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FOR COMPLETION BY OWNER <br />(OR ITS MANAGER) ONLY <br />1. Calculation of Eligible Tenant Income: <br />(a) Enter amount entered for entire household in 2 above: $ <br />(b) If the amount entered in 3(a) above is greater than $5,000, enter the greater <br />of (i) the amount entered in 3(b) less the amount entered in 3(c) or (ii) 10% of the amount <br />entered in 3(a): $ <br />(c) TOTAL ELIGIBLE INCOME (Line 1(a) plus Line 1(b)): $ <br />2. The amount entered in 1(c) is less than or equal to 50% of median income for the <br />area in which the Project is located, as defined in the Declaration. 50% is necessary for status as a <br />"Qualifying Tenant" under Section 3(a) of the Declaration. <br />3. Number of apartment unit assigned: <br />4. This apartment unit was —was not last occupied for a period of at least <br />31 consecutive days by persons whose aggregate anticipated annual income as certified in the above <br />manner upon their initial occupancy of the apartment unit was less than or equal to 50% of Median <br />Income in the area. <br />5. Check as applicable: Applicant qualifies as a Qualifying Tenant (tenants of <br />at least _ units must meet), or_ Applicant otherwise qualifies to rent a unit. <br />THE UNDERSIGNED HEREBY CERTIFIES THAT HE/SHE HAS NO KNOWLEDGE OF <br />ANY FACTS WHICH WOULD CAUSE HIM/HER TO BELIEVE THAT ANY OF THE <br />INFORMATION PROVIDED BY THE TENANT MAY BE UNTRUE OR INCORRECT. <br />JACKSON HILLS RESIDENTIAL SUITES, <br />LLC <br />By: <br />Its: �lf�(� /YJ.pti/s�� �p <br />F-12 <br />5193948 JSB EL185-49 <br />