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TENANT INFORMATION FORM <br />Account Holder <br />Attach Additional Sheets if Necessary <br />If any child or foster child under age six residing in the assisted unit tested positive for an EBL (Elevated Blood Lead Level) <br />list the first name of each child with an EBL here: <br />Have you or any member of your household been convicted of drug-related criminal activity for manufacture <br />or production of methamphetamine on the premises of federally assisted housing?NoYes <br />Are you or any member of your household subject to a lifetime sex offender registration under a State sex <br />offender registration program?NoYes6. <br />1. <br />4. <br />5. <br />Does your family lack a regular nighttime residence, live in a shelter, or other non residential place?NoYes <br />Do you currently live or have you previously lived in, public housing, housing assisted by the Section 8 <br />program, or any other type of federally subsidized housing?NoYes <br />1. <br />Have you or any member of your household been evicted from Public housing, Indian housing, Section 23 <br />housing, or housing assisted by the Section 8 program, for drug-related criminal activity during the past three <br />years? <br />NoYes <br />Do you or any member of your household have a history of controlled substance or alcohol abuse that has <br />not been abated through rehabilitation? <br />NoYes <br />2. <br />3. <br />Part 1: Household (Continued) <br />Part 2: Asset Information <br />Type of Account Account Number Current Balance <br />$ <br />Verification Source Name and Address Documentation Attached <br />NoYes <br />Account Holder Type of Account Account Number Current Balance <br />$ <br />Verification Source Name and Address Documentation Attached <br />NoYes <br />Account Holder Type of Account Account Number Current Balance <br />$ <br />Verification Source Name and Address Documentation Attached <br />NoYes <br />Account Holder Type of Account Account Number Current Balance <br />$ <br />Verification Source Name and Address Documentation Attached <br />NoYes <br />Account Holder Type of Account Account Number Current Balance <br />$ <br />Verification Source Name and Address Documentation Attached <br />NoYes <br />Review and update household assets held by any family member, irrespective of age. Add new assets in the space provided below. <br />An asset is any one of the following types without limitation: <br />401(k) or 403(b) <br />Bonds <br />Certificate of Deposit <br />Checking Account <br />Individual Retirement Accounts (IRA) <br />Inheritances <br />Life Insurance Policies <br />Money Market Account <br />Mutual Funds <br />Pensions <br />Real Property (land) <br />Savings Account <br />Stocks <br />Trust Funds <br />Has any member of the family given away or disposed of assets valued at more than $1,000 for <br />less than fair market value during the past two years?Yes No <br />Account Status <br />ClosedOpen <br />Account Status <br />ClosedOpen <br />Account Status <br />ClosedOpen <br />Account Status <br />ClosedOpen <br />Account Status <br />ClosedOpen <br />DOCUMENTATION REQUIRED:Provide 3 current statements showing the value and interest rate of each asset and check the <br />Documentation Attached box for each asset. <br />7. <br />Page 9 of 29 <br />EXHIBIT 2