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<br />200809274 <br /> <br />216€l1D 68 <br />SELF CERTIFICATION FORM <br /> <br />Household Name: <br /> <br />Date: <br /> <br />Property Name: <br /> <br />Unit # (if assigned): <br /> <br />I, <br /> <br />, certify that: <br /> <br />Under penalty of perjury, I/we 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 Applicant/Tenant <br /> <br />Date <br /> <br />(Updated 11/07) <br />