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LYON <br />COMMUIVMES <br />Support Verification <br />ApplicanVResident Release Statement <br />hereby authorize the release of <br />the following Information in order to determine my eligibility for the Affordable Housing Program. Please complete the <br />form in full and return It to Lyon Management Group, Inc. d /b /a Lyon Communities at your earliest convenience to fax <br />(562) 491 -5223. <br />Signature: Date: <br />Name/Source of Income: <br />source's Mailing- Address - <br />City, <br />Phone #: <br />Fax #: <br />State Zip <br />Please complete the following. If the monies are based on a percentage of your income, please indicate the average <br />amount per period. <br />Type of Benefit Amount Frequency <br />❑ Family Support ❑ weekly ❑ monthly ❑ yearly <br />❑ Alimony ❑ weekly ❑ monthly ❑ yearly <br />❑ Other ❑ weekly ❑ monthly ❑ yearly <br />(Please list type) <br />Do you anticipate any changes In the next 12 months? ❑ Yes ❑ No <br />Comments: <br />Signature of Party Authorized to Verify the above Information: <br />Title: Date: <br />(11 -10) <br />19H -54 <br />