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201109462 <br /> SELF CERTIFICATION FORM <br /> Household Name: Date: <br /> Property Name: Unit#(if assigned): <br /> I, , certify that: <br /> � <br /> Under penalty of perjury,I/we certify that the information presented in this certification is true and accurate to the <br /> best of my knowledge. The undersigned further understand(s)that providing false representation herein constitutes <br /> an act of fraud. False,misleading or incomplete information may result in the termination of a lease agreement. <br /> Signature of ApplicanUTenant Date <br /> (Updated 12/10) <br />