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INCOME VERIFICATION FORM <br />If the total asset value exceeds $5,000, perform the calculations in the following table. If the total asset value <br />is less than $5,000, the amount of investment income to be included in annual household income is $0. <br />Calculation of Investment Income to be Included in Annual Household Income <br />1. <br />Total Annual Household Investment Income <br />$ <br />2. <br />Total Asset Value <br />$ <br />x 10% <br />$ <br />The Greater of #1 or #2 = Investment Income to be Included in Annual Household Income $ <br />Calculation of the Household's Total Annual Income <br />Total Annual Household Gross Earned Income 1 $ <br />Total Investment Income to be Included in Annual Household Income 1 $ <br />Total Household Income 1 $ <br />Documentation <br />Attach True Copies of the Relevant Documents Listed Below <br />Paycheck stubs from three most recent <br />pay periods <br />Employment verification <br />Three years Income tax returns for Title <br />Holders <br />Social security verification <br />Alimony/child support verification <br />Other (Describe) <br />Bank/Savings account verification <br />Self-employment verification <br />Unemployment verification <br />Welfare verification <br />Disability income verification <br />Page 68 <br />Exhibit E <br />55394.00101\43721567.2 <br />