Transcription of Tenant Income Certification Questionnaire
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Tenant Income Certification Questionnaire
Tenant Income Questionnaire (March 2012) Tenant Income Certification Questionnaire One Form per Adult Member of the Household NAME: TELEPHONE NUMBER: _____ ( )_____ Initial Certification BIN #_____ Re- Certification Other Unit #_____ Income INFORMATION YES NO MONTHLY GROSS Income 1. I am self employed. (List nature of self employment) __ _____ (use net Income from self-employment only) $_____ 2. I have a job and receive wages, salary, overtime pay, commissions, fees, tips, bonuses, and/or other compensation: List the businesses and/or companies that pay you: Name of Employer 1)_____ 2)_____
Does the househol d consist of all persons who are full -time students (Examples: K 12, College, Trade School, etc.)? Does the household consist of all persons who have been a full-time student 5 months in the current calendar year?
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