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<br />200809274 <br /> <br />2W1B)J68 <br /> <br /> PART V. DETERMINATION OF INCOME KLlGlBILlTY <br />TOTAL ANNUAL HOUSEHOLD INCOME RECERTIFICATION ONLY: <br /> FROM ALL SOURCES: Household Meets Current Income Limit x 140%: <br /> from (L) on previous page I $ Income Restriction <br /> at; $ <br /> 060% 050% Household Income exceeds 140% at <br /> 040% 030% recertification: <br />Current Income Limit per Family Size: $ o % DYes oNo <br />Household Income at Move-in: $ Household Size at Move-in: - <br /> PART VI. RENT <br /> Tenant paid Rent $ Rent Assistance: $ <br /> Utility Allowance $ Other Nonoptional Charges: $ <br /> GROSS RENT FOR UNIT: I, I Unit Meets Rent Restriction at: <br />(Tenant paid rent plus Utility Allowance & 060% 050% 040% 030% 0_% <br /> other nonoptional charges) <br />Maximum Rent Limit for This Unit: $ <br /> PART VII. STUDENT STATUS <br /> .Student Explanation: <br />ARE ALL OCCUPANTS FULL-TIME STUDENTS? If yes, enter srudent explanation.. I AFDC/T ANF assistance <br />0 Yes 0 No (Also attach documentation.) 2 JTPA Program or equivalent <br /> 3 Single parent/dependent child <br /> 4 Married/Joint taX return <br /> Enter <br /> 1-4 <br /> PART VIII. PROGRAM TYPK <br />Mark the program(s) listed below (a. thm e.) for which this household's unit will be counted toward the property's occupancy requirements. <br />Under each program marked, indicate the household's income status as established by this certificationlrecertification. <br />a. Tax Credit 0 b. HOME 0 c. Tax Exempt 0 d. AHDP 0 e. - 0 <br /> (Name of Program) <br />See Part V above. Income Status Income Status Income Stall/S <br /> 0 5- 50% AMGI 0 50% AMGI 0 50% AMGI Income Statu.< <br /> 0 5- 60% AMGI 0 60'1. AMOI 0 80% AMGI 0 <br /> 0 5- 80% AMGI 0 80%AMGI 0 01 0 <br /> 0 01 0 01 .. <br /> 0 OJ" <br />"Upon recertification, household was determined over-income (01) according to eligibility requirements of the program(s) marked above. <br /> <br />SIGNATURE OF OWNER'S REPRESI<:NTATIVI<; <br /> <br />Based on the representations herein and upon the proofs and documentation required to be submitted, the individual(s) named in Part II of this Tenant Income Certitication <br />is/are eligible under the provisions of Section 42 of the Internal Revenue Code, as amended, and the Land Use Restriction Agreement (if applicable), to live in a unit in this <br />Project. <br /> <br />SIGNATURE OF OWNER'S REPRESENTATIVE <br /> <br />DATE <br /> <br />(Updated Il107) <br />