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HomeMy WebLinkAboutANNUAL COMPLIANCES FILE 2 OF 2_AFFORDABLE HOUSINGao09 0 • CITY OF NEWPORT BEACH 1•_._0_011�_ .,. September 17, 2010 Irvine Apartment Management Company Attn: Barbara Breton, Senior Manager VILLA POINT II 110 Innovation Drive Irvine, California 92617 Re: Villa Point II - Clearance: 2009 Annual Tenant's Certification Dear Ms. Breton: Thank you for your response to the 2009 Annual Tenant Income Certification monitoring request dated May 21, 2010. Based on the documentation submitted support household income and monthly rents charged, all occupied units are in compliance with the income limits and allowable maximum rents in accordance with the recorded Affordable Housing Agreement. If you have any questions, please contact me at (909) 476-9696 ext 220. Sincerely, Program Consultant c: Clint Whited, CDBG Consultant 3300 Newport Boulevard • Post Office Box 1768 • Newport Beach, California 92658-8915 Telephone: (949) 644-3200 - Fax: (949) 644-3229 • www.city.newport-beach.ca.us 40- # Fran Meyer From: Barbara Breton [bbreton@irvinecompany.comj Sent: Monday, July 26, 2010 4:08 PM To: fineyer@mdg-Idm.com Subject: RE: Villa Point II 2009- Cert. Request for additional Information Hi— t. M/0 was 5/29/10 2. M/O was 4/29/10 1 show 2503 as still affordable. The switch I show from 2008 to 2009 was the removal of 2422 and the addition of 2338. Barbara D. Breton HCCP, C0S,C10P, NCP-Exec., TaCC's Director, Affordable Housing Compliance Irvine Company Apartment Communities 110 Innovation I Irvine, California 192617-3040 Phone 949.720.34761 Fax 949.720.5257 bbretonAlrvinecomoanv.com 0 IRVINE COMPANY I APARTMENT sinoo fs6 COMMUNITIES Please consider the envimnmeM before priming From: Fran Meyer [mallto:fineyer@mdg-Idm.com] / Sent: Monday, July 26, 2010 3:49 PM To: Barbara Breton Subject: FW: Villa Point II 2009- Cert. Request for additional Information 01/ Ms. Brenton, In review of the documentation submitted for the 2009 Annual Tenant Certification - Villa Point II I need to following to complete clearance: 1. Termination of lease, vacancy date for Unit #2407 for previous occupant: Branigan 2. Termination of lease, vacancy date for Unit #2503 for previous occupant: Bewli/Arora I notice for 2008 this unit was reported as affordable, but for 2009 the unit is replaced with unit #2424 as vacant. Is this correct? Thank you for your assistance in the matter, Fran Meyer LDMAssoclates, Inc. 10722 Arrow Route, Ste #822 Rancho Cucamonga, CA. 91730 Phone: (909) 476-9696x 220 Fax (909) 476-6086 k/ . 0 j; l r) �� "� { IRVINE APARTMENT COMPANY Villa Point II Summary as of May 2010 NEWPORT NORTH Affordable Housing Agreement- dated November 13,1990 LOW. Villa Points If # APT. RESIDENT FLOOR # OF MOVE IN MOVE Household RENT RECERT NAME $TTP SIZE OCC. DATE OUT DATE Income DUE 128 tA Needham 2+2 1 2 r 4130/10 NIA $56,897.64 $1,575.00 6/01/11 234 Galindo 2+2 1 ' 10/02/98 COG $47,085.84 $1,485.00 6/01/10 `- 242 Antilla 1+1 1 9/30/05 CDC $27,035.00 $1.240.00 6/01/10 ac- 249 ✓ Torgerson 1+1 1 2122/08 COG y$50,500.00 $1 336.00 6/01/10 1140 r4 Navarez 2+2 2 7/18109 Tax Refurns e$12,520.00 1.595.00 6/01/10 -%c-- y 1205 Coghill 2+2 2 8128104 COG $51,942.00 $1.485.00 6101/10 144o Yeager 1+1 1 9/12198 COO $18,483.00 $1,240.00 6/01/10 t)k— ,1528 Greenberg 1+1 1 3/08 CDC $38 950.00 $1,296.00 6/01/10 `- 1558 Dinari 1+1 1 1/10 NIA $50,142.70 jj $1250.00 6/01/11 2338 IA Lippnik 2+2 4 11/10/09 Tax Re urns $44,045.00 1,595.00 6/01/10 2341 Klein 2+2 1 9/11/98 CDC $21,312.00 $1.510.00 6/01/10 0�- 2407 VACANT 2+2 ) 6102110 / 24241 VACANT 2+2 6113110 - yMutatcl � c 2503 1 A Lozano 2+2 2 5/05/10 1 NIA $19,195.07 $1,595.00 6/01/11 25191 Tennis 1+1 2 r 5112106 COG $41 976.37 $1 243.00 6/01/10 2606 0 Preston 2+2 4 5108/10 N/A $60 304.00 $1,495.00 6/01/11 2609 ACalderonlDaVall 2+2 2 11/18/09 Tax Return $48,486.00 1$1,595.001 6101/10 2615 kA Russell ($242) 1+1 1 1/26/08 NIA PHA ✓ $1,238.00 6/01/10 turc_ NI 2010 MI/No support Needed at this time. COG One form for resident to return, signed by all adults PHA Copy ofSection 8 Rental Agreement needed from File Tax Return Tax Return Needed from Resident VILLA POINT II (Off -site Newport North Apartments) Unit No. �J2 c( CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtained.) IMe certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2009, the Total Annual Eligible Income" of the undersigned individual(s) was $ 1 & ; and, 3. During 2009, my total o IN yer(t payment to Villa Point II (Off -site Newport North Apartments) was $ �R1 ( — per month. " Total Annual Eligible Income Includes: wages, tips, overtime, bonuses, commissions, net Income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point 11(Off-site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Nondncome Earning Household Member(s): Name Age Signature(s) of Income Earning Household Member(s): sosture Ignelui Date: • MAI ZV2 ✓ VILLA POINT it (Off -site Newport North Apartments) Unit No. =-1= CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (Far tenants not In possession of a Section 8 certificate or voucher, Income documentation must be obtained.) I/We certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above Indicated leased premises; and, 2. During 2009, the Total Annual Eligible Income" of the undersigned individual(s) was $ �)-$ h� D ;and, 3. During 2009, my total monthly rent payment to Mile Point II (Off -site Newport North Apartments) was $ 1 rr,-tib per month. Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, Interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -Income Earning Household Signature(s) of Income Earning Household Member(s): Member(s): Name Age v' Signature Signature signaturo Data: U6 jU�)/.WkO • VILLA POINT 11(Off-site Newport North Apartments) Unit No. CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtained.) I/We certify to the management of Villa Point II (Off -site Newport North. Apartments) that: 1. The undersigned is/are the only income earring occupant(s) of the above Indicated leased premises; and, 2. During 2009, the Total Annual Eligible Income" of the undersigned individual(s) was $ s�Qt � ; and, 3. During 2009, my total monthly rent payment to Villa Point II (Off -site Newport North Apartments) was $ 0 ;3�7 =`� per month. * Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Nondncome Earring Household Member(*): Name Age Signature(s) of Income Earring Household Member(s): Date: Cf ' Signalum signature Signature Jun 16 2010 11:46RM U - H&RSERJET FRX LEASE Q • b=k ft ("Lm liarn and 77RS ].EASE IS MADE AS OF SrtC1111SE L xoo_e by sad b"— d rauly little ad e W oolloedvdy m[md to MWNwmmfla'Rammt` Ifowns Un am erb MabejottI anu 7. Ds6alA. tloC&MOSMAW Korb B, �6p(ggp lbdlnanba I1/0Crell Ne 8oselt G 92660 city.sw%zlp C Suoot Addreu 9 sxNd 267 MVINUG Na.: d11 m: Nn otVehlohxl LlemxlMMeNa: and mdam D. 1'SIm:COtmKnrl m eente.nber 1. x009 u 11:59p.m (SIS93 )wmonk E.$CRS P. The FEIJiT(ISp dsyofaadalmdruxnth. MONI00 (11U) •°ad H. QMMW. 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If LaMlard b not able to oomtomraeM dam oflhe7am, eitbr tardlord orReddmt rotX pdorla the Lore by pivleywrkronodmto ihs ollar. drys of the t [crud this 41 PW it Ra1dmt dull pry Lmdlwd the Rmd for dm Premlaa rant month (n Nvum m or beMM Rtmt Dm Dae. N addidort dt otba nnawyobllptlmsoCRmldmttmdaklrtaveslWi bodxmrd to leeddl!(ordl Rem Any mlrmm toths anm"PAWIM thht.euealallbodcea dwincludeeddldmal Rent ICRddmtnmvrinm dm AM daYcfdtaowm4 RaMkntshrR pyRentlor dm RtM monk N daamouM Mtown l SMbn IS m dte move•{o date. IfReaidmt moves In on anydsy adterkm tb Rea dry of thetnmdh ReaidmisltMl pryth inldalRmtpaymmtrfaSowa: , k g than Oauter 1 {nUteWllamdmtshown{n 9atlm 1J3 I sikr*A dao b ti pay Rmt b, 6b -� er tllerthe23rh.ICRrtded nlov'tl roan dn:25°otlrndryofketnond416m ger{Jaitahsll [oaken loidalRmt RML pe7mlb/haumol (Ralnorad poAmo cr27.t t inRltofdammi6,PLUS(h the NIIammohtoftheneamouh'a Ilmt Pr taatrrylr, {f Raidetd noun In m October 17, tlx inibd Rmt pryment shall ba the taml oE(q /rsl time be esoanl shower In Srdlon 1,8. pim Bi) the Nlllbvamber Rant In de smmmtshawn In Srdm LF In leis example [hc AnldeaYsumad Rmtpyntmtsball be ttndem Ocanba 1 In the fbVsmomishownln Section M All ymMd m ofrhla Lear NOW ba In full tb oa=4 aft, mmnendn8 m the mava•In data or the dde aptxUhd in SwUm LD abam whkhev"'oocan faar. ThoTam afke Leuo uamed in Sedim I.Daladlmr be sllbmed bythetmm•m pste CC-Mv.IU$Af iniastc 3 OC UwPA•1.ese '7/1t3-011 Jun 16 2010 11:46RM H*RSERJET FAX P•2 0 oaled MLoeuofd"dny ��dds�li DwYSSSwmEOP.dpppubooanPrtdw OdsL Lelow,AaNmtolkdW WARoMent hetedad und:Mmde eeh WOMY4id LANDLO M, RIMINYt Thea"Mrdptd aPorb' epd"tbedp) GA SeNbe 30 eEwe WInoAprt wg Coawnudda.LB.. eDebweee 11e01W Prt"W CMbloe PYoWilm eels vNkh (1) thb Lee" •my aeb�Netdtf aoelk a e bneeey Erse teeeth-t -01 ePon DY:TTw]7is WM dm"PlMdon otbe btn ltet"f. eel (WthSt Ma Rwt�"Yb •Doq 1pbenwd d"I's p h atdleaed loeeaeY. NAMB. DATE: �'NAME: DATE: NAME: DAM TMe: NAME DATE: NAME DATE: NAM DATE: HAMS% DATE: =.e lots '4't LOn� • Revenue SOMW ;ome Tax Return Label L YourfrstrameandiNgal Lastname (see A NARVP. Instruction$ R MICHELLE A do page 14) E If a joint return, spouse's not name and Initial Last name Uwan IRS L Irbil. R Homo address (number and stree0, Ifyou have a P.O. box, Bee page 14. Otherwise, E 400 SOUTH FLOWER STREET please print R "toe. E City, town or poalalfice,state, antl ZlPcoda. Il you have atoreign address. Poe p+ Ci Presidential Orange 19 nge Filing 2filingjoinity(evenIfonlyonehadIncome) Status 3Married filing separately. Enter spouse•$ SSN above ► Check only 6 —_ - n,.dfullnemehere. ► Exemptions If more than four dependents, see page 17 and cheek brae r Income Attach Forms) W2 hero. Also attach Forms W-20 and 1099-Rif tax was withheld. If you did not get a W-2, see page 22. Ba Xlyoureelf. if someone can claim you as a dependent, do not check box 6 Yaxsociwwmwmxr6er 561-85-8295 spouWs sadd sepshy ournbor You must enter . your SSN(s) above. - Checking a box nelow will not change your tax or refund. l i You jF-1, spouse person). lase - c Dependents: �Depends nra (3)Dependent's to uall skit queti n 81exseena1 social security number relationship u echild fa s 1 Flretname Last name JADEN ORNELAS 623-51-147' Son Li I Enclose, but do not attach, any payment. Also, please use Form 1040 V. Adjusted Gross Income d Total number of exemptions claimed • • ' . 7 $a Id 9a Is 10 11 12 13 14 Ise 16a 17 18 19 20a 21 Wages, salaries, Ups, etc. Attach Form(s) W-2 Taxebie interest. Attach Schedule B if required • • • • • • • ' ' ' • ' ' ' ' ' Tax-exempt Interest. Do not Include on line 8a • • • . • • • 8b Ordinary dividends. Attach Schedule B if required • • • • • • • • • .. ' ' ' ' • • ' . ' • Qualified dividends (see page 22) • • • • • • • • • • • • • • 9b I Taxable refunds, credits, or offsets of state and local Income taxes (see page 23) • • • • • • • Alimony received • • • • • • • • • • • • •. •"•"" •. •.... • • •"• • • Business income or (loss). Attach Schedule C or C-EZ • • • • • • • • • • • • • • • . • • • Capital gain or (loss). Attach Schedule D If required. If not required, check here ► (� Other gains or (losses). Attach Form 4797 . • • • • • • • • • • • ... • • • • • • . • • • IRA distributions • • 16e le Taxable amount (seepage 24) Pensions and annuities 186, b Taxable amount (sea page 25) Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E . • • Farm Income or (loss). Attach Schedule F • • • • • • • • • • • • • ' • ' ' ' ' • ' ' ' • • Unemployment compensation in excess of $2,400 per recipient (see page 27) • • • • • • • • Social security benefits • 120a I I b Taxable amount pee page 21) Other income 7 on ----- 92 -,- 0-- 1 11 12 13 14 16b 16b 17 18 19 5b 21 22 Add the amounts in the far fight column for lines 7 through 21. This is your total Income • • ► 22 23 24 25 26 27 28 29 30 31a 32 33 34 35 36 37 Educator expenses (see page 29) • .. • • • • • • • • • • . Certain business expensesd resen1sle, pedorming artists, and fee -baste govemmentonicisls. Attach Fonn2106or2lMEZ • • . Health savings account deduction. Attach Form 8889 • • • . Moving expenses. Attach Form 39D3 • • • • • • • • • • • • One-half of self-employment lax. Attach Schedule SE • • • Self-employed SEP, SIMPLE, and qualified plans • • • . • • Self-employed health insurance deduction (see page 30) • • Penalty on early withdrawal of savings • • • • • • • • Alimony paid b Reciplenrs SSN ► IRA deduction (see page 31) • • . • • • • • • • • • • • Student loan Interest deduction (see page 34) • • • • • • • • Tuition and fees deduction. Attach Form 8917 . • • • • • • • Domestic production activities deduction. Attach -Form 8903 • Add lines 23 through 31a and 32 through 35 • • • • • • • • Subtract line 36 from line 22. This is youradjusted gross income 27 ,.... --, ti e 24 25 26 27 885 28 29 30 31a 32 33 34 35 • . ' ' . • • • • • • • • • • •► 37 n....,, A, t and Paperwork Reduction Act Notice, 500 page 97, EEA Bases checked eck d �. No.ddad= mecaUo: You drsdb� (aeste) Deseadeftorift rwtwtwwaww 1040 • Form 9325 Acknowledgement and General Information for I (Rev. January2010) Taxpayers Who File Returns Electronically Thank you for participating in IRS a -Ole. MICHELLE A NARVAEZ Taxpayer Name 400 SOUTH FLOWER STREET APT B5 Taxpayer Address (optional) Orange CA 92868 1, X❑ Your federal Income tax return for 2009 was filed electronically with the FRESNO Submission Processing Center. The electronic filing services were provided by Express Tax Service 2. n Your return was accepted on using a Personal Identification Number (PIN) as your electronic signature. You entered a PIN or authorized the Electronic Return Originator (ERO) to enter or generate a PIN for you. The Declaration Control Number (DCN) assigned to your return Is 3. Your return was accepted on . Please allow 4.6 weeks for the processing of your return. The Earned Income Credit or a dependent's exemption on your return may be reduced or disallowed due to a child's name and social security number mismatch. 4. C. Your refund or part of your refund may be offset due to a debt owed to the Internal Revenue Service, the Office of Child Support Enforcement, or other government agency. 5. Your electronic funds withdrawal payment was accepted. Your electronic funds withdrawal payment was not accepted. You must pay the balance due by the prescribed due date. You may see your payment options in the "if You Owe Tax" section. Your Form 4868, Application or Automatic Extension of Time to File U.S. Individual Income Tax Return, was accepted on . The Declaration Control Number (DCN) assigned to your extension PLEASE DO NOT SEND A PAPER COPY OF YOUR RETURN TO THE IRS. IF YOU DO, IT WILL DELAY THE PROCESSING OF THE RETURN. If You Need to Make a Change to Your Return If you need to make a change or correct the return you filed electronically, you should send a Form 1040X, Amended U.S. Individual Income Tax Return, to the IRS submission processing center that processes paper returns for your area. The address is available at www.irs.gov, or you can call the IRS toll -free at 1-800.829-1040. If You Need to Ask About Your Refund The IRS notifies your Electronic Return Originator (ERO) when your return Is accepted, usually within 48 hours. If your return was not accepted, the IRS notifies your ERO of the reasons for rejection. If it has been more than three weeks since the IRS accepted your return and you have not received your refund, go to www.1m.gov and click on "Where's My Refund" to view your refund status. Exception: If box 3 above is checked, please allow 4 to 6 weeks for processing of your return. A notice will be sent to you advising of changes to your return. Also, you can call the TeleTax line at 1-800-829-4477, for automated refund information. You should have available the first social security number shown on your return, your filing status, and the exact amount of the refund you expect. TeleTax gives you the date for mailing or depositing your refund. You should receive your refund check within 30 days of the date given by TeleTax, or within one week of that date, if you chose direct deposit. If you do not receive It by then, or if TeleTax does not give your refund information, call the Refund Hotline at 1-800.829.1954. EEA Form 9325 (Rev. 1-2010) The IRS uses refunds to cover overdue taxes and nomies you wnen mks occurs. i ne rmanciai munugunrarn onrvrw (FMS) offsets refunds through the Treasury Offset Program (TOP) to cover past due child support, federal agency non -tax debts such as student loans and state Income tax obligations. FMS sends you an offset notice if it applies your refund or part of your refund to non -lax debts. If you have questions about the offset, contact the agency Identified In the notice. You may also call the Treasury Offset Program Cali Center at 1-800304-3107, if you have additional questions. If You Owe Tax If your return has a balance due, you must pay the amount you owe by the prescribed due date. if you paid by electronic funds withdrawal (direct debit) or by credit card, no voucher is needed. To use your credit card or debit card to pay by phone or Internet, you may call, /-888-PAY-1040 (1.888-729.1040), 1-888.9-PAY-TAX (1-888.972-9829), or 1.888-UPAY-TAX (1-888-872-9829), or visit www.paylG4O.com, www.payUSAtex.com, orwww.officialpayments.com. The service providers will charge a convenience fee, based on the amount of taxes you are paying. The fees and the type of credit or debit cards accepted, may vary between providers. You will be told the amount of the fee during the transaction and you will be given the option to either continue orend the transaction. To learn more about credit and debit card payment options visit, www.irs.gov search e-pay. if you are not paying electronically, you may use the Form 1040-V, Payment Voucher. You will receive the payment voucher In the mail cryou can obtain it from your Electronic Return Originator. If the IRS does not receive your payment by the prescribed due date, you will receive a notice that requests full payment of the tax due, plus penalties and Interest If you can not pay the amount In full, complete Form 9465, Installment Agreement Request, which you may file electronically. To apply for an Installment agreement online, go to www.irs.gov. You may also order Forth 9465 by calling 1.800-TAX-FORM (1.800-829-3676). If approved, the IRS charges a user fee to set up an installment agreement. If You Need to Inquire About Your Electronic Funds Withdrawal Payment You may call 1-888-35344537, to inquire about the status of an electronic funds withdrawal payment. If there is a change to the bank account Information Included on your return, you should call this number to cancel a scheduled payment. You should have available the social security number of the first person listed on the tax return, the payment amount, and the bank account number. Cancellation requests must be received no later than 8:00 p.m. Eastern fine, two business days prior to the scheduled payment date. Refund Anticipation Loans A refund anticipation loan is money borrowed from a lender based on the refund you expect to receive. This loan is a contract between you and a lender. The IRS is not associated with this contract, nor does it grant or deny the loan. If you have questions about refund anticipation loan, contact your Electronic Return Originator or the lender. Instructions to Electronic Return Originators Line 2 - PIN Presence Indicator- Check box 2 If the taxpayer entered a PIN or authorized the ERO to enter or generate the PIN for the taxpayer, and the Acknowledgement File PIN Presence Indicator is a 1, 2, or 3. Forth 8879, IRS a -file Signature Authorization, Is required if the ERO enters or generates the PIN or if the Practitioner PIN method is used. Use Forth $463, U.S. Individual Income Tax Transmittal for an IRS a -file Return, to sand required paper forma or supporting documentation listed next to the form check boxes (do not sand Forms W-2, W-20, or logs-R). Line 3- Exception Processing - Check box 3 if the Acknowledgement File Acceptance Code equals "E." The acceptance code indicates that this return has been previously rejected and this subsequent submission still has invalid data. Line 4 - Debt Code - Check box 4 if the Acknowledgement File Debt Code equals "I", "F", or "B". The "I" in the debt code Indicates that a debt was found on the IRS File for this return. The "F" Indicates that a debt was found on the FMS File for this return. The "B" indicates that a debt was found on both the FMS and IRS Files for this return. The "N" (or blank) indicates that no debt was found on either the FMS or IRS Files. Line 5- Payment Acknowledgement Literal -Check box 5Ifthe taxpayer requested to use electronic funds withdrawal to pay the balance due, and the Acknowledgement File Payment Acknowledgement Literal field equals'PYMNT ROST RECD." Line 6 - Payment Acknowledgement Literal - Check box 6 if the taxpayer requested to use electronic funds withdrawal to pay the balance due, and the Acknowledgement File Payment Acknowledgement Literal field does not equal "PYMNT ROST RECD." If box 6 is checked, inform the taxpayer that he/she must pay by check, money order, debit card, or credit card. Note: EROS can use the Acknowledgement File information, translated by the transmitter, to complete Form 9325. EEA Form 9325 (Rev. 1.2010) 0 For Privacy Notice, get form FTB 1131. FORM California Resident Income Tax Return 2009 540 C1 Side APE ATTACH FEDERAL RETURN_ 561-85-8295 NARV ** MICHELLE A NARVAEZ 09 PBA 711510 AC 400 SOUTH FLOWER STREET APT 85 ORANGE CA 92868 01 4 72 0 408 0 APE 0 06 0 73 0 409 0 FS 0 09 0 74 0 410 0 3800 0 10 1 75 623511475 411 0 3803 0 12 0 76 0 412 0 SCHG1 0 14 0 77 1050 413 0 5870A 0 16 0 78 525 414 0 5805 5805F 0 17 11635 91 525 1].0 0 DESIGNEE 0 16 7274 92 0 111 0 TPIDP 00904181 31 55 93 525 112 0 FN 34 0 94 0 113 0 41 0 95 0 115 525 42 0 400 0 116 525 43 0 401 0 117 0 44 0 402 0 45 0 403 0 46 0 404 0 61 0 405 0 62 0 406 0 63 0 407 0 64 0 71 0 R RP DDR1 322280485 27332007 1 ee e n ons o m out you ou a awpyo yourwmp o re m, n erpena as penury, e re haw Sign exmNnedthff1a Qn'd[naaccempanyinp schedules an atoments, and to the be at ofmykno ledge antl better, ll iet ue, correct,and complete. Here ,Yourstgnaturs Spouses/RDPs sianeWm(Ifa joint retum. both must aipn) Dayame phone number(optional) 714-421-9935 Date 02-18-2010 1l la unlawful Paid PMPareta alpnatum (derlraYmafpaPrarsaaeedan Wkiorrnelion alMatlr Pr°p�artraaryrrotoMadp°) 10Paitl PrePerefs SSN/PTIN to tape a apauaa'ar RDP's aipnatum Joint retuml (see pop 17) Finryaname(oryouraifselPapployed) EXPRESS TA9Im9MMCE 300 E. 4TH STREET SUITE 105; SANTA ANA, CA 92701 Do you want to allow another person to discuss this return with us (see page 17)7 P00904181 • FEIN LfYes [X No Print Third Party Designee's Name Telephone Number p� 3101096 r— • ! Your name:MICHELLE A NARVAEZ Your SSNoriTIN:561-85-8295 aro 1 ['Single aws 2 DMarded/RDPfilingjointly.(seepage4) 3 1 '•Married/ROP filing separately. Enterspouse's/RDP's SSN or ITIN above and full name here 4 IRS Head of household (with qualifying person). (see page 4) 6 (Qualifying widow(er) with dependent child. Enter year spouse/RDP died. If your California filing status is different from your federal filing status, check the box here • ' • • • ' • • • • • • • • • e If someone can claim you (or your spouse/RDP) as a dependent check the box here (see page 7) • • • • • - • a 19 E 7 Personal: If you checked 1, 3, or above, enter 1 in the box. If you checked 2 or 5, enter 21n the box. yltgledeaesetly x If you checked the box on line 6, see page 7 • • • . • • • • .. • • • ' • • • ' • • 7 1] X $98 = $ 9 00 • • 8 X $98 = $ 00 m g Blind: Ifyou(aryaurepoveerR�P)ere Waudly Mpeinxl. Dolor l; IrOolh eio visually Impaired. enter • ' ' ' It It 9 Senior. If you (or your spouse/RDP) are 65 or older, enter 1; if both are 65 or older, enter 2 • 8 X $98 = $ 00 1 10 Dependants: Enter name and relationship. Do not Include yourself or your spouse/RDP. o inSTATEMENT#1 Total dependent exemptions •101 X $98= $ 9 00 _ • 11 Exemption amount: Add line 7 through line 10. Transfer this amount to line 32 . ' • • 11 $ 00 12 State wages from your Form(s) W-2, box 16 ' • • • .. • • • ' • • • • • • ' ' • . • 12 100 T 13 Enter federal adjusted gross Income from Form 1040, line 37; Form 1040A, line 21; Form 1040EZ, line 4 .. • • • 43 1163 00 a 14 California adjustments -subtractions. Enterthe amount from Schedule CA (540), line 37, column B • • e 14 00 X c 16 Subtract line 14 from line 13. If less than zero, enter the result in parentheses (see page 9) • • ' • • • ' .. • ' 45 1163 00 b m 19 California adjustments -additions. Enter the amount from Schedule CA (540), line 37, column C • • • • • • • • • 16 00 a• 17 California adjusted grass Income. Combine line 15 and line 16 • • • • • • • ' ' • • • • . • • • • • • • • • • • • 17 1163 00 18 Enter the larger of your CA standard deduction OR your CA Itemized deductions • • • • • • • • • • • • • .• 18 7274 00 19 Subtract line 18 from line 17. This is your taxable Income. If less than zero, enter-0. • • • • • • ' • • • • .. • . 31 5 00 32 Exemption credits. Enter the amount from line 11. If your federal AGI is more than $160,739 (see page 10) . • • • . 32 19 00 T 33 Subtract line 32 from line 31. If less than zero, enter -0. ' • • .. • • • • • • . • • • • • ' • • ' • • • • • • • • 33 00 x 34 Tax. (see page 11) Check box if from: ❑Schedule G-1 'Form FTB 5870A • • • • • • • • • • • ' • • • 0 34 00 36 Add line 33 and line 34 ' • . ' . ' • • • • • • ' • • • ' . • 35 00 41 New jobs credit, amount generated (see page 11) .. ' • • . e 41 1 00 42 Newjobs credit, amount claimed (see page 11) • • • ' • • • • • • • • • • • • ' • • • 42 00 P 6 43 Credit Code amount • • • • 10-43 00 c d 44 Credit Code amount ►44 00 1 1 45 To claim more than two credits (see page 11) • • • ' • ' • • . • • • • • ' • • • ' • • • 46 00 I a 46 Nonrefundable renter's credit (see page 12) • • • • • • • ' • • • • • • • • • • • • • ' • 46 00 47 Add line 42 through line 46. These are your total credits • • • • . • ' • • • • • • ' ' • ' • . • • • • • • ' ' ' ' 47 00 48 Subtract line 47 from line 35. If less than zero. enter-0- • . ' • • . • . • • • ' ' • • • • • ' • • 4800 O T 61 Mlemative minimum tax. Attach Schedule P (540) • • • • . • .. ' ' • • • • • • ' • • e 61 00 ha 62 Mental Health Services Tax (see page 12) • ' • • • • ' • • • • • • • • • ' • • • • ' . • 62 00 e e 63 Other taxes and credit recapture (see page 13) • • .. • • • • • • • • • ' • ' . • • • • 63 00 r s 64 Add line 48, line 61, line 62, and line 63. This is your total tax • • • ' • • • • • • • • • • • • • • ' • • • ... • 64 C W 71 California Income tax withheld (see page 13) • • • • • • • . • • • • • • • • • • • ' .... • ' • ' ' ' • • • • 71 00 72 2009 CA estimated tax and other payments (see page 13) •• • • ' • • • ' • • • • • • ' • ' • • • • • • ' • • e 72 00 P 73 Real estate and other withholding (see page 13) • • • • .... • • • • • • • • ' ' ' . • .. • ' ' ' ' ' • • • 73 00 a 74 Excess SDI (or VPDd) withhold (see page 13) - • • • • • ........................... 0 74 00 m Child and Dependent Care Expenses Credit (see page 13). Attach form FTB 3506. • in75 Qualifying person's social security number • ' • • • • • • ' ' • • • ' • • • . • ' ' ' • 76 623-51-1475 t 79 Qualifying person's social security number • • • • • • • • • • • • • • • • • • • • ' • 76 a 77 Enter The amount from form FTB 3506, Part III, line 8 • • • • • ' • • • • • ' • • • • • • • 77 1050 00 78 Child and Dependent Care Expenses Credit from farm FTB 3606, Part III, line 12 • • • • ' • • • • • • • • • • • • 76 52d 00 79 Add line 71, line 72, line 73, line 74, and line 78. These are yourtotal payments (see page 14) • • • • • • • . • ..79 52 00 91 Overpaid tax. If line 79 Is more than line 64, subtract line 64 from line 79 • • • • • • • • • • ' ' • • • • . • • • . 91 57 00 om 92 Amount of line 91 you want applied to your 2010 estimated tax • • • • • • • • • ' ' ' • as 00 TeN 93 Overpaid lax available this year. Subtract line 92 from line 91 • • • • • • ' ' • • . • • • • • ' • • ' . ' • • • e 93 _ 52 00 TM 94 Tax due. If line 79 is less than line 64, subtract line 79 from line 64 • • • • • • • • ' • ' • • • • • • • • • • • • 00 use 95 Use Tax. This Is not a total line (see page 14) • • • • • • ' • • ' • • • • • • • ' • • • 96 100 Tax 1 Side 2 Form 540 C1 2009 043 3102096 MICHELLE A NARVAE2 561-85-8295 Code Amount xr, California Seniors Special Fund (see page 22) • • • • - • • • • • • • • • • • • • • • • • • • • - • • a • ' • e 400 Alzheimees Dlsease/Relaled Disorders Fund - • • - • • • • • ' • • • • • • • • • • • • • • • • ' ' ' ' • • • 0 401 =y+ California Fund for Senior Citizens • - • - • • • • • • • • • • ' • • • ' • • • ' ' • • ' ' ' ' • • ° 402 •��� Rare and Endangered Species Preservation Program • - • • • - - - • • • • • ' • • • • • • • • ' • • • • • • • 403 State Children's Trust Fund for the Prevention of Child Abuse - • • • • • • • • • • • • • • • • • • • • • • • • • 404 California Breast Cancer Research Fund • - • • • • • • • • • • • • • • • • • a • • ' ' ' ' ' ' • ' ' • ' ' ' ° 405 California Firefighters'Memorial Fund • • • - - • • • • • • • • • • • • • • • • • • "' • • • •. • •. • • .0 406 Emergency Food For Families Fund - • • • - - • • • • • • • • • • ' • • • • • • • • • • • ' • ' ' ' • ' ' ' • • 407 California Peace Officer Memorial Foundation Fund - - • • • • • • • • • • • • • • • ' • • • • • • • ' • ' • • • 408 California Military Family Relief Fund - - - • • • - • • • • • • • • • • • • • • • • • • • ' ' ' • ' • ' ' ' ' • 0 409 California Sea Otter Fund • • • • • - • • • ' . • 0 410 California Ovarian Cancer Research Fund - 411 T. Municipal Shelter Spay -Neuter Fund • • • • • • • • • • • • • • • • • • • • • • • • a • • ' ' ' ' • ' ' a • • e 412 's California Cancer Research Fund • • • • • • • • • • ' • • • • • • • • • ' • • • • , ' , ' ' ' ' • ' ' ' ' ' • • 413 ALS/Lou Gehrig's Disease Research Fund • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • ' • • ' 0 414 7 ! 