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<br />200809274 <br /> <br />REAL ESTATE VERIFICATION <br /> <br />~6lil968 <br /> <br /> <br />TO: <br /> <br />Name & Address <br /> <br />Phone Number <br /> <br />Fax Number <br /> <br />RE: <br /> <br />Applicant/Tenant Name <br /> <br />Social Security Number <br /> <br />Applicant/Tenant Name <br /> <br />Social Security Number <br /> <br />Unit # (if assigned) <br /> <br />I hereby authorize release of my real estate information. <br /> <br />Signature of Applicant/Tenant <br /> <br />Date <br /> <br />Sif,'llature of Applicant/Tenant <br /> <br />Date <br /> <br />The individual(s) named directly above is an applicant/tenant of a housing program that requires verification of income. The information provided will <br />remain contidential and will be used solely for the purpose of determining eligibility for occupancy. Your prompt response is crucial and greatly <br />appreciated. <br /> <br />Signature of Owner's Representative <br /> <br />Return Form To: <br /> <br /> <br />$ <br /> <br />Market Value: <br /> <br />$ <br /> <br />Cash Value"': <br /> <br />Average Assessment Ratio: <br /> <br />% <br /> <br />"'Cash Value is the current value less the cost to turn the asset into cash. <br /> <br />Please provide documentation of cost incurred in converting this asset to cash. <br /> <br />Additional Remarks: (please indicate any anticipated changes.) <br /> <br />Signature <br /> <br />Printed Name & Title <br /> <br />Date <br /> <br />Name and Address <br /> <br />Phone # <br /> <br />E-mail <br /> <br />Fax # <br /> <br />NOTE: Section 100 I of Title 18 of the U.S. Code makes it a criminal offense to make willful false statements or misrepresentations to any Department or Agency of the <br />United States as to any matter within its jurisdiction. (Updated 11107) <br />