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INCOME VERIFICATION <br /> (for employed persons) <br /> The undersigned employee has applied for a rental unit located in a project financed by <br /> City of South Bend. Every income statement of a prospective tenant must be stringently verified. <br /> Please indicate below the employee's current annual income from wages, overtime, bonuses, <br /> commissions or any other form of compensation received on a regular basis. <br /> Annual wages <br /> Overtime <br /> Bonuses <br /> Commissions <br /> Total current income <br /> I hereby certify that the statements above are true and complete to the best of my <br /> knowledge. <br /> Signature Date Title <br /> I hereby grant you permission to disclose my income to MAH Cedar Glen, LP, an <br /> Indiana limited partnership, in order that it may determine my income eligibility for rental of an <br /> apartment located in its project which has been financed by the county of City of South Bend. <br /> Signature Date <br /> Please send to: <br /> B-10 <br />