110 Add code 400 through code 414 This is your total contribution • • • • • • • • • • • • • • ' • • • • • • e 110 100_ ^,m nt 111 AMOUNT YOU OWE. Add line 94, line 95, and line 110 (see page 15). Mail to: YOUown FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267-0009 • • • ° 111 DD we. 112 Interest, late return penalties, and late payment penalties • - - • • • • • • • • • ' • • • • • • • • • • • ' • 112 OD eruct 113 Underpayment of estimated lax. Check box: Q FTB 5805 attached [j FTB 6805F attached • • - • at 113 00 a114 Total amount due (see page 16), Enclose, but do not staple, any payment - • • - • • • • • • • • • • • • • 114 00 D 115 REFUND OR NO AMOUNT DUE. Subtract line 95 and line 110 from line 93 (see page 16). Mail to: FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240-0009 • ° 116 52a OD Rr Fill In the Information to authorize direc it deposllof our refund into ono ortwo acm na. Donor attach avoided cheek e depooll SUP (NO Pepe 18) ee r ar 1 c Have you verified the routing and account numbers? Use whole dollars only. ut n All or the following amount of my refund (line 115) is authorized for direct deposit into the account shown below: d D ° 52 � oD e o 322280485 (X�Checktng []Savings 22332007 d a • Routing number 0 Type ° Accountnumber ° 116 Direct deposit amount I The remaining amount of my refund (tine 115) Is authorized for direct deposit into the account shown below: t Q100 Checking ❑Savings a Routing number a Type Account number 0 117 Direct deposit amount 4 31 3103096 1 Form 540 Cl 2009 Side 3 TAXABLE YEAR . CALIFORNIA FORM 2009 Child and Dependent Care Expenses Credit 3606 ae shown on return I SSN or _.....______.....,.__�..-d_,a_....,....At� enne see innln,Minne rani urraarnae,,,��,.,o.n....................___..__... ----'---...---._ SOURCE OF INCOIEIFUNOS AMOUNT SOURCE OFINCOMEIFUNDS AMOIMr • • • • Part II Persons or Organizations Who Provided the Care in California - You MUNI WMIJ10u, uua pa" 1 Enter the following Information for each person or organization that provided care In California. Only care provided In California qualities for the credit iryeu need more space, attach a se state sheet. Provider Provider a. Care providers name FIRST BAPTIST CH b. Care providers address (number, Street, 1010 WEST 17TH STREET apt. no., city, state, and ZIP Code) Santa Ana CA 92706 c. Care providers telephone number a7145477881 _ Person ('Organization d, Is provider a person or organization X Person Organization e. Identification number(SSN or FEIN) 304-27-0123 f. Address where care was provided (number, street, apt, no., city, state, and 1010 WEST 17TH STREET zip code) POBox not acceptable. Santa Ana CA 92706 g. Amount paid for care provided L 3 000 Did you receive dependent cam benefits? ► ► ► ► ► No. 2LUUMPIUw rura lit uarvv. Yes. Complete Part IV on Side 2 before you complete Part III. PartIII Credit for Child and Dependent Care Expenses (a) Pe N) I pert Qualifying persan's name llff�vIIneporson's Oualdylne pstill rcentage of Qualified aspen Que nodal nearly nutMor(SSN) tlale of ldh physleel Inarted and aitli DOB: —1475 Diem DOB: Disah 3 Add the amounts in column (a) of line 2. no not enter more than $3,000 for one qualifying person or $6,000 for two or more qualifying persons. If you completed Side 2, Part IV, enter the amount from line 34 .. • • • .. • 3 4 Enter YOUR earned Income. See instructions • • • • • . • • • . • • • . • ................... • 4 Nonresidents: Enter only your earned income from California sources. If you do not have earned Income from California sources, stop, you do not qualify for the credit. Military servicemembers, see Instructions. Part -year residents: Enter the total of (1) your earned income from California sources received while you were a nonresident and (2) all earned income recelved while you were a resident. Military servimmembers, "a Instructions. 6 If married or an RDP filing a joint retum, enter YOUR SPOUSE'SiROP's earned Income. (if your spouse/RDP was a student or was disabled, see the instructions) If not filing a joint return, enter the amount from line 4 • • • • • • • • 6 Norauleaac Enter only your spouse'saiDPs earned income samcdaamiasoanxs. IrywaspouseIRDPdooinothaw: eamed Income from Califomla sources, slop. you do net quality for the credit. Mllilat, seMcomemlreta, see line 4 instmdions. Pat-yeanasidsi. Enter the total of(1) yourspouse'sIRDPs earned Income aorrrcamomiasaaees recalvedwhiloheor she was a nonresident and (2) all earned Income your spousemOP recelved while he "she was a resident. Military "Mcertambens, see Ise 41nswctions. 6 Enter the smallest of line 3, line 4, or line 5 . • . • • • • • • • • • ....................... • 6 7 Enter the decimal amount shown In the chart on page 4 of the instructions for line 7 . • • • • • • • • • • • • • • • 7 8 Multiply line 6 by the decimal amount on line 7. Enter the amount here and on Form 640/540A, line 77; or Long Form 54ONR, line 87 ............................. • ............ • 8 9 Enter the decimal amount listed In the chart on page 4 of the instructions for tine 9 • • • • • • • • • • . • • • • • • 9 10 Multiply the amount on line 8 by the decimal amount on line 9 • • • • • • • • • • • • • .. ' ........ • • • 10 11 Credit for prior year expenses paid in 2009. See instructions for line 11 • • • • . • • • • • • • ........ • • 11 12 Add line 10 and line 11. Enter the amount here and on Form 640/540A, line 78; or Long Form 540NR, line 88 • • • • 12 X X 00 00 00 043 1 7251094 r— FfS3506 2009 Side1 Direct DepositiDebit Information CA8879.LD2 Retain for your records 2009 Name ID Number MICHELLE A NARVAEZ 561-85-8295 D REFUND OR NO AMOUNT DUE .. . • • • • ... • • • • • • . • ..............0 525 1 Have your refund directly deposited to one or two separate accounts. Rr oa u It 30 d D 322280485 ]Savings 27339007 525 it t o * Routing number oType Account number ■ Amount you want to direct dopes n o Remaining portion of total refund you want to direct deposit: d a (,'Checking t 'Savings ;-Routing number ♦Type oAccountnumber ■Amountyou want todirect deposit aBalance Due ........................................ a D a r -]Checking n a cc Clsavings o t oRoutingnumber oType oAccounlnumber ■ Amount you want todirect debit DD ibDale of withdrawal .................... .............................. I at n d Notes: Electronic Filing Authentication Record Information 0008 Pin Type Code P 0020 Taxpayer Pdor Year AGI 0025 Taxpayer Signature 58295 0030 SpouselRDP PdorYearAGI 0035 SpouselRDP Signature 0040 Taxpayer Signature Date (YYYYMMDD) 20100218 0o45 JuraUDisclosure Code D 0050 PIN Authorization Code 2 0060 ERO EFINIPIN 305958987 65 CABB79 L02 on CA 640 Dependent Exemptions Enter name and relationship. Do not Include Dependent Dependent 2009 STM 01 Number CA Arrot.LD State: CA For your records only. Self-Ernoloyment Tax Worksheet 2009 SE Tax STATE Summary Names) as shown on state return Social Security Number MICHELLE A NARVAEZ 561-85-8295 PsiYl I Self-EmpiQvment Tax Note. If your only income subject to self-employment lax is church employee Income, skip lines 1 through 4b. Enter-0- on line 4c and go to line 5o. Income from services you performed as a minister ora member of a religious order Is not church employee income. See page SE-1. A If you are a minister, member of a religious order, or Christian Science practitioner and you filed Form 4361, but you had $400 or more of other net earnings from self-employment, check here and continue with Part I • • • • • • • • • • • • • • • • • ► ; Is Net fans profit or (loss) from Schedule F, line 36, and farm partnerships, Schedule K-1 (Form 1085), 1a box 14, code A. Note. Skip lines la and lb if you use the fans optional method (see page SE-4) • • • • • • It If you received social security retirement or disability benefits, enter the amount of Conservation Reserve Program payments Included on Schedule F, line So, or listed on Schedule K-1 (Form 1065), box 20, code X 1b 2 Net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065), box 14, code A (other than farming); and Schedule K-1 (Form 1065-B), box 9, code A Ministers and members of religious orders, see page SE-1 for types of Income to report on this line. See page SE-3 for other income to report. Note. Skip this line If you use the nonfarm optional method (see page SE-4) • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 2 12,520 3 12,520 3 Combine lines la, 1 b, and 2 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 4111 11,562 4s If line 3Is more than zero, multiply line 3 by 92.35% (.9235). Otherwise, enter amount from line 3 • • • • • • 4b to If you elect one or both of the optional methods, enter the total of lines 15 and 17 here • • • • • • • • • • • c Combine lines 4a and 4b. If less than $400, atop; you do not awe self-employment fax. Exception. If less than $400 and you had church employee Income, enter-0• and continue • • • • • • • ► 4c 11,562 6 a Enter your church employee Income from Form W-2. See page SEA for definition of church employee Income • • • • • • • • • • • • • • • • 6a It Multiply line 5a by 92.35% (.9235). If less than $100, enter .0. • • • • • • • • • • • • • • • • • • • • • • • 6b 6 11,562 6 Not earnings from saH-employment Add lines 4cand So • • • • • • • • • • • • • • • • • • • • • • • • 7 Maximum amount of combined wages and self-employment earnings subject to social security tax or the 6,2% portion of the 7.65% railroad retirement (tier 1) tax for 2009 • • • • • • • • • • • • • • • • • 7 106,800.00 So Total social security wages and tips (total of boxes 3 and 7 on Forn(s) W-2) and railroad retirement (tier 1) compensation. If $106,800 or more, skip lines 8b through 10, and go to line 11 • • • • • • • • • • 8a b Unreported tips subject to social security lax (from Forth 4137, line 10) • • • • • fib c Wages subject to social security tax (from Forth 8919, line 10) • • • • • • • • • Bc 9d dAdd lines Be, 8b,and Sic • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 9 106,800 9 Subtract line Bid from line 7. If zero or less, enter-0- here and on line 10 and go to'line 11 • • • • • • • • ► 10 1,434 10 Multiply the smaller of line 6 or line 9 by 12.4% (.124) • • • • • • • • • • • • • • • • • • • • • • • • • • • 11 335 11 Multiply line 6 by 2.9%(.029) ................ • ... • • • ... • ............ 12 Self-employment tax. Add lines 10 and 11. Enter here and on Form 1040, line 69 • • • • • • • • • • • • • 13 Deduction for one-half of s40f�mployment tax. Multiply lure 12 by 12 1 769 50% (.50). Enter the result here and on Form 1040, line 27 • • • - • • • • • • • 1 13 885 1' 5PTit-F70ptional Methods To FI ure Net Earnings (see page SEA) Farm Optional Method. You may use this method only if (a) your gross farm Income vlas not more than $6,540, or (b) your net farm profits were less than $4,721. _ 14 Maximum Income for optional methods • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 16 Enter the smaller of: two-thirds (213) of gross farts income trot less than zero) or $4,360. Also 14 4,360.00 ...... ... ... .................. Include this amount on line 4b above • • 16 Nonfarm optional Method. You may use this method only if (a) your net nonfarm profits 1G6re less than $4,721 and also less than 72.189% of your gross nonfarm Income4and (b) you had net earnings from self-employment of at least $4001n 2 of the prior 3 years. caution. You may use this method no more than five times. 16 Subtract line 15 from line 14 • • • • • • • • • • • • • • • • • • • • • • • • • , • • • • • • • • • • • • • • is 17 Enter the smaller of: two-thirds (2/3) of gross nonfarm Income (hot less than zero) or the amount on line 1B. Also Include this amount on line 4b above • • • • • • • • • • • • • • • • • • • • • • • • 1T 1From Sch. F, line it, and Sch.K-11(Fann 1065). box 14. code 9. 3 From Scb. lC.11ine31;(FM, C-Zlin 3; Se mu(Jtn 1005)'box 14. 2From Sch. F. line 3e, and Bch. K-11Fonn 10651. box 14, code 4 From Sch. C, line 7: Sch. C•EZ. line is Salt. K-1 IF=1005). box 14, A -minus the anxwntyou would have entered on Una It, had you not coda C; and Sch. K-1(Fetm t0ese), box 9, =a J2. used tiro optionalmethod. State: CA For your records only. Ad usted Gross Income Split Worksheet Names) as shown on state return MICHELLE A NARVAEZ 2009 AGi FD ST summary Social Security Number 561-85-8295 Federal stow Income & Adjustments Col. A Col. B Cal. A (:d, B Tax a er S oase Tax a ex ftoixse 7 Wages, salaries, tips, eta - • • • • • - • • • ea Taxable interest. • • • • - • • • • • • • 9a Ordinary dividends. • • • • • • • • • • • • 10 Taxable refunds, credits, or offsets of state and local income taxes • • • • • • • 11 Alimony received • • • - • • • • • - • • • 12 Business Income or (loss) • • • • • • • • • • 13 Capital gain or (loss)• • • - • • • • - • • • • 14 Other gains or (losses) • • • • - • • • • • • 16b Taxable amount of IRA distributions • - - • • 16b Taxable amount of Pensions and annuities • 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. • • • • • • • • • 16 Farm Income or (loss) • • • • • • • • • • • • 19 Unemployment compensation • • - - - • • • 20b Taxable amount of Social security benefits • 21 Other Income .••••••••••••••• 22 Add the amounts in each column for Ins 7thru21. This is your total income • • 7 9a 9a 10 _ 11 12 12 520 12,520 13 14 15b 16b 17 16 19 20b 21 22 12,52 12,520 23 Educator Expenses • • • • • • • • • • • • • 24 Certain businew oxpensaa Ofmservi6ls, perform4xl artists, & ro"asis an. oiNdals • • • • 26 Health savings account deduction • • • • • • 26 Moving expenses • • • • • • • • • • • • • • 27 One-half of self-employment tax • • • • - • • 29 Self-employed SEP, SIMPLE, and qualified plans •-•••--••• 29 Self-employed health insurance deduction - • 30 Penalty on early withdrawal of savings • • • 31a Alimony paid ••••••••••••••• I 32 IRAdeductlon• - - • • • - • • • • • • • - 33 Student ban Interest deduction • • • • • • • 34 Tuition and fees deduction • • - • • • • • • 36 Domestic production activities deduction - - • Line 36 other adjustments - • • • • • • • - 36 Add lines 23thru31aand 32lhru35• • • • • 37 Subtract In36fromIn22.ThisIsyourAGI • • 23 24 26 26 27 885 88 28 29 30 31a 32 33 34 36 36 885 88 37 11 635 11 635 1D CAWK5805 Underpayment of Estimated Tax Worksheet 2009 Name California ID Number MICHELLE A NARVAEZ 561-85-8295 1 Enter total taxable income from your 2009 Forms 540/540A or Long/Short Form 640NR, line 19, Form 541, line 20 . • • • 1 4,361 2 Forms 6401540A and Form 64ONR Biers figure the tax on the amount on line 1 using the tax rate schedule below, unless form FTB 3800, Tax Computation for Children with Investment Income, is attached. If form FTS 3800 Is attached, complete a second form FTB 3800 using the tax rate schedule below and enter the recalculated amount from the second form FTB 3800, line 18 • • • • • • • • • • • • . • • • • . • • • . • • • • • • • • • • • • • • • 2 44 If form FTB 3803 is attached, complete a second form FTB 3803 using the tax rate schedule. Add the amount of tax from each Farm FTB 3803, line 9, to any tax you entered on line 2. 3 Form 541 filers use the single tax rate schedule. a Figure the tax on the amount on line 1 • • • • • • • • • • • • • • • • • • • • • • • • • 30 b Enter the amount from Form 541, line 21b and 21c • • • • • • • • • • • • • . • • • • 3b c Add line 3a and line 3b, enterlhe total here and online 6, below • • • • • • . • • • • 3e 4 Nonresidents a Enter your California taxable Income, Long/Short 540NR, line 35 • • • • • • • • • • • • 45 b Compute the CA Tax Rate: Tax on total taxable income from line 2 • • • • • • • • • • 4b Total taxable Income from line 1 c Multiply the amount on line 4s by the CA Tex Rate online 4b • • • • • • .. • • • • . • • • • • . • • • • • . • • 4m 5 Enter the amount from Fortes 540/540A, line 11 (add $206 for each dependent claimed online 10) or Long/Short Form 540 NR, line 11 (add $206 for each dependent claimed on line 10, multiply that amount by your exemption credit percentage, Long/Short Form 540NR, line 38). If your federal AGI is more than $160,739 your credits may be limited. Complete the AGI Limitation Worksheet on page 6 • • • • • • • . • • • • .. • • • • • • • • 5 402 6 Residents subtract the amount on line 5 from line 2, Nonresident subtract the amount on line 5 from line 4c • • • • .. • 6 7 Enter the amount from Form 540, line 47, 540A, line 47, Long Farm 540NR, line 62, or Short Forth 540NR, line 61, Form 641, line 24 (total credits) • • • • . • . • • • • • • • • • • • . . • • • • • • • • • • • 7 8 Subtract the amounts on line 7 from line 6 ............ • • • ................... • • • • • • 8 9 Alterative Minimum Tax, Form 540 filers, multiply the amount on Sch P, line 24 by.9655, less line 2, above. Form 54ONR filers, recompute your'Sch P, multiply line 24 by .9655. Subtract line 4c, above, from line 43 of your recomputed Sch P. Form 541 filers, multiply the amount on Sch P, line 8 by.9655, less line 3a, above. Ifless than zero, enter zero .......................... • .. • • ... • ............ 9 to Enter the amount from Forms 540/540A, line 62 or Long Form 540NR, line 72, Form 541, line 27 (Mental Health Services Tax) • •................................. • 10 11 Add the amounts on line 8, line 9, and line 10 ........................ • • • . • • • • • . • • • 11 12 Enter the amount from Forms 540/540A, line 74 or Long Form 540NR, line 84 (Excess SDI or VPDI) • • • • • • • • • • 12 13 Enter the amount from Forms 540/540A, line 78 or Long Form 540NR, line 88 (Child and Dependent care Expense credo • • • 13 525 14 Add the amounts on line 12 and line 13 • • • • . • • • • • • • • . • • • • . • • • • • • • • • • • • • • • • • • • • • 14 525 16 Subtract line 14 from line 11. Enterthe amount here and on FM Form 5805, Part II, line 1 • • • • • • • • • • • • • • • 15 (52 5 ) See Computation below Exemption Credits = $196 Dependent Exemption = $206 Total = $402 CANM5ae5 L02 star•: Notes about the return 2009 PAGE 1 Name(s) Your social security number MTCHELLE A NARVAEZ 561-85-8295 1. CA 4803E (Head of Household Questionnaire) Not Completed For your clients who file electronically, the Franchise Tax Board highly recommends that they also file a form 9803E, Head of Household Questionnaire, with their electronic return. The Franchise Tax Board has a very active Head of Household Audit Program. Every year FTB sends more than 200,000 audit letters to taxpayers who claim the filing status, asking them for information to verify their eligibility. By pre -Filing with a 4803e most electronic Filers can avoid receiving that audit letter. 2. CA 540 2EZ is not produced due to income computed from sources other than Total wages, Total Interest Income, Total Dividend Income, & Total Pensions. 3. If you want to suppress the state's notes page from generating when it only concerns long form vs short form do the following: Escape out of the tax package data entry screen, go to Setup -Options -States tab. Select CA From the list; check box for "Suppress the CA Notes Page concerning ONLY the reason a short form did not print." Note: This will turn off ONLY notes about why a California short form was not generated. STNO7ES LD Earned Income Credit Worksheet 2009 Form 1040, line 64a, Form 1040A, line 40a, or Form 1040EZ, line 8a Name(s) as shown on form 1. Enter the amount from Form 1040 or Form 1040A, line 7, or Form 1040EZ, line 1 plus any nontaxable combat pay elected to be Included in earned Income • . • • • • • • .. • . • . • • • • • . • . • • • • • • • • • • • 1. 2. If you received a taxable scholarship or fellowship grant that was not reported on a W-2 forth, enter that amount here; plus any amounts received for work performed while an inmate in a penal institution; plus any amounts received as a pension or annuity from a nonquallfied deferred compensation plan or a nongovernmental section 457 plan . • . • • • • • • • • • • • • • • • . • • • • • • • • • • • • • • • • • • • 2• 3. Subtract line 2 from line 1 ... • ..... • .. • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 3. 4. If you were self-employed or used Schedule C or C-EZ as a statutory employee, enter the amount from the worksheet for self employed taxpayers • • • • • • • • • • • • • • • • • • • • • 4. 11,635 a. Add lines 3and 4•••••••-••••••••••.......I................••••• 6• 11,635 S. Look up the amount on line 5 above in the Etc Table on pages 55.71 to find your credit. Enter the credit here. 6. 3,043 If line 6 Is zero, stop. You cannot take the credlL Enter "No" directly to the right of Form 1040, line 64, or Fonn 1040A, line 40a. 7. Enter your AGI or Form 1040EZ, line 4 . • • • • • • • • • • • • . • • • • • • • • • • • • • • • • • • • • • • 7. 11,635 8. Is line 7less than - 9 $7,500 If you do not have a qualifying child? ($12,500 if marled filing joint) $16,460 If you have at least one qualifying child? ($21,450 If married filing joint) Yes. Go t0 line 9 now. No. Lookup the amount on line 7 above In the EIC Table to find your credit. Enter the credit here .............................. • ............ 3• 9. Earned Income credit. • If you checked "Yes" on line 8, enter the amount from line 6. • If you checked"No"on line 8, enterthe smaller of line 6 or line 8 • • • • • • . • • • • • • . • • • • • • • • 9. 3,043 For additional Information on the EIC calculation see the forth instructions or IRS Publication 596. I^..:ie'.7" Worksheet B I Earned Income Credit (EIC)-Lines 64a and SOForm 1040 for Your Records Use this worksheet If you answered "Yes" to Stop 6, question 3, on page 60. • Complete the parts below (Parts 1 through 3) that apply to you. Then, continue to Part 4. • If you are manied filing a Joint return, Include your spouse's amounts, if any, with yours to figure the amounts to enter in Parts 1 through 3. �N So Employed, j Members of the omy, and IC people With Church Employee )Income Filing chedule SE 1a. Enterthe amount from Schedule SE, Section A, line 3, or Section B, line 3, whichever applies. b. Enter any amount from Schedule SE, Section B, line 4b, and line 5a. c. Combine lines to and 1b. d. EnterI a amount from Schedule SE, Section A, line 6, or Section B, line 13, whichever applies. e. Subtract line 1d from 1c. 2009 1a 12,520 1b 1c 12,520 Id 885 2. Do not Include on these lines any statutory employee income, any net profit from services performed l rart t as a notary public, any amount exempt from self-employment tax as the result of the filing and approval of Form 4029 or Form 4361, or any income or loss from a qualified Joint venture reporting only rental real estate income not subject to self-employment tax. Se Employed a• Enter any net farm profit or (loss) from Schedule F, line 36, and from 2a NOT Required fans partnerships, Schedule K-1 (Form 1065), box 14, code A. To File b. Enter any net profit or (loss) from Schedule C, line 31; Schedule C-EZ, P Schedule VE i line 3; Schedule K-1 (Form 1065), box 14, code A (other than farming); + 2b For exampleyour ( and Schedule K-1 (Form 1065-B), box 9, code A net earnings from 1 s•M�mployment Ie WOM.6400. c. Combine lines 2a and 2b. = 2V ewers l *Reduce any Schedule K-1 amounts by any partnership section 179 expense deduction claimed, unreimbursed partnership expenses claimed, and depletion claimed on oil and gas properties. If you have any Schedule K-1 amounts, complete the appropriate line(s) of Schedule SE, Section A. Enter your name and social security number on Schedule SE and attach It to your return. ^� �r'rirtar 8 }¢tetutoty Emplcyee�s � 3. Enter the amount from Schedule C, line 1, or Schedule C-EZ, line 1, that 3 Filing Schedule C or a4z you are filing as a statutory employee. 1 i r•'. 4a. Combine lines le. 2c, and 3. This Is your total self-employed Income. 11 635 ' AlI Files Uflr�?. (WorkshepttiV, EEA Forms 1040, 104ONR Child Tax Credit Worksheet CAUTIONI To be a qualifying child for the child tax credit, the child must be underage 17 at the and of 2009 and meet the other requirements listed in instructions. Psrt q' 1. Number of qualifying children: 1 X $1,000. Enter the result. 1 1,000 2. Enter the amount from Form 1040, line 38; Form 1040A, line 22; or Form 1040NR, line 36, 2 11,635 3. 1040 Filers. Enter the total of any- 9 Exclusion of Income from Puerto Rico, and Amounts from Form 2555, lines 45 and 50; Form 2555-EZ, line 18; 3 and Form 4563, line 15. 1040A and 104ONR Filers. Enter -0-. 4. Add lines 2 and 3. Enter the total. 4 11,635 6. Enter the amount shown below foryour filing status. 0 Married filing jointly - $110,000 Single, head of household, or qualifying widow(er)-$75,000 5 75,000 9 Married filing separately -$55,000 6. Is the amount on line 4 more than the amount on line 5? NJ No. Leave line 6 blank. Enter-0- on Una 7. []Yes. Subtract line 5 from line 4. 6 If the result is not a multiple of $1,000, Increase it to the next multiple of $1,000. For example, Increase $425 to $1,000, increase $1,025 to $2,000, etc. 7. Multiply the amount on line 6 by 5e/a (.05). Enter the result. 7 0 B. Is the amount on line 1 more than the amount on line 77 �] No. STOP You cannot take the child tax credit on Form 1040, line 52; Form 1040A, line 33; or Form 1040NR, line 47. You also cannot take the additional child lax credit on Farm 1040, line 66; Form 1040A, line 41; or Form 1040NR, line 61. Complete the rest of your Form 1040, 1040A, or Form 1040NR. (Yes. Subtract Tina 7 from line 1. Enter the result. Go to Part 2. 8 1,000 `stl 9. Enterthe amount from Form 1040, Iine 46, Form 1040A, line 28, or Form 1040NR, line 43. 9 10. Add the amounts from - Form 1040 or Form 1040A or Form 1040NR Line 47 Line 44 + Line 48 Line 29 Line 45 + Line 49 Line 31 + Line 50 Line 32 Line 46 + Form 5695, line 11 ............•'•"""""""""' + Form 8834, line 22............•••••...••.....••...•• + Form 8910. line 21 • • • • . • • • • • • • • • • • • • ................ + Form 8936, line 14 • . • . • .. • • • • . • • • • .. • • • • .......... •. + Schedule R, Iine 24................................. + Enter the total. 10 11. Are you claiming any of the following credits? • Mortgage Interest credit, Farm 8396 • Adoption credit, Form 8839 Residential energy efficient property credit, Form 5695 District of Columbia first-time homebuyer credit, Form 8959 ('X No. Enter the amount from line 10. 11 F-, Yes. Complete the Line 11 Worksheet on the next page to figure the amount to enter here. 12. Subtract line 11 from line 9. Enter the result. 12 13. Is the amount on line 8 of this worksheet more than the amount on line 12? ; No. Enter the amount from line 8. This Is your Yes. Enter the amount from line 12. See the TIP below, child tax credit 13 FnlertlYa emoMlon TIP You may be able to lake the additional child tax credit on Form 1040, line 66; Form 1D40A, line 41; Form 1040, line52; or Form 10401,111, line Si, only if you answered "Yes"online 13. orFFormm 10044ONR 1line47. a First, complete your Form 1040 through line 65, Form 1040A through line 40a, or Forth 104ONR through Iine 60. S Then, use Form 8812 to figure any additional child tax credit. 1Nr_ee12LD • Carryover Worksheet • List of items that will carryover to the 2010 tax return I 2009 (Keep for Your records) shown on realm Itemized Deductions Carryover Amount Contributions subject to100%ofAGI limitations • . • • ' • • • ' • • • • • • ' • • • • • • • • • • • • • • • • • • • Contributions subject to50%ofAGI limitations • • • • • • .............................. • Contributions subject to 30% of AGI limitations (50%capital gains appreciated property) • • • • • • • • • .. • • • • . Contributions subject to30%ofAGI limitations • • . • • • • • • • • • • • • • • • • • • • ' • • ' • • • • • • • • • • • Contributions subject to 20%of AGI limitations (30% capital gains appreciated property) • • • • • • • • • Taxable state and local refunds to Form 1040, line 10 - - • • • • ........................ • • • • Stalellocal taxes paid in 2010 to flow to the Schedule A • • • • • • ........................ • • Preparer Fee to flow to the Schedule A • • - - • • • • • • " ........................ • • • • 59 State donations and contributions carryover • • • • • • • • • ' ' • • • • • • • • • • • • • • ' • • • • • • • • • • ' ' State overpayment applied to next year ... • • • • • • ' • • • . • . • . • • • • • • • • • • • • • • • • • • ' • • • Expenses Office in home operating expenses ............. • .... • • . • ..... • ..... • . • ...... . Office in home excess casualty losses and depreciation .. • • • • . • • • • • ' • • . • • • • • .. • • • . ' • • • • • Disallowed investment interest expense • • • • • • • • • • • • ' • • • • .. • ' • • • • • • • • . • • . ' • • • • Section 179 expense ................................. .............. . Operating expenses, from Form WK_E, Sch E - Rental limitation on deductions when used for personal use . • • • • . . Losses Short-term capital loss . •.............................................. . Long-term capital loss ................................................ . Net operating loss • .................................................. Nonrecaptured not section 1231 losses • • • • ' • • • • • • • ' • • • • • • • • • • • Credits Mortgage interest credit ................................... • • .......... . General business credit (should be carded back before being carried forward) • • • • . • • • • • • • • • • • • • • • Creditforprioryearminimum tax .. • .. • . • • ..... • • • • • • • • • • • • • • • • • • • • • I ....... . Foreign Tax credit ................................................... District of Columbia first time home owner's credit • • • • • • • • • • • • • • • • • • • ' • • • • • • • • • • • ' Adoption credit ..................................................... First-time homebuyer Credit .................................... • • ........ . Other Overpayment applied to next year's estimates • • • • • • • • • • • • • • • • • • • • • • • • • • • • Federal tax liability for 2210 calculation ' • • • • • • . • • • • • . • • . • • • • • • • • • • • • • • • • • • • • • • • • U State tax liability for state 2210 calculation • • • • • • • ' • • • • • • • ' • • • • • • • • • • • • • • • • • ' IRAbasis ... • ............. ' • • • • • • • • ..... Taxpayer Spouse Excess depreciation, from Form WIC E, Sch E- Rental limitation on deductions when used for personal use • • • Passive Activity At Risk Limitations Form 1040f2009)MTCHRT,TR A NAR&.7. a 561-85-8295 Paget 38 Amount from line 37 (adjusted gross income) • • • • • • • • • • • • • • • • • • • • Tax and 394 Check rr You were born before January 2, 1945, []Blind.) Total boxes Credits 1 Spouse was born before January 2,1945, JBIInd. J checked ►39a 38 11,635 vs. Standard Is If your spouse itemizes on a separate MUM oryouwere adual-status allan,wepg35and check hem III- 39bLle�`p Deduction 40a Itemized deductions from Schedule A) or our standard deduction (see left margin) • • • for_ ( Y 9) 40a 8 350 41 3.285 •People who to Iryou arohmmasingyeurstandard deduction bycerlern realestato lazes, newmetor check any "Md&I, , ore net dismtoriuss. Match Schedule Land check hem(seepage 35) • • • - • - ►4ob box on 41 Subtract line 40a from line 38 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 39a, 39b or 40b orao 42 Exemptions. If line 38 Is $125,100 or less and you did not provide housing to a Midwestern be ccllaimeed as a displaced individual, muhiply $3,650 by the number on line 6d. Otherwise, see page 37 - • • dependent, see page 35. 