NORTH BROADWAY HOUSING PARTNERS LP (C/O OF JAMBOREE AND WISEPLACE)

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17. ❑ ❑ I have a savings account(s) If yes, list bank(s) % $ 2) % $ 18. ❑ ❑ 1 have an EBT, Debit Visa, MasterCard account(s). (Including Social Security wages, Unemployment, Public Assistance, Disability, Etc... ) If yes, list sources(s) of income being received/type of account(s) 1) $ 2) $ 3) $ 19. ❑ ❑ 1 have a revocable trust(s) If yes, list bank(s) 1) % $ 20. ❑ ❑ 1 own real estate. If yes, provide description: $ 21. ❑ ❑ I own stocks, bonds, or Treasury Bills If yes, list sources/bank names l) % $ 2) % $ 3) % $ 22. ❑ ❑ I have Certificates of Deposit (CD) or Money Market Account(s). If yes, list sourceebank names 1) % $ 2) % $ 3) % $ 23. ❑ ❑ I have an IRA/Lump Sum Pension/Keogh Account/401K. If yes, list bank(s) 1) % $ 2) % $ 24. 0 ❑ I have a whole life insurance policy. If yes, how many policies $ 25. ❑ ❑ 1 have cash on hand. 26. ❑ ❑ I have disposed of assets (i.e. gave away money/assets) for less than the fair market value in the past 2 years. If yes, list items and date disposed: 1) 2) STUDENT STATUS YES NO ❑ ❑ ❑ ❑ ❑ ❑ Does the household consist of all persons who are full-time students (Examples: K-12, College, Trade School, etc.)? Does the household consist of all persons who have been a full-time student 5 months in the current calendar year? Does your household anticipate becoming an all full-time student household in the next 12 months'? If you answered yes to any of the previous three questions are you: ❑ ❑ • Receiving assistance under Title IV of the Social Security Act (AFDC/TANF/Cal Works - not SSA/SSI) ❑ ❑ • Enrolled in ajob training program receiving assistance through the Job Training Participation Act (JTPA) or other Similar program ❑ ❑ • Married and filing (or are entitled to file) a joint tax return 0 ❑ • Single parent with a dependant child or children and neither you nor your child(ren) are dependent of another individual ❑ ❑ 1• Previously enrolled in the Foster Care program (currently age 18-24) UNDER PENALTIES OF PEW URY, I CERTIFY THAT THE INFORMATION PRESENTED ON THIS FORM IS TRUE AND ACCURATE TO THE BEST OF MY/OUR KNOWLEDGE. THE UNDERSIGNED FURTHER UNDERSTANDS THAT PROVIDING FALSE REPRESENTATIONS HEREIN CONSTITUES AN ACT OF FRAUD. FALSE, MISLEADING OR INCOMPLETE INFORMATION WILL RESULT IN THE DENIAL OFAPPLICATION OR TERMINATION OF THE LEASE AGREEMENT. PRINTED NAME OF APPLICANITFENANT SIGNATURE OF APPLICANT/TENANT DATE WITNESSED BY (SIGNATURE OF O WNER/REPRESENTATIvF.) Tenant Income Questionnaire (July 2018)