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201109462 PART V. DETERMINATION OF INCOME ELIGIBILITY TOTAL ANNUAL HOUSEHOLD INCOME RECERTIFICATION ONLY: FROM ALL SOURCES: Household Meets Current Income Limit x 140%: From(L)on previous page 1 $ Income Restriction at: $ ❑60% ❑50% Household Income exceeds l40%at ❑40% ❑30% recertitication: Current Income Limit per Family Size: $ ❑ "/o ❑Yes ❑No Household Income at Move-in: $ Household Size at Move-in: PART VL RENT Tenant paid Rent $ Rent Assistance: $ Utility Allowance $ Other Non-optional Charges: $ GROSS RENT FOR LTNIT: Unit Meets Rent Restriction at: (Tenant paid rent plus Utility Allowance& other non-optional charges) $ ❑60% ❑50% ❑40% ❑30% ❑ % Maximum Rent Limit for This Unit: $ PART VII. STUDENT STATUS "`Student Explanation: ARE ALL OCCUPANTS FULL-TIME STUDENTS? If yes,enter student explanation.* 1 AFDC/TANF assistance ❑ Yes ❑ No (Also attach documentation.) 2 JTPA Program or equivalent 3 Single parent/dependent child 4 Mamed/Joint tax return 5 Foster Care Enter I-5 PART VIIL PROGRAM TYPE Mark the program(s)listed below(a.thru e.)for which this household's unit will be counted toward the property's occupancy requirements. Under each program marked,indicate the household's income status as established by this ceRification/recertification. a. Tax Credit ❑ b. HOME ❑ c. Tax Exempt ❑ d. AHDP ❑ e. ❑ (Name ofProgram) See Part V above. Ir�come Stotus /ncome Status Income Status ❑ < 50%AMGI ❑ 50%AMGI ❑ 50%AMGI /ncome Status ❑ < 60%AMGI ❑ 60%AMGI ❑ 80%AMGI ❑ ❑ < 80%AMGI ❑ 80%AMGI ❑ �I�� ❑ � p]"' ❑ OI�' ❑ OI'. ��Upon recertification,household was determined over-income(OI)according to eligibility requirements of the program(s)marked above. SIGNATURE OF OWNER'S REPRESENTATIVE Based on the representations herein and upon the proofs and documentation required to be submitted,the individual(s)named in Part 11 of this Tenant Income Certification is/are eligible under the provisions of Section 42 of the Internal Revenue Code,as amended,and the Land Use Restriction Agreement(if applicable),to live in a unit in this Projec[. S[GNATURE OF OWNER'S REPRESENTATIVE DATE (Updated 12/10)