43 Taxable Income. Subtract line 42 from line 41. If line 42 is more than line 41,enter-0- • • • Is All others: 44 Tax (see page 37). Check if any tax is from: a OForm(s) 8814 b t�u Form 4972 • • ,,,,,` 42 7,300 43 0 µ 0 46 Single or, , 46 Alternative minimum tax (see page 40). Attach Form 6251 • • • • - • • • • • Married Oling 46 Add lines 44 and 45 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • ► separately, • • - $5,700 47 Foreign tax creditL Attach Form 11161f required • • • • • • • • 47 Married filing 48 Credit for child and dependent care expanses. Attach Form 2441 • • • • 48 8 boinll or 49 Education credits from Form 8863, line 29 • • • • • • • • • • • 49 S117er), 46 , ua�ry ing 60 Retirement savings contributions credit. Attach Fann 8880 • • • !i0 $11,400 51 Child tax credit (see page 42) • • • • • - • • • • • • • • • • • 61 0 Head of 62 Credits from Form: a ss9e b 1839 c 15695 62 house $8,350Ok1, 63 Other credits fromFartn: a�38e0 b L jBBDI e 63 54 Add lines 47 through 53. These are your total credits • • • • • • • • • • • • • • • • • • • • , --• 64 1 66 0 66 Subtract line 54 from line 46: If line 54 is more than line 46, enter-0. • • • • • • • • • • ► 66 Self-employmenttax. Attach Schedule SE • • • • • - - • • • • • • • • • • • • - - • • • Other 67 Unreported social security and Medicare lax from Form: a �]4137 b J8919 • • • • Taxes 58 Additional tax on IRAs, other qualified retirement plans, etc. Attach Foam 53291f required • • 69 Additional taxes: a ❑ AEIC payments b ❑ Household employment taxes. Attach Sch. H 6e 1,769 67 68 59 60 Add lines 55 through 59. This is your total tax • • • - • • • • • • - • • • • • • • • • • ► so 1,769 Payments 61 Federal Income tax withheld from Forms W-2 and 1099 • • • • 62 2009 estimated lax payments and anrounlappiled from 2008 return ' ' • • 61 62 63 400 63 making work pay and government Mires, credit& Attach Schedule M • • • If you have a 64a Earned Income credit (EIC) • • • • • • • • • • • • • • • • • qualitying child, attach b Nontaxable combat pay erection • • 64b Schedule EIC. 66 Additional child tax credit. Attach Form 8812 • • • • • • • • • 64a 3,043 �w B25 65 66 66 Refundable education credit from Form 6863, line 16 • • • • • 67 67 First-time homebuyer credit. Attach Farm 5405 • • 66 Amount paid with request for extension to file (see page 72) L•e} 68 69 _ 69 social security and liar 1 RRTA tax withheld (me page 72) �• Excess 70 Credits from Form: a Cj2439 b ❑413s c LJa801 d 1 IaeeS payments • • • • • • ► 71 71 Add lines 61, 62, 63, 64a, and 65 through 70. These are yourtotal 4,268 72 If line 71 is more than line 60, subtract line 60 from line 71. This is the amount you overpaidn Refund 73a Amount of line 72 you want refunded to you. If Form 8888 is attached, check here • • ► LJ Dkeddeposit7 See page 73 ► b Routingnumber 3 2 2 2 8 0 4 8 5 ►c Type: Xchecking Savings 72 2,499 73A 2,499 and fill in 73b, ► d Accountnumber 2 7 3 3 2 0 10 17 730, and 73d, or Form 8888. 74 AmoumdNx72 awanl SPPUdb2MOOOknWAdbx • .► 74 Amount 76 Amount you owe. Subtract line 71 from line 60. For details on how to pay, see page 74 • ► You Owe 76 Estimated tax penalty (see page 74) • • • • • • • • • • • • 76 79 �'•. 'r Third Party Do you want to allow another person to discuss this return with the iHJ (seepage yo)-r LJ Yes. uomprete me Touolmng. LXJ no Uesi n@@ Designews Phone Penonalidemnmum �T—r I I ID g name ► no. ► number(PIN) ► I I ( Sign Under penalties ofpe4ury.I declare that l he" examined this return and accompanying schedules and statements, and to the beater my knowledge and belief. Here they are true, carnal, and complete. Declaration or preparer(other than taxpayer) Is based avail mfonnahon ofwhich pmpaverhas any knowledge. Joint return? Yourelgnature Data Youroocupenon Daytime phone number See page 15.58295 02-18-2010 AITRESS Keep acopy spouses signature. its joint return. boar musleign. Date Spouss'aocalpauon 714-421-993. for your records, i` Data _. PreoeMls SSN or PTIN Paid Npnres J0 Preparer's Use Onlyname (or years youn lr aelfamployad). address, and ZIP cede 0 SCHEDULE C-EZ (Form 1040) Nana ofpropdelor Net Profit From Business (Sole Proprietorship) ► Partnerships, joint ventures, etc., generally must Ole Form 1066 or 1065-B. It Attach to Form 1040,1040NR, or 1041. ► See Instructions. General information You May Use Schedule C-EZ J* Instead of Schedule C Only If You: Had business expenses of $5,000 or less. Use the cash method of accounting. Did not have an Inventory at any time during the year. Did not have a not loss from your business. Had only one business as either a sole proprietor, qualified joint venture, or statutory employee. And You: 2009 socalwmft,a-d-csw Had no employees during the year. Are not required to Ole Form 4562, Depreciation and Amortization, for this business. See the Instructions for Schedule C, line 13, on page C•5 to find out if you must file. Do not deduct expenses for business use of your home. Do not have prior year unallowed passive activity losses from this business. A Principal business or profession, including product or service B ; buwaasouas(aae esy ENTERTAINMENT 711510 C Business name. If no separate business name, leave blank. D Ereery=aN(minin.) MICHELLE A NARVAEZ E Business address (Including suite or room no.), Address not required if same as on page 1 of your tax return. 400 SOUTH FLOWER City, town or post office, state, and ZIP code Orange CA 92868 Figure Your Net Profit 1 Gross receipts. Caution. See the instructions for Schedule C, line 1, on page C-4 and check the box iF. 0 This Income was reported to you on Form W-2 and the "Statutory employee" box ❑ on that form was checked, or ► You are a member of a qualified joint venture reporting only rental real estate Income not subject to self-employment tax. 2 Total expenses (see Instructions). If more than $5,000, you must use Schedule C • • • • • • • • • • • • 3 Net profit. Subtract line 2 from line 1. If less than zero, you must use Schedule C. Enter on both Form 1040, line 12, and Schedule BE, line 2, or on Form 1040NR, line 13. (if you checked the box on line 1, do not report the amount from line 3 on Schedule BE, line 2.) Estates and trusts, nnlor an ram 1041. lino 3 • • • • • - • • • • • • • • ' • • • • • • • • • ' ' ' • ' • ' • Information on Your Vehicle. Complete this part only if you are claiming car or truck expenses online 2. 4 When did you place your vehicle In service for business purposes? (year, month, day) It. 5 Of the total number of miles you drove your vehicle during 2009, enter the number of miles you used your vehicle for: a Business b Commuting (see instructions) c Other e Was your vehicle available for personal use during of -duty hours? • • • • • • • • • • • • • • • ' • • • • • ' • • . Yet (—, No 7 Do you (or your spouse) have another vehicle available for personal use? • • • •. • • • • • • • • • • • • • • • •' ❑Yes No Be S e Do you have evidence to support your deduction? • • • • • • • • • • • • • • • • ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' ' U Yes L No "is the evidence written? • • • • • • • • • ' I I Yes I J No Act Notice, 800 EEA 0 SCHEDULE SE OMe Nd.15/5 0074 (Form 104-0) Self -Employment Tax 2009 Department or 07 Attachment reesury Attament Internal Revenue Service (9g) ► Attach to Form 1040. ► See Instructions for Schedule SE (Form 1040). Sequence No. 17 Name of person with self-employment income (as shown on Form 1040) Social security number of person MICHELLE A NARVAEZ with self-employment Income ► 561-85-8295 Who Must File Schedule SE You must file Schedule SE !f: You had net earnings from self-employment from other than church employee Income (line 4 of Short Schedule SE or line 4c of Long Schedule SE) of $400 or more, or You had church employee Income of $10828 or more. Income from services you performed as a minister or a member of a religious order Is not church employee Income (see page SE-1). Not*. Even if you had a loss or a small amount of income from self-employment, it may be to your benefit to file Schedule SE and use either"optional method" in Part II of Long Schedule SE (see page SE-4). Exception. If your only self-employment Income was from earnings as a minister, member of a religious order, or Christian Science practitioner and you filed Form 4361 and received IRS approval not to be taxed on those earnings, do not Ole Schedule SE. Instead, write "Exempt -Form 4361"on Form 1040, line 56. May I Use Short Schedule SE or Must I Use Long Schedule SE? Note. Use this flowchart only N you must file Schedule SE. If unsure, see Who Must File Schedule SE, above. Are you a minialer, memberofa religious order, or Un asm Science predblonerwho received IRS approval not to be taxed on earnings kom these Sources, but you owe Self-employment No Are you using one of the optional methods mdgureyour not earnings (See page 8E4)? Did you receive church employee Income reported on Form %2 or $108.28 or more? You my tw Shod Sche" SE beloty Yes Was the total of yourwa0es and Ups Subject to Social security or railroad millemeal(Uer It tax plus your not earnings from sell mploymont more Nan$10s,800? No Did you receive UPS subled to social security or Medicare tax thatyou didnot reportloyouremployer? Did you report any wages on Fenn 8010, Unooeacled Social Seedy end Medicare Tax on Wagas7 Yes Yes I Younariue Long So*" SEon p@gg2 I Section A. Short Schedule SE, Caution. Read above to see if you can use Short Schedule SE. la Net farm profit or (loss) from Schedule F, line 36, and farm partnerships, Schedule K-1 (Form 1065), box 14, code A ........................................... 1s b If you received social security retirement or disability benefits, enter the amount of Conservation Reserve Program payments Included on Schedule F, line 6b, or listed on Schedule K-1 (Form 1065), box 20, code Y 1b 2 Net profit or (loss) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1(Form 1065), box 14, code A (other than farming): and Schedule K 1 (Form 1065-B), box 9, code J1. Ministers and members of religious orders, see page SEA for types of income to report on this line. See page SE-3 for other Income to report • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 2 12,520 3 Combine lines 1a, tb, and 2 • • • • • . • • • • • • • • • • • • • • • • • • • • • . • .. • • • • • • • • • 3 12,520 4 11,562 4 Net earnings from self-employment. Multiply line 3 by 92.35% (.9235). If less than $400, do not file this schedule; you do not owe self-employment tax • • • . • • • • • • • • • • • • • • • • • • • • ► s Self-employment tax. If the amount on line 41s: $106,800 or less, multiply line 4 by 15.3% (.153). Enter the result here and on Form 1040, line 56. e More than $106,800, multiply line 4 by 2.9%(.029). Then, add $13,243.20 to the result. Enter the total here and on Form 1040, line 60 .............................. • 5 1,769 I 6 Deduction for one-half afgolf-employment tax. Multiplyllne5 by 50% (.5). Enter the result here and on Form 1040, line 27 • • • • . • • • • 1 6 885 For Paperwork Reduction Act Notice, see Form 1040 instructions. EEA Schedule SE (Form 1040) 2009 Child and Dependent Care Expenses oMe Ne.16/6A Form 2"1 ► Attach to Form 1040, Form 1040A, or Form 1040NR. 2009 Department of the Treasury Attachment ► See separate Instructions. senuenceNo. Part I I Persons or Organizations Who Provided the Care - You must complete this part. nfvar haves mare then two care providers. see the instructions.) 1 (a) Care prcvider's name (b) Address (number, street, apt. no., city, state, and ZIP code) (c) Identifying number (SSN or EIN) (d) Amount paid (see instructions) FIRST BAPTIST CH 1010 WEST 17TH STREET 304-27-0123 3,000 Santa Ana CA 92706 [—Did you receive No —► Complete only Part 11 below. 1 dependent care benefits? I_ yes —► Complete Part III on page 2 next. Caution. If the care was provided in your home, you may owe employment taxes. If do, you cannot file Form 1040A, For details, see the Instructions for Form 1040, line 59, or Fern 104ONR, line 56. (e) Quatdying person's name ng persons, see the instructions. (D)Qusllrylne Persm's sodel iGD incurred 3 Add the amounts In column (c) of line 2. Do not enter more than $3,000 for one qualifying person or $6,000 for two or more persons. If you completed Part III, enter the amount from line34.......................................... 4 Enter your earned Income. See Instructions • . • • • • • • . • • • • • . • • • • • • • • • • - 6 If married filing jointly, enter your spouse's earned income (d your spouse was a student or was disabled, see the instructions); all others, enter the amount from line 4 • • • • • • • - 6 Enter the smallest of line 3, 4, or 5 ........................ • • • • . . 7 Enter the amount from Form 1040, line 38: Form 1040A, line 22; or Form 104ONR, Ilne 36 .. • • • • • • .. J 7 I 11, 63 8 Enter on line 8 the decimal amount shown below that applies to the amount on line 7 If line 71s: If line 71s: But not Decimal Over over amount Is $0.15,000 .35 15,ODO-17,OOD .34 17,OD0.19,0D0 .33 19,000 - 21,000 .32 21,ODO - 23,000 .31 23,000 - 25.000 .30 26.000.27,000 .29 27,000.29,000 .28 But not Over over Decimal amount Is S29,OOD-31,000 27 31,OD0 - 33.000 .26 33,OD0.35,000 .25 35,000 - 37,000 .24 37,0DO - 39,ODO .23 39.000 - 41,000 .22 41,000 - 43,ODO .21 43,000-No limit .20 3 6 9 Multipy line 6 by the decimal amount on line 8. If you paid 2008 expenses in 2009, see _ the Instructions ........................................ �9 10 Enter the amount from Form 1040, line 46; Form 1040A, line 28; or Form 1040NR, line 43 • • • • . • • • • 10 11 Enter the amount from Form 1040, line 47; or Form 104ONR, line 44. Form 1040A filers, enter -0 . • • • • • • 11 _ 12 Subtract line11 from line 10. If zero or less, stop. You cannot take the credit . • . • • • .. • • 12 13 Credit for child and dependent care expenses. Enter the smaller of line 9 or line 12 here and on Form 1040, line 48; Form 1040A, line 29; or Form 104ONR, line 45 • • • • • • • • . 13 For Paperwork Reduction Act Notice, see page 4 of the instructions. EEA X. SCHEDULE EIC Earned Income Credit OMe No. 1545. (Form 1040A or 1040) Qualifying Child Information 2009 Complete and attach to Form 1040A or 1040 nepaMRevenu a Internall Revenue Senasuy rvlca (ee) Only if you have a gU011fying Child. Attachment Sequence No. Names) shown on return YoaaorLl seoaey.U.O r MICHELLE A NARVAEZ 1 301-03—Cc7D Before you begin: • Seethe Instructions for Form 1040A, lines 41a and 41b, or Form 1040, lines 64a and 64b, to make sure that (a) you can take the EIC, and (b) you have a qualifying child. Be sure the child's name on line 1 and social security number (SSN) on line 2 agree with the child's social security card: Otherwise, at the time we process your return, we may reduce or disallow your EIC. If the name or SSN on the child's social security card Is not correct, call the,Soclal Security Administration at 1.800-772-1213. 9 If you take the EIC even though you are not eligible, you may not be allowed to take the credit for up to 10 years. See Instructions CAUTION! for details. 0 It will take us longer to process your return and Issue your refund If you do not fill In all lines that apply for each qualifying child. Qualifying Child Information Child 1 Child 2 Child 3 Flretnema Lastneme First name Last name First name Lastname 1 phill's name I you (rave more than three qualifying children, you only have to list three to get JADEN the maximum credit. ORNELAS CC arff.sg r� 2 'fhelcfilltl m s have an SSN as defined on page 45 of the Form 1040A Instructions or page 51 of the Form 1040 instructions unless the child was bom and died in 2009. If your child was bom and died in 2009 and did not have an SSN, enter "Died" on this line and attach a copy of the child's birth certificate, death certificate, or hospital medical records. 623-51-1475 3 Child's year of birth Year 2005 Year Year Ifbomaner1990 andthedYldwas itbam alter 1960 and the child was Ilbomaner1990 atdmechddwas younger than you (oryour spouse. if younger then ym (or your spouse. N younger Nanyou(oryourspouset,lr filing jointly), skip lines 4a and 4b: go filing Jointly). skip lines 4a and 4b; go filing Jointly), skip free 4a and 4b; go to line 6 Wines 5 line 5 4a Was the child under age 24 at the end of Yes. D No. LJ Yes. No. C Yes. G No. 2009, a student, and younger than you (or your spouse, if filing jointly)? Go to line S. Continue. Go to line li. Continue. Go to line 6. Continue. b Was the child permanently and totally disabled during any part of 20097 Yes. No. F Yes. O No. Yes. n No. Continue. The child is not a Continue. The child is not a Continue. The child is not a qualifying child. qualifying child. qualifying child. 5 Child's relationship to you (forexample, son, daughter, grandchild, niece, nephew, foster child, etc.) SON 6 Number of months child lived with you in the United States during 2009 is If the child lived With you for more than half of 2009 but less than 7 months, enter'7." 0 If the child was bom or d"red in 2009 and your homechild'sa forThe 12 months months months wolive during entire he or she was e Do not enter more than 12 Do not enter more then 12 Do not enter more than 12 2009, enter "12." months. months. months. For Paperwork Reduction Act Notice, $se Fermi 1040A EEA acneuule cic lrormi nIMVA or nwo) zwe or 1040 Instructions. - Form 8812 Additional Child Tax Credit Depamne nt or aro Treasury shorn on re:um and Form 1040A, or Form 1040NR. 1 1040 filers: Enter the amount from line 6 of your Child Tax Credit Wokksheet (see the Instructions for Form 1040, line 51). 1040A tilers: Enter the amount from line 6 of your Child Tax Credit Woksheet (see the Instructions for Form 1040A, line 33). 1040NR filers: Enter the amount from line 6 of your Child Tax Credit Worhaheet (see the Instructions for Form 1040NR, line 47). If you used Pub. 972, enter the amount from line 8 of the wrksheet on page 4 of the publication. 2 Enter the amount from Form 1040, line 51, Form 1040A, line 33, or Form 1040NR, line 47 • • • • • • • • • • • 3 Subtract line 2 from line 1. If zero, stop; you cannot take this credit • • • • • • • • • • • • • • • • • 4a Earned Income (see Instructions) • • • • • • • • • • • • • • • • 'a 8,503 b Nontaxable combat pay (see Instructions) • • • 4b " 5 Is the amount on line 4a more than $3,000? No. Leave line 5 blank and enter-0-on line 6. • • • r„ I Yes. Subtract $3,000 from the amount on line 4a. Enter the result • 9m 5,503 6 Muftiply the amount on line 5 by 15% (.15) and enter the result • • • • • • • • • • • • • Next Do you have three or more qualifying children? No. If line 6 is zero, stop; you cannot take this credit. Otherwise, skip Part II and enter the smaller of line 3 or line 6 on line 13. (� Yea. If line 6Is equal to or more than line 3, skip Part II and enter the amount from line 3 on line 13. Otherwise, no to line 7. 1 2 2009 Artechm nt 7 Withheld social seourily and Medicare taxes from Form($) W-2, boxes 4 and 6. If married filing jointly, Include your spouse's amounts with yours. If you worked for a railroad, see Instructions • • • • • • • • • • • • • • • 7 9 1040 filers: Enter the total of the amounts from Form 1040, lines ` 27 and 57, plus any taxes that you identified using code "LIT"and entered on the dotted line next to line 60. 9 1040A fliers: Enter-0-. 1040NR filers: Enter the total of the amounts from Form 1040NR, line , 53, plus any taxes that you identified using code "u7" and entered on the dotted line next to line 57. 9 Add lines 7 and 8 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • 9 10 1040 filers: Enter the total of the amounts from Form 1040, lines _ 64a and 69. 1040A filers: Enter the total of the amount from Form 1040A, line 41a, plus any excess social security and tier 1 RRTA 10 taxes withheld that you entered to the left of line 44 (see instructions). 1040NR filers: Enter the amount from Form 1040NR, line 63. 11 Subtract line 10 from line 9. If zero or less, enter -0. • • • • • • • • • • • • • • • • • • • • • • • • • • • • 11 12 12 Enter the larger of line 6 or line 11 • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • • Next, enter the smaller of line 3 or line 12 on line 13. I' Additional Child a Credit 13 This Is your addlUonal child tax credit • • • • • • • • • • • • • • • • • • • • . • • • • • • • • • • • • • 13 825 Enter this amount on Form 1040, line 65, Form 1040A, line 42, or Form 1040NR, line 61. For Paperwork Reduction Act Notice, see Instructions. EEA Form 8812 (2009) SCHEDULE M (Form 1040A or 1040) Depanmenl of Um Treasury 9 0 Making Work Pay and Government Retiree Credits ► Attach to Form 1040A or1040NR. It -see se OMB No.1545-0074 Name(s) shown on Mum Yeuraoddfeuaaynarbar MICHELLE A NARVAE2 561-85-8295 is Important: Seethe instructions if you can be claimed as someone else's dependent or are filing Form 1040NR. Check the "No" box below and see the instructions if (a) you have a net loss from a business, (b) you received a taxable scholarship or fellowship grant not reported on a Form W-2, (c) yourwages Include pay for work performed while an Inmate in a penal Institution, (d) you received a pension or annuity from a nonqualified de- ferred compensation plan or a nongovernmental section 457 plan, or (9) you are filing Form 2555 or 2555-EZ. Do you (and your spouse if filing jointly) have 2009 wages of more than $6,451 (512,903 if married filing jointly)? ��� Yes. Skip lines la through 3. Enter $400 ($8001f married filing jointly) online 4 and go to line 5. JXJ No. Enter your earned income (see Instructions) • . • • • • . • • • • .I 1a 1 8,503 b Nontaxable combat pay Included on line 1a (see Instructions) • • . • • • • • • 11b 2 Multiply llne la by 6.2% (.062) .................. • • • • • 3 Enter SOO ($800 If married filing jointly) • • • • • • . • • • • • • . • • • • 1 3 1 400 4 Enter the smaller of line 2 or line 3 (unless you checked "Yes" online 18) • • • • • • • • • • • • • • • • • • 4 5 Enter the amount from Form 1040, line 38', or Form 1040A, line 22 • • • • • L 5 6 Enter $76,000 ($150,000 If married filing jointly) • • • • • • • • • • • • . • . L 7 lathe amount on line 5 more than the amount on line 6? No. Skip line 8. Enter the amount from line 4 on line 9 below. � Yes. Subtract line 6 from line 5 .................. • • 7 8 Multiply line 7 by 2% (.02)........................................ 8 9 Subtract line 8 from line 4. If zero or less, enter -0- • • • . • • • • • • • • • • • • • • • • • • • • • • • 9 10 Did you (or your spouse, if filing jointly) receive an economic recovery payment in 2009? You may have received this payment If you received social security benefits, supplemental security Income, railroad retirement benefits• or veterans disability compensation or pension benefits (see Instructions). ' J] No. Enter-0-on line 10 and go to line 11. [� Yes. Enter the total of the payments received by you (and your spouse, if filing ....... . jointly). Do not enter more than $250 ($500 if married filing jointly) 11 Did you (or your spouse, If filing jointly) receive a pension or annuity In 2009 for services performed as an employee of the U.S. Government or any U.S. state or local government from work not covered by social security? Do not Include any pension or annuity reported on Form W-2. No. Enter 4)- on line 11 and go to line 12. j Yes. o If you checked "No" on line 10. enter $250 ($500 if married filing jointly and the answer online 11 is "Yes" for both spouses) e if you checked "Yes" on line 10, enter .0. (exception: enter $250 If filing • • • • • • jointly and the spouse who received the pension or annuity did not receive an economic recovery payment described on line 10) 12 Add lines 10 and 11 .. • • ........ • ....... • ...................... . 13 Subtract line 12 from line 9. If zero or less, enter-0. . • • • • • • . • • • • • • • • • • • • • • • • • 14 Making work pay and government ratires credits. Add lines 11 and 13. Enter the result here and on Forth 1040, line 63; Form 104DA, line 40; or Forth 1D40NR, line 60 . • • • • • • • . • • • • • • • • • Form 2555, 2555-FZ, or 4563 or you are excluding Income from Pued i Act Notice, see Forth 1040A, 1040,.or EEA 1040NR Instructions. +fi 11 14 Jun 02 2010 4:23PM HP.SSERJET FAX . p•1 VILLA POINT II (Oif-site Newport North ApaRrtents) (qqol Unit No. CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (Forte"ots not in passadon er s Section a cerditato or voucher, Income docamentado* mast be obtained.) INVe certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned Is/are the only income earning occupants) of the above indicated leased premises; and, 2. During 2009, the Total Annual Eligible Income" of the undersigned Individual(s) was $ and; 3. During 2009, my total monthly rent payment to Villa Point II'(Off--site Newport North Apartments) was $ IaO f O • per month. • Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commiaatons, net income from a business or rental property, Interest and dividends, social security payments, retirement fund or pension payments and distributions, disabi8ty benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point 11(Off-site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided Information In the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification Is made under penalty of perjury in Newport Beach, California on the date indicated below: Nevus and Acres of Non -Income Earning Household eignaturn(s) of Income Eaming Household Member(*): Member(o): Name Age N f R sc /H Lj M c.wrr yea s-- Dale: C • VILLA POINT 11(Off--site Newport North Apartments) Unit No. ,��b CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession of a section 8 certificate or voucher, Income documentation must be obtained.) We certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2009, the Total Annual Eligible Income* of the undersigned Individual(s) was $ �) J '?- J2' ; and, 3. During 2009, my total monthly rent payment to Villa Point II (Off -site Newport North Apartments) was $ % 2 q L ' per month. " Total Annual Eligible Income Includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point 11(Off-site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents.to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the data indicated below: Names and Ages of Non -Income Earning Household Member(s): Name Signature(s) of Income Earning Household Msmber(s): Age r , Signstum Date: Signature Slgnatum Jun 16 2010 11:46RM HP&SERJET FRX n �N P. 33e) 1vIV ' LEASE - LEA4ISMADBASOI'Nmeober10.W2bYandbthwal haelnaAm(`Lvdlud"), andS,Y1p Iiableaod w all colkollray referred to f L..� .7bB8 kmlk Raxk t I��w' hereYlMcr "RnYeaL" Ifawro then tint, eYA MAII be)oIM1Y and aavmdly �+ �t Y 9taldmt' hweN. L Daft A. CQN®mRY: NYmmt North a Apsamea A. Newport Bead, CA 92660 Clty. Sp4, ZIP D. 7ICRl1l:t]altaumber Mt. C M,+"N - 131 MallbaNa- 212 No. ofVahlclea• 2 Lku*oP]amNa: D. TAW:Commcoccom Noventhr I0. 2009 andmdam atmbw9.20i0 Y 111l9p.m 8,Rgal; OwnsousandPi H edmd N3njhLHve And W100 (5]593,DO pw month F. Raines Dalai noIRMST(IST) dayarsaeh alenme month. 0.3anviw Daaadl; Soven�Othad Aid M)IM (RMO N, $OWNk: um UYeer Sinh Morgan Lhmn•k 060/1997 josinnetWnik 11/15=W -- L Thds: NOI= ), Fred Geraghty, Addrinafto hic"Nonh Aporbocr4 • 2MiWo NewpatBendl, CA M60 (949)7ZO4170 R. Iw,Mlerd'a Relay &Reavlatloee: Revision Dale: 3106(SY P.shihn"A') A Prnebaa The Fra d= IoYW an Resident consist of residential Adt101011a Will any Ilppllanma window covemtga. caper and othw Wl*inp lined an die rrarain than, and the amW and/orm mbar of Pokmg Spoca(a) hakd in 1.0 above. Lendlordmay change RaYm11 dmlyut<d Owego od/ar petktog Spam, Dens time a ti m. Resident shaft comply vvhh the Poking Rules wmlrwd in the Rules and Retuladom attached hrrcoomH>dt16R"A" the ofma OarggaaPaAing Spuefw artylhingetherlhn Yapodtled Its the RWo nd Regulaama Isprahlbbed A Tarns: Landlord make, on representation that the Pmmixs will be ready 1hr ono VnW on the commencement: doe of the Term. If Landlord is unable 10 deliver possession ofthePmuaiacs tithe oommeroemem of the Tam. Landlord shall not be liable fardamaga to ResldenL ban Resident shall not be responsible fa payment orRmt fan the POW belwem the commmocment of the Term ad the limn, wl*n laidlord deRxm pwatdoa. V Landlord Is not able to deliver pYassion within many (30) drys of the mlrawrleemertl dak afthe Tena.ithcr ladlordw Rcdded roq. prior W the tltm whm Lwrdbrd delivoe, puss edoru canal thb Lute by glvhrg woman raU a to tun alive. a Rant: Ruldenl shall pay Landlord ten Rod for No Pmmba each month is sWalce on or befra Rent Due Den. In xYldon, at other romxrry obligations afResldml under this Lease Mull bedentrid a be additional Rer4 Anyrrrhmaculothalelm'7ttorin 0da Lase shag bedamedtolndude addidorW ReM. If Resident move, in on Res that day oftha comb, Resident") paYRat for 9a Rra momhwthe a+lawR abotM in Batton l.Em thamoralR tYta IfResidem movesln an my ray mbrthon the Ara day of thn month, Re,1deM sMll pryMe InRkl Rea Pg7nenlYfollows: h Llave in aflyda la andhefire thc23th ifRcddet moves In eDwthe is day ofthe mooch and Florin the 230 Ulna, mmmh thrn Raiders shall make m initial Real payment on the movain died In sprnntad amount for the remaining days oftho moyWn moods. For example. If Roklut move, in on the 30 dry of Septmsbr, them Rosidul "I pay Rant upon mavain in an assistant equal Io2/O0 times Ike arnomtabsm In Section 1.E above. In tbbesxnple, the Reddem'sseand Rant payment shall be modem Ootobw I In thelWl amomt shown InSeaion 133 , 0. hlovo-"man a.. toe 7e• IfNYldent moves lamthe25o minter day ofthemaoth. than RrIldemhng makers, Mltial Real psymmnequsim,the sumof (I) aprmatedportion ofthe minalMng day, afthamonth, PLil3 (11) the Fill aoont afthe wairamah's Ram For "&Wks If Resident mores In an October 27. the Initial Rom Payment shall be the s6 el of (1) 4f31 times the amomt shown In Section 1.B, plan (1) the full November Rama in the nmomc shown In Section I.E. 1n side Yample, live Raldent's wand Real poyit er aalall be aaade an Dccanber 1 In the fall oaimt shown fs Swum 1]1 AN provisions of this Lease shell be so Nil farce and efca aameneacing at the move -in data or the data speei@d in Session 1.13 above, whkhareraawn Omar. 7hc Tam urthe l.rnrouauted In Scctlm l.Dslali mi be affmtcd bylhe move -in doe. oC-Ras. IQ21A1 2-W sheep A.Lata lam' wash: Jun 16 2010 11:48RM H*SERJET FHX • P.2 IN WITNPSS tYNMWp.4w Pulia ba have*Mated this Itasom ot@e dWud ymtM Mbmcvuitlen. HTddnh; below. RWdm7 MClmowkdN7M Resident 6Ysreod and tlOdua:wdrmchmdwary mrn� eola+nnt and PmvMondddsLeece. Kt=XM. LINDIARD: The underddrd,gprmV uderstand(d) thtt lfecth"30 ab"I WlneAptmeMm CmommWeq LP., OMUe Emiwd pubm*p Cen1Yr pesWOkaO mdv "" (0) this Le"s mW aatempocallY "ROOM ■atnmty Roo med trmonlh up" Dr.. The Wbw Compmy ApwWwtOmma IdA tnc. Me npkRlM oflhM fsrs ►mefr and (b)t►attbRmlMlyba aDckw a cotpondol; waduly a the rizel MdMR {MNAMId da(1Y[► BatlM trmeq. NAMIi• DATE: �0 Dr. NAME: DAM �/ Nwm: we NAM@ DATE: TIOO: ��k: �• - NAME: DA.M.. NAME: DATE: NAME: DATE. NAME: DATE: a_allo .w e xawNUYr rw.O . Jun 15 2010 8:40RM HPoSERJET FRX • lu lV V- (I P.1 F m, $879 IRS a- file Signature Authorization P. 