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<br />200809274 <br /> <br />2\QIQl68 <br />SAFE DEPOSIT BOX VERIFICATION <br /> <br />Household Name: <br /> <br />Date: <br /> <br />Property Name: <br /> <br />Unit # (if assigned): <br /> <br />The contents of my Safe Deposit Box are as follows: <br />(Please specify what kind of papers and give specific details of other items in the box.) <br /> <br />ITEM <br /> <br />VALUE <br /> <br />Under penalty of perjury, I/we certify that the information presented in this certification is true and <br />accurate to the best of my knowledge. The undersigned further understand(s) that providing false <br />representation herein constitutes an act of fraud. False, misleading or incomplete information may result <br />in the termination of a lease agreement. <br /> <br />Signature of Applicant/Tenant <br /> <br />Date <br /> <br />Signature of Applicant/Tenant <br /> <br />Date <br /> <br />(Updated 11107) <br />