1901 E. FIRST STREET OWNER LLC (2) - 2014

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7. Do the persons whose income or contributions that are Included in item 6 above have any savings, equity in real property, or other form of capital investment (but do not Include necessary items such as furniture or automobile), enter the following amount: a) The total value of all such assets owned by such parsons: $. b) The amount of income expected to be delivered from such assets in the 12 month period commencing with the occupancy of the apartment $ a. Neither myself nor any other occupant of the unit [Ave propose to rent is the owner of the rental housing project in which the unit is located (hereinafter the "Owner"), has any family relationship to the Owner; or owns directly or indirectly any Interest In the Owner. For purposes of this paragraph, indirect ownership by an individual shall mean ownership by a family member, ownership by a corporation, partnership, estate or trust in proportion to the ownership or beneficial interest In such corporation, partnership, estate or Trustee held by the individual or a family member; and ownership, direct or indirect, by a partner ofthe individual. 9. This certificate Is made with the knowledge that It will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and 1/we declare that all information set forth herein is true, correct and complete and based upon Information live deem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. 10. IMle will assist the Owner in obtaining any information or documents required to verify the statements made herein, including providing copies of my /our income tax returns, certified by melus as true, for the most recent tax year in which a return was filed and at least one of the following: (a) Two paycheck stubs from my /our most recent pay periods. (b) An income verification certification from mylour employer. (c) An income verification certification from Social Security Administration and /or California Department of Social Services if 1/we receive assistance from such agencies. (d) An alternate form of Income verification reasonably requested by Owner if none of the above forms of verification are available. 11. IMle acknowledge that Ilwe have been advised that the making of any misrepresentation or misstatement in this declaration will constitute a material breach of mylour agreement with the Owner to lease the unit and will entitle the Owner to prevent or terminate mylour occupancy of the unit by institution of an action for ejection or other appropriate proceedings. Me declare under penalty of perjury that the foregoing is true and correct. Executed this day of California Appllcant/Resident Appllcant/Resident 20_ (year) in the City of Applicant/Resident Applicant/Resident (Signature of all persons except minors under the age of 1a years listed in number 2 above required)