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SAVINGS BONDS VERIFICATION 201109462 � ��`,,THIS SECTIC?N T4'BE'COIu1PLE'T�D BY T'�N�� A:ND EXEGUTED B�M?iNA,1GEMENT .. ��.,,., ��.: +v.�:�. A , �.st. , - q, e � ;., �4 ��':.�� TO: Name&Address of Financial Institution Phone Number Fax Number RE: ApplicanUTenant Name Social Security Number Unit#(if assigned) I hereby authorize release of my asset information. Signature of ApplicanUTenant Date 'I'he individual named directly above is an applicanUtenant 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 Tv: '- �...., . � a�, �k. � � - � < THiS SECT`ItJN:TO B�GQMPLE'fED BI',�.FTN�F�TAL iNSTI'TU'T'ION c ";,� �# ��- Bond Serial Number: Denomination: $ Series: ❑EE Bond ❑I Bond ❑E Bond ❑ Savings Notes Issue Date: Final Maturity: Interest Rate: % Value of Bond: $ Note: ❑Not Issued ❑Not eligible for payment ❑Includes 3 month interest penalty ❑Matured and not earning interest Additional Remarks: (please indicate any anticipated changes.) Signature Printed Name&Tide Date Bank Name and Address Phone# Fax# E-mail NOTE: Section 1001 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/]0)