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AtnntORRJFt,Ynaat.. 1W RahperworkR•duolbn/NtYlolke.eeaPaYeleltbrm Form M2 MW) �t��M��aaee�� t1:F1Y/.7a eMaTi7t�u• DeOYneht tYM • aoto nne Ya o.\+r. M• 9T/60 39Vd • S63d-)3H"RF l 66619M99 6E:ST BTSZ/01/90 Jun 15 2010 8:43AM H*SERJET FRX 0 p.10 ®YOU Oat111ot take this Oredil If silhar Of the (ollowinp app(tea. • fifamounton Form two. kna3s; FDrm 1w0A, IIna27:aFdm1101ONH, Yna98imorsrlant{27,Ts0 g41,gt6 MhaW dhowatwld;i66,6O0tmwrNdtanp)oMty). • Thspsnan(s)wM madathapuwit.d aanlribudona alacdvadaMrtNq)waabanafter.lanwry 1, 7O8t,(b) Mdtimedas a«teludws �r . ter. qw. . . . ! ti>•crwdM.n+I�toalolfWorolh. .wquwUsdampbywpim,wlunt ry ampbyeacwk*wWrw. and SOi (o)(1b)(0)plancaobwutbnoftw9%a (awlnatnwtlalq . a Addlrolan02 . . . . . . . 4 GarlabdlealfWionarodehradaher20O(landbeforsthadueaals lb W&gw alona)o11your20Oelm raNm(aw;nsbastonq. If murYdtiinppinMy,ixlrM.bghspousw' nc. 1tNbarr`dbrlsbran aacapton . I. t31bU1Alwa4frorpbwll.111:oroort" 0• . { Naad10O1dmn,MNraNanalarolWNty DOD 7 AddlMamaaNsankna6.Nlwo,Noptytiw k a 6nlwtwwnoumlromFormlaa0,tna9s`:Farmlw6t,Ns22:or lbrmlwONR.RION . . . . . . . . . I Lntor boappkabledednlelamor raftwnbNowi sulnot Mwrled Hwldol du• ayw• Wly t<teAliD siaa a/a0O0 s2f .1 024.760 $27.0OO .6 .2 .1 SVAM 5271760 A .1 .1 W.730 f03,000 A .1 .D f0OAoo i3%000 .2 .1 .0 11e1GA00 $41,4112a J 1 .O $41,WS $$%GOD A .O .0 10 groWytamowUaa V � 11 ErNalh.wnounthomFbrtn1D10.yr»48:Wrm Nna form 1010MR0M43. 1 to 10 MUS:.lnwlh.loWotyauaradlk:tromtin.s47mrouph4e.• and eohadule ti W024. 1L11OA111ara: tFrNwdlepWaryourorWkahomknn2atxouphel. 104NMIlan: in`wd,apwlatyourwadtitromllnn44and 4e. 1a 1e Oubdaatyno 12*mWWI 1. HUM . . . . . . . . 14 GYstlltta�uMrladratbalWNltaavklfepntrlbullaN.RltKMamaMaro1hN10orWrb F«m1O10A.N1432• Fam 1w0NR, tne40 UherearnlonF«m1Dt0, Wre60; ,« - - '8w". a/Obrtlaemo«nloonatrIfyou are GW1O Form REM25M Ror4613 oryouarowAVdinghcomefrom Fuedo Flw. =4 Farlt orwarkttaduwHorlActlbdw.awpa/a2erbnn. F«InaNO(R0tID) 'llo owajeOWrrIMrt Ion- 2MOH1167maroe ;iti lvt.o 91/01 3JVd St13dT�11 It1931 GGGLeapass 06:91 Olgatoi/se Jun 15 2010 8:43RM H*SERJET FRX rare 8829 Expenses, for Business Use of Your Home ► FTNanyWlhSe wWw O(renebudn wduminprNaFora+elt6/eraadr hameyW ueANebuaMMrdwlnytMyam InwnlorYaproduelaamplealtrNNM6uatyla) ! Towareaaftno . . . . . . . . . . . . . . . . . . . . f DMdGl1MlbYWM2,EMWIh6fWAASapNa+dxpa _ . . • 4 MWplydaymusedlordaya i ToklhouawaYableforw 6 DNWaINM4bykM6. Erato 7 ownw Powa ve fbrr a �.Ilalra.q�sa lsuu�.au.wnwn�u �..— Dedudlbl6 mww9e InfeMet(NNneU RripW6Naw(eNlrMuugbnaj . AddWMatKorrtll MYRMllyanai A cMwn (b)bV Ww7, AddMM1$cdumn(a)andWw1S . . . III i# JI�I l:lafMaellMle141rornktea I(SMODrlpa,snfr•4 Dra6aarnorg6pemtsroat(aphatruotbnc) 1 lmrwm . . . . . . . . . . . . . . 17 Mnt HapWea 4malrowtance . . . . . . . . lit.. . Olhrmporme(StOM YOOiaM) 21 Add kw/6t rough2l.. 22 Mutlpykw22.00lumn@)by 2 9 cw"w"w6l4qPwaMpeNPeM In 626 Adtl1M22oobmn(a).1n126. A*wmbNopar&t6i;wpwdmESNarlhaamaimrolline l6orYne2S . . . . . . . . . . . . . IIIMlm ratan oaawNlaaauand depraebalon. 3Ubpact1ne2GFmmWM 16, BcaaaaaalMlty baap (aee hatnwtgrol . . . . . . . . . . . I . b Oeprplal *1y*whommfrcm Mw41b*w . . C4Ryorrol woMoawarry loomand dopredAdon lmm 206Form 6626, IYrq AdOl k wJ66rMuph3n . . . . . . . MIawWlsaacepoMYMylowaaantldapnoill' 2fot/ Add kNa l4.26,wW S2 . . . . . . GaualtyNePetlbll,YanY.iramNnpl4arlddlT�� A6owekNefW6tM6at6rbwlMpuwaya+r 9ubt mlhe Fntrtwtraand >r frr1er61ewrMlrofyourhoma'stlpsfed bal4oriNlWmukNvaaM(NeMNtg.. . . . . . . . . a7 VMmolNntlhaiudedanRM36 . . . . . . . . . . . . . . . . . . . . . . . p ewaabrrtl►w.arsa.etw+e6Tm.mth.x . . . . . . . . . . . • . . . . . . . . . at wlrkmabaekolbuWhwMLOPNkmoobyW7 . . . . . . . . . . . . . . . . . . . 49 tWmW1onWrowVLW(eNYnbu9O") . - - • • ' NlaNmanaaro.6mr•0 . . . . . . . . . . . . . aapW 1�e�m� �1 fb6�26•1Y1.1 FfMl6allrplt:0/IfNINI 7fN•3ata HR6 Tu O.aW. G 9L/LL 3rJVd 5213d13fR1'J3I 666G8ZbZ99 we 6E:51 GTOZOT/So Jun 15 2010 8:43AM HPO'SERJET FAX 0 p. 12 SCHEDULE M IFarmlowerlo" 114 DOYoupndl ttlnslowft'? BYaa. IN rfa. EN Making Work Pay rand Gtovemmod Retiree Credits m IaM&tatl.wIWlINa. ►rkwoomm"Olaa b N*n%wbl•oombmpaylnoludadon Wwa(satinumlona) . . . . . . . . I tb I Mu2plylnalabyll2%(.002) . . . . . . . . . . . . . . . . 7 EnNrM00{I/tlOkmaRladlgn/I�MI)l. . . . . . . . . . . . . . Murat••nlwar«ftla2«wl.s(ulYn.You 'Yea' •t I Enl•rth*Wwnlfrom A:rmtWO.IMt3smt 0 f5�br776,OD0(7160,000ImarNdfilii0la 7 Iha amo untonino smme omnth•amounton tro St !10. Iklpana/.Intorlho mourdtmmIha4enina7bakw. Yaa. 9dbU•ottntsfrortlli'las . . . . . . . . . . . . . . 7 MUMpVbB7bV2%jA2). . . . . . . . . . . . . . . . . . . . . . . . . . . s 10 ft shonemlinetomdgotorntIf. Visa. raMrthslMolthepaymontsraoahradbYYw(and you#waL If002 joinoyl, txnteantarmor•thani260(tsoDNmanNdYWp(ohYY) 11 not o� ®ND. Enle•aonkNllandpomltlow . Ye•. • Nywetwmkq'Na'onpnol0,rIx amlMwWwonlintllWYaa' AS •I(YouoMCkad`Yes'mNnalO.wu•0•(auroaptkn:rdari23Dssktp snto rmumkf �MymrooM *wIwd w:4D nudydldnMraoahN 12 AddanWIQWWtl . . . . . . . . . . . . . . . . . . . 17/lbuuotM»tskomltis&Nrsroorlao,arNer•D• . . . . . . . . . . . 11 rakktalaettlwy.nl7owrrplw,entbuuraadha.Addlnaallandl9.EnNrfh•rruAMn and an form I W0, anse3. f'bm 1010A, 11041%orebrm 1010NF4 *w6O . . . . . . . . . . . . . 'IlveuwHYi�Form •1666 Ti1E.QeraSt3wVd}•nlatmdN/0 inodnth'dn PtU[SO RI00 aaaanaalAalona. KMII NrIAMM I(Re YctlonAelPbtlw.arKormlW0a, 1010. ar 10WNRnrtrualar. sab•WNMIron07(M011ar101pI00i �ir�afarntilidCif�lnr ruaa• >;aie nn• tw o :waii�oV1.0 ST/LT 3mci S213cIMH MM 15GUf ZOO 06IST 0183/01/90 Jun IS 2010 8:44AM H*SERJET FAX is p.13 supporting schedule* 2608 •MumsA DAM= 1 A CARLA, 2 LSPPIizK sBNi 636-55-6027 ----------------------------------------r-r---------------------------------- •sCMVUL! C - SUCK LIPPXZK LYNS i - GROSS RaCEXPTS OR SALSS/YA3NSNC6 reseriptioA a, At y - - - - M --Y SCAW MWALB OF AMR NSLLS LARGO TOTAL 20,744 41,43s 32,106 SCStLUL! C - BROCK LtPVNXK LZNs as - TMESS AND LSC=NBSB Deseriptioa Amount --------------r---Y..-w-........------------------....-Y...................... SUSSNRss ssAss soNp 16O 37s 575 1,s10 SWC1 3wd SdBd-L-JH- XJ3-1 6661BZ4Z9S pB:St matspT/90 Jun 15 2010 8:44AM H*SERJET FAX • p•14 FOfPlhffoyNagw.gl tfaim IRS 4131. APE p 556-55-6027 LIPP 565-17-3761 09 PHA 236100 AC SRECK E LIPPNIK A CARLA I LIPPNIK R RP 2338 NAPLES NEMRT BEACH 01 06 09 10 12 14 16 17 18 31 34 41 42 43 44 45 46 61 62 63 64 71 Sign Here fiMYWOMAwn111D1ti 91/01 3 Wd 2 0 0 2 44045 0 0 40183 7274 599 0 0 0 0 0 0 120 0 0 0 87 598 CA 92660 72 0 pilyo 0 73 0 0 74 0 0 75 76 0 4120 77 0 413, 0 78 0 414 0 91 521 110 0 92 0 111 0 93 511 122 0 94 95' 1 400 0 401OJMLYO 0 402 403 0 404 0 405 0 406 0 407 0 APE 0 FS 0 3600 0 3803 0 SCHC01 0 5870A 0 5805 5805F 0 DESIGNEE , 1 TPIDP 00142079 FN 431871840 DO NOT WMIMpheirnY.1NMIrnO1;, (999) 76U—UV-16 Opp /Y/I OfM1Yr'�NYMYYf� (YYCIMNIM Y1 P1YpYtN lr Yo�YMtl11nINYIMIM Of MMIN NYWNhr MYYMWINN) PNnrr mmnfgry nlfuib&"MY&dl PIMn'YMf1fs NO PREPARER _ rtim Ulm Prnr Pomon as MOPS 0 b 3201096 Sd3d-M IM3'1 GSGZOZOZSS 6ElSi MUPS/98 Jun 15 2010 8:44AM H*SERJET FOX • p.15 vow mKR*+-1'+CK E LT.PPN_TK Your33NWMW556-55-6027 1 stool. N' 2 Maale ADP4Unoloinly.(aaaPaoe4 a = WaNd/IDPANmia4Aalary, FntvspauralROPabSNorRIN�6awandlWruKnokwY 4 MMdofhouW*M(wMqualltwNpaim1•(aa*pmp4) ■ GuW"Vwidow(or)1NfldopondmicM.EnkcyarapouWlROPWed. 7 ►raoaal: ayoudlaolad t,3,rg4abWe,tlmlrtlndnbrx4llyouMeoka02r6.amar2indteeox. 1111foNd -, Wdy tlyoudw*Addmboxoni S.mfi e7 .......... .......................I K tell•$ 3,96. a iitld:gym (orya+rpauWRO WfVlWWmpN md,maw I;lbv64rov%"vjmpAw.4nw2 s K iPi-i f i srdacdyrw(aryowepouWPOP)tua 40 a 2 .► 0 X $0-3 fi )3a/eraletllo.04ornameendre .00 ur hNNIF • 9EE ATTACI mm4T -dalwptm • to LA X 3ii-i 196. r 129Wataap�kamyotrrForm(a)1NRbo��:...�.�PC..PPr..........Pw..* v IS Ftllrrpafaltq(ualWoroaekloomelromPorm1A10.IkN87;Popnil?fOA.IkN4f;Porm1M0E2.inN........... u 14 C&WomiadiuswMa.sthhodona.Emiw»mmonikankMedul*CA(MO.AM37.00lumn0.............014 i IS Btlbkaalktel4fromNnel3.dteaadwntiro.MterdlewWiNpwMtlleae3(aeepeoeD) ..................... 1e r 1ir�Nfwntaadjwktrnls•addiUorur.BnlwflnamounlhamBaAaduNC.t(6�0).Md37.toWnM1C...............�ti 17 CedlarmlaedlUUMDMealncoma.CambNeknl5wdfrn1e...1............ • 17 1i oewvwwwolyourCAwndwddaduaiomoRywCAkmyladdedNeiana .........................010 .� .e.._ . _.. .L..............rW'r.�.�49I6..Jffib.w.i tlalr' to >f TOLC40dtboxymm: tal-raarama u n + .............W.. r 7Q t3twylbmaedha®rtrM4molalt ' Urn11. w Plenil (r•epaoal%.......... 32 392 >b "vWWna2lnxnyna01.Ilk M :...... .................... 31 207 3i Tm(onpapeli)ChecRboxEft m: u 1 ....................Q34 SO Add lkle33Wdin34 ,, >M 207 41 NOWWAaedk.amountlN WA W (eeepaoall)....... • 41 42 Niwjoba«adH,m wwdeukmd(wpago11) ............................... • 42 43 Cradk Coda•_ Amounl ............ ► 43 44 C(Wk Cade_ „_&Mmf ............ ► 44 r r 49 TooWmmarch*ntwoogdK/GMPagotl).................................. 049 A, m 140 NorxiKadWNtenroreorW t2) 47 Add9mo42Ihtouohino4e, oretl ....... �. .... ... ............ 47 4a 41 Matti. ih .... n AWMWmydmumtax 41 ACT! Q ManlmlHaudr5arvk#eTa 12j as 07 CtlwvA"&Womdlreoaplum(wep+pel3)....................... 63 N Addlkn4Rlnael Ilna4 and An U111MR 0tal .. • M •71 CmWArjWkwbmoIMWMhpId(mp4pel3j.................................................... • 71 72 2MCA"UmaMMxmWolherpaym"M(rrMpeoet3)........................................... g 72 73 nWMrapamdathorwtbhoMMo(lm W9e13) .......................... ............ ............073 I 74:iwMtBpllorVP011whhhaM(aaapao•13)..................................................... $ 74 v CMdrld R"Wi emi care mvKi a cf"lI( 1 75 Ow*Atp pemodeamwmurky mumbw.AE .. A. Ill 70 owsmonopaaon'setxWapcurhynumhw mo 77 E'VWlho udkomratrnR11835m.PaRl ♦..... .. ..... • .. • 77 72 ChIW* dP4padwNCw4EV W4"Crad mbrm .................... • ve Ti'1 inCmtpalaLLtrl x. RIImomeormown gnat. auoaac[Ww"Uom Mary ........... I... I ................. .. 02 Amounto(Un►9f youww toppled lopur2oloeslhnrdadlo,...................... .I .................. • Y2 p M ovwpWd&U&v*&bldWayer, 3uatrW*wQ2komrne9l .............. , 993 511. i 14 Tutdua. Yana7BYMea iN atbuacl lmrr7ahanlYna4........ Yt 0. NTAKU UnTwL 7hla lonotatowlipe(a_eepaoe 14) ..a t6 2 Farm 540 of 2WO 046 3102096 r• 91/91 39Vd 5d3dl3H-lM3'1 BGuezozgq Ve:9T OTOZ/07/90 Jun 15 2010 6:44RM H* SERJET FAX . p.16 VaurrmaesBRECK 2 LIPPNIT{ Yowsmori :556-55-6027 T •100 ............................... Altll•YnutiOraudPldareddroMwtRnd................................ I..................... aim cammkMrdloaso wcomns.............................................................. 0402 wreanaErwanpaw "IsaPNaavadm+Pr wn..................I....:....................... 40407 GrwCdldnW&rnsmArrdlorHaPNvantknolCNklAawa........ ....... I.......................... *10a C&ftmA0romKCanGwRmsrahFund •406 �r ....................... ........ II C0I; mIaFN@HWaW Mw4rW PoW.............................................................•401 !J 6earp ocyFacd Fa FarnWmFund............•. •4A T ................................................ CWlomkP woOMlwt&modAiPbudtlbnFund . ........ ............... ...... a401 cwlwnkMiwryfamMyRslMFmtl ... .. ... ... ............... aape a Colaamkaa 9OeKFYnd, a410 CaNamkOvrriwrCw=rfkwaroh ........ ...... .... ................... 0611 MurNO�>fd2h4NK9payNaulKPund ... .. .. .......... .................... a41i CaNlamkCMOKMwarohPund ...... ...... .... .......... ..................... aata AtJ/ILouOAhdp'aalaaa Mo wah fund ....................................................... •414 110 Addedla400drauahcda4147hkkvourtatatcwrlrlhution..................................... •110 na ............�y ............. ........ ...... ... lfit Urldaryuymantota•tNrudaddr Chaakbdc F7Geleaaltaolrad Ll PTpae0aPa11sotwd...:..... 0.113 PmANaleesrAxwArAPanoxjra40,spRal ♦ogWdoee ..Wr......... a11e M•rlMblowhpamaumolmy nwrd tins ilg k��gihdisW ardiroaldopoatna Macedntriarinhsbw: ❑ Ch Nra L1 Savkpt • tlouartpnumbK a Type a Aowwtnun*ar • 11eONeCI0sp0altamdmt fiannWnlnpamamtofmynrund(W»11a)kawrodxwPordlraddapoaitiMolhaaowunehown4•loxn ❑ chooNq ❑ eauaga •FbudrgnumeK • NOT •1lsgroeldapakamaura FILE 0*1 3103096 9T/9T mvd SN 13i"k/ M Is). Farm M ct 200e Skl• 0 ESSME6Z99 PCIST Graz/CT/9a VILLA POINT 11(Off-site Newport North Apartments) Unit No. CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtained.) We certify to the management of Villa Point 11(Off-site Newport North Apartments) that: 1. The undersigned istare the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2009, the Total Annual Eligible Income' of the undersigned individuals) ;and, 3. During 2009, my total monthly rent payment to Villa Point iI (Off -site Newport North Apartments) was $ 1<1 C, �"C, o _ per month. Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point 11(Off-site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -Income Earning Household aignature(s) of Income Earning Household Member(s): Member(s): Name Age s,gnewrs signature / Signature Date:��/d VILLA POINT II (Off -site Newport North Apartments) Unit No. CERTIFICATIONOF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession or Section 8 certificate or voucher, income documentation must be obtained.) Me certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 20 9, the Total Annual Eligible Income"` of the undersigned individual(s) was $ l 7 ; and, 3. During 2009, my total monthly rent payment to Villa Point II (Off -site Newport North Apartments) was $ 'lad ° ' per month. * Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -Income Earning Household Signature(s) of Income Earning Household Member(s): Member(s): Name Age slgnaturo Jun 16 2010 11:52RM HROSERJET FRX _vim I P O P•1 0. LEASE �fl`',�-' 1{ / TNIS LEm IS MADE AS OF Nn r 16. 2t109 by end betwpm hetebaAw ("Landlord"), and V �' be tener.0y Sable ad as all colledfvely / ✓/ I; Douala haehrRer'Wtidnl.^ Ifmore tlni area, etch aledl )dnUy and _Mrla rttnaab a'RNWeor' hasda 1. Dafi , SgComoot0lt A A, 0: NemortNmth APamnntr B. EMKWF Unit amber 2601 Ma on, laewportEadt CA 92660 Seen AdANs Cig.�a21P C. SpaeNO• 170 Mdlb"No.: 277 No. M VOWda2 11oraao PhaeNai D. 1=:Camnglas on, Mach 15,2010 andemhon AKU 1A. 2010 a I109p.n E. A&W. Oao7hoo d Fe"•HnAed NIN1v.Ffve Aad ON100 (S 1495,001 par North P.PJMIDae neFIRST(ISTldgofearhcalendarmotdh. OneThoufand Pour HpndKd'Merry AndOWI00 (flam.flDl H. 2mij,gy, ?Lena Dateoe0lnh NU 1. P= No Feb . J. Auderinad ane,ofCorri aNev: Fred fka&W Adiketifto NmixotNOMAPUbs" 2 MUeno NewportBach, CA 92660 (949)720.3765 K. LwWlwd'sRules &I0Ol goes ReAsionlilm 3r06 (See ExWbIt•A-) 2, Fts6a The Peesnha INsd to Raidart consist oft, residentlal act toplhwwlth anY OPPllanoca window covering; carpetard olhalhmithblgr llmdon the moralnfonn, and the Owfo nNornuNba otpafdng Speer(a)ihkd In LCabote. Landbrdmay change Residanfs daignard Oarago and/or Perking Spaw ftvrn gm to date. R"Walt Shall WRVIY Will UK Pstleg RUIN mealned in the Ru1N and Regulations aracbdd hercm a5 Exhibit ••A." Use otter Oaage or Parking Space fNmything other than a specified in the Hula and Regulations isprohlb'asd 3. Taws lanclod malorsm rgr,Natatin that the Pandso, will be ready fbr owuparey n the comme000raot daseofAw Trans If WtANd isumblab dohmpwdomoftbe Ptc lam a0K the Tara, ter4ord sIWI not be liable fordmges to Resident, but Raidenl shall nor be rNporelbh for psymant direct far the period bcOvocn its mnenenccoeN of the TL7m and the this who Landlord ddives. possession If Landlord Is to able 10 deliver pomealon w0hin thirty (30) depv of the wnmteaNNm dab Ot a Term, obha Landlord or RorldtN may, pilortithe throe when t Wlord dsUwn pNaaron, camel rids Lew by givingwrlaari aaicebthpothar. d. RmU RaWent shall PRY Lwdlad UK Ran the the Ptemises oath monde m advance on or before Rent Doe Doe fn addihne,aU agar monauy oWgallom otReddmtnoda this Lew shall bedanwd to be additional Rea. Any reRteaeto de tam "Rnt"in thislAmshagbcdaun toincludesddlUaKlRent.IfRNidontnorNln as UK Orssdgohhe rhotd, RWdenlslNllpayRem for the &elmmdIfPaldmt tsova in on try dayNherthm Me flan day of the month, Reagent shall pay UK isidal Rempgment ea follows a Mova in afterthe la and behre the 25th 1tRashlent morKi In a0a the to day of the mmidi end plotter Oe25e of the Nor h, than Ratldea shall make an Initial Ras PgttKa on the movie time In apmaaed annoad for the mmaiaing d A of1M nevvin ssualh. Foraa*s. if Rena mover in on the 39day ofScpkebm Wra Resident shall pgRnt upon n ovain In n woum putt a l in d cttKl than onotmt rhotvn lnSon ).F I.E ahwe. InNtsexunpia Use ReaWat'saarond Rent pryrNmrhall haNadO n Oaoba 11n Me1el(arwuntanown b SaUon 1.E on the25e or later day of UK nand, it=Resident, shall make an Initial In this All provislaN oCd& Lame shall be to Nil fbtm and eRecr mamenciug on the enovOn case a The dine spcdfld in Sccdat I.D abava whkheverowara ha. TlteTnn ufthe Lew Kissed InSWIon I,Dshall mtbeatfected b"Ornove•In doe OC-Rev. IOnAt 2 OC Om WA•Lew Jun 16 2010 11:52RM H*SERJET FRX • p•2 M WRNSSS WILE EDP,1hoprdesbwctobaae esw eattcd thtsiaesoftm dry and Year ibatabcvewdaea. EYelpttaS below) EppettledrgxkdtesdletReadeNbm torland ad,drdseeab nd every tmm, oosenrdardprovisim ofddAGssa. E]�C1f71 LANDLORDt TMasdrdtnd aplw4 ardsnemWc) Hat Setda StlabM IrvineAWrnC%tCamMd4C%. LP..s Detav'a"Ura dprtnaddp Combine prMslns ndr wkieb (e) tNe base My A Cammenitle Itic.. sdeamaretly toetlate Of a t."WY from ssgnib fo•ssoelb up" SY.'rnslrrlaeCompW' l Ae mphate attic trm Instant. and (b)WItbeRntmryN nDAYvarcommdbn,RedoW diodud d Inreamd datl wtYc tla W1enry. NAME: DAZE: AAq-45 or.. NAME: as I l V I Name: NAME: DATE• TNe: (•— NA"6.1 NAME: DATE: NAME: DATE: NmE; DATE: Nµ{g; DATE: x-s Ica. Mle a•OCa,Ml14n • • ' ` nve02--14P0 .. , Form ""'iiepertiileltF6f"Tieos"pry=lnftvial iievenue'Semce. -� - t, AC— 1040A t1:S 'Individual- Income Tax Return. -, 2009 IRS Use onlY--Dolhot wale of ataple In this 6'ace.' LabelYou t fast name and initlal Last name �" • "' ; 'oMa')Jo11545^ .., .Yoir; 'sb�ril.ddt+ritl!riumtwP (see pagel7.) LAURA M CALDERON i g 621 46 n907 , Use the E If a joint return, spouse's first name and Initial Last name Spouie' '.-aactilsieurxt! pumber.: IRS label. L i; t Omerwise H Home address (number and atroeq. If you have a P.O, box, sae page 77. Apt no.rr''ROeteritat please pent n P.O. Box 7063 .�. gr•SsN(q)ebovp. E City, town crpost office, state, and ZIP code. If you have a foreign address, see page 17. a,itox;belo, WWlV66t a - Presidential 61r.::J; atr tax Ortertllid, ElectionCsmpalgn yieck'N:ICyotY_ody"ours(iousa'N.(Iliriglolhtly;'want;$33ago.tothlsfupd(Seepage17) .'r Q'•You, -; '(1,spodee- Filing 11 ❑ Sindle'. 4 ® Head.of.household (Whlj,lualifymg person). (See page 16.) status 2 'Q' Marriad'fiiing Jointly (even if.only, one had income) 'If the qualifying person Is a child but not your -dependent, Check only 3 Q'.Marded filing,a6parately.Erderspouse's SSN.aboVe and' enter this child' rla '''here. 00- one box. full name`,hale,.► 5 (� Qua(ifying,widow(erliwkh',depehd8kit,ehlld (I;Q; ge l9); —_ Exemptions ...6g JR,You self.' 'If's6meond bad dlalirfyoh'as,a•dbOenderit,. do ndt check' n bo*6a.- c�hAIMIL, cfwMdb 1 p' CI sP, QVIS01- 61 P600, Jent'd: . Ue net • _ (2) pb••g,n's aodfal '' onecwhoi, '(3),. penitents (4)✓li qu01144ng De' ehlltl,fdretlNsf ^, - Of.-Nstname Cdsrname rdynOmber•' .telatlonshipto�You - ',aaxoriiid10)se- e did l If more than six dependents, - - MARIA A _ _ _' 20 ..s. _ eriihYod duo • , iodtvoreior see page 20. , w on HIPS, d'Tothlri'6"[ber'ofetternptions.claimed. Income : 7 Wades,•salaries,ti s,;etc::Attach-Porm(Q 2. e'' 7_ 48,486 00 Attach ..� .'-.,-'-> -.• ., ".:,'=: Form(s) W-2 8a• Tezetile;lnterest..Attach SohedtiJerB•,If ie' aired. •.'_ .' 8a _ here. Also b'- •�aX_exe i0t.ihterest., Do not lncIUde-on;line:8a., attach t3a prdlnarydividends. Attach:Schedule.Bitreauired. 92, Forfn(a) 1099-R if tax b: , qu211 vie viti was withheld. ,'1-" Cam 'pile. gl�in.d If you did not 14a 'IRA � '" ' • get a W2, aee distributions•. page 24. •Pew n$l�and Enclose, but do - •anrlultles.` •.'. not attach, any , payment. Mao, 13. Unelpploymet pleessuse Porm •Alaska,Perril9 10404. - Adjusted gross income Aci i ., FOf Privacy N000, get form FTB7131. name Imes last name L,A,U,R,A M I C A L D YOU FORM 540A c1 stde 1 ^4 6M0.9.0 L, n e a c 11 - A 9 2 6 5 8- If you filed your 2008 tax return under a different last name, write the last name only from the 2008 fax return. 0 Taxoaver-.--- n 1 Q Single 4 0 Head of household (with qualifying person). (seepage 4) _ 1}�g9 2 OMarried/RDP filing jointly. (seepage 4) 5 0 qualifying widow(er) with dependent child.Enteryear spouse/RDP died rn 3 O Married/RDP filing separately. Enter spouse's/RDPs SSN or ITIN above and full name here If your California filing status is different from your federal filing status, III In the circle here. . ......... . ....... • 8 If someone can claim you (or your spouselRDP) as a dependent fill in the circle here (see page 7)............. • 6 n ...o ,,,,o o, m,e o, unu nnu 1 u: mumply the amount you enter in the box by the pre-printed do8ar amount for that Ii 7 Persarel: If you filled in 1, 3, or 4 above, enter 1 In the box If you filled in 2 or 5, enter 2 in the box If you filled in the circle on line 6, see page 7...................... 8 Blind., If you (or yourspouse/RDP) are visually Impaired, enter 1; if both are visually impaired, emer2..... 813X 8 8eeipr If you (or yourspouse/RDP) are 65 or older, enter 1; if both are 65 or older, enter 2.......... 0 9 ❑ X 10 Dependents: Enter name and relationship. Do not InelNde yourself oryovrspoe Mop. Maria (mother) Total dependent exemptions ........ _. • 10 X 11 EXIMPtlon amount -Add line 7through fine 10. Transfer this amount to line 32....:..................11 $98=$ 98 $98 = $ $98 = $ $98=$ 98 12 • State wages from your Form(s) W-2, box 16......................................... 0 12 . 4 8 4 8 6 0_0 13 Enter federal adjusted gross Income from Form 1040, line 37;1040A, line 21; or 1040E2. line 4........... 13. d R d a c mo 14 CalUorele Income Adjustments. See pages 8 and 9 for line 14a through,line 14f. StateIncome tax refund, ......................... . ..... 14s unemployment compensation .......................... 14b U.S, social security or railroad retirement .... . ............ 140 California non-taxable interest or dividend income ........... 141 California IRA distributions ........ . .................... 14e Non-taxable pensions and annuities ...................... 14f Total California Income adjustments. Add line 14a through line 14f........... ..........41 140, 1 . . 0000 17 Subtract line 14gfrom line 13. This Isyour California adjusted grpssIncome ...................... 017• .4.8. 4 13 600 18 Enterthe Your California itemized dedNetlons or standard deduction larger of. shown below for your filing status: • Single or MarrWIRDP filing separately ............................ $3,637 • Married/RDP filing jointly, Head of household, or qualiying widow(er) ... $7,274 If the circle on line 61s filled in, STOP. (see page 9) ........... . .... ............ • 18 , �_ 7y 0�0 18 Subtract line 18 from line 17. This is your taxable Income If less than zero, enter-0...................18 4 1 2 Do 81 Tax. See Tax Table 62 ...................... ...................... 31,1 Exemption credits. Enterthe amount from line 11. If line 13 is more than $160,739, see page 10............... . .. ....32 , L 9. & 00 18 . _ Nonrefundable renters credit. (see page 12) .. . .................. • 46 1� 2 0 . 00. 17 Total credits. Add line 32 and line 46 18 ........................................................ ........ Subtract line 47 from line 31 3, 1 6• 00 12 .............................................................. Mental Health Services Tax. (see page 12)............... 48. —. 6 4 00 14 Add line 48 and fine 62. This is total tax If less 82 g 0 your than zero, enter-0 .........................* 64, _ ,00• 3121097 r- May 26 2010 3: 03PM HRSERJET FAX �.,^Fax Numbers: W 30 ^ 'p� Occupancy "' "" : ob*— 'f�l (714) 480-2701 t eCCointnurnty Resources ,tp \ (714) 48D 2937 i., .x7 h•.v.�ww- p r a ri ate Cs O Id Ilil t 0-ti 3I n o. ./-1.16 h I t J Leasing/Inspections 1770 N. Broadway - Santa Ana, CA 92706 (714) 480-2822 (714) 460-2700 • (714) 480-2926 Too Special Housing Programs http;//www,ochousing•oro (724) 480.2922 12/17/2009 Irvine Apartment Communities LP Q/0 Newport North Apts 2 Milano Newport Beach CA 92660 --_Dear: lrvineApartmentCammunities LP ....._ Tenant ID:P117919 Henrietta L. Russell 2615 San Marco Newport Beach, CA 92660 This letter is to inform you of a CHANGE IN RENT as follows: Previous Tenant Share $ 242.00 r'�� �O�Y Previous Housing Assistance Payment $ 996.00 r Previous Rent to Owner $ 1233.00 Tenant's New Share Rent $ 249.00 New Housing Assistant Payment $ 989.00 New Contract Rent $ 1238.00 IMPORTANT NOTICE - PENDING RENT INCREASES: The above contract rent amount may not reflect a pending rent increase (new contract rent you requested.) You will receive a separate notice with adjusted owner portion from your Field Representative when the rent increase is completed. AMENDMENT TO HOUSING ASSISTANCE PAYMENTS CONTRACT: The contents of the Housing Assistance Payment Contract signed on 02/01/2008 shalt prevail except for the changes shown above. 'These bhanges will become effective 02/01/2010. If you have questions please call Yvonne Taylor at 714-480-2709. YT12117l2009 HAPPYeoflware, Inc. June 16, 2010 City of Newport C/O Ms. Fran Meyer LDM Associates, Inc. 10722 Arrow Route, Suite 822 Rancho Cucamonga, CA 91730 RE: Villa Point II 2009 Annual Compliance for Qualified Households Dear Fran, The attached information is in response to your request dated May 21, 2010 and is related to our 18 affordable units at Newport North Apartment Homes participating in the Villa Point II Program. Please let me know if you require any further information to support our current household(s) compliance. Irvine Company LLC, *warn Limited Liability Company HCCP, COS, C10P, NCP-Exec.,TaCC's Director, Affordable Housing Compliance Irvine Company Apartment Communities 110 Innovation I Irvine, California 1 92617-3040 Phone 949.720.3476 1 Fax 949.720.5257 bbreton ,irvinecomapny.com CC: Kenneth McCarren t4, IRVINE COMPANY I APARTMENT Since 1864 COMMUNITIES PO a 6 CITY OF NEWPORT BEACH uz P.O. BOX 1768, NEWPORT BEACH, CA 92659-1768 low August 11, 2009 Irvine Apartment Management Company Attn: Barbara Breton, Senior Manager VILLA POINT II 110 Innovation Drive Irvine, California 92617 Re: Villa Point II Clearance: 2009 Annual Tenant's Certification Dear Ms. Breton: Thank you for your response to the 2009 Annual Tenant Income Certification monitoring request dated June 5, 2009. Based on the documentation submitted support household income and monthly rents charged, all occupied units are in compliance with the income limits and allowable maximum rents in accordance with the recorded Affordable Housing Agreement. If you have any questions, please contact me at (909) 476-9696 ext 220. Sincerely, �n Meyer Program Consultant 3300 Newport Boulevard, Newport Beach www.dty.newport-beach.ca.us 0 Irvine Company Communities Newport North/Villa Point II Program Affordable Housing Agreement- dated November 13, 1990 �0 \� ,n� ' # APT. RESIDENT NAME $TTP FLOORI SIZE # OF JOCC.1 I MOVE IN DATE I Compliance I Status 1HOUSEHOLD1 I INCOME RENT 126 I? Bahamonde 2+2' 3 4/28/07 Received $16,279.00 , $1,485.00 ✓ 234 Galindo 2+2/ 1 10/02/98 Received $43,318.00 $1,485.00 ✓ '242 Antilla 1+1 1 9/30/05 Received $39,015.00 $1,240.00 249 Tor erson 1+1 1 2/22/08 Received $47,038.00 • $1,336.00 ✓ •1140 Gross 2+2 Moved out 7/05/09 / AJ 20• - l'L32i' 1205 rl, Co bill 2+2 ' 2 8/28/04 Received $48,329.56 $1,485.00 1440 rL Yeager 1+1 1 9/12/98 Received $19,955.00 $1,240.00 / '1528 iL Greenberg 1+1• 1 4/13/08 A Received $37,486.00. $1,294.00' '1558 Feinber 1+1 1 Moved out 5106/09 t .2341 I! Klein 2+2 1 9/11/98 Received $20,899.00 $1,510.00 2407 fL Brani an 2+2 / 2 9115/07 Received $45,246.00 $1,565.00 2424 Crain 2+2 / Moved out 3/10/09 .o 2503 - Bewli/Arora 2+2/ 2 5/12/08 Received $49,000.00 $1,595.00 (,[7�• 2519 1?