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17. I have a savings account(s) <br /> If yes, list bank(s) <br /> 1)________________________________ <br /> 2)________________________________ <br /> <br /> <br />_______% <br />_______% <br /> <br /> <br />$_____________ <br />$_____________ <br />18. I have an EBT, Debit Visa, MasterCard account(s). (Including Social <br />Security wages, Unemployment, Public Assistance, Disability, Etc…) <br /> If yes, list sources(s) of income being received/type of account(s) <br /> 1)________________________________ <br /> 2)________________________________ <br /> 3)________________________________ <br /> <br /> <br /> <br /> <br /> <br /> <br />$_____________ <br />$_____________ <br />$_____________ <br />19. I have a revocable trust(s) <br /> If yes, list bank(s) <br /> 1)_______________________________ <br /> <br /> <br />_______% <br /> <br /> <br />$_____________ <br />20. I own real estate. <br /> If yes, provide description: <br />_____________________________________________ <br /> <br />$____________ <br />21. I own stocks, bonds, or Treasury Bills <br /> If yes, list sources/bank names <br /> 1)_______________________________ <br /> 2)_______________________________ <br /> 3)_______________________________ <br /> <br /> <br />______% <br />______% <br />______% <br /> <br /> <br />$____________ <br />$____________ <br />$____________ <br />22. I have Certificates of Deposit (CD) or Money Market Account(s). <br /> If yes, list sources/bank names <br /> 1)_______________________________ <br /> 2)_______________________________ <br /> 3)_______________________________ <br /> <br /> <br />_______% <br />_______% <br />_______% <br /> <br /> <br />$____________ <br />$____________ <br />$____________ <br />23. I have an IRA/Lump Sum Pension/Keogh Account/401K. <br /> If yes, list bank(s) <br /> 1)_______________________________ <br /> 2)_______________________________ <br /> <br /> <br />_______% <br />_______% <br /> <br /> <br />$____________ <br />$____________ <br />24. I have a whole life insurance policy. <br /> If yes, how many policies __________ <br /> <br />$_____________ <br />25. I have cash on hand. <br /> <br />$_____________ <br />26. I have disposed of assets (i.e. gave away money/assets) for less than the <br />fair market value in the past 2 years. <br /> <br /> If yes, list items and date disposed: <br /> 1)_________________________________________ <br /> 2)_________________________________________ <br /> <br /> <br /> <br />$_____________ <br />$_____________ <br /> <br />STUDENT STATUS <br /> YES NO <br /> <br /> <br /> <br />Does the household consist of all persons who are full-time students (Examples: K-12, College, Trade School, etc.)? <br />Does the household consist of all persons who have been a full-time student 5 months in the current calendar year? <br />Does your household anticipate becoming an all full-time student household in the next 12 months? <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />If you answered yes to any of the previous three questions are you: <br />• Receiving assistance under Title IV of the Social Security Act (AFDC/TANF/Cal Works - not SSA/SSI) <br />• Enrolled in a job training program receiving assistance through the Job Training Participation Act (JTPA) or <br />other similar program <br />• Married and filing (or are entitled to file) a joint tax return <br />• Single parent with a dependant child or children and neither you nor your child(ren) are dependent of another <br />individual <br />• Previously enrolled in the Foster Care program (currently age 18-24) <br />UNDER PENALTIES OF PERJURY, I CERTIFY THAT THE INFORMATION PRESENTED ON THIS FORM IS TRUE AND ACCURATE TO THE BEST OF MY/OUR KNOWLEDGE. THE UNDERSIGNED FURTHER <br />UNDERSTANDS THAT PROVIDING FALSE REPRESENTATIONS HEREIN CONSTITUES AN ACT OF FRAUD. FALSE, MISLEADING OR INCOMPLETE INFORMATION WILL RESULT IN THE DENIAL OF APPLICATION <br />OR TERMINATION OF THE LEASE AGREEMENT. <br />_________________________________ ________________________________________ ______________________ <br />PRINTED NAME OF APPLICANT/TENANT SIGNATURE OF APPLICANT/TENANT DATE <br /> <br />_________________________________________________ _____________________ <br />WITNESSED BY (SIGNATURE OF OWNER/REPRESENTATIVE) DATE <br />Tenant Income Questionnaire (July 2018) <br />EXHIBIT 5