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55394.00101\43724951.1 <br /> <br /> <br />Page 64 <br />Exhibit E <br /> <br />EXHIBIT E <br />INCOME VERIFICATION FORM <br />Affordable Unit Address: ________________________________________________________________ <br />Head of Household (Print Name): <br /> <br />Current Address (if <br />different from above): <br /> <br /> <br />Telephone Number: Home: Work: Cell: <br />Email address: <br /> <br />Date of Birth: Social Security # or TIN: <br /> <br />Household Composition <br /> <br />List All Household Members Living in the Affordable Unit <br /> <br />Name Sex Age <br />Dependent <br />(Y/N) <br />Social Security # <br />or Taxpayer ID # <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />List additional household members on a separate sheet of paper. <br /> <br />  <br />  <br />City Council 19 – 77 6/3/2025