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Tenant Income Certification (April 2021)4 <br />INSTRUCTIONS FOR COMPLETING <br />TENANT INCOME CERTIFICATION <br />This form is to be completed by the owner or an authorized representative. <br />Part I - Development Data <br />Enter the type of tenant certification: Initial Certification (move-in), Recertification (annual recertification), or Other. If other, designate the purpose <br />of the recertification (i.e., a unit transfer, a change in household composition, or other state-required recertification). <br />Effective Date Enter the effective date of the certification. For move-in, this should be the move-in date. <br />For annual income recertification’s, this effective date should be no later than one year <br />from the effective date of the previous (re)certification. <br />Move-In Date Enter the most recent date the household tax credit qualified. This could be the move-in <br />date or in an acquisition rehab property, this is not the date the tenant moved into the <br />unit, it is the most recent date the management company income qualified the unit for <br />tax credit purposes. <br />Property Name Enter the name of the development. <br />County <br />TCAC# <br />Enter the county (or equivalent) in which the building is located. <br />Enter the project number assigned to the property by TCAC. Please include hyphens <br />between the state abbreviation, four digit allocating year, and project specific number. <br />For example: CA-2010-123 <br />BIN # Enter the building number assigned to the building (from IRS Form 8609). <br />Address Enter the physical address of the building, including street number and name, city, state, <br />and zip code. <br />If applicable, CDLAC# If project is awarded 4% bonds please enter the project number assigned to the property <br />by CDLAC. Please include hyphens between the state abbreviation, four digit allocating <br />year, and project specific number. For example: 16-436 <br />Unit Number Enter the unit number. <br /># Bedrooms <br />Square Footage <br />Vacant Unit <br />Enter the number of bedrooms in the unit. <br />Enter the square footage for the entire unit. <br />Check if unit was vacant on December 31 of requesting year. For example, for the <br />collection of 2011 data, this would refer to December 31, 2011. <br />Part II - Household Composition <br />List all occupants of the unit. State each household member’s relationship to the head of household by using one of the foll owing definitions: <br />H Head of Household S Spouse U Unborn Child/Anticipated <br />A Adult Co-Tenant O Other Family Member Adoption or Foster <br />C Child F Foster child(ren)/adult(s) <br />L Live-in Caretaker N None of the above <br />Date of Birth <br />Student Status <br />Last Four Digits of Social Security <br />Number <br />Enter each household member’s date of birth. <br />Check FT for Full-time student, PT for Part-time student, or N/A if household member <br />is not a student and question does not apply. <br />For each tenant 15 years of age or older, enter the last four digits of the social security <br />number or the last four digits of the alien registration number. If the last four digits of <br />SSN or alien registration is missing, enter 0000. For tenants under age 15, social security <br />number not required, although please enter 0000. <br />If there are more than 7 occupants, use an additional sheet of paper to list the remaining household members and attach it to the certification. <br />EXHIBIT 5