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TENANT INCOME CERTIFICATION - TBRA <br /> Property Name/Address : Effective Date <br /> Unit # # Bedrooms : County <br /> HOUSEHOLD COMPOSITION <br /> HH Name Sex Relationship DOB Head of Occupation of Social Security # <br /> # Household Head <br /> Code <br /> 1 HEAD <br /> 2 <br /> 3 <br /> 4 <br /> 5 <br /> 6 <br /> HH of Household Codes : 1 — Single/non -Elderly 2 — Elderly 3 — Related/Single Parent 4 — Related/Parent 5 - Other <br /> ANNUAL INCOME (USE ANNUAL AMOUNTS) <br /> HH (A) (B) (C) (D) <br /> # Wages/Salaries Benefits/Pensions Public Assistance Assets/Other Income <br /> Totals <br /> (E) Gross Annual Income <br /> HOUSEHOLD CERTIFICATION <br /> I/We certify that the information on this form is true and complete to the best of my/our knowledge and belief. I/We consent to the disclosure of such <br /> information to the <br /> Federal or State agency with oversight of the program(s), and to the Florida Housing Finance Corporation in its capacity to monitor the <br /> property ' s compliance with <br /> applicable program requirements. <br /> Signature of Lessee (Date) Signature of Lessee (Date) <br /> Signature of Lessee (Date) Signature of Lessee (Date) <br /> Unit # : <br /> Household Name : <br /> Gross Annual Income : (from line E) <br /> Current income limit : <br /> WARNING : Section 1001 of Title 18 of the U .S . Code makes it a criminal offense to willfully falsify a material fact or make <br /> a false statement in any matter <br /> within the jurisdiction of a federal agency. <br /> Florida Housing Finance Corporation Page I Attachment A , Exhibit 2 (Rev . 09/05 ) <br />