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<br />D-11 <br />516911v4 JAE MU205-47 <br />FOR COMPLETION BY OWNER <br />(OR ITS MANAGER) ONLY <br /> <br />1. Calculation of Eligible Tenant Income: <br /> <br />(a) Enter amount entered for entire household in 2 above: $__________ <br /> <br />(b) If the amount entered in 3(a) above is greater than $5,000, enter the greater of (i) the <br />amount entered in 3(b) less the amount entered in 3(c) or (ii) 10% of the amount entered in 3(a): <br />$__________ <br /> <br />(c) TOTAL ELIGIBLE INCOME (Line 1(a) plus Line 1(b)): $__________ <br /> <br /> 2. The amount entered in 1(c) is less than or equal to 60% of median income for the area in <br />which the Project is located, as defined in the Declaration. 60% is necessary for status as a “Qualifying <br />Tenant” under Section 3(a) of the Declaration. <br /> <br /> 3. Number of apartment unit assigned: ___________. <br /> <br /> 4. This apartment unit was ____ was not ____ last occupied for a period of at least <br />31 consecutive days by persons whose aggregate anticipated annual income as certified in the above manner <br />upon their initial occupancy of the apartment unit was less than or equal to 60% of Median Income in the <br />area. <br /> <br /> 5. Check as applicable: _______ Applicant qualifies as a Qualifying Tenant (tenants of at least <br />__ units must meet), or ____ Applicant otherwise qualifies to rent a unit. <br /> <br />THE UNDERSIGNED HEREBY CERTIFIES THAT HE/SHE HAS NO KNOWLEDGE OF ANY FACTS <br />WHICH WOULD CAUSE HIM/HER TO BELIEVE THAT ANY OF THE INFORMATION PROVIDED <br />BY THE TENANT MAY BE UNTRUE OR INCORRECT. <br /> <br />BOULEVARD APARTMENTS, LIMITED <br />PARTNERSHIP, a Minnesota limited partnership <br /> <br /> <br /> By: Mounds View Group LLC <br /> Its: General Partner <br /> <br /> <br /> By: ____________________________ <br /> Christopher J. Stokka <br /> Its: Chief Manager