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Tenant Income Certification (April 2021)2 <br />PART V. DETERMINATION OF INCOME ELIGIBILITY <br />RECERTIFICATION ONLY: <br />TOTAL ANNUAL HOUSEHOLD <br />INCOME FROM ALL SOURCES: <br />From item (L) on page 1 $ <br />Unit Meets Federal <br />Income Restriction at: <br />60%  50% <br />Current Federal LIHTC <br />Income Limit x 140%: <br />$ <br /> If Applicable, Current Federal Bond <br />Income Limit per Family Size: <br /> Household Income as of Move-in: <br />Or Federal A.I.T. at: <br />80%  70%  60%  50% <br />40%  30%  20% <br />Unit Meets State Deeper <br />Targeting Income Restriction <br />at: <br />Other ______% <br />Household Income exceeds <br />140% at recertification: <br />Yes  No <br />$ <br />$ <br />Household Size at Move-in: <br />PART VI. RENT <br />Tenant Paid Monthly Rent: $ Federal Rent Assistance: $____________ *Source: ______ <br /> Monthly Utility Allowance: <br /> Other Monthly Non-optional charges: <br />$ Non-Federal Rent Assistance: $____________ (*0-8) <br />Total Monthly Rent Assistance: $____________ $ <br />GROSS MONTHLY RENT FOR UNIT: <br />(Tenant paid rent plus Utility Allowance & <br />other non-optional charges) $ <br />*Source of Federal Assistance <br />1 **HUD Multi-Family Project Based Rental Assistance (PBRA) <br />2 Section 8 Moderate Rehabilitation <br />3 Public Housing Operating Subsidy <br />4 HOME Rental Assistance <br />5 HUD Housing Choice Voucher (HCV), tenant-based <br />6 HUD Project-Based Voucher (PBV) <br />7 USDA Section 521 Rental Assistance Program <br />8 Other Federal Rental Assistance <br />0 Missing <br />** (PBRA) Includes: Section 8 New Construction/Substantial Rehabilitation; <br />Section 8 Loan Management; Section 8 Property Disposition; Section 202 <br />Project Rental Assistance Contracts (PRAC) <br />Maximum Federal LIHTC Rent Limit for <br />this unit: $ <br />If Applicable, Maximum Federal & State <br />LIHTC Bond Rent Limit for this unit: <br /> Unit Meets Federal Rent Restriction at: <br />Or Federal A.I.T. at: <br />If Applicable, Unit Meets Bond Rent <br />Restriction at: <br />Unit Meets State Deeper <br />Targeting Rent Restriction at: <br />$ <br />60%  50% <br />80%  70%  60% <br />50%  40%  30% <br />20% <br />60%50% <br />Other: ________% <br />PART VII. STUDENT STATUS <br />*Student Explanation: <br />ARE ALL OCCUPANTS FULL TIME STUDENTS? If yes, Enter student explanation* 1 AFDC / TANF Assistance <br /> (also attach documentation) 2 Job Training Program <br />Yes No 3 Single Parent/Dependent Child <br />Enter <br />1-5 <br />4 Married/Joint Return <br />5 Former Foster Care <br />PART VIII. PROGRAM TYPE <br />Identify the program(s) for which this household’s unit will be counted toward the property’s occupancy requirements. <br />Select one of the following. <br />9% Allocated Federal Housing Tax Credit <br />4% Allocated Federal Housing Tax Credit <br />Tax-Exempt Bond Only (No tax credits) <br />Select all that apply. <br />HOME (including TCAP) <br />CDBG <br />Other HUD, including 202, 811, and 236 <br />National Housing Trust Fund <br />USDA Rural Housing Service, including 514, 515, and 538 <br />Other state or local housing programs <br />SIGNATURE OF OWNER/REPRESENTATIVE <br />Based on the representations herein and upon the proof and documentation required to be submitted, the individual(s) named in Part II of this Tenant <br />Income Certification is/are eligible under the provisions of Section 42 of the Internal Revenue Code, as amended, and the Lan d Use Restriction <br />Agreement (if applicable), to live in a unit in this Project. <br />SIGNATURE OF OWNER/REPRESENTATIVE DATE <br />Current Federal LIHTC Income Limit per <br />Family Size (Federal Income Restriction at <br />60%, 50% or A.I.T. (20% - 80%)):$ <br />EXHIBIT 5