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NO INCOME CERTIFICATION FOR <br />HOUSEHOLD MEMBER <br />b (NAME) certify that as of <br />(DATE), I am not receiving any type of Income Including, but not <br />limited to, wages and salaries, overtime pay, commissions, fees, tips, bonuses, or any <br />other compensation for personal services, net income from the operation of a business <br />or profession, dividends or interest, net Income from any kind of real or personal <br />property, Social Security, annuities, retirement funds, pensions, death or disability <br />benefits, unemployment or disability compensation, workers compensation, severance <br />pay, welfare or other public assistance, alimony, or child support. <br />By this Certification, I declare under penalty of perjury that all of the foregoing <br />Information is true and correct. Misrepresentation or misstatement may be a violation <br />of law that could result in a fine, criminal penalty or a default on the Incluslonary <br />Housing Regulatory Agreement made in conjunction with the rental of this Inclusionary <br />Unit. <br />Signature <br />Print Name <br />Date <br />Administrative Procedures Manual Page 1 <br />Rental Residentlal DoVelapment April 27, 2023 <br />