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201109462 <br /> SAFE DEPOSIT BOX VERIFICATION <br /> Household Name: Date: <br /> Property Name: Unit#(if assigned): <br /> The contents of my Safe Deposit Box are as follows: <br /> (Please specify what kind of papers and give specific details of other items in the box.) <br /> ITEl�f VALUE <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 ApplicanUTenant Date <br /> Signature of Applicant/Tenant Date <br /> (Updated 12/10) <br />