- Tennis 1+1 2 5/12/06 Received $41,831.42 $1,240.00 ' 2605 Roseli 2+2 / 4 6/28/02 Received $1,485.00 Z aV- 2609 i° Hazewinkel 2+2 / 1 9/24/94 Received $46,000.00 $1,485.00 2615 Russell TTP$231 1+1 1 1/26/08 X Received $12,828.00 $1,238.00 2422 Fr nco 2+2 5 Moved outl 6124109 Total number of apartment: # of property deemed Incon TTP = Total Tenant Paymen July 22, 2009 City of Newport CIO Ms. Fran Meyer LDM Associates, Inc. 10722 Arrow Route, Suite 822 Rancho Cucamonga, CA 91730 RE: Villa Point II 2008 Annual Compliance for Qualified Households Dear Fran, The attached information is in response to your request dated June 5th and is related to our 18 affordable units at Newport North Apartment Homes participating in the Villa Point II Program. We appreciate the extra time needed to secure this information from our affordable families. Please let me know if you require any further information to support our current household(s) compliance. Sincerely, The Irvine Company LLC, *�Dela e Limited Liability Company J L ara Breton CP, COS, C9P, NCP-Exec.,TaCC's Senior Manager BMR Compliance Irvine Company Apartment Communities 110 Innovation I Irvine, California 1 92617-3040 Phone 949.720.3476 1 Fax 949.720.5257 bbreton(@—irvinecomayny.co CC: Kenneth McCarren Opp? IRVINE COMPANY I APARTMENT Since 1864 COMMUNITIES Jul 21 2009 2:15PM P. 1 HP LASERJET FAX • 0 1 ._ �r, f Wb.' 1, � PXitoltza VILLA POINT II (Off -site Newport North Apartments) �4r Unit No. ? a C911'riFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For teaanta oot•In p0e04eaion ofa'Section 8 iertifiente.or vonoher, Incontedocumentation mtttt•be ebtAine4 j IIWe certify to the management of Vitla'Peint !I (Off Newport North Apartments) that 1. The undersigned is/am-the only income'earning occupanf p) of the above indicated leased prerhis; ' and, 2. During.2l)t)t3,•the.Total Annual. Eligible I»com'e*of ihe'undersigned Individuai(s) _ — -.... _. vres 4, _;and, 3. During 2008, my total monthly rent payment to Villa Point II (Off -site Newport -North Apartments) was $ 4 g cJ per month'; " Total Annual Ellgibie income Ihciudes: wages, tips, overtime, bonuses, commissions, net Income from a business or rental property, Interest.and dividends, social security payments, retirement.fund or pension payments and distributipns,.disabiiitybenefils, workers' compensation and disability pay, severance pay, alimony, child support, all regularand special pay and allowances of a member of the Armed Forces'(to exclude hostile fire allowance). The undersigned acknowledge(s) that Vlllsi;Point II (Off -site Newport North Apartments) and the City of Newport Beach are'relying on -the accuracy of the provided information'in'the6'leasing of an apartment to the undersigned; and In conferdng•on-the•undersigned the monetary benefits of the Agreement which restricts the'renfs collectible fbr occupancy of the above indicated leased'premfses. The.undersigned consents to -the dellvery.,of•a copy. of this• Certification •of•Continued' Household Eligibility to the dity of Newpotf'Bdach. This Certificatton is made under penalty of.per)ury In Newport Beach, Califomia.on the•date'Indicated below: Names and Ages ol.Non•Incoms, Esming Household Member(s): Name Ape r1oery-%a Wo ?1 &OV "GnDN-tb-a U 4,3 Srgnature(s) of Income Earning Household Member(*): Date:' 0 VILLA POINT II (Off -site Newport North Apartments) Unit No. d01­ CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY gatzt ao (For tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtolned.) UWe certify to the management of Villa Point II (Off -site Newport North Apartments) that; 1. The undersigned islare the only income earning occupant(s) of the above indicated leased, premises; and, 2. During 2 08 the,rr��Total Annual Eligible Income* of the undersigned individual(s) was $ d'© ; and, 3, During 2008, my total mon hl, ren payment to Villa Point II (Off -site Newport North Apartments) was $ 11-0 per month. " Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point it (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased. premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach, This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -Income Earning Household Member(s): Name Age Signatures) of Income Earning Household Member(s): Signature I/ VILLA POINT II (Off -site Newport North Apartments) ✓ Unit No. �— CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (Cor tenants not in possession of a Section 8 certificate or voucher, Income documentation must be obtained.) INVe certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2008, the Total Annual Eligible Income* of the undersigned individual(s) was$` °1tdt ;and, 3. During 2008, my total monthly rent payment to Villa Point II (Off -site Newport North Apartments) was $ la4O per month, " Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance.pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date Indicated below: Names and Ages of Non -Income Earning Household Member(s): Name Age Signature(s) of Income Earning Household Member(s): Signature Signature Signature Data. d `� j0-V a of VILLA POINT II (Off -site Newport North Apartments) Unit No. CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (for tenants not in possession of Section 8 certificate or voucher, income documentation must be obtained.) INVe certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated, [eased premises; and, 2. During 2008, the Total Annual Eligible Income* of the undersigned individual(s) was $ —�r—; and, 3. During 2008, my total monthly rent pa anent to Villa Point II (Off -site Newport North Apartments) was $ M 1. 3?z� per month. * Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay; alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -income Earning Household Member(s): Name Ago Signature(s) of Income Earning Household Member(s): Signature t,.S/ign lu(re Date: l �t 1001 Keep this forofor your records -DO NOlMAIL TO FTB Declaration Control Number (DCN) r� = — I I I 1 1 1� — L�I I I —I — ❑ Date Accepted TAXABLE YEAR California Online e-file Return Authorization FORM 2008 for Individuals 8453AL Your first name and Initial Last name Your SSN or ITIN TERRI B TORGERSON 550-23-8693 If Joint return, spouse's/RDP's first name and Initial Last name Spouse's/RDP's SSN or ITIN Address (including number and street, PO Box, or PMB no.) Apt. noJSte.no. Daytime telephone number PO BOX 3264 714 852-1087 City State ZIP Code TUSTIN CA 92781 Part I Tax Roti 1 California adjusted gross income. (Form 540, line 17; Form 540 2EZ, line 16; Long Form 540NR, line 21; or Short Form 540NR, line 21)................................................................1 2 Refund or No Amount Due. (Form 540, line 66; Form 540 2EZ, line 28; Long Form 540NR, line 73; or Short Form 540NR, line 73)................................................................2 3 Amount you owe. (Form 540, line 62; Form 540 2EZ, line 27; Long Form 540NR, line 69; or snort corm 54DNK, line uu)................................................. 4 0 Direct Deposit of Refund 5 ❑ Electronic Funds Withdrawal Be Amount 5b Withdrawal Date (MM/DD/YYYY) $47,039.00 $29.00 Part III Make Estimated Tax Payments for Taxable Year 2009 These are = installment payments for the current amount you owe. First Payyment Due 4/15/09 Second Payment Due 6/15/09 Third Payment Due 9/15/09 Fourth Payyment Due 1/15/10 6 Amount 7 Withdrawal Date PartW Banking Information (Have you verified your banking Information?) 8 Amount of refund to be directly deposited to account below $29.00 12 The remaining amount of my refund for direct deposit 9 Routing number 322079353 13 Routing number 10 Account number 375759091 14 Account number 11 Type of account: 91 Checking ❑ Savings 15 Type of account: ❑ Checking ❑ Savings Part V I authorize my account to be settled as designated 1n Part II. If I check box 4,1 declare that the direct deposit refund information in Part IV agrees with the authorization stated on my return. I authorize an electronic funds withdrawal for the amount listed on line 5a and any estimated payment amounts listed on line 6 from the account listed on lines 9,10, and 11. If I have filed a joint return, this is an irrevocable appointment of the other spouse/RDP as an agent to receive the refund or authorize an electronic funds withdrawal. Under penalties of perjury, I declare that the Information I provided to the Franchise Tax Board (FTB), either directly or through a4lle software, including my name, address, and social security number (SSN) or Individual taxpayer identification number (ITIN), and the amounts shown in Part I above, agrees with the information and amounts shown on the corresponding lines of my 2008 California income tax return. To the best of my knowledge and belief, my return is true, correct, and complete. If I am filing a balance due return, I understand that if the FTB does not receive full and timely payment of my tax liability, I remain liable for the tax liability and all applicable Interest and penalties. I authorize my return and accompanying schedules and statements to be transmitted to the FTB directly or through the e4lie software. If the processing of my return or refund is delayed, I authorize the FTB to disclose to me, either directly or through the e4ile software, the reason(s) for the delay or the date when the refund was sent. Sign Here It is unlawful to forge a spouse's/RDP's signature. For Privacy Noece, get form ftB i ii is FTB 8453-OL 02 2008 . Keep this fo0for your records - DO N66MAIL TO FTB Your name: TERRI B TORGERSON Your SSN or ITIN: 550-23.8693 35 Enterthe amountfrom Side 1,line 34.....................................................................35 1672100 36 California Income tax withheld (see page 15)...... • • • • • • ............................0 36�� 1701 00 37 2008 CA estimated tax and other payments (see page 15) ..............................• 37 00 38 Real estate and other withholding, Forms 592-B, 593, and 594 (seepage 15)....... ........• 38 00 39 Excess SDI (or VPDI) withheld. To see If you quality (seepage 16).......................• 39 00 Child and Dependent Cara Expenses Credit (see page 16). Attach form FTB 3506. • 40 a 41 • 42 ---� • 43 l00 44 Add line 36, line 37, line 38, line 39, and line 43, These are your total payments (see page 16) ....................... 44 1701 �00 45 Overpaid tax. If line 44 Is more than line 35, subtract line 35 from line 44........................................ 45 29100 46 Amount of line 45 you want applied to your 2009 estimated tax .............................................. • 46 00 47 Overpaid tax available this year. Subtract line 46 from line 45................................................ • 47 29 00 48 Tax due. If line 44 is less than line 35, subtract line 44 from line 35.............................................. 48 00 49 Use Tax. Thisls not a total line (seepage 16)................................... Is 49 JO0 CA Seniors Special Fund (see page 60) .................. ► 400 Alzheimer's Disease/Related Disorders Fund .............. ► 401 o CA Fund for Senior Citizens ........................... Rare and Endangered Species Preservation Program........ 0- 402 ► 403 a State Children's Trust Fund for the Prevention of Child CA Breast Cancer Research Fund ....................... Abuse . ► 404 ► 405 0 CA Firefighters' Memorial Fund ......................... ► 405 Emergency Food For Families Fund ..................... ► 407 CA Peace Officer Memorial Foundation Fund. ► 408 CA Military Family Relief Fund .......... ► 409 CA Sea Otter Fund ................. . ...► 410 CA Ovarian Cancer Research fund ....... ► 411 Municipal Shelter Spay -Neuter Fund .....► 412 CA Cancer Research Fund .............► 413 ALS/Lou Gehrig's Disease Research Fund . ► 414 61 Add code 400 through code 414. These are your total contributions ... . . . . ......................... . ........... • 67 0 j00 62 AMOUNT YOU OWE. Add line 48, line 49, and line 61 (see page 17). Do not send cash. Mail to: FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267.0001................062 63 Interest, late return penalties, and late payment penalties...................................................... 63 00 64 Underpayment of estimated tax. Fill in circle: O FTB 6805 attached 0 FTB 5805F attached .................... • 64 00 65 Total amount due (seepage 18). Enclose, but do not staple, any payment ......................................... 65 00 66 REFUND OR NO AMOUNT DUE. Subtract Ilne 49 and line 61 from line 47 (seepage 18). Mall to: FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240-0002 ................. 066 _ _ _29 00 Fill In the information to authorize direct deposit of your refund Into one or two accounts. On not attach a voided check or deposit slip (see page 18). Have you verified the routing and account numbers? Use whole dollars only. All or the following amount of my refund (line 66) is authorized for direct deposit into the account shown below: 322079353 0 Checking 375759091 00 ❑ Savings _ a Routing number .Type •Account number 9 67 Direct deposit amount The remaining amount of my refund (line 66) is authorized for direct deposit Into the account shown below: ❑ Checking , OD ❑ Savings -- • Routing number *Type *Account number • 68 Direct deposit amount IMPORTANT: Seethe Instructions to find out If yyou should attach a copy of your complete federal return. Under penalties of perjury, I declare that I have examined this return, Inclutling accompanying schedules and statements, and to the best of my knowledge and Sign belief, it Is true, correct, and complete. Here Yourdgnature apouseWIRDP's signature pfalDlnl return, both must sign) Dame phone number(opllonaii (714)852-1087 It Is unlawful to forge aspouss's/ROP§ X signature. Pal Joint MIMI? (see page 19) Do you want to allow another person to discuss this return with us (see page 19)? ............ • O Yes ❑ No Side 2 Form 540 Of 2008 7 3102083 , Keep this foi0for your records -DO NOOMAIL TO FTB For Privacy Notice, get form FTB 1131. FORM California Resident Income Tax Return 2008 540131 Side 1 Fiscal —at filers only! Enter month of year and: month _ _ vear 2009. Your first name Initial Last name Your SSNorrnN TERRI B TORGERSON 550-23-8693 If joint return, spoum's/RDP's first name InNa Last name Spouse'srRDPs SSN or ITIN Address (Including number and street, PO Box, or PMB no.) Apt noble. no. PEA Code PO BOX 3264 City (If you have a foreign address, see page 9) State ZIP Code TUSTIN CA 92781 If you tiled your 2007 tax return under a different last name, write the last name only from the 2007 tax return. e Taxpayer 9 Spouse/RDP 1 0 Single 4 0 Head of household (with qualifying person). (see page 3) 2 0 Marrled/RDP filing jointly. (see page 3) 5 0 Qualifying wldow(er) with dependent child. Enter year spouse/RDP died 3 0 Marded/RDP filing separately. Enter spouse's/RDP's SSN or ITIN above and full name here If your California filing status Is different from your federal filing status, fill In the circle here ....................• 0 6 If someone can claim you (or your spouse/RDP) as a dependent, till In the circle here (see page 9)..............• 60 ► For fine 7, line 8, line 9, and line 10: Multiply the amount you enter In the box by the pre-printed dollar amount for that line. Whole dollars only 7 Personal: If you filled In 1, 3, or 4 above, enter 1 In the box. If you filled In 2 or 5, enter 2, in the box. If you filled In the circle on line 6, see page 9.................................................. 7 UIX $99 = $ 99 8 Blind: If you (or your spouse/RDP) are visually impaired, enter 1; if both are visually Impaired, enter 2 .... 8 ❑ X $99 = $ 9 Senior: If you (or your spouse/RDP) are 65 or older, enter 1; if both are 65 or older, enter 2........... • 9 FIX $99 = $ 10 Dependents: Enter name and relationship. Do not include yourself or your spouse/RDP. Total dependent exemptions........... e10 X $309= $ 11 Exemption amount: Add line 7 through line 10. Transfer this amount to line 21 ......................11 $ 99 12 State wages from your Form(s) W-2, box 16 or CA Sch W-2, line 3 .......................... • 12 47039 0o 13 Enter federal adjusted gross income from Form 1040, line 37;1040A, line 21; or 1040EZ, line 4......................... 13 47039 00 14 California adjustments —subtractions, Enterthe amount from Schedule CA (540), line 37, column 8 .................. • 14 00 16 Subtract line 14 from line 13. If less than zero, enter the result In parentheses (see page 11) .......................... 15 47039 oo 16 California adjustments —additions. Enter the amount from Schedule CA (540), line 37, column 0..................... • 15 00 17 California adjusted grass Income. Combine line 15 and line 16................................................ • 17 47039 oo 18 Enterthe Your California Itemized deductions from Schedule CA (540), line 44; OR larger of: Your California standard deduction shown below for your filing status: • Single or Married/RDP flling separately ...... . . .................... $3,692 • Married/RDP filing jointly, Head of household, or Qualifying widow(er) ... $7,384 If the circle on line fits filled in, STOP. (see page 11)......................... I................. • 18 3692100 19 Subtract line 18 from line 17. This Is your taxable Income. If less than zero, enter-0 ............................... 19 43347 00 20 Tax. RII in the circle if from: STaxTable 0Tax Rate Schedule 0 FB 3800 O FIB 3803..................0i 20 1771 00 21 Exemption credits. Enterthe amount from line 11. if yourfederal AGI is more than $163,187, see page 13............... 21 99 00 22 Subtract line 21 from line 20. If less than zero, enter-0... . . ......... ......................................... 22 1672 oo 23 Tax (see page 13). FlII in the circle if from: O Schedule G-1 O FB 587OA..................................1 23 00 24 Add line 22 and line 23................................................................................ 24 1672 00 25 Enter credit name code no and amount ......... ►25 100 26 Enter credit name code no and amount ......... ► 26 00 27 To claim more than two credits (see page 14) ...... ................................. • 27 00 28 Nonrefundable renter's credit (see page 14)........................................ • 28 00 29 Add line 25 through line 28. These are your total credits....................................................... 29 00 30 Subtract line 29 from line 24. If less than zero, enter -0.... .................................................... 30 1672 00 31 Alternative minimum tax. Attach Schedule P (540) ........ . .......................... • 31 00 32 Mental Health Services Tax (see page 15) . ........ . . . ....... . ...................... • 32 00 33 Other taxes and credit recapture (see page 15)...................................... • 33 00 34 Add line 30, line 31, Ilne 32, and Ifne 33. ThIs is your total tax ................................................ • 34 1672l00 ---I' 3101083 F_ •, • 0 Deparbnant of thm Treasury— Internal Revenue Semw Form income Tax Return for Single and 1040EZ Joint Filers With No Dependents (99) 2008 OMB No. 154SW Yourfirstname MI Last name Your social security number Label (son lnstwcllons) L TERRI B TORGERSON 550-23-8693 Ifelolmr tum, spouWa Nat name MI Lost name Spouw's social security number 9 UsethelRS E L Othefrwise, H Home address street). If you have a P.O. box am instruction. Aptre. You must enter your po`type. t R PO BOX 3264 SSN(s)above. City, loam or post office. If YOU have a foreign address, swlnalmclions. Stale 7JPwtle Checking a box below will not E Presidential mrremTrr M 92781 change your tax or refund. Campaign ' ea Famed Income crad ( ) (on . . lose Inns) Check here if you or your spouse If a joint return, want $3 to 0o to this fund?......... ► n You n spouse Income 1 Wages, salaries, and Ups. This should be shown in box 1 of your Form(s) W-2. Attach your Form(s) W-2...................................... 1 47,039. 2 Taxable Interest. If the total Is over $1.500, you cannot use AttachForm 1040EZ........................................... 2 W-2 here. 3 Unemployment oompensa8on and Alaska Permanent Fund dividends(see lnsWctons)..................................... 3 Enclose but do not attach, any 4 Add lines 1 2 and 3 This is your adjusted gross Income . .................... 4 47,039. payment. 5 If someone can claim you (or yours pouse If a joint return) as a dependent, check the applicable box(es) below and enter the amount from the worksheet. You Spouse If no one can claim you (or our spouse if a joint return), enter $8,950 if single; $17,900 if married6lingjointly Seelnstruall ns ............................... 5 8,950. 6 Subtract line 5 from line 4. If line 5 is larger than line 4, enter-0-. This Is your taxableIncome ........................................ ► 6 38,089. Payments tax 7 Federal Income tax withheld from box 2 of your Form(s) W-2 .. . 7 6,504. and it EIC 1 tructt s. ) Be saens ...................... b Nontaxable combat pay election .................. 8 b 9 Recovery rebate credit (see instructions) .............................. 9 0. 10 Add lines 7 8e and 9 These are Your total payments ..................... ► 10 6,504. 11 Tex. Use the amount on line 6 above to find your tax in the tax table In the instruction DOOKIeL I nen, enter me tax imm ma iaDiu vn uns nin .. ..... .. .. . . , . Refund 12a If line 10 Is larger than line 11. subtract line 11 from line 10. This is your refund. Have It dremy If Form 8888 is attached, check here ► ► 12a 641. ................... depoenetll sea '"012b tied ► bRoulingnumber .. 322079353 ► cT e: Checking QSavings and 12d or Form 8088' ► dAccountnumber.. 375759091 Amount 13 Iffinellislarger. than line 10, subtract line 10 from line 11. This is the amount you owe. You owe For details on how to pay, see Instructions ........................... ► 13 Third party Do you want to allow another person to discuss ttlisreuonwilhlhelRS(seekwitictmts)? ........... U Yes. Completethefollamng. XUNo designee timlip es Phone Pemonoi lD flame ► no. ► no.(PIN) ► Sign Under penalges of rlurWedare that l have examined this whom, and to the bestof my kroxledoe and belief It is lee ooaecLandecwmtelylBbdlanumeand here sources fincomeln ce during are tazyea. Decimation ofpwpewr(ohherthan the tavayer) Is based an R lnfwnalion ofwhkb to pwponerhas any koMedge. Vauralgnture (Date IYouracwpagon IDnylimo phone no Jolnlrehom? ' See Inthe• Bons. Keep a copy for yourrewlds. Data Pawnees SSN or PTIN Preperefs Paid signahom ► Rsmdayed preparer'8 ours Self —Prepared Flmrename(orcod Ube onlyaddress, anyed). �N etltlress, antl 2lP code ► aAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see Instructions. FDRA0201 10/31/08 Form 1040EZ (2008) Name(s) Shown on Return Tax Payments Worksheet • 2008 ► Keep for your records Social Secunty Number Estimated Tax Payments for 2008 (if more than 4 payments for any state or locality, see Tax Help) Federal state Local Date Amount Date Amount ID Date Amount ID 1 2 3 4 5 Tot Payments.. 04/15/08 04/15/08 04/15/08 06/16/08 06/16/08 06/16/08 09/15/08 09/15/08 09/15/08 01/15/09 01/15/09 01/15/09 Estimated . Tax Payments Other Than Withholding (If multiple states, see Tax Help) Federal State ID Local ID 6 Overpayments applied to 2008.... 7 Credited by estates and trusts 8 Totals Lines 1 through 7 ...... 9 2008 extensions ............ .... _ _ _ Taxes Withheld From: Federal State Local 10 Forms W-2...................... 11 Forms W-2G ..................... 12 Forms 1099-R .................... 13 Forms 1099-MISC and 1099-G........... 14 Schedules K-1 .................... 15 Forms 1099-INT, DIV and OID 16 Social Security and Railroad 17 Form 1099-B ....... 18 a Other withholding .... b Other withholding .... c Other withholding .... 19Loc'_ Total Withholding Lines 10 20 Total Tax Payments for 2008 ........... Benefits ....... St _Loc St Loc _ St Loc _ St I- through 1Be... ........... 6,504. 1,701. 6,504. 1,701. 6,504. 1,701. Prior Year Taxes Paid In 2008 (If multiple states or localities, see Tax Help) state ID Local ID 21 Tax paid with 2007 extensions 22 2007 estimated tax paid after 23 Balance due paid with 2007 24 Other (amended returns, installment .............. 12/31/07 ......... return ............ payments, etc) . . _ _ _ Federal Carryover Worksheet 2008 ► Keep for your records Name(s) Shown on Return I Social Security Number 2007 State and Local Income Tax Information (See Tax Help) (a) State or Local 10 (b) Paid With Extension W Estimates Pd After 12131 (d) Total With- held/Pmts (0) Paid With Return M Total Over- payment (9) Applied Amount Totals . . Other Tax and Income Information 2007 2008 1 2 3 4 5 6 7 8 Filing status ............................. Number of exemptions for blind or over 65 (0-4)......... Itemized deductions after limitation ................ Check box if required to Itemize deductions ............ Adjusted gross income ....................... Tax liability for Form 2210 or Form 2210-F ............ Alternative minimum tax ....................... Federal overpayment applied to next year estimated tax..... 1 2 3 4 5 6 7 8 _ 1 Sincf1e 2 077. �— —M- 47,039. 5 , 863 . QuickZoom to the IRA Information Worksheet for IRA information (see Tax Help) ....... ► Excess Contributions 2007 2008 9 a Taxpayer's excess Archer MSA contributions as of 12131 .... b Spouse's excess Archer MSA contributions as of 12131 ..... 10 a Taxpayer's excess Coverdell ESA contributions as of 12131... b Spouse's excess Coverdeil ESA contributions as of 12131.... 11 a Taxpayer's excess HSA contributions as of 12131 ........ b Spouse's excess HSA contributions as of 12131 ......... 9 a b 10 a b 11 a b Loss and Expense Carryovers 2007 2008 12a Short-term capital loss ........................ b AMT Short-term capital loss .................... 13 a Long-term capital loss ........................ b AMT Long -tens capital loss ..................... 14 a Net operating loss available to carry forward ........... b AMT Net operating loss available to carry forward ........ 15 a Investment interest expense disallowed .............. b AMT Investment interest expense disallowed ........... 16 Nonrecaptured net Section 1231 losses from: a 2008... b 2007... c 2006... d 2005... e 2004... If 2003... 12a b 13 a b 14 a b 15 a b 16 a b c d e f VILLA POINT it (Off -site Newport North Apartments) r Unit No. �zUS CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (tor tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtained.) I/We certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2008, the Total Annual Eligible Income' of the undersigned individual(s) was $ ..41 29�. 32-2o and, 3. During 2008, my total monthly rent payment to Villa Point it (Off -site Newport North Apartments) was $ %N$�• per month. * Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net Income from a business or rental property, Interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -Income Earning Household Member(s): Name Age yoy x� Mc-/1' w e�6') J- Signature(s) of Income Earning Household Member(s): Date: Signature 4 i y5. VILLA POINT II (Off -site Newport North Apartments) Unit No. AP/0 CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession of a Section 8 certificate or vauclier, income documentation must be obtained.) INVe certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2008, the Total Annual Eligible Income* of the undersigned individual(s) was $ _ J j g �$S_; and, 3. During 2008, my total monthly rent payment to Villa Point][ (Off -site Newport North Apartments) was $ / 2t%0. per month. " Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date Indicated below: Names and Ages of Non -Income Earning Household Member(s): Name Age Signature(s) of Income Earning Household Member(s): MUM Signature Data: _ QUALITY Jul 17 2008 3:18PM HP LRSERJET FAX P.1 VILLA POINT 11.(Off-site Newport.North Apartments) {trait No, 'QZ CERTIFICATION OF CONTINUED HOUSEHOLD ELIOISILITY (For tenants not b possession of a Section S ecrdfimts or voucher, Incatae docutnentguoa must be obtsiaed,) INVe certify to the management of VUIa'Point II (Off -site Newport North -Apartments) that 1. Tito undersigned Islam the only income eaming-occupent(s).of the eboVa Indicated leased premises; and, 2. Duriing 2008, the Total Annual Eligible Income of the undersigned indlvldual(s) w4e',$ 3�, ql to ; and, & During 2 8, my total mo ily rent payment to Villa PoInt 11(Off-site Newport North Apaitme ) was $ Wper month. ' Total Ann AE 1611911210 income includes: wages, tips, overtime, bonuses, commissions, net Income from a lwsines i or rental property, interest -and dividend$, social security peyMents, retirement ftmd'or pahsilon p mehts and distributions,.disebility benefts, woAerst compensation and disability pay, severan y, alimony, child support, all regular and special pay and allowances of a'member of the Armed Fo is (tc4=lude'hosti1e fire alfowancol. The undersigned a, owledge(s) that Villa Point it (Oft -site Newport North Apartments) -and ihe'City of Newport Beach are ying on the -accuracy of the.provkted information.tn the leasing of an apartment to the undersigned; an n conferring on the undersigned the•rnonstafy benefits of the Agreement which restricts the rents co 1 etible for occupancy of the above Indicated leased'premises. The undersigned to the City of Nev This Certification is below. Names and 'Ages of Member(s): its to the.deilvery of a copy of this Certification of Continued Household Eligibility uhderjrenalty of pedury in Newport Beach, California on the date indicated naming Houdehold Ape Signatare(s) of income Earning Household Msmber(s): ftnokn oeto• tom/ 0 Jul 17 200S 3:18PM HP LRSERJET FRX eF of AA n Department of the Treasury—lntsmal Revenue Service • P.2 Label L - ,o nu. ,a•wur• Your fir6t name and lnPoal Lastneme Yoursodar sseurky number (see A �Y M Greenberg 21B-62-0291 H L xa)olm return, spouse's Brat name end initial Last home apoutes social sscuray number Use the IRS Otherwise, N E. Home address (number and street). If you here a P.O. box, sae Insinclions. Apt no, 1528 Valencia - s)abovt enter pleas► print 6' urSSNYou . yourSSN(c) above, . or type, City, lor+rt or Postofnce, state, and 7JP code. xyou haves foreign addreae, seelnsbuc6ons. Presidential Newport Beach CA 92660-3285 changi oubtaxorlu Will not ' Efrmaen Campaign Chock here If you, or your spouse if filing jointly, want $3to'me to this RIM (see Instructions) ► ❑ You ❑ spouse Filing Status 1 ❑X Single Heatl of household (with quallty)ng person). (See Insir,) If the qualifying person Is a child but not your dependent, enter 2 Married filln ointl even If on one had Income 91 Y ( N ) Check only , this child's name here. ► 3 ❑ Marled filing separately. Enter spouse's SSN above one box and full name here. ► 6 Q Qualifying wldow(er) with dependent child (sewlnstf'uetbns) Exemptions Its b to If nrore than four dependents, see Instructions. Yourself. If someone can claim you as a dependent, ;do notphectl box Be ; Spouse ....... , Dependents: 11)First name Lastnama a Dryandant4 Ia)nopenden, aO�al aeOYkY numbs rsiatbneNp to W a Ly'r rtri wta�� tlYadll aea�Mn.; Income 7 Wages, salaries, tips, etc. Attach Forms) W 2 8a Taxable Interest Attach Schedule B If required ............ . Attach Forms) b Tax-exempt interest. Do not Include on line 8a , , , ,,, , , , , , , , , 8le W 2 here. Also Be Ordinary dividends. Attach Schedule 8 If required ......... . . ... attach Forms W20 slid . ......... . to Qualified dividends (see Instructions) ..... . ......:...... " 196 '0 10 Taxable refunds, credits, or offsets of state and local Income taxes (see instrud)ons) 1099-R if tsx 11 , Alimony recelved .... . . . ' ' • was wNhheld. 12 Business Income or (loss). Attach Schedule C or C-EZ ,, , , , , , , 13 , , , , , , , , , , • .. , Capital gain or(loss)•Altaci,seheadsosr«gwed. snotregeked,meckhere , , , , , , , , ,.....,... ► If you did not 14 Other galas or (losses). Attach Form 4787 .. , .. . .. �.....to get aW-2, sae instructions. 15a IRA distributions . Taxable amount(me inst.) 16a Pensions and annuities .... ,' .. 16a b Taxable amount (see IriaL) Enclose, but do 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E not attach, any 18 , Farm Income or (loss). Attach Schedule F ... payment. Also,19 . ............ Unemploymentcompensatbn . . , . . Form 040use Forsn1ti40-V. 20a Social security benefits ... I20a tY .. '•• Taxable amount(seelnst.) 21 Other. income. List type and amount (seetnstrucdons)__—____ 22 _ _ Add the amounts In the far right column for lines 7 through 21. This is ourtotal Income ,^, ► Adjusted 23 Educator expenses (see Instructions) ........... . .. . . . . 23 Gross 24 Certaln business expenses of reservists, performing artists, and Income fee -basis government officials, Attach Form 2106 or2106-EZ .... , , , 24 0 26 Heakh savings account deduction. Attach Form 8889 ....... , , , 26 0 26 Moving expenses. Attach Forth 39D3 ...... .. . 26 a 27 One-half of 5e111-empfoyment tex Attach Schedule SE ........... 27 0 28 Self-employed SEP, SIMPLE, and qualified plans ............"ID • 29 Self-employed health Insurance deduction (see instructions) .. .. 30 Penalty on early withdrawal of savings .... . ... . . . . .. . . 