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19H - INCLUSIONARY AGMT 1901 E FIRST ST
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19H - INCLUSIONARY AGMT 1901 E FIRST ST
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Last modified
11/13/2014 6:36:09 PM
Creation date
11/13/2014 3:30:47 PM
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City Clerk
Doc Type
Agenda Packet
Agency
Community Development
Item #
19H
Date
11/18/2014
Destruction Year
2019
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TENANT INCOME VERIFICATION FORM <br />Monthly Gross Income* <br />List All Sources of Income of All Household Members Living in the Inclusionary Unit <br />Part 2: Investment Income <br />Head of <br />Household <br />Other Adult <br />Household <br />Members. <br />Total <br />Household <br />Investment <br />Income <br />1. <br />Interest paid on Bank and Savings accounts <br />$ <br />$ <br />$ <br />2. <br />Dividends and other payments from stocks and <br />bonds <br />$ <br />$ <br />$ <br />3. <br />Income from real property (i.e. rental property) <br />$ <br />$ <br />$ <br />4 — <br />Other(descrtbe)— <br />Subtotal: Monthly Investment Income: <br />$ <br />Total Monthly Investment Income x 12 = $ Total Annual Household Investment Income <br />*Note: The following items are not considered Income: casual or sporadic gifts; amounts specifically for or in <br />reimbursement of medical expenses; lump sum payments such as inheritances, insurance payments, capital <br />gains and settlement for personal or property losses; educational scholarships paid directly to the student or <br />educational institution; special pay to a serviceman head of family away from home and under hostile fire; <br />relocation payments under federal, state or local law; foster child care payments; value of coupon allotments <br />for purpose of food under Food Stamp Act of 1964 which is in excess of amount actually charged the eligible <br />household; payments received pursuant to participation in the following programs: VISTA, Service Learning <br />Programs, and Special Volunteer Programs, SCORE, ACE, Retired Senior Volunteer Program, Foster <br />Grandparent Program, Older American Community Services Program, and National Volunteer Program to <br />Assist Small Business Experience. <br />Tenant Income VeriRcation Form Page 3 <br />Santa Ana, California 19H-68 August 8, 2014 <br />
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