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201109462 <br /> DISPOSAL OF ASSETS CERTIFICATION <br /> Household Name: Date: <br /> Property Name: Unit#(if assigned): <br /> I, hereby certify that during the two year(24 month)period <br /> preceding the effective date of my certification or recertification of eligibility for tax credit housing <br /> participation,I have disposed of the following asset(s)as identified below: (i.e.,real estate, financial gifts, <br /> etc.) <br /> A B C D <br /> ASSET CASH VALUE* DATE DISPOSED ACTUAL AMOUNT <br /> RECEIVED <br /> If you state in column D that you received money, where is the money now?(Please provide appropriate <br /> documentation, if applicable) <br /> * CASH VALUE is the market value of the asset minus reasonable costs incurred in selling converting <br /> the asset to cash. Such reasonable costs include: <br /> 1. Penalties of withdrawing funds before maturity. <br /> 2. Broker/legal fees for the sale or conversion of assets. <br /> 3. Settlement costs for real estate transaction. <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 /> Signature of Applicant/Tenant Date <br /> (Updated 12/10) <br />