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Exhibit “C” <br />Tenant Income Verification Form Page 1 <br />Administrative Procedures Manual: Rental Housing Development June 3, 2025 <br /> <br />AFFIDAVIT <br />This Affidavit is made with the knowledge that it will be relied upon by the _____________ City of <br />Santa Ana, our landlord and the owner of our apartment building, to determine maximum income for <br />eligibility. (I/we) warrant that all information set forth in this document is true, correct and complete <br />and based upon information (I/we) deem reliable and based upon such investigation as (I/we) deemed <br />necessary. <br />(I/We) acknowledge that (I/we) have been advised that the making of any misrepresentation or <br />misstatement in this affidavit will constitute a material breach of (my/our) rental agreement with the <br />property owner to rent the unit and will additionally enable the property owner to initiate and pursue <br />all applicable legal and equitable remedies with respect to the unit and to me/us. <br />(I/We) do hereby swear under penalty of perjury that the foregoing statements are true and correct <br />and that this affidavit has been executed as of the date specified below by each adult member of the <br />household which intends to occupy an Inclusionary Unit located at ______________________ ,Santa <br />Ana, California. <br /> <br />Signature Date <br /> <br />Printed Name <br /> <br />Executed at __________________________________, Santa Ana, California <br /> <br />Signature Date <br /> <br />Printed Name <br /> <br />Executed at __________________________________, Santa Ana, California <br /> <br />