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Page 2: Income Certification Form <br />For Cornerstone Village, City 4f Santa Ana <br />Tenant Signatures EMPLOYER INFORMATION <br /># Tenant Signature Certifies Employer Name Address Phone # Name of Contact <br />Information provided is accurate. Providing Data <br />Not required for children under 18 s g <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br />Use these spaces or Supplemental Form <br />attached for additional employers. <br />Instructions for Completing Page I information. <br />(1) For reporting purposes, we need to have one person designated as head of household. If apartment is rented to un-related individuals or more <br />than one family, select one tenant's name and indicate relationship to that tenant for all other occupants. <br />(2) All income to be counted. Follow instructions from calculation guide in Exhibit H to ensure you have included all required income. <br />(3) For Income Verification indicate indicate one of the following: (a) obtained a pay stub for the most recent pay period, (b) obtained an income <br />tax return for the most recent tax year, (c) conducted a TRW credit or similar search, (d) obtained income verification from the applicant's or <br />tenant's current employer, (e) obtained an income verification form from the Social Security Administration and/or the California Department of <br />Social Services if the applicant receives assistance from either of such agencies, or (f) if the applicant is unemployed and/or has no such tax return, <br />obtained another form of independent verification of income and/or assets noted below. <br />If (f), indicate source of verification here: <br />I do hereby certify that the information provided above is accurate and in conformance with the Cornerstone Village <br />Owners Participation Agreement. <br />Owner's (Or Owner's Designee's) Signature <br />Exhibit Z: 2 of 11 <br />Date Signed <br />