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FOR COMPLETION BY APARTMENT PERSONNEL ONLY: <br />1. Calculation of eligible income: <br />a) Enter amount entered for entire household in & <br />b) Enter amount entered in 7(b) <br />c) TOTAL ELIGIBLE INCOME line a) plus line b): <br />2. The amount entered in 1 c above): <br />❑ Qualifies the applicant(s) as a Lower- Income Resident(s) <br />❑ Qualifies the applicant(s) as a Moderate - Income Resident(s) <br />3. Apartment number: Bedroom size: <br />4. Method used to verify applicant(s) income: <br />❑ Copies of tax returns <br />And <br />❑ Employer Income Verification Form <br />❑ Two most recent consecutive pay stubs <br />❑ SSI statement or letter <br />❑ Un- employment statement or two pay stubs <br />❑ Other <br />Property Director <br />19H -52 <br />Date <br />Rent: <br />3 <br />