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BANK VERIFICATION 201109462 ��- - _ _: . ,.., _ _ k. f .. THIS SECTIOAT TO BE GC)MPLETED;:BY�TENANT.AND'EXECUTED BY MANAGEMENT ,, � . � _ ,.. � ,,�w�, TO: Name&Address of Financial Institution Phone Number Fax Number RE: ApplicanUTenant Name Social Security Number ApplicanUTenant Name Social Security Number Unit#(if assigned) I hereby authorize release of my asset information. Signature of Applicant/Tenant Date Signature of ApplicandTenant Date The individual named directly above is an applicandtenant of a housing program that requires verification of income.The information provided will remain confidential and will be used solely for the purpose of determining eligibility for occupancy.Your prompt response is crucial and greatly appreciated. Signature of Owner's Representative Return Form To: Po�� `i'HIS SECTtON TO BE COMPLET`�D,BY FII�AN�TAL INS�'+TTUTIQN ��' "�"', �:�� :� :� �, €: '��,�' ,.,,�:,s SAVINGS ACCOUNT: SAVINGS ACCOUNT: Acct#: Acct#: Current Balance$ Current Balance$ Cunent%Rate Current%Rate CHECKING ACCOUNT: CHECKING ACCOUNT: Acct#: Acct#: Average Balance for the Past Six Months:$ Average Balance for the Past Six Months:$ Cunent Balance: $ Current Balance: $ Rate of Interest: % Rate of Interest: % Please list other asset accounts below(Certificates of Deposit,Money Market Accounts,etc.) Account Type of Rate of Number Balance Account Interest Cash Value* $ % � $ % $ $ % � *NOTE:CASH VALUE IS THE CURRENT VALUE MINUS ANY PENALTIES FOR EARLY WITHDRAWAL. Signature Printed Name&Tide Date Bank Name and Address Phone# Fax# E-mail NOTE: Section]001 of Tide 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 United States as to any matter within its jurisdiction. (Updated 12/10)