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55394.00101\43724951.1 <br /> <br /> <br />Page 68 <br />Exhibit E <br /> <br />INCOME VERIFICATION FORM <br />If the total asset value exceeds $5,000, perform the calculations in the following table. If the total asset value <br />is less than $5,000, the amount of investment income to be included in annual household income is $0. <br />Calculation of Investment Income to be Included in Annual Household Income <br /> <br />1. Total Annual Household Investment Income $ <br />2. Total Asset Value $ x 10% $ <br /> <br />The Greater of #1 or #2 = Investment Income to be Included in Annual Household Income $___________ <br /> <br />Calculation of the Household’s Total Annual Income <br /> <br />Total Annual Household Gross Earned Income $ <br />Total Investment Income to be Included in Annual Household Income $ <br /> <br />Total Household Income $ <br /> <br />Documentation <br />Attach True Copies of the Relevant Documents Listed Below <br /> <br /> Paycheck stubs from three most recent <br />pay periods <br /> <br />Bank/Savings account verification <br /> <br />Employment verification <br /> <br />Self-employment verification <br /> Three years Income tax returns for Title <br />Holders <br /> <br />Unemployment verification <br /> <br />Social security verification <br /> <br />Welfare verification <br /> <br />Alimony/child support verification <br /> <br />Disability income verification <br /> <br />Other (Describe) <br /> <br /> <br />  <br />  <br />City Council 19 – 81 6/3/2025