HUMPHRIES, VALERIE R. - Laserfiche WebLink

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(h) the value of coupon allotments for the purchase of food pursuant to the Food Stamp Act of 1977; (i) payments to volunteers under the Domestic Volunteer Service Act of 1973; (j) payments received under the Alaska Native Claims Settlement Act; (k) income derived from certain sub -marginal land of the United States that is held in trust for certain Indian tribes; (1) payments or allowances made under the Department of Health and Human Services' Low -Income Home Energy Assistance Program;. (m) payments received from the Job Training Partnership Act; (n) income derived from the disposition of funds of the Grand River Band of Ottawa Indians; and (o) the first $2,000.00 of per capita shares received from judgment funds awarded by -the Indian Claims Commission or the Court of Claims. 3. Additional Income to be included. (Follow instructions to determine amount.) Do any of the persons whose income or contributions that are included as part of the income calculations from above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necessary items of personal property such as furniture and automobiles and interests in Indian trust land); _Yes —No or (b) disposed of any assets (other than at a foreclosure or bankruptcy sale) during the last two years at less than fair market value? _Yes No (c) If the answer to (a) or (b) above is yes, does the combined total value of all such assets owned or disposed of by all such persons (include total for all persons over 18 years old in the household) total more than $5,000 Yes No (d) If the answer to (c) above is yes, then the highest amount derived from the following calculations must be added to the income being reported. Calculation method #1: (1) Take the amount of income expected to be derived from such assets in the 12 month period beginning on the date of initial occupancy in the unit that you propose to rent. (2) Subtract from this number, the amount of such income, if any, that is being included from item 1 (Income to be included as anticipated income for reporting purposes) above. Calculation method #2 (1) Multiply the amount of income expected to be derived from such assets in the 12 month period beginning on the date of initial occupancy in the unit that you propose to rent by the current passbook savings rate to determine what the total annual earnings on that amount Exhibit I: 6 of 11