31a Alimony paid b Reciplents SSN ► - 32 IRA deduction (see Instructions) . ....... ... ... .. ..... .33 Student loan Interest deduction (500Instructions) .. ...........34 Tuition and fees deduction. Attach Form 8917 .... ...... . ....35 Domestic production activities deduction. Attach Form 6903 ...... 36 Add lines 23 through 31a and 32 through 35 ................37tractIln3from line 22 This is your adjusted gross Income .. K1/1 For Olejac, ure, privacy Act, and Paporwork Reduction Act Notice, see instructions. 9oaMchwked 1 on as and eb No, of children on ec who: a lived Wfaf yse • drdnol—Wah You oroa uuppW, ntod (warn,Wdl,n,) --r 0epsode6ts on ec 110lMa11ad ihOW Addnumbenof, n N 317 Form 1U4U (2008) Jul 17 2009 3:18PM HP _Lfi9_ERJET FAX P•3 roM 2SU�Ss 4b �'3m:f1'iioan. 2 8'.W 3 sow�ts+eurg23 6.46 t seddwcrgM'466 16 M xhN74�66 2SM161t,.46 YNNswRWVIOMM � �•6S f d Om wwPowe cow, Np �ruwanl� 1 ' 6006 'twu3R 16 a t�gbyar►nan4 Ml��.�7R aMe FILI-ERFRI:SH MOCHA TIMS Jul 15 2009 10:52RM HP LRSERJET FAX ,,7iq1 t/P . 1 VILLA POINT It (off -site Newport North Apartments) Unit No. C; CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenanti not invonession of a sections certificate or voucher, income docunentafiea meat be obtained,) INVe certify to the management of Villa Point 11 (Off -site Newport North Apartments) that: 1. The undersigned isfare the only income earning occupant(s) of the above indicated leased premises: and, 2, During 20DS, the Total Annual Eligible Income* of the undersigned Individuals) anti --- vWas• � , 3. [luring 2008, my total monthly rent payment to Villa Point ii {Off -site Newport North Apartments) was $ 6 = per month. 16-10 * Total Annual Eligible Incgme.includes.. wages, tips, oveitime, bonuses, commissions, net Income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workets' compensation and disability pay, severance pay, alimony, child support, all regular.and special pay and allowances of a member of the Armed Foroes (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point it (Off -site Newport North Apartments) and the City of Newport teach are retying on the accuracy of the provided information in the teasing of an apartment to the- undersigned: and In conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach, This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Nori-income Eaming Househord Mortiber(s): Name ABa Signature(s) of income Eaming Hoosabotd Member(s): Slpnaers SIpnANn Oats- VILLA POINT 11(Off-site Newport North Apartments) Unit No. 7 CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (ror tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtained.) I/We certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 20�0�8f, the Total Annual Eligible Income* of tthe undersigned individual(s) T� �'+wft 7 On ax rG r''Lr was $ � ;and, - 3. During 2008, my total monthly rent payment to Villa Point II (Off -site Newport North Apartments) was $ 1 S (05 ' T' per month. " Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net Income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non•lncome Earning Household Signature(s) of Income Earning Household Member(s): Msmber(s): Name Age si nature Signature Ar Signature %,�( Date: µ am) a 6O 1 ry r 6WA-41 VILLA POINT 11(Off-site Newport North Apartments) Unit No. aso3 CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (b'or tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtained.) INVe certify to the management of Villa Point 11 (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2008, the Total Annual Eligible Income* of the undersigned individual(s) was $ 4q= ; and, 3. During 2008, my total monthly rent payment to Villa Point II (Off -site Newport'North Apartments) was $ 601 • M per month, tom. C6 > " Total Annual Eligible Income Includes: wages, tips, overtime, bonuses, commissions, netIncome from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a -copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -income Earning Household Signature(s) of Income Earning Household Member(s): Member(s): Name Age �AttirArc�7 et— r S gcwt,► Signature IWtXA Cr A 3D -- Signature Date: Signature Unit A45 VP II Units NPN Head ofHousehold's Name:Bewli/Arora ❑ Initial Certification 6W 1 ,'._ 4-e Date: Date of Expected Move -In: g Recertification (Annual or7ntertm) Effective Date: 2008 7/1/2009 You reside in an apartment that is governed by the federal Housing Credit Program or Department of Housing and Urban Development's (HUD) regulations. These programs require us to certify all of your income, asset and eligibility information as part of determining your household's eligibility. Program requirements state we must verify each income and asset source as well as other claims of eligibility. We must determine this prior to granting your eligibility and, if such eligibility is granted, each subsequent year you remain in the unit. I, Kawalleet S. Bewli and Sarika G. Arora certify that: I participate in the Villa Points II Program at Newport North. I moved to the property in 2008. 1 have been asked to provide my 2008 Tax Returns for the City's annual Recertification Process. I did not file taxes in 2008. I certify that my income does not exceed the Income Limits set for this program. I certify that the information given above is true and complete to the b st of my knowledge. I understand that providing false or misleading information is a breach of my leas may be subject to criminal penalties. Signature of Applicant/Resident: Irvine Company Apartment Communities Porn 6 Self Affidavit Revised 07/08 0 • Newport North 2 Milano Newport Beach, CA 92660 To whomsoever this may concern: This letter is to state that we undersigned live at 2503 Salerno Newport Beach, CA 92660. We also state that we file income taxes jointly and have filed extension for our tax filings for year 2008. Please call us at 949-289-2640 if you have any questions. Yours sincerely, Ka aljeet S. Bewli Safika G. 9 10 VILLA POINT II (Off -site Newport North Apartments) Unit No. CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtained.) ]Me certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2008, the Total Annual Eligible Income* of the undersigned individual(s) was $ _ 1 831 r �2 ; and, _ 3. During 2008, my total monthly rent payment to Villa Point II (Off -site Newport North Apartments) was $ 04) per month. " Total Annual Eligible Income Includes: wages, tips, overtime, bonuses, commissions, net Income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -Income Earning Household Member(s); Name Age Signature(s) of Income Earning Household Member(s): WMILW s gnalure Signature sl nat/�ure Date; -11 I Jul 21 2009 5:04PM Print Run 3108240708 / P.1 �'�(// Jul 21 2009\4:56PM H*RSERJET FAX • p,2 V14LA POINT If (Off -site Newport North Apartments) Unit No.�� CEi TIFICl•1TION OF CONTINUED HOUSEHOLD ELIGIBILITY (F'or tcdnnts nos to possonfan of a 6action8 certlr'.toskar voucka, Iacono docurnentatloa mast boobtAhMl,) I/We certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are-the only Income earning ocoupant(e) of the above indicated leased premises; and, �. During 2008, the Total Annual Eligible Income` of the undersigned individuals) wast..$ 'Jm,4f" . ;and,. 3. During 2008, my total morithlyrent paymelitio.Villa Point II (Off -site Newport North Apartments) wag $ _ / V?._ per month. • Total Annual 011ilble Income includes: wages, tips, overtime, bonuaes, commissions, net income from a business or rental property, Interest and dividends, social security payments, retirement fund or pension 3ayments and disfributlohs, disablilty benefsfs, workers' compensation and disability pay, severan a pay, allinony, ohdd support all regular and special pay and•allowandes of a member of the Armed F age (to -exclude hostile fire allowance). The undersigned agknowiedge(s) that Vita Point 11(Otf-site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents c�lectible for occupancy. of the above indicated leased premises. i The undersigned consents nsents to the delivery of a dopy of this Cepcation of Continued Household Eligibility to the City of Newport Beach. This Certification Is made under penalty of. perjury in Newport Beach, Calliornia on the date Indicated below: Names and AQos of N6n4n=m& Earning Hotnshold Member(a): T1 ;N¢me AUa ' Pub ,:z f7j tcr/>'� ti A-c7 t4_ / rr-r t Z ' We: 7, z /. 69 • Ito-Z,4 to f,04.4 L r,-, VILLA POINT II (Off -site Newport North Apartments) Unit No.a� CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (ror tenants not in possession of a section 8 certificate or voucher, income documentation must be obtained.) IMe certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersignelyare the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2008, the Total Annual Eligible Income* of the undersign individual ) was $ 000; and, 3. During 2008, my total mo thiy rent payment to Villa Point II (Off -site Newport North Apartments) was $ � per month. " Total Annual Eligible Income Includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay -and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above Indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -income Earning Household Member(s): Name Age Signature(s) of Income Earning Household Member(s): Date: Signature Signature Jul in auuo G: GYrn nr rnn .. " 1>156111(� , I N Housing & Community Services Department i i i I ORANGE COUNTY HOUSING AUTHORITY 1770 North Broadway, Santa Ana, CA 92708.2642 Telephone (OCHA): (714) 480-2700 FAX: (714) 480.2812 F O R M A T 1 O N S Date: 2/6/2008 Subsidy Number: PI-17919 Tenant's Name: Henrietta Kussell Address: 2615 San Marco City: Irvine CA 92660— Owner Name: Newport North Apartments Effective Date: 2/1/08 End Date: M2M RENT Tenant Portion OCHA Portion Total Rent 11- PRO-RA-TED RENT Pro -Rate for Tenant Pro -Rate OCHA Pro -Rate TOTAL PRO -RATE Field Representative: Telephone Number: $ 231 / $ 1,007 $ 1;238 days of carolyn chin (714)480-2973 H E E T CITY OF NEWPORT BEACH P.O. BOX 1768, NEWPORT BEACH, CA 92659-1768 June 5, 2009 Irvine Apartment Management Company Attn: Barbara Breton VILLA POINT H 110 Innovation Drive Irvine, California 92617 Re: Transmittal of 2009 Income Limits and Maximum Rents -Revised Villa Point II — (Off Site Newport North) Dear Ms. Breton: This correspondence transmits the revised income limits and maximum rents as they apply to the Villa Point II (Off -site) Newport North Apartments. Adherence to these income limits and rents will provide conformance with the City of Newport Beach and U.S. Department of Housing and Urban Development's (HUD) affordability requirements. (1) The 7 one -bedroom units and 11 two -bedroom units must be rented to families or individuals that meet HUD's low-income standards (80% of area median income). This may be accomplished by renting the units to Section 8 Certificate or Voucher holders. When Section 8 tenants are not available, one bedroom units may currently be rented for no more than $1,330 per month. Subsequently, the two -bedroom units may be rented for no more than $1,595 per month to individuals whose total household income does not exceed low income standard (see enclosed income limit chart). (2) Based on the HUD Orange County median income of $86,100, and adjustments for family size, the maximum rents that can be charged are as follows: Unit Size Maximum Rent Income Limit 1 Bedrooms Section 8 (OCHA) Section 8 (OCHA) 1 Bedrooms Section 8 FMR 2 Persons: $59,500 3 Persons: $66,950 (HUD) ($1,330)* 4 Persons: $74,400 2 Bedrooms Section 8 Section 8 (OCHA) (OCHA) 3300 Newport Boulevard, Newport Beach www.dty.newport-beach.ca.us Irvine Apartments/ Barb•Breton Villa Point II (Off -site Newport North Apartments) Transmittal of Revised Income and Rent Limits June 5, 2009 2 Bedrooms Section 8 FMR 2 Persons: $59,500 3 Persons: $ ,0 (HUD) ($1,595)* 4 Persons: $7474,40400 *with utilities: Gas/Elec & Refrigerator HUD's policy for two -bedroom units is that they must not be occupied by one individual or a married couple. It is HUD's position that housing assistance funds are very limited, and should be used to house people as efficiently as possible. This policy should be applied to all two - bedroom units. Individuals or families occupying a unit in this development shall enter into a rental agreement, the terms of which includes a requirement for the submission of verification information regarding the income of the occupants. Additionally, a rental agreement provision shall also be included that provides for termination of the tenancy in the event of misrepresentations, as described in the affordable housing agreement with the City. Information verifying tenant income at the time of initial occupancy and for each yearly re -certification thereafter, shall be maintained in the tenant's individual file. Rental rates may be adjusted periodically to reflect published changes in the Section 8 Fair Market Rents (FMRs) and applicable revised income limits. Notice of proposed rent increases must be given to tenants in writing at least 30 days prior to the effective date of the increase, or in conformance with applicable state law, whichever is longer. A copy of the written rent increase notification must also be maintained in your records for compliance with HUD requirements. To simplify monitoring and minimize paperwork, the City is requesting that the following forms be submitted annually to the City: A. For mots occupied by tenants with Section 8 certificates or vouchers, please provide the City with a copy of the Section 8 Rental Agreement. B. For the remaining units, not occupied by Section 8 tenants, each new tenant must submit a copy of their most recent signed income tax form, and be eligibility qualified. Retain a copy of their income tax form in their file, and forward a photocopy of each of the new rental agreements to the City. C. For the remaining units, not occupied by Section 8 tenants, each continuing tenant must complete and return to you a "Certification of Continued Household Eligibility" form for the annual reporting period. A copy of this form is attached for your duplication and distribution. Forward a copy of the Certification form to the City for each continuing tenant. Irvine Apartments/ Barbara Breton Villa Point II (Off -site Newport North Apartments) Transmittal of Revised Income and Rent Limits June 5, 2009 D. An Annual Affordability Monitoring Summary Report form is attached for your completion. Transfer the requested information from your tenant submissions, and return this form to the City. The City of Newport Beach has retained the services of LDM Associates, Inc. for performance of its annual affordable housing compliance. Please submit the above requested documentation by July 17, 2009 to: City of Newport c/o Fran Meyer LDM Associates, INC. 10722 Arrow Route, Suite 822 Rancho Cucamonga, CA 91730 The aforementioned income limits and rents are in accordance with the Affordable Housing Agreement dated November 13, 1990. If you have any questions, or require any additional information, please contact me at your earliest convenience at (909) 476-9696 ext. 220. Sincerely, Meyer Program Consultant Attachments: HUD Orange County Income Limits Table County of Orange Housing Affordability Table Certification of Continued Household Eligibility Annual Affordability Monitoring Summary Report Form 0 Fran Meyer From: Fran Meyer lfineyer@mdg-Idm.com] Sent: Monday, July 26, 2010 3:40 PM To: 'Barbara Breton' Subject: Villa Point 12009- Cert. Request for additional Information Ms, Brenton, In review of the documentation submitted for the 2009 Annual Tenant Certification - Villa Point I I need to following to complete clearance: 1. Copy of Lease Agreement for Unit #346- Howze 2. Unit #335 was vacant in 2008 and reported vacant for 2009, has any advertizing taken place to attempt occupancy? 3. Termination of lease, vacancy date for Unit #676 for previous occupant: Osterstock Thank you for your assistance in the matter, Fran Meyer LDMAssoclates, Inc. 10722 Arrow Route, Ste #822 Rancho Cucamonga, CA. 91730 Phone: (909) 476-9696x 220 Fax: (909) 476-6086 email: mer(amd.e-ldm.com 1 WETLAND PROTECTION THE IRVINE COMPANY APARTMENT COMMUNITIES May 28, 2008 City of Newport c/o Raul Gomez LDM Associates, INC. 10722 Arrow Route, Suite 822 Rancho Cucamonga, CA 91730 Re: Villa Point H (Off Site Newport North) Annual Affordability Monitoring Summary Report Dear Mr. Gomez, Enclosed you will find the 2008 Annual Affordability Summary Report and the Certification of Continued Household Eligibility form for each resident on the Villa Point II program. If you have any questions, or require additional information; please contact me at your earliest convenience at (949) 720-5690. Sincerely, Jason Di Antonio, BMR Compliance Manager Attachments: Annual Affordability Monitoring Summary Report Documentation for each Villa Point II Apartment 110 Innovation Drive, Irvine, California 92617 (949) 720-5600 • IRVINE APARTMENT COMPANY BOND SUMMARY APRIL 2008 MOVE -INS APRIL 2008 RE -CERTIFICATIONS NEWPORT NORTH Affordable Housing Agreement- dated November 13, 1990 LOW- Villa Points # APT. RESIDENT NAME $TTP FLOOR SIZE # OF OCC. MOVE IN DATE MOVE OUT DATE HOUSEHOLD INCOME RENT RECERT DUE 126 Bahamonde 2+2 3 4/28/07 $48,199.00 $1,317.00 4/01/08 234- Galindo 2+2 1 10/02/98 $43,318.00 $1,409.00 4/01/08 242 Antilla 1+1 1 9130/05 $38,710.00 $1,175.00 4/01/08 249 Torgerson 1+1 1 2/22/08 $47,500.02 $1,238.00 4/01/08 1140 Gross 2+2 2 6/06/03 $43,135.19 $1,465.00 4/01/08 1205 Co bill 2+2 2 8/28/04 $47,037.44 $1,409.00 4/01/08 1440 Yeager 1+1 1 9/12/98 $15,392.00 $1,175.00 4/01/08 1528 Greenberg 1+1 1 4/13/08 $1,238.00 4/01/08 1558 Herdrich $829.50 1+1 1 3/05/07 $1,155.00 4/01/08 2341, Klein 2+2 1 9/11/98 p$40,423.52 $1,409.00 4101/08 2407 Brani an 2+2 2 9/15/07, $1,485.00 4/01/08 2503 Bewli/Arora 2+2 2 5/12/08 $1,485.00 4/01/08 2519 Tennis 1+1 2 5/12/06 $1,175.00 4/01/08 2605 Roseli 2+2 4 6/28/02 $70,900.00 $1,375.00 4/01108 2609 Hazewinkel 2+2 1 9/24/94 $42,500.00 $1,409.00 4/01/08 2615 Russell $231 1+1 1 1/26/08 $12,828.00 $1,238.00 4/01/08 2705 Miao 2+2 3 8/21/06 $49,460.00 $1,409.00 4101/08 2736 Nofal 2+2 3 10/31/02 $24,000.00 $1,409.00 1 4/01/08 Total number of apartments on this property: 570 # of property deemed Income Restricted (Low): 18 TTP = Total Tenant Payment (Resident is: an Employee; on Certificate/Voucher) 2008 ANNUAL AFFORDABILITY MONITORING SUMMARY REPORT Apartment Name: Villa Point I (Off site Bayw00d Address: Apartments) Unit # Tenant Name Un1t Size Move -in Date Monthly Rent Family Household income Size 1 Br. $ $ Br. $ $ 3 Br. $ $ 4 Br. $ $ 5 Br. $ $ 6 Br. $ $ 7 Br. $ $ 8 Br. $ $ 9 Br. $ $ Br. $ $ 11 Br. $ $ 12 Br. $ $ 13 Br. $ $ 14 Br. $ $ 15 Br. $ $ 16 Br. $ $ 17 Br. $ $ 2008 ANNUAL AFFORDABILITY MONITORING SUMMARY REPORT Apartment Name: Villa Point I (Off -site Baywood Address: Apartments) Unit # Tenant Name Unit Size Move•in Date Monthly Rent Family Household Income Size $ 18 Br. $ $ Sr. $ $ 20 Br. $ $ 21 Br. $ $ 22 Br. $ $ 23 Br. $ $ 24 Br. $ $ 25 Br. $ $ 26 Br. $ $ Br. $ $ 28 Br. $ • CITY OF NEWPORT BEACH PLANNING DEPARTMENT April 17, 2008 C),o�D Irvine Apartment Management Company VD Attn: Jason Di Antonio, BMR Compliance Manager VILLA POINT II 110 Innovation Drive Irvine, California 92617 Re: Transmittal of 2008 Income Limits and, Maximum Rents Villa Point II — (Off Site Newport North) Dear Mr. Di Antonio: This correspondence transmits the revised income limits and maximum rents as they apply to the Villa Point II (Off -site) Newport North Apartments. Adherence to these income limits and rents will provide conformance with the City of Newport Beach and U.S. Department of Housing and Urban Development's (HUD) affordability requirements. (1) The 7 one -bedroom units and 11 two -bedroom units must be rented to families or individuals that meet HUD's low-income standards (80% of area median income). This may be accomplished by renting the units to Section 8 Certificate or Voucher holders. When Section 8 tenants are not available, one bedroom units may currently be rented for no more than $1,330 per month. Subsequently, the two -bedroom units may be rented for no more than $1,595 per month to individuals whose total household income does not exceed low income standard (see enclosed income limit chart). (2) Based on the HUD Orange County median income of $84,100, and adjustments for family size, the maximum rents that can be charged are as follows: Unit Size I Maximum Rent I Income Limit I Bedrooms Section 8 (OCHA) Section 8 (OCHA) 1 Bedrooms Section 8 FMR 2 Persons: $59,500 (HUD) ($1,330)* 3 Persons: $66,950 4 Persons: $74,400 Section 8 Section 8 2 Bedrooms (OCHA) (OCHA) 3300 Newport Boulevard • Post Office Box 1768 • Newport Beach, California 92658-8915 Telephone: (949) 644-3200 • Fax: (949) 644-3229 • www.city.newport-beach.ca.us Irvine Apartments/ JasonDi Antonio • Villa Point II (Off -site Newport North Apartments) Transmittal of Revised Income and Rent Limits April 17, 2008 2 Bedrooms Section 8 FMR 2 Persons: $59,500 (HUD) ($1,595)* 3 Persons: $66,950 4 Persons: $74,400 *with utilities: Gas/Elec & Refrigerator HUD's policy for -two-bedroom units is that they must not be occupied by one individual or a married couple. It is HUD's position that housing assistance funds are very limited, and should be used to house people as efficiently as possible. This policy should be applied to all two - bedroom units. Individuals or families occupying a unit in this development shall enter into a rental agreement, the terms of which includes a requirement for the submission of verification information regarding the income of the occupants. Additionally, a rental agreement provision shall also be included that provides for termination of the tenancy in the event of misrepresentations, as described in the affordable housing agreement with the City. Information verifying tenant income at the time of initial occupancy and for each yearly re -certification thereafter, shall be maintained in the tenant's individual file. Rental rates may be adjusted periodically to reflect published changes in the Section 8 Fair Market Rents (FMRs) and applicable revised income limits. Notice of proposed rent increases must be given to tenants in writing at least 30 days prior to the effective date of the increase, or in conformance with applicable state law, whichever is longer. A copy of the written rent increase notification must also be maintained in your records for compliance with HUD requirements. To simplify monitoring and minimize paperwork, the City is requesting that the following forms be submitted annually to the City: A. For units occupied by tenants with Section 8 certificates or vouchers, please provide the City with a copy of the Section 8 Rental Agreement. B. For the remaining units, not occupied by Section 8 tenants, each new tenant must submit a copy of their most recent signed income tax form, and be eligibility qualified. Retain a copy of their income tax form in their file, and forward a photocopy of each of the new rental agreements to the City. C. For the remaining units, not occupied by Section 8 tenants, each continuing tenant must complete and return to you a "Certification of Continued Household Eligibility" form for the annual reporting period. A copy of this form is attached for your duplication and distribution. Forward a copy of the Certification form to the City for each continuing tenant. Irvine Apartments/ Jason9i Antonio Villa Point II (Off -site Newport North Apartments) Transmittal of Revised Income and Rent Limits April 17, 2008 D. An Annual Affordability Monitoring Summary Report form is attached for your completion. Transfer the requested information from your tenant submissions, and return this form to the City. The City of Newport Beach has retained the services of LDM Associates, Inc. for performance of its annual affordable housing compliance. Please submit the above requested documentation by May 301h9 2008 to: City of Newport c/o Raul Gomez LDM Associates, INC. 10722 Arrow Route, Suite 822 Rancho Cucamonga, CA 91730 The aforementioned income limits and rents are in accordance with the Affordable Housing Agreement dated November 13, 1990. If you have any questions, or require any additional information, please contact me at your earliest convenience at (909) 476-9696 ex.109. Sincerely, Raul Gomez, Affordableliousing Consultant Attachments: HUD Orange County Income Limits Table County of Orange Housing Affordability Table Certification of Continued Household Eligibility Annual Affordability Monitoring Summary Report Form n u' HUD - ORANGE COUNTY INCOME LIMITS April 2008 NUMBER OF PERSONS IN FAMILY COUNTY STANDARD 1 2 3 4 5 6 7 1 8 Extremely low income 19,550 22,300 25,100 27,900 30,150 32,350 34,600 36,850 ORANGE (30% of Area Median Income) County Area Very low income 32,550 37,200 41,850 46,500 50,200 53,950 57,650 61,400 median: (50% of Area Median income) $84,100 Lower income 52,100 59,500 66,950 74,400 80,350 86,300 92,250 98,200 (80% ofArea Median Income) Median Income 58,900 67,300 75,700 84,100 90,800 97,600 104,300 111,000 (100% of Area Median Income) Moderate Income 70,600 80,700 90,800 100,900 109,000 117,000 125.100 133.200 (120%of Area Median Income) VILLA POINT II (Off -site Newport North Apartments) Unit No. CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtained.) IMe certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2007, the Total Annual Eligible Income* of the undersigned individual(s) was-$ ; and, 3. During 2007, my total monthly rent payment to Villa Point II (Off -site Newport North Apartments) was $ per month. * Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -income Earning Household Signature(s) of Income Earning Household Member(s): Member(s): Name Age Signature Signature Signature Date: 0 a,16 ,1,g4?c95, VILLA POINT II (Off -site Newport North Apartments) Unit No. 4—� O URGENT CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtained.) I/We certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2007, the Total Annual Eligible Income* of the undersigned individual(s) was $ 48110i 1:� ; and, 3. During 2007, my total monthly rent payment to Villa Point II (Off -site Newport North Apartments) was $ i , 3 Z 3 er month. •i3l""l rya,pj�."�. * Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -income Earning Household Member(s): Name Age Verna 8atAarn©kooe 05 Cs5A0-j MEnt 117'2-kb-,-,U (Dq `PAO U MErlo°�ab�L 42J Signature(s) of Income Earning Household Member(s): Pfizer Inc 1972 Port Claridge Place Newport Beach, CA 92660 Tel 949 718 0900 Fax 949 718 0901 Cell 949 922 8112 Voice Mail 888 733 2006 ext 68856 Email Nina.B.Elisius®pfizer.com Cardiovascular Nina B. Elisius May 2, 2008 Senior District Manager To: Newport North Apartments This letter is to advise you that Norma Bahamonde is still employed by me at a weekly salary of $350.00 per week. If you have any questions, please don't hesitate to contact me to discuss. Nina Elisius May 6, 2008 To: Newport North Apartments This letter is to advise you that Norma Bahamonde is employed by me at a weekly salary of $210.00. Please contact me with any questions whatsoever. Okv� Kim Krotts 1984 Port Claridge Place Newport Beach, CA 92660 949.640.8876 For Privacy Notice, get form M 1131. FORM California Resident Income Tax Return 2007 540 2EZ C1 Side CAIA4612 12/05/07 P 909-71-7127 MEND ** 615-64-5455 07 AC CESARAUGUST MENDIZABAL A NORMA F BAHAMONDE R RP 1621 MESA DRIVE APT 20 SANTA ANA CA 92707 Filing Status Check the box for your filing status. See instructions. 1 Shigle 2 X Married/RDP filing jointly (even if only one spouse/RDP had income) 4 Head of household. STOP! See instructions. 5 Qualifying widow(er) with dependent child. Year spouse/RDP died If your California filing status is different from your federal filing status check the box here ..................... • n Exemptions 6 if another person can claim you (or your spouse/RDP) as a dependent on his or her tax return, even if he or she chooses not to, you must see instructions..................................................... • 6 7 Senior: If you (or your spouselRDP) are 65 or older, enter 1; if both are 65 or older, enter 2 .............. • 7 2 Dependent 8 Number of dependents. Enter name and relationship (Do not include yourself or your spouselRDP) ...... • 8 Exemptions Taxable 9 Total wages (federal Form W-2, box 16 or CA Sch W-2CG, line C). Income and See instructions ................................ .......................... ..... • 9 5,040. Credits Enclose, but do not staple, any payment, 'Attach a copy of your Form(s) W-2 or complete CA Sch W-2CG: 10 Total interest income (Form 1099-INT, box 1) See instructions ........................ • 10 11 Total dividend income (Form 1099-DIV, box 1). See instructions ..................... • 11 12 Total Pensions See instructions. Taxable amount ............. • 12 13 Total capital gains distributions from mutual funds (Form 1099-DIV, box 2a). Seeinstructions ................................. . ............................ .. • 13 14 Unemployment compensation ......... ................. 14 15 U.S. social security or railroad retirement ................. 15 16 Add line 9, line 10, line 11, line 12, and line 13. Caution: Do not include line 14 and lineIS................................................................... ........ • 16 5,040. 17 Using the 2EZ Table for your filing status, enter the tax for the amount on line 16. Caution: If you checked the box on line 6, STOP. See instructions, Dependent TaxWorksheet................................. ....................... I.. . ...... 17 0. 18 Senior Exemption: See instructions. If you are 65 and entered 1 in the box on line 7, enter $94. If you entered 2 in the box on line 7, enter $188 ............................ 18 168 . 19 Nonrefundable renter's credit. See instructions ...... ....... ............. .......... • 19 20 Credits. Add line 18 and line 19.................................................... 20 188. 21 Tax. Subtract line 20 from line 17. If zero or less, enter-0............................. • 21 051 3111074 r_ YaurName: C. MENDIZABAL & N. F. BAHAMONDE YoufSSNorITIN: 909-71-7127 Overpaid Taxf 22 Total lax withheld (federal Form W-2, box 17 or CA Sch W-2CG, box 17 and/or Tax Due Form 1099-R, box 10)............................................. .... ........... • 22 13. 23 Overpaid tax. If line 22 is more than line 21, subtract line 21 from line 22 .......... ... • 23 13. 24 Tax due. If line 22 is less than line 21, subtract line 22 from line 21. See instructions................................................................... 