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0 <br />COMMUNITIES <br />Income Verification for UNEMPLOYED Persons <br />I, have submitted an application to rent an <br />apartment at <br />nI itiai and complete if applicable <br />(a) I am not presently employed and do not anticipate becoming employed within the next twelve <br />months. <br />(b) I am not presently employed but anticipate becoming employed within the next twelve <br />months. <br />Based on my past work experience, skills, and Income history as reflected In my income tax <br />return for the most recent tax year (COPY ATTACHED) and with adjustment to reflect <br />circumstances anticipated within the next twelve months, <br />I expect to earn <br />per year when I become employed. <br />(c) I am receiving Unemployment Compensation benefits In the amount of $ <br />(Benefits —statemen Fat fached). <br />(d) I will be living off my savings of $ until employment Is found (Statement attached). <br />_ (e) I will be receiving support from (source) <br />in the amount of $ every (Letter of support attached or statement). <br />_ (f) Declaration of No Income <br />I, <br />, do hereby certify that I do NOT <br />receive income from ANY source. <br />I understand source of income includes, but is not <br />limited to the following: <br />Employment <br />AFDC <br />General Assistance <br />Unemployment <br />SSI <br />Disability <br />Compensation <br />Retirement Funds <br />Union Benefits <br />Workers Compensation <br />Alimony <br />Family Support <br />Study <br />Income from Assets <br />Annuities <br />Self Employment <br />Pensions <br />I certify that the foregoing information is true, complete and correct to the best of my knowledge. <br />Inquiries may be made to verify statements herein. I also understand that false statements or omissions <br />are grounds for dlsqualiflcation. <br />Applicant/Resident's Signature <br />12 -10 <br />19H -55 <br />Data <br />