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INCOME VERIFICATION FORM <br /> Assets ** <br /> List the Current Value of All Assets of All Household Members Living in the Affordable Unit <br /> If the Asset generates income, that income must be specified In Part 2 above <br /> Other Adult <br /> Head of Household <br /> Household Members Total Value of <br /> Value Value Assets <br /> 1. Bank and Savings accounts $ $ $ <br /> 2. Stocks and bonds $ $ $ <br /> 3. Real property (i.e. rental property) $ $ $ <br /> 4. Other(describe) $ $ $ <br /> Total Asset Value $ <br /> "Note: Necessary items, such as furniture and automobiles, used for personal use are excluded from <br /> household assets. Collections of items for hobby, investment or business purposes must be included in <br /> household assets. If the total value of household assets exceeds $5,000, the calculation of the household's <br /> annual income shall include the greater of the actual amount of income, if any, derived from all of the <br /> household assets; or 10% of the total value of the assets. <br /> Page 67 <br /> Exhibit E <br /> 5 5394.00101143423340.1 <br /> i <br /> i <br />