24 0. Use Tax 25 Use tax. This is not a total line. See instructions ............... • 25 Contributions Voluntary Contributions. Code California Seniors Special Fund. See instructions .............. ....... .. ........... • 50 Alzheimer's Disease/Related Disorders Fund ............. .......... ........... ... • 51 California Fund for Senior Citizens ................... .............................. • 52 Rare and Endangered Species Preservation Program ................................. • 53 State Children's Trust Fund for the Prevention of Child Abuse ........ ............... . • 54 California Breast Cancer Research Fund ...................................... ...... • 55 California Firefighters' Memorial Fund ................................ ........... .. • 56 Emergency Food Assistance Program Fund .......... .............................. • 57 California Peace Officer Memorial Foundation Fund ... ......... ..................... • 58 California Military Family Relief Fund .............................. ................. • 59 California Sea Otter Fund........................................................... • 60 Amount You Owe Direct Deposit (Refund Only) 26 Add line 50 through line 60. These are your total contributions ...... .. ............. . • 26 Amount 27 AMOUNT YOU OWE. Add line 24, line 25, and line 26. If line 23 is less than line 25 and line 26, enter the difference here. See instructions. (Do Not Send Cash) Mail to: FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267.0001 .. • 27 Pay Online — Go to our Website at www.ftb.ca.gov and search for Web Pay 28 REFUND OR NO AMOUNT DUE. Subtract line 25 and line 26 from line 23. See instructions. Mail to: FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240.0002 .... • 28 Complete this section to authorize direct deposit of your refund into one or two accounts. Do not attach a voided check or a deposit slip. Have you verified the routing and account numbers? Use whole dollars only. All or the following amount of my refund (line 28) is authorized for direct deposit into the account shown below: 8 Checking Savings • Routing number • Type • Account number • 29 Direct Deposit Amount The remaining amount of my refund (line 28) is authorized for direct deposit into the account shown below: 8 Checking Savings • Routing number • Type • Account number • 30 Direct Deposit Amount 13. Under penalties of perjury, I declare that, to the best of my knowledge and belief, the information on this return is true, correct, and complete. Sign Here Your signature Spouse'sIRDP's signature (if filing jointly, both must sign) Daytime phone number (optional) It Is unlawful to forge a spouse'sIRDP's signature. Joint return] See Instructions. X preparer is based on Fum's name (or yours if selhemployea) ORTIZ INCOME TAX 3702 E. CHAPMAN AVE. #C has any Date Paid FEIN Side 2 Form 540 2EZ C1 2007 051 3112074 r- CAIA4612 12/05107 TAXABLE YEAR I DO NOT ATTACH PAYMENT TO THIS SCHEDULE I CALIFORNIA SCHEDULE 2007 Wage and Withholding Summary W-2 CG Important: Attach this schedule directly behind Page 2 of your return. Name(s) as shown on return SSN or ITIN C. MENDIZABAL & N. F. BAHAMONDE 909-71-7127 Caution: If yyour Form(s) W-2 are from multiple states, or this schedule is not filled out, then attach copies of your Form(s) W-2, 592-13, 593-B, 594, and 1099 showing CA tax withheld. Attach this schedule directly behind Side 2 of your return. Taxpayer W-2 information. (Transfer amounts from your Form(s) W-2 to the appropriate boxes below.) Complete a box for each Form W-2 you receive. 1st W-2 Social Security Number (box a) 909-71-7127 Employer ID Number (EIN) (box b 94-1729892 State & Employer's State ID Number box 15 CA Employer Name (box c) BNIDFORD BUILDING SERVI State Wages, Tips, etc. box 16 5,040. CA Stale Income Tax box 1 13. Sooial,Securit Wages boxa ' S 040. SDI/VPDI LocalIncome Tax (box14or19 3rd W-2 Social Security Number (box a) Employer ID Number (EIN) (box b State & Employer's State ID Number box 15 Employer Name box c State Wages, Tips, etc. box 16 CA Slate Income Tax box 1 Social Securit Wa es (box 3 SDINPDI Local Income Tax (box 14 or 19)-,, 2nd W-2 Social Security Number (box a Employer ID Number (EIN) (box b State & Employer's State ID Number box 15 Employer Name (box c State Wages, Tips, etc. (box 16 CA State Income Tax box 1 ciaDSo eW(boxa' •aces SDNalinome Tax) box 14 oh19 4th W-2 Social Security Number box a Employer ID Number (EIN) (box b State & Employer's State ID Number box 15 Employer Name box c State Wages, Tips, etc. (box 16 CA Stale Income Tax box 1 ,Social Security Wages x 3 SDINPDI•(Locai Income Tax •, boxl4tor19 SpouselRDP W-2 information. (Transfer amounts from your Form(s) W-2 to the appropriate boxes below.) Complete a box for each Form W2 you receive. 1 st W-2 Social Security Number box a Employer ID Number (EIN) (box b Stale & Em to er's Slate ID Number box 15 Employer Name box c State Wages, Tips, etc. box 16 CA State Income Tax box 1 Social Se urity wages box 3 SDINPDI Local income Tax(box 14or19 3rd W-2 Social Security Number box a Employer ID Number (EIN) (box b Stale & Employer's State ID Number box 15 Employer Name box c . Stale Wages, Tips, etc. box 16 CA Stale Income Tax box 1 Securi Wages (box a ZSocial SDINPDI Local income Tax � (box 14I- 18 2nd W-2 Social Security Number (box a Employer ID Number (EIN) (box b) State & Employer's State ID Number box 15 Employer Name (box c State Wages, Tips, etc. (box 16 CA Stale Income Tax (box 1 Social. Securit Wages bdx 3 , SDI%VPDI (Local lnddmeTax) (box 14dr19 4th W-2 Social Security Number box a Employer ID Number (EIN) (box b State & Employers State ID Number box 15 Employer Name box c Stale Wages, Tips, etc. box 16 CA State Income Tax box 1 Social Security Wages x3 ;SDINPDI: Local Income Tax • boxl4'or14 1 Total state wages from your Form(s) W-2 for taxpayer (Add box 16 from all Form(s) W-2 for taxpayer) ............ $ 5,040. For nonresidents orpartyear residents, enteryourtotal California wages from all your Forms) W-2 for taxpayer (Add box 16 from all Forms) W2 fortaxpayer . 2 Total state wages from the Form(s) W-2 for spouse/RDP (Add box 16 from•all Form(s) W-2 for spouse/RDP) ...... $ For nonresidents or part -year residents, onterthe total California wages from all Form(s) W-2 for spouselRDP (Add box 16 from all Forms) W2 forspouselRDP). 3 Total California Wages from all Form(s) W-2 (Add line 1 and line 2, and enter it here and on Form 540 2EZ, line 9; Form 540A, line 12a; Form 540 or Form 54ONR (Long or Short), line 12. If completing Form 54OX, report any W-2 income online a, Column B, that was not reported on your original tax return.) ............................ $ 5,040. For Privacy Notice, get form FTB 1131. 051 8041074 1 CAIA4501 OW09/07 Schedule W-2 CG (2007) • COPY Department of the Treasury — Internal Revenue Service Form 1040A U.S. Individual Income Tax Return Label Your first name and initial Last name (See Instructions) Use the IRS label. Otherwise, please print orlypo. Filing status Check only one box. Exemptions If more than six dependents, see Instructions. name — Do not write or staple in this space. Ova No. 1545 0074 Your social security number 909-71-7127 Spouse's social security number Home address (number and street). If you have a P.O. box, see instructions. 1621 MESA DRIVE Apartment no. 20 . You must enter ,. your SSN(s) above City, town or post office. If you have a foreign address, see instructions. Slate ZIP code Checking a box below will SANTA ANA CA 92707 not change your tax or refund Check here if you, or yourspouse if filing jointly, want $3 to go to this fund (see Instructions .. You Souse 1 Single 4 Head gf household (with qualifying person). (See instruchons.) 2 X Married filing jointly (even if only one had income) If the qualifying person is a child but not your dependent 3 Married filing separately. Enter spouse's SSN above and enter this child's name here ► full name here ► 5 ❑ Qualifying widow(er) with dependent child 6a xl Yourself. If someone can claim you as a dependent, do not check box 6a ............J Boxes checked on hn Sri...........................................................................6aand6b ... . 2 c Dependents: (2) Dependent's (3) Dependent's o. dror (0 " it on 6e whlo: social security relationship ch IE�Io * lived number to you child tax wllhyou (1) First name Last name credit • did not live with you due to divorce or separation (se instructions) Dependents on 6e not entered above d Total number of exemptions claimed ..................................................... ... on lines above 'I z I Income 7 Wages, salaries, tips, etc. Attach Form(s) W-2......................................... 7 5,040. Attach Form(s) 8a Taxable interest. Attach Schedule 1 if required ...................................... .. 8a W-2 here. Also attach Forni b Tax-exempt interest Do not include on line 8a ...................... 81b 1099-Riftax 9a Ordinary dividends. Attach Schedule 1 if required ....................................... 9a was withheld. b Qualified dividends (see instructions) ....................... 9b 10 Capital gain distributions (see instructions) ............................................. 10 11 a IRA distributions ............... 11 a 11 b Taxable amount ...... 11 b 12a Pensions and annuities ........ 12a 12bTaxable amount ...... 12b 13 Unemployment compensation and -Alaska Permanent if you did not ....................................... . Fund dividends ........• ..................•• 13 get a W2, see instructions. 14a Social security Enclose, but benefits ....................... 14a 14b Taxable amount ...... 14b annot yment. 15 Add lines 7 through 14b (far right column). This is your total income ................... 01 15 5,040. Adjusted 16 Educator expenses (see instructions) ....................... 16 gross 17 IRA deduction (see instructions) ........................... 17 income 18 Student loan interest deduction (see instructions) ....... .... 18 19 Tuition and fees deduction. Attach Form 8917 ............... 19 20 Add lines 16 through 19. These are your total adjustments .............................. 20 21 Subtract line 20 from line 15 This is your adjusted gross income ......... ........... 1" 21 5,040. BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. Form 1040A (2007) FOIA1312 11/14/07 CESAR AUGUSTO n U 2 Tax, 22 Enter the amount from line 21 (adjusted gross Income) .................... ............. 22 5,040. credits, and 23a �I--11 Check X8 You were born before January 2, 1943, Blind Total boxes ► payments if: spouse was born before January Z 1943, Blind checked . 23a 2 Standard L b If you are married filing separately and your spouse itemizes deductions, see Instructions and check here .......................................... ► 23b Deduction for — 24 Enter your standard deduction (see left margin) .................. ..................... 24 - — 12,800. • People who 25 Subtract line 24 from line 22. If line 24 is more than line 22, enter-0..................... 25 0. checked any box on line 26 If line 22 is $117,300 or less, multiply $3,400 by the total number of exemptions claimed 23a or 23b or on line 6d. If line 22 is over $117,300, see the instructions •••••-••�•�••••••••••••••-•••• 26 6,800. who can be 27 Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-. This is our claimed as a taxable income .............. ....... ......... y.......... ► 27 0. dependent, 28 Tax, including any alternative minimum tax see instructions. (see instructions) ...................0.............................. .............0.4 28 0. • All others Ingle or Married flung 29 Credit for child and dependent care expenses. 29 separately, Attach Schedule 2 . $5,350 30 Credit for the elderly or the disabled. Attach Schedule 3 ...... 30 0. 31 Education credits. Attach Form 8863 ............... ....... 31 Married filing jointly or 32 Child tax credit (see instructions). Qualifying Attach Form 8901 if required ............................... 32 widow(er), 33 Retirement savings contributions credit. Attach Form 8880 ... 33 $10,700 34 Add lines 29 through 33. These are your total credits .............. . Head of 35 Subtract line 34 from line 28. If line 34 is more than line 28, enter .0..................... 35 0. Household, $7,850 1 36 Advance earned income credit payments from Form(s) W-2, box 9 .4 ..................... 36 37 Add lines 35 and 36. This is your total tax ...4...............6......... ......... ... ► 37 0. 38 Federal income tax withheld from Forms W-2 and 1099 ...... 38 153. S9 2007 estimated tax payments and amount applied from If you have L 2006 return....................6.6........................ 39 al uali in cld, a lath 40a Earned income credit (EIC) ........................... No.. 40a Schedule EIC. loNontaxable combat pay election. 40b 41 Additional child lax credit. Attach Form 8812 ................ 41 42 Add lines 38 39, 40a, and 41. These are your total payments ..................................... ► 42 153. 43 If line 42 is more than line 37, subtract line 37 from line 42. 153. Refund This is the amount you overpaid ....................................... ..6........... 43 44a Amount of line 43 you want refunded to you. If Form 8888 is attached, check here .. ► 44a 153. Direct deposit? See instructions ► bRouting number XXXXXXXXX ► c Type: Checking ❑ Savings and fill in 44b, .......... 44c, and 44d or ► clAccount Form 8888. number .......... XXXXXXXXxXXXXXXXX 45 Amount of line 43 you want applied to your 2008 estimated tax ............................................ 45 Amount 46 Amount you owe. Subtract line 42 from line 37. For details on how to pay, you owe see instructions ..... .................. .........................................'► 46 47 Estimated tax penalty (see instructions) 47 Do you want to allow another person to discuss this return with the IRS (see instructions)? .......... LJ Yes. Complete the following. X No Third party designee g Phone Designee's ► no. ► Personal Identification number (PIN) ► Sign here Joint return? See instructions. ' Keep a copy for your records. Paid preparer's use only Under penalties of perjury, I declare that I have examined this return and accompanying schedules and stat are We, correct, and accurately list all amounts and sources of income I received during the lax year. Dec[ information of which the preparer has any knowledge. Your signature I Date I Your occupation joint return, Preparers , signature Dale to the Check if self- Firm's name ORTIZ INCOME TAX _ _ _ _ _ _ _ _ (or Yours it self- __________________ employed), 3702 E. CHAPMAN AVE. #C _________________ address. and ___________________ ZIP code nR ANrR CA 92869-3811 FDIA1312 11/14107 or my knowledge and belief, they r than the taxpayer) ,s based on all Daytime phone number PTIN I68 Form 1040A (2007) 'ah, aepuntf. fift"iilf� a � 'A6TI Uff � at tvww.irs.gov/eflle. ' Employee Reference -Copy -2 WageStatemand Tax 2007 ent C /IX am •a recotdt. OMB No 15L5-000a I control numlmr LrW6 COIp. Empiger u. my )000001722WY1 W555 53441 I I 1 Employer's name, addreea, and ZIP code BRADFORD BUILDING SERVICES 14262 FRANKLIN AVE STE 108 TUSTIN, CA 92780 ,M Empby'• namq addrea•, end ZIP eode CESAR A MENDI7ABAL 1101 W. STEVENS AVE. k213 SANTA ANA, CA 92707 In • num r a Ent oyes a SSA number 94-1 29892 603.20-4938 I Wagss,tlq,othercamp. Federal Income laz withheld 5039.50 153.15 f 3isimuraywe0es 4 social security tax withheld 5039.50 312.45 f• MMkx• wapn and lips 0 Medinmtaxwlthheld 5039,50 73.07 i Social security llps a Allocated tips f Advano• EIC payment 10 Dependent care benef is 11 ""will id plans 12a , one Of N 3�0.24 CASDI 12 12e I tzd Mies em flet.pm nl pilyekk Pry 16 Stela EmployerY •tete ID r,o. 1S state wages, tips, ete. CA 24241120 8 5039.50 17 Stele Meanie= IB Leul wpe'-"ele. 13.33 Is Local Ina mat tax 20 Locality name 2007 W-2 and EARNINGS SUMMARY . I The wages, tips, and other compensation reflected in box 1 are the sum of those wages shown on your last pay statement, plus any additional compensation or adjustments received after the payroll close. Your gross pay may not match your box 1 totals due to adjustments made for GTL, 401(k), cafeteria plans, etc... To change your employee W-4 profile information, file a new W-4 with your payroll department. CESAR A MENDIZABAL 1101 W. STEVENS AVE. #213 SANTA ANA, CA 92707 O 2001 ADP, INC. Social Security Number603-20-4938 Taxable Marital Status: MARRIED Exemptions/Altowances: Federal:1 State: 1 Local, 0 Fold 0M oomcn ____________________________________— Depadmenl of the Treasury — Internal Revenue Service 2007 Form 1040A U.S. Individual Income Tax Return IRS Use Only— Do net write or staple in this space. Label Your first name and initial Last name OMB No. 1545-OD74 Yoursoclal security number (See instructions.) I PAUL IVAN' MENDIZAVAL I 960-78-2419 Use the If a joint return, spouse's first name and initial Last name Spouso's social security number IRS label. Otherwise, please print or type. Home address (number and sbee ). If you have a P.O. box, see instructions. Apartment no. . You must enter . 126 LAURENT your SSN(s) above City, town or post office. If you have a foreign address, see instructions. Stale ZIP code Checking a box below WIII NEWPORT BEACH CA 92660 not change your Presidential tax or refund Election Campaign Check here if you, or your spouse if filing jointly, want $3 to go to this fund see instructions .. You Souse Filing 1 Single 4 X Head of household (with qualifying person). (See instructions.) status 2 Married filing jointly (even if only one had income) If the qualifying person is a child but not your dependent, 3 Manied filing separately. Enter spouse's SSN above and enter this child's name here � full name here 5 ❑ Qualifying widow(er) with dependent child Check only one box. (see instructions) Exemptions 6a X❑ Yourself. If someone can claim you as a dependent, do not check box 6a ............ Boxes chocked chocked on and..... 1 — If more than six dependents. see instructions. Income Attach Form(s) W-2 here. Also attach Form(s) 1099-R if tax was withheld. If you did not get a W-2. see Instructions. Adjusted gross income c Dependents: (2) Dependent's social security (3) Dep, endent's relationship (4) "'f on gglpio9 number to you child tax wiu (1) First name Last name credit STEPHANIE ADRIANA MENDIZAVAL 960-78-2420 Daughter X live yei dlv sae Ins Del on end of children 3c who: ved you .. . 1 did not with due to Me or aratlon (see ructlons) . ,indents 3c not :red above . 7 Wages, salaries, tips, etc. Attach Form(s) W-2......................................... 7 16,279. Sa Taxable interest. Attach Schedule 1 if required ......................................... 8a b Tax-exempt interest Do not include on line So ...................... 8b 9a Ordinary dividends. Attach Schedule 1 if required ....................................... 9a b Qualified dividends (see instructions) ....................... 9b 10 Capital gain distributions (see instructions) ............................................. 10 11 a IRA distributions . ............. 11 a 11 b Taxable amount ...... 11 b 12a Pensions and annuities ........ 12a 12bTaxable amount ...... 12b 13 Unemployment compensation and Alaska Permanent Funddividends...................................................................... 13 14a Social security benefits ......... ............ 15 Add lines 7 throuoh 14b (far rich 16 17 18 19 20 14a This is 14bTaxable amount ...... Educator expenses (see instructions) ....................... 16 IRA deduction (see instructions) ........................... 17 Student loan interest deduction (see instructions)............ 18 Tuition and fees deduction. Attach Form 8917 ............... 19 Add lines 16 through 19. These are your total adjustments ............................... 20 21 Subtract line 20 from line 15 This is your adjusted gross income ..................... P. 21 16,279. BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. Form 1040A (2007) FDIA1312 11114/07 n, U Tax, credits, and payments Standard Deduction for — • People who checked any box on line 23a or 23b or who can be claimed as a dependent, see Instructions. • All others: Single or Married riling separately, $5,350 Married filing jointly or Qualifying widow(er), $10,700 If you have a rll mgg chid, a ch Schedule EIC. 22 Enter the amount from line 21 (adjusted gross. income) .................................. 22 16,279. 23a Check _F e You were born before January 2,1943, 8 Blind Total boxes if: Spouse was born before January 2,1943, Blind checked . ► 23a ll b If you are married filing separately and your spouse itemizes deductions, see Instructions and check here .......................................... ► 23b 24 Enter your standard deduction (see left margin) ... .................................... 24 7,850. 25 Subtract line 24 from line 22. If line 24 is more than line 22, enter-0..................... 25 8,429. 26 If line 22 is $117,300 or less, multiply $3,400 by the total number of exemptions claimed on line 6d. If line 22 is over $117,300, see the instructions ......................... .... 26 6,800. 27 Subtract line 26 from line 25. If line 26 is more than line 25, enter -0-. This is your taxable income................................................................... ► 27 1, 629. 28 Tax, including any alternative minimum tax (see instructions).................................................................... 28 164. 29 Credit for child and dependent care expenses. Attach Schedule 2........................................ 29 30 Credit for the elderly or the disabled. Attach Schedule 3 ...... 30 31 Education credits. Attach Form 8863 ....................... 31 32 Child tax credit (see instructions). Attach Form 8901 if required ............................... 32 164. 33 Retirement savings contributions credit. Attach Form 8880 ... 33 34 Add lines 29 through 33. These are your total credits ................................... 34 164. 35 Subtract line 34 from line 28. if line 34 is more than line 28, enter -0. .................... 35 0. 36 Advance earned Income credit payments from Form(s) W-2, box 9 ....................... 36 37 Add lines 35 and 36. This is your total tax ............... ........................... ► 37 0. 38 Federal income tax withheld from Forms W-2 and 1099 ... .. 38 853. 39 2007 estimated tax payments and amourit applied from 2006 return ............................................... 39 40a Earned income credit (EIC)................................ 40a loNontaxable combat pay election. 40b 41 Additional child tax credit. Attach Form 8812 ................ 41 679. 42 Add lines 38 39 40a and 41. These are your total payments ..................................... ► 42 1,532. Refund 43 If line 42 is more than line 37, subtract line 37 from line 42. 43 1,532. This is the amount you overpaid ..................................................... 44a Amount of line 43 you want refunded to you. if Form 8888 is attached, check here .. ► ❑ 44a 1,532, Direct deposit? See instructions ► bRouting number XXXXXXXXX ► c Type:TypeL n Checking ❑ Savings and fill in 44b, .......... 44c, and 44d or ► clAccount Form 8888. number .......... XXXXXXXXXXXXXXXXX 45 Amount of line 43 you want applied to your 2008 estimated tax .................. ........................ 45 Amount 46 Amount you owe. Subtract line 42 from line 37. For details on how to pay, you owe see instructions.................................................................... ► 46 47 Estimated tax penalty (see instructions ...... 6.... 6....... 6 47 Third party Do you want to allow another person to discuss this return with the IRS (see instructions)? .......... LJ Yes. Complete the following. X No designee Personal Designee's Phone name ► no. ► Identification number (PIN) ► Sign Under penalties of perjury. I declare that I have examined this return and accompanying schedules and statements, and tothe best of my knowledge and belief, they are lme, correct and accurately list all amounts and sources of income I received during the tax year. Declaration of preparer (other than the taxpayer) is based on all here information of which the preparer has any knowledge. Your signature Date Your occupation Daytime phone number Joint return? See instructions. - MAINTENANCE , both Date Spouses occupation Keep a copy spouse's signature. if a joint return, must sign. for your records. - Dela Chock if Preparers SSN ar PTIN Preparers , signature 04/25/2008 self - employed X P00845371 Paid preparer's Firm'sname _ORTIZ INCOME TAX use only (or yours if self - employed), / 3702 E CHAPMAN AVE STE C ____________________________________ EIN 26-2148818 Phone no. (714) 745-8468 address, and ZIP code ORANGE CA 92869 FDIA1312 11114/07 Form 1040A (2007) s Fo(m81 2 Name(s) shown on return Additional Child Tax Credit and attach to Form 1040, Form 1040A, or Form 104ONR. OMB No. 1545.0074 2007 achment ouence No. 47 Yoursoelal security number 1 Enter the amount from line 1 of your Child Tax Credit Worksheet in the Form 1040, Form 1040A or Form 104ONR instructions. If you used Publication 972, enter the amount from line 8 of the worksheet on page 4 ofthe publication....................................................................................... 2 Enter the amount from Form 1040, line 52, Form 1040A, line 32, or Form 104ONR, line 47 ................... 3 Subtract line 2 from line 1. If zero, stop; you cannot take this credit ...................... ................. 3 4a Enter your total earned income (see instructions) .............................. dial 16,279. b Nontaxable combat pay (see instructions) .........I 01 5 Is the amount on line 4a more than $11,750? HxNo. Leave line 5 blank Yes. Subtract $11,750 f om the enter ount otn line 4a. Enter the result.... ..... 5M 4,529. 6 Multiply the amount on line 5 by 15% (.15) and enter the result .......................................... 6 Next. Do you have three or more qualifying children? - © No. If line 6 is zero, stop; you cannot take this credit. Otherwise, skip Part II and enter the smaller of line 3 or line 6 on line 13. Yes. If line 6 is equal to or more than line 3, skip Part II and enter the amount from line 3 on line 13. Otherwise, go to line 7. . 11*a4li 7 Withheld social security and Medicare taxes from Form(s) W-2, boxes 4 and 6. If married filing jointly, include your spouse's amounts with yours. If you worked for a railroad, see the instructions .......... ... 7 .. ........................ . 8 1040 filers: Enter the total of the amounts from Form 1040, lines 27 and 59, plus any taxes that you identified using code 'UP and entered on the dotted line next to line 63. 8 1040A filers: Enter -0-. 104ONR Biers: Enter the total of the amounts from Form 1040NR, line 54, plus any taxes that you identified using code 'UT' and entered on the dotted line next to line b8. 9 Add lines 7 and 8........................................................... 9 10 1040 filers: Enter the total of the amounts from Form 1040, lines 66a and 67. 1040A filers: Enter the total of the amount from Form 1040A, line 40a, withheld that excess you entereial d to the left of line er I g2TA taxes (see instructions). 10 104ONR filers: Enter the amount from Form 104ONR, line 61. t 11 Subtract line 10 from line 9.Ifzero or less, enter-0....................................................... 12 Enter the larger of line 6 or line 11......................................................... Next, enter the smaller of line 3 or line 12 on line 13. 13 This is your additional child tax credit................................................................... 679. Enter this amount on Form 72 line 68, or Form 1040A, line 41, or Form 7040NR, line 62. BAA For Paperwork Reduction Act Notice, see instructions. FDIA3001 11/09/07 Form 8812 (2007) For Privacy Notice, get form FTB 1131. FORM California Resident Income Tax Return 2007 540 2EZ ct Side CAIA461Z 0227108 P 960-78-2419 MEND 07 AC PAULIVAN MENDIZAVAL A R RP 126 LAURENT NEWPORT BEACH CA 92660 Filing Status Check the box for your filing status. See instructions. 1 Single 2 Married/RDP filing jointly (even if only one spouselRDP had income) 4 X Head of household. STOP! See instructions. 5 Qualifying widow(er) with dependent child. Year spouse/RDP died If your California filing status is different from your federal filing status check the box here ..................... • n Exemptions 6 if another person can claim you (or your spouselRDP) as a dependent on his or her tax return, even if he or she chooses not to, you must see instructions...................................................... • 6 7 Senior: If you (or your spouselRDP) are 65 or older, enter 1; if both are 65 or older, enter 2 .............. • 7 Dependent 8 Number of dependents. Enter name and relationship (Do not include yourself or your spouse/RDP) ...... • 8 1 Exemptions S MENDIZAVAL 9 Total wages (federal Form W-2, box 16 or CA Sch W-2CG, line 3). Taxable See instructions.................................................................. • 9 16,279. Income and Credits 10 Total interest income (Form 1099-INT, box 1) See instructions ......................... • 10 11 Total dividend income (Form 1099-DIV, box 1). See instructions ....................... • 11 • 12 Total Pensions See instructions. Taxable amount ............ 0 12 Enclose, but 13 Total capital gains distributions from mutual funds (Form 1099-DIV, box 2a). do not staple, See instructions ........................................ .......................... • 13 any payment 14 Unemployment compensation ........................... 14 15 U.S. social security or railroad retirement ................. 15 'Attach a copy of 16 Add line 9, line 10, line 11, line 12, and line 13. Caution: Do not include line 14 and your Form(s) W-2 line 15 ............................................................. .............. • 16 16,279. or complete CA Sch W-2CG.' 17 Using the 2EZ Table for your filing status, enter the tax for the amount on line 16. Caution: If you checked the box on line 6, STOP. See instructions, Dependent Tax Worksheet..................................................................... 17 0. 18 Senior Exemption: See instructions. If you are 65 and entered 1 in the box on line 7, enter $94. If you entered 2 in the box on line 7, enter $188 ............................ 18 19 Nonrefundable renter's credit. See instructions ....................................... • 19 20 Credits. Add line 18 and line 19 .................................................. 20 21 Tax. Subtract line 20 from line 17. If zero or less, enter-0............................. 0 21 0. -0511 3111074 r� Yogr Name: PAUL IVAN MENDIZAVAL Your SSNor ITIN: 960-78-2419 Overpaid Tax/ 22 Total tax withheld (federal Form W-2, box 17 or CA Sch W-2CG, box 17 and/or • 22 93. Tax Due Form 1099-R, box 10) ........................ ......................... ........... 23 Overpaid tax. If line 22 is more than line 21, subtract line 21 from line 22 .............. • 23 93. 