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73505919v2 <br /> <br /> <br /> B-2-1 <br /> <br />EXHIBIT B–2 <br />FORM OF INCOME RECERTIFICATION <br />INCOME CERTIFICATION <br /> Initial Certification Recertification Other* _________ <br />Effective Date: _____________________ <br />Move-in Date: _____________________ <br /> (MM/DD/YYYY) <br />*Transfer from Unit: ___________ <br />PART I – DEVELOPMENT DATA <br />Property Name: County: <br />Unit Number: # Bedrooms: <br /> PART II. HOUSEHOLD COMPOSITION <br /> <br />HH <br />Mbr # Last Name First Name & Middle <br />Initial <br />Relationship to <br />Head <br />of Household <br />Date of Birth <br />(MM/DD/YYYY) <br />Last 4 digits of Social <br />Security Number <br />1 HEAD <br />2 <br />3 <br />4 <br />5 <br />6 <br />7 <br /> PART III. GROSS ANNUAL INCOME (USE ANNUAL AMOUNTS) <br /> HH <br />Mbr # <br />(A) <br />Employment/Wages <br />(B) <br />Soc. Security/Pensions <br />(C) <br />Public Assistance <br />(D) <br />Other Income <br /> <br /> <br /> <br /> <br /> <br />TOTALS $ $ $ $ <br />Add totals from (A) through (D) above TOTAL <br />INCOME (E): <br />$ <br /> PART IV. INCOME FROM ASSETS <br /> HH <br /> Mbr # <br />(F) <br />Type of Asset <br />(G) <br />C/I <br />(H) <br />Cash Value of Asset <br />(I) <br />Annual Income from Asset <br /> <br /> <br /> <br />TOTALS: $ $ <br /> TOTAL INCOME FROM ASSETS (K) $ <br /> <br />(L) Total Annual Household Income from all Sources [Add (E) + (K)] $ <br /> <br />