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Affordable Unit Address: <br />Head of Household (Print Name): <br />Current Address (if <br />different from above): <br />Telephone Number: Home: <br />Email address: <br />Date of Birth: <br />EXHIBIT E <br />INCOME VERIFICATION FORM <br />Work: <br />Social Security # or TIN: <br />Household Composition <br />List All Household Members Living in the Affordable Unit <br />Cell: <br />Dependent Social Security # <br />Name Sex Age (Y/N) or Taxpayer ID # <br />List additional household members on a separate sheet of paper. <br />Page 64 <br />Exhibit E <br />55394.00101 \43423340.1 <br />