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EXHIBIT “B” <br /> Income Verification Form Page 1 <br />Santa Ana, California <br /> <br /> INCOME VERIFICATION FORM <br />Inclusionary Unit Address: ________________________________________________________________ <br />Head of Household (Print Name): <br /> <br />Current Address (if <br />different from above): <br /> <br /> <br />Telephone Number: Home: Work: Cell: <br />Email address: <br /> <br />Date of Birth: Social Security # or TIN: <br /> <br />Household Composition <br /> <br />List All Household Members Living in the Inclusionary Unit <br /> <br />Name Sex Age <br />Dependent <br />(Y/N) <br />Social Security # <br />or Taxpayer ID # <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br /> <br />List additional household members on a separate sheet of paper. <br /> <br />