Sc pan . C!) l a'Titie 1;a of t: c t: 3 Cc& makes it a criminal offense o:, ", Kc wii', fur raise taterncres or r : reNreticn:ncons w any G'cpurimen: ��, ed ;2',t 3;c <br />...,Lwfw:aunits } atisd: uan. <br />