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201109462 HOME OWNER/REAL ESTATE CERTIFICATION Household Name: Date: Property Name: Unit#(if assigned): Do you currently own 100%of the Real Estate Property? ❑Yes ❑No If not,what percentage do you own: % (Please provide appropriate documentation supporting this percentagel Address of real estate property: Do you rent or are you anticipating renting this property in the next 12 months? ❑ Yes ❑No If yes,currently/anticipating renting property for $ per month or $ per year (Please provide rental documentation,if applicable) Is this property under a land contract financed by the applicant/tenant? ❑ Yes ❑No (Please provide the appropriate documentation) Please provide documentation of fair market value and any costs to convert this asset to cash. Please note: If the property has already been sold,please provide settlement statement, land contract or purchase agreement and if applicable, amortization schedule. Additional remarks Under penalty of perjury,I/we certify that the information presented in this certification is true and accurate to the best of my knowledge. The undersigned further understand(s)that providing false representation herein constitutes an act of fraud. False,misleading or incomplete information may result in the termination of a lease agreement. Signature of ApplicanUTenant Date Signature of Applicant/Tenant Date (Updatcd 12/10)