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EXHIBIT B <br />TF ''T CQ:1IE +f`'ERTIFIC iTID Eft`eetiveDate.: <br />El initial Ceatifcatioll © Recertification ` €1 Other 2doxe:Ia I]ate. " ' <br />-LSD-]'Yl'Y <br />`....' <br />PART I`-DE't'ELOPIN IENT DATA <br />Property Nan3F-- Ggnnty; <br />Address.: <br />Unit Number_- #Bedrooms: SquareFobiage <br />PART -H. HOUSEHOLD COMPOSITION <br />II Vacant OeA if unk tras.vacaut oo Decemher3l eft Date Year) <br />zIH <br />Mbr4 <br />Middle Relationship to,Head Date ofBit&'. 5tudentStatus list4 digits of <br />Last Name F-ustName Initial n Fnuseliold o4LIii7a'k i -M (Check One) Socizi S A <br />1, <br />HEMI Fi13*tEPNh❑ <br />-2 - <br />vi❑+r❑Still❑ - <br />4 <br />i t0#i❑,NA❑ <br />5 <br />#❑ PY❑ Nh <br />6" <br />eC Fa❑rtiitC <br />7 <br />=�G psIIMAC <br />P.IRT III OROSS iIV Ai LhC:41IE ?5E i1�I�-LT2iI.:AXIOLT'TS) <br />HH _ <br />ilbr } " <br />() (B) (C) ...) <br />Employment or ,Wages -Soc. SenrcitvlPeasions Publir: Assistance Other Income <br />YOTALS <br />S," <br />Add totais: frcxin (A) througli (D), ab -re TOTAL.INCONIE (E) <br />S <br />PART IV. INCOME FROMASSETS <br />HH <br />Mbrr <br />(G) (H) tTJ <br />Type of Asset C -I. Cash Value of Asset AnnuallncomefromAsset <br />TOTALS: $ S <br />If incaffie tmknatvn� <br />S Cash Value from (Ii) X ittse current Passbook Rate = (J) Impmed Income $ <br />Add totals from (Hl and R TOT 41, INCOME FROM 4SSE.FS (iti') <br />(L) Total Atmual Homr�ehold Ifltcome from all Sources [Add FE) +'(Is'.}] <br />$ <br />HOUSEHOLD CERTIFICATION & SIG-NINATURFS <br />The inkrmafian am this fosm will be wool to Ltermimp maxin om income eligib ity Ihuve have pimided fon eachpercm(s) set Earth in -Part II acceptable G;iif catk m of <br />cuv?ntamicipaiadmot incene Tvreagreetonotifvthe>aaa7ardimmediatelyuponauyrrembera`theheusehedmovin;oiroftheunitaeanynewmember <br />mmin;m I'we igge to notify rlLe 1",11 itnmedia&k upon any membubecominga f�E time student <br />Lineupenaliiesofpe[;u-n,,Twecertify that *Pichrmaddopresented im this Certifiudwistrueand accurate tothebes#oftn ourknoaole eandbelief.'Ibeundenigned <br />:unherundermardrThat pm%idiogLe»acaasrinnesanact of rand- Filse mldeiku acmcon..:xtoinformation mayie-idinthatenninari000f <br />the lease agteemer-t <br />sienarars t2aw <br />SAM= (Datn <br />REV: 05-20-25 LF <br />simam PON) <br />Sienam <br />!DX 1 <br />Tenant Income Cer55catiom (April N21) <br />ATTY/AGR.2025.100.3/HEART-SV (417 Stambaugh - Reoulatory Agreement) (Pane 33 of 35) <br />