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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 of <br />(i) the amount entered in 3(b) less the amount entered in 3(c) or (ii) 10% of the amount entered <br />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 area <br />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 ANY <br />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 STREET APARTMENTS, LLC <br />By: <br />Its: <br />F-12 <br />EL185-70-769416.d7 <br />