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<br />20 VOJIj 8 <br /> <br />HOME OWNER I REAL ESTATE CERTIFICATION <br /> <br />200809274 <br /> <br />Household Name: <br /> <br />Date: <br /> <br />Property Name: <br /> <br />Unit # (if assigned): <br /> <br />Do you currently own 100% of the Real Estate Property? <br /> <br />DYes <br /> <br />DNo <br /> <br />Ifnot, what percentage do you own: % <br />(Please provide appropriate documentation supporting this percentage) <br /> <br />Address of real estate propcrty: <br /> <br />Do you rent or are you anticipating renting this property in the next 12 months? D Yes <br /> <br />DNo <br /> <br />If yes, currently/anticipating renting property for $ <br />(Please provide rcntal documentation, if applicable) <br /> <br />per month or $ <br /> <br />per year <br /> <br />Is this property under a land contract financed by the applicant/tenant? <br />(Please provide the appropriate documentation) <br /> <br />DYes <br /> <br />DNo <br /> <br />Please provide documentation of fair market value and any costs to convert this asset to cash. <br /> <br />Please note: If the property has already been sold, please provide settlement statement, land contract or purchase <br />agreement and if applicable, amortization schedule. <br /> <br />Additional remarks <br /> <br />Under penalty of perjury, I1we certify that the information presented in this certification is true and accurate to the <br />best of my knowledge. The undersigned further understand(s) that providing false representation herein constitutes <br />an act of fraud. False, misleading or incomplete information may result in the termination of a lease agreement. <br /> <br />Signature of ApplicantlTenant <br /> <br />Date <br /> <br />Signature of Applicant/Tenant <br /> <br />Date <br /> <br />(Updated 11/(7) <br />