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I/We declare under penalty of perjury that the foregoing is true and correct. <br /> Executed this day of in , Indiana. <br /> Applicant Applicant <br /> Applicant Applicant <br /> [Signature of all persons over the age of 17 years listed in number 2 above required.] <br /> SUBSCRIBED AND SWORN to before me this day of , 20_ <br /> (NOTARY SEAL) <br /> Notary Public in and for the State of <br /> My Commission Expires: <br /> FOR COMPLETION BY APARTMENT OWNER ONLY: <br /> 1. Calculation of eligible income: <br /> a. Enter amount entered for entire household in 6 above: $ <br /> b. (1) if the amount entered in 7(C)(i) above is <br /> greater than $5,000, enter the total amount <br /> entered in 7(C)(ii), subtract from that figure <br /> the amount entered in 7(C)(iii) and enter the <br /> remaining balance($ ); <br /> (2) multiply the amount entered in 7(C)(i) times <br /> the current passbook savings rate as <br /> determined by HUD to determine what the <br /> total annual earnings on the amount in <br /> 7(C)(i) would be if invested in passbook <br /> savings ($ ), subtract from that <br /> figure the amount entered in 7(C)(iii) and <br /> enter the remaining balance($ ); and <br /> B-7 <br />