Item 62 - Pre-Commitment of Affordable Housing Funds for Jamboree Housing Corporation and WISEPlace

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Tenant Income Certification (April 2021)3 PART IX. SUPPLEMENTAL INFORMATION FORM The California Tax Credit Allocation Committee (CTCAC) requests the following information in order to comply with the Housing and Economic Recovery Act (HERA) of 2008, which requires all Low Income Housing Tax Credit (LIHTC) properties to collect and submit to the U.S. Department of Housing and Urban Development (HUD), certain demographic and economic information on tenants residing in LIHTC financed properties. Although the CTCAC would appreciate receiving this information, you may choose not to furnish it. You will not be discriminated against on the basis of this information, or on whether or not you choose to furnis h it. If you do not wish to furnish this information, please check the box at the bottom of the page and initial . Enter both Ethnicity and Race codes for each household member (see below for codes). TENANT DEMOGRAPHIC PROFILE HH Mbr # Last Name First Name Middle Initial Race Ethnicity Disabled 1 2 3 4 5 6 7 The Following Race Codes should be used: 1 – White – A person having origins in any of the original people of Europe, the Middle East or North Africa. 2 – Black/African American – A person having origins in any of the black racial groups of Africa. Terms such as “Haitian” apply to this category. 3 – American Indian/Alaska Native – A person having origins in any of the original peoples of North and South America (including Central America), and who maintain tribal affiliation or community attachment. 4 – Asian – A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent: 4a – Asian India 4e – Korean 4b – Chinese 4f – Vietnamese 4c – Filipino 4g – Other Asian 4d – Japanese 5 – Native Hawaiian/Other Pacific Islander – A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands: 5a – Native Hawaiian 5c – Samoan 5b – Guamanian or Chamorro 5d – Other Pacific Islander 6 – Other 7 – Did not respond. (Please initial below) Note: Multiple racial categories may be indicated as such: 31 – American Indian/Alaska Native & White, 41 – Asian & White, etc. The Following Ethnicity Codes should be used: 1 – Hispanic – A person of Cuban, Mexican, Puerto Rican, South or Central American, or other Spanish culture or origin, regardless of race. Terms such as “Latino” or “Spanish Origin” apply to this category. 2 – Not Hispanic – A person not of Cuban, Mexican, Puerto Rican, South or Central American, o r other Spanish culture or origin, regardless of race. 3 – Did not respond. (Please initial below) Disability Status: 1 – Yes If any member of the household is disabled according to Fair Housing Act definition for handicap (disability): •A physical or mental impairment which substantially limits one or more major life activities; a record of such an impairment or being regarded as having such an impairment. For a definition of “physical or mental impairment” and other terms used, please see 24 CFR 100.201, available at http://fairhousing.com/legal-research/hud-regulations/24-cfr-100201-definitions. •“Handicap” does not include current, illegal use of or addiction to a controlled substance. •An individual shall not be considered to have a handicap solely because that individual is a transgender. 2 – No 3 – Did not respond (Please initial below) Resident/Applicant: I do not wish to furnish information regarding ethnicity, race and other household composition. (Initials) __________ __________ _________ __________ __________ __________ __________ (HH#) 1. 2. 3. 4. 5. 6. 7. EXHIBIT 5