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Head of Household (Print Name): <br />Address: <br />Telephone Number: Home: <br />Date of Birth: <br />EXHIBIT "B" <br />INCOME VERIFICATION FORM <br />Work: <br />Social Security #: <br />Cell: <br />Household Composition <br />List All Household Members Living in the Inclusionary Unit <br />Name <br />Sex <br />Age <br />Dependent <br />(Y/N) <br />Social Security # <br />List additional household members on a separate sheet of paper. <br />Income Verification Form Page 1 <br />Santa Ana, California <br />