Self-Certification of Annual Household Income
To be completed by the Tenant(s) for the second annual certification and all
subsequent certifications in 100% LIHTC projects.
Types of Income: include but are not limited to: wages, salary, tips, bonuses, commissions, military pay, public assistance,
Social Security/SSI, retirement benefits, VA benefits, child support, regular gifts, unemployment, and some types of financial
aid, and income earned on assets (checking, savings, IRA, etc.). Include what you receive now and what you anticipate
receiving in the next 12 months.
Income from Assets: Income from assets must also be included in Total Annual Income. Assets include, but are not limited
to: checking accounts, savings accounts, cash on hand, money market accounts, certificates of deposit, stocks/bonds, 401(k)
and real estate. Include the annual interest from these accounts in your total income.
TENANT’S OBLIGATION: I agree to notify management IMMEDIATELY if:
• Anyone in my household becomes a full-time student, and/or
• My household composition changes in any way.