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LYON <br />.) <br />COMMUII MES <br />Support Verification <br />Applicant/Resident Release Statement <br />M <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: <br />Name /Source of Income: <br />Source's Mailing Address: <br />City <br />Phone #: <br />Fax #: <br />Date: <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 <br />❑ Family Support <br />❑ Alimony <br />❑ Other <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: <br />•4.1 a�,f,�Tc:i.ri °i ".4B <br />(11-10) <br />Date: <br />Frequency <br />❑ weekly ❑ monthly ❑ yearly <br />❑ weekly ❑ monthly ❑ yearly <br />❑ weekly ❑ monthly ❑ yearly <br />