ࡱ> 574#`  bjbj\.\. C>D>D"6666666J2228j v$J !9-0]0 $"h%  6 66 MMMd66MMMVZ@66 ~wPL2d  0 ! &&&6,>,M$4 X !JJJ dJJJJJJ666666 CERTIFICATION OF ZERO INCOME (To be completed by adult household members only, if appropriate.) Household Name: Unit No. Development Name: _____________________________________ City:___________ 1. I hereby certify that I do not individually receive income from any of the following sources: a. Wages from employment (including commissions, tips, bonuses, fees, etc.); b. Income from operation of a business; c. Rental income from real or personal property; d. Interest or dividends from assets; e. Social Security payments, annuities, insurance policies, retirement funds, pensions, or death benefits; f. Unemployment or disability payments; g. Public assistance payments; h. Periodic allowances such as alimony, child support, or gifts received from persons not living in my household; i. Sales from self-employed resources (Avon, Mary Kay, Shaklee, etc.); j. Any other source not named above. 2. I currently have no income of any kind and there is no imminent change expected in my financial status or employment status during the next 12 months. I will be using the following sources of funds to pay for rent and other necessities: __________________________________________________________________________ Under penalty of perjury, I certify that the information presented in this certification is true and accurate to the best of my knowledge. The undersigned further understand(s) that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information may result in the termination of a lease agreement. Signature of Applicant/Tenant _______________________________ Printed Name of Applicant/Tenant _______________________________ Date On this the day of ___________, 20 before me came_____________________________, known and known to me to be the applicant/tenant identified as such in the foregoing certification. _____________________________________________________ NOTARY PUBLIC     COAH, February 2006 27rs~ 7 DEFc  ϳ꥝hIhIhICJOJQJaJhmAjhmAUhrh6p}5OJQJaJhrhrOJQJ\aJhrhr>*OJQJaJhrhrOJQJaJhrh6p}>*OJQJaJhrh6p}OJQJaJhrh6p}aJ3abc2 3 ^$ x#$`'(0*h.a$gdr$ P x#$h.a$$ P !x#$")h.a$$  P !x#$`'0*h.a$$a$$a$    n o * + r s 7 8 9  & F *!")>`>gdr  T ^ `  ^` ^`^ BCDFdef `0gdr  ,"#1$ jJ#|)1$  ! !")h^hgdr  gdI  ,"#1$ $ `0a$gdr `0gdrA0PP&PP:pI/ =!"#$% N@N Normal$a$ CJOJQJ_HkH'mH sH tH DA@D Default Paragraph FontVi@V  Table Normal :V 44 la (k(No List 4 @4 Footer  !bOb #Helvettica,12 Point,Right JustifiedbOb #Font: Helvetica 12 Point,Justified4@"4 Header  !TC@2T Body Text Indent^`OJQJXR@BX Body Text Indent 2^`OJQJ`S@R` Body Text Indent 3 T ^ `OJQJ8>@b8 Title$a$ 5OJQJ abc23no*+rs789BCDFdef 0000000000000000000000000000000000000 00000000000000000000000000000h00)h00h00)h00h00)h00h00)h00@0h00h00  {00a{00 00 !!!$       e S#e TJ$e Te \R V =*urn:schemas-microsoft-com:office:smarttags PlaceName=*urn:schemas-microsoft-com:office:smarttags PlaceType9*urn:schemas-microsoft-com:office:smarttagsplace (G`+,  3rrssEFc66  4 ()As';S@0^`0o(.0^`0o(.**^*`o(.)A4;Sr6p}IVImA @\\dcas03\DCA P73Ne02:winspoolXerox DocuPrint N3225 PS\\dcas03\DCA P73TS odXXLetterPRIV0''''\KhC6Ղ 5XRX>@Draft00222222\\dcas03\DCA P73TS odXXLetterPRIV0''''\KhC6Ղ 5XRX>@Draft00222222CC XCC @@UnknownGz Times New Roman5Symbol3& z Arial?& Arial Black9New York;" Helvetica3Times"/J0J3SF--;4d2Q;HX ?IV2ABarb's:Desktop Folder:template transfer:HTC Cert of Zero Inc 1/99CERTIFICATION OF ZERO INCOME Info Systemsldegraw   Oh+'0  8 D P \hpx CERTIFICATION OF ZERO INCOMEInfo Systems99ldegraw3Microsoft Office Word@V@qx@bPL@bPL-՜.+,0 hp  NIFA CERTIFICATION OF ZERO INCOME Title  !"#%&'()*+-./01236Root Entry F~wPL81Table6&WordDocumentCSummaryInformation($DocumentSummaryInformation8,CompObjq  FMicrosoft Office Word Document MSWordDocWord.Document.89q