24 Tax due. If line 22 is less than line 21, subtract line 22 from line 21. 24 0. SeeInstructions................................................... ............... Use Tax 25 Use tax. This is not a total line. See instructions ............... • 25 Contributions Voluntary Contributions. Code Amount California Seniors Special Fund. See instructions ..................................... • 50 Alzheimer's Disease/Related Disorders Fund ......................................... • 51 California Fund for Senior Citizens ....................................... .......... • 52 Rare and Endangered Species Preservation Program ................................. 0 53 State Children's Trust Fund for the Prevention of Child Abuse .......................... 0 54 California Breast Cancer Research Fund ............................................. • 55 California Firefighters' Memorial Fund ................................................ 0 56 Emergency Food Assistance Program Fund .......................................... • 57 California Peace Officer Memorial Foundation Fund ................................... • 58 California Military Family Relief Fund ................................................ • 59 California Sea Otter Fund........................................................... • 60 26 Add line 50 through line 60. These are your total contributions ......................... • 26 Amount 27 AMOUNT YOU OWE. Add line 24, line 25, and line 26. Ifline 23 is less than line 25 You Owe andDo Not Send Cash) ail Ito: FRANCHI E TAX BOARD, PO BOXine 26, enter the difference here. See n( 942867, SACRAMENTO CA 94267.0001 .... • 27 Direct Deposit Pay Online — Go to our Website at www.ftb.ca.gov and search for Web Pay (Refund Only) 28 REFUND OR NO AMOUNT DUE. Subtract line 25 and line 26 from line 23. See instructions. Mail to: FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240-0002 .... • 28 93. Complete this section to authorize direct deposit of your refund into one or two accounts. Do not attach a voided check or a deposit slip. Have you verified the routing and account numbers? Use whole dollars only. All or the following amount of my refund (line 28) is authorized for direct deposit into the account shown below: Checking Savings • Routing number • Type • Account number • 29 Direct Deposit Amount The remaining amount of my refund (line 28) is authorized for direct deposit into the account shown below: eChecking Savings • Routing number • Type • Account number • 30 Direct Deposit Amount Under penalties of perjury, i declare that, to the best of my knowledge and belief, the information on this return is true, correct, and complete. Sign Here Your signature Spouse's/RDP's signature (it fling jointly, both must sign) Daytime phone number (optional) It is unlawful Date to forge a spouse's/RDP's signature. X X Joint return? Paid preparer's signature(declaration ofprepawr is based on all information or which Preparer has any knowledge) Paid Preparers SSN/PTIN See instructions. • P00845371 Fires name (or yours If self-employed) Firms address FEIN ORTIZ INCOME TAX 3702 E CHAPMAN AVE STE C CA 92869 • 26-2148818 ORANGE Side 2 Form 540 2EZ C1 2007 (REV 01.08) 0511 3112074 1 CAAA4612 02WIN TAXABLE YEAR I DO NOT ATTACH PAYMENT TO THIS SCHEDULE I CALIFORNIA SCHEDULE 2007 Wage and Withholding Summary W-2 CG Imoortant: Attach this schedule directly behind Paqe 2 of vour return. return SSN or ITIN PAUL IVAN MENDIZAVAL 960-78-2419 Caution: If our Form(s) W-2 are from multiple states, or this schedule is not filled out, then attach copies of your Form(s) W-2, 592-B, 593-B, 594, and 1(199 showing CA tax withheld. Attach this schedule directly behind Side 2 of your return. Taxpayer W-2 information. (Transfer amounts from your Form(s) W-2 to the appropriate boxes below.) Complete a box for each Form W-2 you receive. 1 st W-2 Social Security Number (box a) 960-78-2419 Employer ID Number (EIN) (box b State & Employer's State ID Number box 1 CA Employer Name box c State Wages, Tips, etc. (box 16) 16,279. CA State Income Tax box 1 93. dl I purl Wa eS 'x,3 16,279. t bl Local Income Tax box14'ort9 3rd W-2 Social Security Number box a Employer ID Number (EIN) (box b State & Employer's State ID Number box 15 Employer Name box c State Wages, Tips, etc. box 16 CA Slate Income Tax box 1 'I cGrf dJa es boic3 ' b N - )': oral Income Tax - box.14 or 19 2nd W-2 Social Security Number box a Employer ID Number (EIN) (box b Slate & Employees State ID Number(box 15 Employer Name (box c State Wages, Tips, etc. (box 16 CA State Income Tax (box 1 Social Securit ,: Wa es box a '. ' SdI1VPDI Local lncomeTax) boxl4or14) 4th w-2 Social Security Number (box a) Employer ID Number (EIN(box b State & Employer's State ID Number box 15 Employer Name (box c State Wages, Tips, etc. box 16 CA State Income Tax box 1 Social, Security, Wa es• boR3 SDINPbI (Loca6Incometax • (box l_4,or19 Spouse1RDP W-2 information. (transfer amounts from your Form(s) W-2 to the appropriate boxes below.) Complete a box for each Form W-2 you receive. 1 st W-2 Social Security Number (box a) Employer ID Number (EIN) (box b State & Employer's State ID Number box 15) Employer Name (box c)' State Wages, Tips, etc. box 16 CA State Income Tax box 1 1+'§e4tifit' � x P I: 0callhcomeTax+ box14o09 3rd W-2 Social Securitv Number boxa Employer ID Number IN box b State & Employer's State ID Number box 15 Employer Name box c State Wages, Tips, etc. box 16 CA State Income Tax box 1 ialtSi�euri we 's'box ` , dcal i Corhe Tax box 14,or il9 - 2nd W-2 Social Security Number (box a Employer ID Number I(box b State & Employer's State ID Number box 15 Employer Name box c State Wages, Tips, etc.(box 1 CA State Income Tax box 17 Sociat-Securi 'Wa es. b6x $DINPb1• ocallncomeTax z14'or14` -' 4th W-2 Social Security Number (box a Employer ID Number I box b State & Employer's State ID Number box 15 Employer Name ox c Stale Wages, Tips, etc. box 16 CA State Income Tax box 17 -S'ocfal Seduri •Nita es' x 3' SDINPDI, Loc i Income Tax bo 14,or.19 Total slate wages from your Form(s) W-2 for taxpayer (Add box 16 from all Form(s) W-2 for taxpayer) ........... For nonresidents one 2 ents or part- ear residents, enter your total callfomia wages from all your Form(s) W-2 for taxpayer (Add box 16 from all or Total state wages from the Form(s) W-2 for spouselRDP (Add box 16 from all Form(s) W-2 for spouselRDP) ..... For rrnonresidents onds) W 2 forsorpart-yDeaa)r residents, enter the total California wages from all Fonn(s) W-2 for spouselRDP (Add box 16 from all $ 16,279. Total California Wages from all Form(s) W-2 (Add line 1 and line 2, and enter it here and on Form 5402EZ, line 9; Form 540, Form 540A, or Form Form (Long or Short), line 12. If completing Form 54OX, report any W-2 income on line a, Column B, that was not reported on your original tax return.) ................................ $ 16,279. For Privacy Notice, get form FTB 1131. r CAIA4501 03113108 051 8041074 1 Schedule W-2 CG (2007) (REV 02.08) 65fl Use ��at www.1 govyehle. - 'Employee Reference Copy N_ Wage and Tax 2007 Statement C for en de les'a records. OMB No 164GeWe Caarol numtaer t Corp. Empimymuseonly IW031114 WYt W545 25677 Employer'& name, address, and ZIP code AMERICAN PLANT PROTECTION 5200 EASTERN AVE LOS ANGELES, CA 90012 Employee's name, address, and ZIP code PAUL IVAN MENDIZABAL 126 LAURENT NEWPORT BEACH, CA 92660 m rs number 95-1658746 a Employee's SSA number 605-60.7093 Wpes,tips,aurrcomp. 2 Federal lncometaxwlthhold $450.00 452.36 SorAlsecudtywage& 4 Socialoecuritytaxwithheld 8450.00 523.90 Medicare wages and Ups 6 Medlcaretaxwithheld 8450.00 122 53 social security tips a Albuted ups Askance, Etc payment 10 Dependenteare benefits Nanquslmed plane as i a 1 12o I 5�0.70 CA SDI 12d I is Snlem pnn pray sick pay slate Employer'& stab inm. l6 State wages, tips, eta CA 072.4382 7 8450.00 State Income tax to Local wages, Ups, eta 64.53 Local income tax 20 Locality name LVV( \e -L QI IV I-a1111\t1\MV VVIe11fsv as it 1 • • The wages, tips, and other compensation reflected in box 1 are the sum of those wages shown on your last pay statement, plus any additional compensation or adjustments received after the payroll close. Your gross pay may not match your box 1 totals due to adjustments made for GTL, 401(k), cafeteria plans, etc... To change your employee W-4 profile information, file a new W-4 with your payroll department. PAUL IVAN MENDIZABAL 126 LAURENT NEWPORT BEACH, CA 92660 O =07 ADP, INC Fold ar Social Security Number£05-60-7093 Taxable Marital Status: MARRIED Exemptions/Allowances: Federal:I Stale: 1 Local: 0 Wages, Line, atlror comp. 2 Federal Incomelsotwithhold 1 Wallet, tips, other comp 2 Fed.rallmoUsetoxw0held 1 Wages,tipa, othercomp. 2 Federal income lax withheld 452.36 8450.00 452.36 l 8450.00 452.36 18450.00 social securitywpn 4 Social secudlyferwahheld j 3 Secialaecur6ywappe�a x withheld 4 Social security tax i 3 Soeul aeeuNtywea�geeaa tax withheld 4 Social security t 523.90 845p.00 523.90 i 8450.00 523.90 1 e .00 Metlloarewagesarldtipa 6 Mediumhxw1uheld 5 Medloarcwagesaml Ups 6 Mediurctaxwithheld j 5 Medloamwpesandtips 6 MedloaretAKwilhheld 8450.00 122.53 l 8450.00 122.53 I 8450.00 122.53 of CoMrd numb& Dept. Cap. Emplgmuse only I, d Control number Dept Cap, EmplgmtMe only 1 d Contrd number Dept Corp. Eltgrlger use gnly Ill W545 25677 i OO,x1031114 WY1 W545 25677 i 0000031114 WY7 W545 256Ti Employer's name, address, and71P code I c Employer's name, address, and ZIP code j e Employeesname,•ddtns,and ZlPcode AMERICAN PLANT PROTECTION i AMERICAN PLANT PROTECTION j AMERICAN PLANT PROTECTION 52DO EASTERN AVE I 5200 EASTERN AVE 1 5200 EASTERN AVE LOS ANGELES, CA 90012 i LOS ANGELES, CA 90012 I i LOS ANGELES, CA 90012 i i I i f Emgq rwmber • p t b gs jo g,Fs gp ID number a Employ 605 A 7093 b ID number a Employ60bS60 �7093 95-1658740DID 605-60�709^ 95mplboye8r� Social security tips 8 Allocated tips 7 Social security tips 8 Allocaledtips 7 Soetatsecorilyups 8 Allocatedtips i 9 Advance Etc payment I 10 Dependent care benefits Advance Etc payment 10 Dependent eero benefit ! 9 Advance Etc payment 10 Dependent earebenatas Nonquallified pans 12a Sae instructions for b" 12 i 11 Norlquelifled plans 120 j 11 Nonqual9ledpiena 128 other 1 j 14 ether 14 14 Other 1 50.70 (:A SDI I 50.70 CA SDI 50.70 .CA SDI lac 20 tzc I i i tastuMIL netphn Npsrtyalckp laslatem IleLpbn padyalckpay 13 Stal eat Rot plan 310 Perryekk Ply Employee's name, address and ZlP code on Employee's name, address and ZIP code I ell Empbyae'a name, address and ZlP cede PAUL IVAN MENDIZABAL i PAUL IVAN MENDIZABAL j PAUL IVAN MENDIZABAL 126 LAURENT NEWPORT BEACH, CA 92660 126 LAURENT i NEWPORT BEACH, CA 92660 f 126 LAURENT i NEWPORT BEACH, CA 92660 i Slate Em�p�ssyyer's slate lO rlo. 6 Stile wages, lips, cla 15 State Emppl1oyer's elate lD m. 7 l6 Sttewages,llpa, eta u 15 Sute Em�pIIoyer'a state lD no, '`- CA 072.4382 7 16 Stale wages, tips, eta 8450.00 CA 072-4382 7 State Income tax 8450.00 16 Local wager, ups, eta CA 072-4382 o11Sula income tax 8450.00 I. Local wages, lips, eta o 17 Stale income tax 54.53 18 Local w89n, Ups, eta 54.53 Local irmoam tax 20Localayname z 54.53 o 19 Localincome tax Zu Locality name o 19 Localincometax 20 Locality name Federal Filing Copy ; A. State Filing Copy Wage Tax I City or Local Filing Copy007 e and Tax 22 WStatement -2 Wage and Tax 2007 and i w-2 2207 ■ti Statement i wa�2 rr Statement .■ OMB o Sa50aeB : 11tnhefitedwahemoloyee's Federallnomel"ax Datum. I o ws-0o0Bnt., I Cnpy 210 be0led with employee's Stile lneome�ax eiurm <s I Co 2tobemedwllhem loyee'aC or LorMcome ex e, one, i001,nNr visit IM IM Well) V ill WI µse ®at WWW.Irs.9oV/e01B. Employee Reference Copy -2 Wage and Tax 2007 err Statement IN C 10r 'i mOad4 OMe No 1615deea cim rd member Dept. Corp. Employer We tmly DODD01738 WY1 I I W555 53512 Employer's nome, address, and ZIP code BRADFORD BUILDING SERVICES 14262 FRANKLIN AVE STE 108 TUSTIN, CA 92780 / Employee's now, address, and VP code PAUL IVAN MENDIZABAL 1621 MESA DR. ,f20 SANTA ANA, CA 92707 _Em 9892 numb"a 94 m Anum r 605S60.7093 Wages, tlpe,odw come 2 Fedemlincome tax withheld 4878.00 381.31 so" security wages 4 SWalsecuftbmwithheld 4878.00 302.44 Medicare wiles and tips 6 Medkarctaxwlthheld 4878.00 0.73 socblseouraytlp4 a Albcaledtips Advance Etc payment t0 Depended care berneiib 1 Nampumbdpbn 11s m I r or 117tlmr 29.27 CA SDI 12 1z0 I 12d I 135mm n padyakkpay 5 abM Employer's male ID na 165tab wages, tips, ele. CA 242-6120 8 4878.00 7 aate Nteometax filLocalwatien,tipeetc. 38.40 Local Nwemstax al Locality Mme -LUU! VY-z anu CAKNINUI ZIUMMAMY • • The wages, tips, and other compensation reflected in box 1 are the sum of those wages shown on your last pay statement, plus any additional compensation or adjustments received after the payroll close. Your gross pay may not match your box 1 totals due to adjustments made for GTL, 401(k), cafeteria plans, etc... To change your employee N-4 profile information, file a new X-4 with your payroll department. PAUL IVAN MENDIZABAL 1621 MESA DR. #20 SANTA ANA, CA 92707 O 2007 ADP, INC Social Security Number.605-60-7093 Taxable Marital Status: SINGLE Exemptions/Allowances: Federal:1 State: 1 Local: 0 Wagw,tipe, etitereomP taxes i 1 WegMt1pa,e6mrcomp. 2 FederalmoometmtwilhiwM 1 Wages,tipe,ottwcomp. 4878.00 2 Federal income tax withheld 381.31 4878.00 381.31 i 4878.00 381.31 1 Social seanrttyw 4 Socialsecuritytaxwithheld i 3 Social ueuritywa,r9ea 4 Social aecurNytaxwNhhNd 1 3 Soelal aeeurNyw 4 Social security taxWdhheld 302.44 48 8.00 302.44 j a678.00 302.44 I 48 .00 Medlsarawageeandtips 6 MedlearetaxwNhheld 5 Medkarewagen and tips 6 Medlearetaxwl6,held I S Medicarewagesamdtips i 6 Me4io mtaxwNhheld 70.73 4878.00 70.73 1 4878.00 70.73 4878.00 Condrel nuat,ar DWI Crop. Employrtummnly j d Callol number Dept Corp. Employer lag only i d comrdnumber Dept Corp. Employer use only 000001738 WYt W555 53512' 0000001736 WY7 W555 53512 s 0000001738 WY1 W555 5351: Employees name, address, and 23P cods c Employer's name, address, and ZIP ode o Employer's norm, address, and ?JP code BRADFORD BUILDING SERVICES I BRADFORD BUILDING SERVICES I BRADFORD BUILDING SERVICES 14262 FRANKLIN AVE STE 108 i 14262 FRANKLIN AVE STE 108 i 14262 FRANKLIN AVE STE 108 TUSTIN, CA 92780 TUSTIN, CA 92780 I TUSTIN, CA 92780 � I I b Emppooyyer's FED IO number • Fmpbyee'a SSA number 605-60-7093 1 b Emppt1ooyyaappa FED ID number I 94-1729892 a Employee's SSA number 605.60.7093 E ppyar• FED ID number a m ca s num r 8 1729�92 605.60-7093 I 94-1729892 1 7 Soclelsecutlytips ealep 8 Allodtis j 7 soc aecurNy llpa I 8 Allocated Ups Seoul Security tips a Al1ocNMtips Advance, EIC payment 10 Depsmlmd care benalit, a Advance EIC payment 1a Depended um betwms j 9 Advance EIC payment 1 10 Depended com benerne Ho"unalified pans 12a Sea inslNelbns for box 12 i 11 NoaqualNkd plans 121, 11 Nonquzm pans 12a I 4 DOW i 14 Other 29.27 CA SDI 14 ONmr 29.27 CA SDI 20 12e 29.27 CA SDI 2e i 2 i I 13satem neL pm Padys"Ply 135INem nee. pion 3Npaltyak M 13 atnwp.0d.plm PadY mot I 4 Empayw's name, MMrees 0141 ZIP code eR Employee a name. address eM ZIP cab ' on Employee's name, address e,d ZIP code PAUL IVAN MENDIZABAL PAUL IVAN MENDIZABAL PAUL IVAN MENDIZABAL 1621 MESA DR. N20 I 1621 MESA DR. #20 'y6 i 1621• MESA DR. 420 SANTA ANA, CA 92707 SANTA ANA, CA 92707 SANTA ANA, CA 92707 x De 15 Stele Em��Ioy,eeaeWelD ne l6 Sbtewagea, tips, sic 8 4878.00 15 SING Emmp�4ocyyee��••s sots lD 5tale wages, tlpa, eta o CA 242.6IA 8 4878.00 ateb Employer's stab 10 ne BStabwapee,llpe, ate CA 242-612D 8 7 State Income lax 4878.00 IS LoeN wape4 tips, eta o CA 242.6120 D Sbte lmxemetax Local wages, tips, eta 17 Stab incomefax Leoslwagea,tlpa,. 38.40 TOD 38.40 38.40 o 19 t.ocallncomelax 20Localrwname o 8 Loulirtcometax Loeailtyname s Lacalhtcomebx =Locauryname Federal Filing oily i A. State Filing Copy i Tax 1 '7 City or Local Filing Copy00 1 Wage and Tax W2 Wage and Tax 2907 Wage and 2007 YY�2 Statement 2no i Statement 2 W�2 - - a Satement oa6L a �a I C 21n Mflbd wNl,emolnvee'a Stale lncmne Tax aMUfm 91Bn„itw COW2bb fikd WNh4mPt0yaa'f CNya LOea nCOme a% I\ e Gerard manler 1 Wages. bps, other .Federal hcaletacwMhold 2 951.1 19.39 OMe Na 154547008 SSabel seanlywages 4Sodal seanrytavvnUawd 2,951.17 182.97 E rployerWetilil"ban'". 6Modiase wagesand bps 6Medcarstaxw4ftid 33-0493568 2,951.17 42.82 c En4dgers name, address, and ZIP code Calico Building Services, Inc. 15550-C Rockfield Blvid. Irvine CA 92618 e Fmployewslist name and hNol ;Lastname Suit. Easb----------- --I-- '-U@D} .zab•AL------------ 126 Laurent Newport Beach CA 92666 faroovedsaddressand2l000do a Ettplvyces SSN 7Sodalsocunty Bps 8Allocated bps 605-60-7093 9 Advance Elc payment 10Dapenoox are benefits 11 NwgjldW plans 1y 14 Oarer CA SDI 17.70 __L 12i_ --------------- 120 r --------------- 129 , ryo8ranen 17 $tel a ❑ Nor t❑ 71urd.oaty sicNPa/' ❑ $late fspbyersslablDnwti 19Stalewagee Ups,ote. 1178badoi=Mobax CA j345_5733_0______ _____2,951_,�.7 __________ 181ocslwages,bps,ela 18 Cancan kcano Icon 20 Loardy name ---2�95.11— 7 --------2-91 ------------ �s w--T.abna 0.glMyee sn'DEMT Recur W2 2007 capyereearn.awnbEmparee'aFEDEnal.Taxluwm tl caw number 1 Wegea. UPS, oUrer minPensation 2 Federal income mxwUihald 2,951.17 19.39 MB ONo 154541D00 3sodalsoomtywages 4 Sams seamry taxw Uft1d 2 951.17 182.97 Employer fartibor 6MedcaewraBeS bps 6Medxare larw,aaied 33-0493568 2,951.17 42.82 c Ertployera rune. address. old LP code Calico Building Services, Inc. 15550-C Rockfield Blvid. Irvine CA 92618 e Enpbyea'afuatnaneandhdial rLadname Suff. Paul Laurent CA 92666 BeachWWS 1NEmepwwypa�ortt address 3W Zip 7Social socnry bps 9alocatedbps 605-60S$7093 9 Advance EIC payment 18DlPWOOnt as CoMMs 11 NorWdiod Plans 123 14 Men _______ CA SDI 17.70 ------'---------------- 12c 12d t 13 Slal o ❑ Wament❑ pay ❑ 1s Stale fmployefsslatelonunber 1651ate wages, ll S. elan 175Weincomatax CAI 345 _5733 _0----- ----- 2.95p1_ - __________ 18lscal wages li eta. 19Localhometax _______ 2 -- 26 name SETT_ER___________- Am a Cmvol number We Ups.ottwconpensallon 2 Federalincomotax"Nveld 2,951.17 19.39 OMB No. 1545 MOM 7Social sea rtywages 4 SocialseonNtaxwoftmld 2,951.17 182.97 b 5rployer idenbfxaUon mamba 6 Madcmewages and bps 6Medxare Lax" adWd 33-0493568 2,951.17 42.82 c EmplWs name, address, and ZIP code Calico Building Services, Inc. 15550-C Rockfield Blvid. Irvine CA 92618 a Employee's SSN 7 Social seemmytips a Allocated UPS 605-60-7093 a Empoyers first memo and Initial Lest name Suit. Paul I !Mendizabal --------------------------------------------- 126 Laurent Newport Beach CA 92666 f Rlovedsad&=and 21code 13 Semrepbrree El� 1 ❑ TNrdp�y ❑ sit pay 9 Advance EIC payment 190epedon(carebenefils 11 NagsUdndpars 12a 14 MW CA SDI 17.70 ----------------------- 12b r ------ 1_________________ 12c l ------ i----------------- 12d 15 State D'5"!-T splelD nwaba 16 Stale wages, U s, atc 17 Slate Income tax CA 345-5733-0 2-9�1.17 _________ 18 Lsxal wages U s, eta 19 LsxW krmmetax :97ETT rLomltynams ER ___________ ya Wwv-sTa5h1nv1 2LQU7 ft ydz..Y mtlPownn Sa,(m L Cm To se fiMwM&npby,M1 aW. CRY,« I 4 Tu a.Mn d Caand amber 1wages. OFomacompa4salian 2Fetlaa kwona lazwUawd 2,951.17 19.39 OMB No. 15454M 3 $ocial sQCUmy%09eS 4$odel socunry taxwvalheld 2.951.17 182.97 b ariPloYer denafwban number 6MedcaewagesendtFs GP919rotm%tMd 33-0493568 2,951.171 42.82 e Employers name, addess, and ZIP code Calico Building Services, Inc. 15550-C Rockfield Blvid. Irvine CA 92618 e EmployedsfastnameaMlmgei I 'Lastmame Suff. Paul --------------- 1- Mendiz4ba1------------ 126 Laurent Newport Beach CA 92666 f STOnyods addmss and Zip code a Employee's SSN 7social wanly Ups 8Aflocaled Ups 605-60-7093 B Advaoce ElC payment w Deponidaacorebenefbs 11 NatgWifad pans 12a 140UM ____________________ CA SDI 17.70 ------`'--------------- 12c __--------------- 12e 17 Slat ory ❑ Woman, ❑ '�d� 4 p� ❑ 6rybysfs ablelDn 16Slalewagos,li $•elanj tisState 345 _5733 _0 ___2:9?1_ 17 __________al xmga9a ,a¢ 19 Lcoal inoarre tax 20 tocY nano _ ER___________ - Tam W.2 woa4T.smnrx 2 u u _e owa.+drm..rnr+rxw.,.s.,a CoyySTob fiNwNFirybms's aab, Ca1',nleW Man Tan WWm raa W' woauT.9Amax 2 u U e copy c nor t:mv LVTt_Ca =ddnuc TNskdani0misbekqfumisWtotheintwWRevaue Service. Urdu ere requlredtafilaa tax rob.M anegligaxe penaltya cowswdkn maybe hnposed on you if this income Is taxable and you fail to report it 9Pmm� en?eryreo Fepa• FOBb152a: VILLA POINT II (Off -site Newport North Apartments) Unit No. CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtained.) INVe certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2007, the Total Annual Eligible Income* of the undersigned individual(s) was $_; and, 3. During 2007, my total monthly rent payment to Villa Point II (Off -site Newport North Apartments) was $ �y�� ©© per gtOnth. ' Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -Income Earning Household Signature(s) of Income Earning Household Member(s): Member(s); Name Age IG Signature Signature ,,ccam� Signature p Date: �I /o 0 /#I 161:2, f it VILLA POINT II (Off -site Newport North Apartments) Unit No. 02 a- O URGENT CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtained.) Me certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2007, the Total Annual Eligible Income* of the undersigned individual(s) was $ 2a.alo J and, 3. During 2007, my total monthly rent payment to Villa Point II (Off -site Newport North Apartments) wa $ er month. * Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -Income Earning Household Member(s): Name Age Signature(s) of Income Earning Household Member(s): Signature Signature Signature Date: 7 a • 0 a/uo 4--OZ165 VILLA POINT 11(Off-site Newport North Apartments) Unit No. C_ O URGENT CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtained.) [Me certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2007„ cue- TTotal Annual Eligible Income* of the undersigned individual(s) was $and, 3. During 2007, my total m nthly rent payment to Villa Point]] (Off -site Newport North Apartments) was $ 161 per month. Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -Income Earning Household Signature(s) of Income Earning Household Member(s): Member(s): Name Age ` Sign ure Signature Date: 5q ✓tu TTikT ♦'ATYV TWTlT/lli R1T liT.iYl T7T]Y/"'1 F.ffrntivr Tlah!• na O2)-3l •ll . 1_•_ "1111•.111 1 1 I So l • 11 Property NDyRo—rt--NorthCounty:BIN 1 Orange Address: • II "1 1 Ilt iIII' Bedrooms: WMAIWMAN. Relationship to Head of Household = PM: �W ri�11�� •—` pyQy�alq�' I'LX_•u'.(t'.�: ��yy �JZ_f'.:-E,i E11 • It.bl • M r (1�i.E)Jy};h�Y4�lf \tom', Ek;i•�+EJ1..(.f=-c ' 1 I �(-- �SY�S�1,Eik�\[ IIS�jC.� ' • e`5 .+,rl%*'Vii..>, f ;X�Ft +, a � 1 1 • !u! Add totals from (A) through (D), above TOTAL INCOlvEE (E): A $ ' H —11 D v"o-_. k�a'.Y-ri��,ry�� `, it "Rn 4•d - ': k�l Mr�3'�N.% �4•�v q�,��•VI �i E+ + fa:. )a�Mal �'f71P,S1'��ia�� '�`��{�n Yat. ���-i I• �S f�frt)l�i�� ii+h �t�... '�f .Vil �`• Y • •� -.1..2.:�. _�..1�'� 1 f� i'+ � � j,�Tj fi �u �•Y lK-}.k-�5'�•t1t`;XF��V �a wills IY. 1 1 1•i 111'I11 1 1• ��, LQ) ,•frS rJ�J 1. ..-.ilfll rk. i�llf `1�-.: 11 +I II I•I Il .l.+f lyf/ui�•._�J•V� AM j?• S the information on this form will be used to detetmino maximum income eligibility. Uwc have provided for each person(s) set forth,in Part II acceptable verification of current anticipated annual income. VW; agree to notify the landlord harnediately upon any rocniber of the household tnovingout of the unit or any new rnernber mowngm. Uwe agree to notify the landlord immcdiatelyupon mymemberbecomingafull timestudent Under tI,ry, Uwe certify that the information presented in this Certification is true and accurate to the best of mylour knowledge and belie£ 711 and erstands that providing false representations herein constitutes an act of fraud. Fate, misleading or incomplete information may result in th t tionglecrnakt t`'} Signature (Date) ©J Signature (Dare) Signature (Date) Signature (Date) RECERTIFICATION ONLY: TOTAL ANNUAL HOUSEHOLD INCOME _ Household Meets Current In ome Limit x I40%: FROM ALL SOURCES: ' PZ 5v Income RestrictionFrom item (L) on page11$q v at: $ �� ❑ 60% ❑ 50% Household Income exceeds I40%at ❑ 40% El30% recertification: Current Income Limit per Family Size: _ $J� I �p t�7 % ❑Yes ❑No Household Income at Move -in: $ 1 t L-3 U Household Size at Move -in: M I•`'�, 1,'- :tii'-r:-•; z•-"_ - - - r:.5'.Y r�O T`Rv: [-x��=•ar. r•v.A7i"Z`'i: r•_.f e.JJ,.r't :::,'.nr Tenant Paid Rent {�'i_'7 b Rent Assistance: $ _ Utility Allowance $ .� Other non -optional charges: $ GROSS RENT FOR UNIT: 1/,� Qr� (Tenant paid rent plus Utility Allowance & k l� other non -optional charges) $ Unit Meets Rent Restriction at: ❑ 60% ❑ 50% ❑ 40% ❑ 30% LU F ti Maximum Rent Limit for this unit: $ .7�..«vr .w•vN' r � v'� �S' •- •''iwk":+.—,` {--+�<;-.Y,- : ,Jf 7.i. w:-. • - *Student Explanation: ARE ALL OCCUPANTS FULL TIME STUDENTS? If yes, Enter student explanation* 1 TANF assistance �,{j (also attach documentation) 2 Job Training Program ❑ yes q+,po 3 Single parent/dependent 4 Married/jointreturn Enter IA nq �` , N'i" /c)' m.r.,,.r:..,.,._r.a iYrG"'f +''r a,:ni5<.`.';Ja',••a�-, •.$ . �„• ;. ',r.,.',4uR :: ma5 `-�=' a`+5 �:'l:°+,:�'Y .: R,i`•7i ) 4 L i y� �kl• a+., `r .... n'•::rsn•'r",.fas rtia•rYti:. r e.r�Ar,•: >�,� . _ t'••1 t.a��x.�[k; �'IZaVASulhltG`,t'I'�3`�Si�r, Mark the program(s) listed below (a. through e.) for which this household's unit will be counted toward the property's occupancy requirements. Under each program marked, indicate the household's income status as established by this certification recertification. a. Tax Credit ❑ b. HOME ❑ c. Tax Exempt ❑ d. AHDP ❑ e• \ (Name °fprogmmf See Part Vabove. Income Status income Status Income Status ❑ 550%AMGI ❑ 50%AMGI ❑ 50%AM0I II meStat_ us / ❑ 560%AMGI ❑ 60%AMGI ❑ 80%AMGI 0 ❑ 580%AMGI ❑ 80%AMGI ❑ 01** ❑ OI** ❑ OI** ❑ OI** ** U on recertification, household was determined over -income O according to eligibility requirements of theprogram(s) marked above. �f �,.: r. ,,�,r-�sa7•.�.7 .�;a r' '�yI�IN�.�i�+��•��r� 1Y`/kEYi{?`f!•ii,l�"i1.N{�tH�'Y��a,w.�.5•r,. �:.,�%i-.:r���r.-v � nnl,'!7„i,''L r. t3s'��,.f�j Based on the representations herein and upon the proofs and documentation required to be submitted, the individual(s) named in Part 11 of this Tenant Income Certification is/are eligible under the provisions of Section 42 of the Internal Revenue Code, as amended, and the Land Use Restriction Agreement (if ap "cab e), to live in a unit in this Project. 0 S Gt O OWNER/REPRESENTAT£VE ATE 2 Tenant Income Certification (September 2000) TEN INCOME CERTIFICATION QUESTI2 IRE NAME; 'PRONE NUMBER: In , id —al Certification BIN # ❑ Re certification ❑ Other Unit# INCOME INFORMATION YES WO $MONTHLY GROSS INCOME ❑ Owe am self employed. (List nature of self employment) (use net income from business) ❑ Owe have ajob and receive wages, salary, overtime pay, commissions, fees, lips, bonuses, and/or other compensation: List the businesses and/or companies that pay you: Name of Employer 2) $ 3) $ ❑ Owe receive cash contributors of gifts including rent or utility payments, on an ongoing basis from persons not living with me. $ ❑ I/we receive unemployment benefits. ❑ I/we receive Veteran's Administration, GI Bill, or National Guard/Military benefiitstincome. ❑ Uwe receive periodic social security payments $ ❑ The household receives uneamed income from family members age 17 or under (example: Social Security, Trust Fund disbursements, etc.). $ ❑ Uwe receive Supplemental Security Income (SSI). $ ❑ Uwe receive disability or death benefits other than Social Security. $ ❑ Uwe receive Public Assistance Income (examples: TANF, AFDC) $ ❑ Uwe am entitled to receive child support payments. $ ❑ Owe am currently receiving child support payments. $ If yes, from how many persons do you receive support? ❑ Uwe avdare currently making efforts to collect child support owed to me. List efforts being made to collect child support: ❑ Uwe receive alimony/spousal support payments ❑ 11— Owe receive periodic payments from trusts, annuities, inheritance, retirement funds or pensions, insurance policies, or lottery winnings. If yes, list sources. 1) $ 2) $ ❑ Owe receive income from real or personal property. (use net earned income) ASSET INFORMATION YES NO ❑ Owc have a checking account(s) ACCOUNT NUMBER INTEREST RATE CASH VALUE If yes, list bank(s) wes�owt c��tt 3 I S Sq $ t> _% z, % $ Uwe have a savings accounts �Itf�yes, list ba%'k�(s�)/�7 I r 1) Rkttcf)fbt..1/If.CdT ACCOUNT NUMBER INTEl P%T RATE _% CASH VALUE ✓. S� 2) _% $ ❑ Uwe have a revocable trust(s) If yes, list bank(s) I) _% $ ❑ Vwe own real estate. If yes, provide description: $ ❑ Vwe own stocks, bonds, or Treasury Bills If yes, list sourcestbank names 1) _% $ 2) _% $ ❑ Uwe have Certificates of Deposit(CD)or Money Market Account(s). If yes, list sources/bank names 1) _% $ 2) _% $ ❑ Uwe have an IRA/Lump Sum Pension/Keogh Account(401K. If yes, list bank(s) 1) _% $ 2) _% $ ❑ Uwe have a whole life insurance policy. If yes, how many policies $ ❑ Uwe have cash on hand. ❑ Uwe have disposed of assets (i.e. gave away money/assets) for less than the fair market value in the past 2 years. If yes, list items and date disposed: 1) S ❑ dent financial aid (public or private, not including student loans) $ STUDENTSTATUS YES NO ❑v� ❑ Does the household consist of persons who are all full-time students ( Examples: Colleize(University, trade school, etc.)? ❑ ❑ Does your household anticipate becoming a full-time student household in the next 12 months? ❑ ❑ If you answered yes to either of the previous two questions are you: ❑ ❑ • Receiving assistance under Title IV of the Social Security Act (AFDC/TANF) ❑ ❑ • Enrolled in ajob training program receiving assistance through the Job Training Participation Act MA) or other similar program ❑ ❑ • Married and filing aloint tax return ❑ ❑ ingle parent with a dependant child or children and neither you nor your hildren are dependent of another individual UNDERSTANDS APPLICATIONI INFOMMATION PRESENTED ONTRIS FORM IS TRUE AND ACCURATE TOTIIE DEST OF MYIOUR KNOWLEDGE. TIIE UNDERSIGNED FURTIIER IONS HEREIN CONSTITUES AN ACr OF FRAUD. FALSE, MISLEADING ORINCOMPLETE INFORMATION WILL RESULTIN MIE DENIAL OF AUiNT. _ SIGNATURE Di+ PPL" T/TENANT DATE -�a of o�cum�mnrri DATE Earned Income Calculation Worksheet Name Employer Most Recent Ending Pay Period Date 1)- 15,i �)-1 Hire Date -2q,o-� , YTD Income Gross per Pay Period divided b Q-N Start with hire date if (+) at job for less than a year (_) (how often paid) (x) Calculated Annual Income divided by (how often paid (x) (=) Calculated Annual Income FM 0 The Inl remain a cck_ EMPLOYMENT VERIFICATION . '3d3i xxx-m Applloanl/f n RNatte Social Socudly Number Unit a(fassigned) empbymont lnkumadon, Uriate of Applldanlffeneht owe above is � appibanlAenantof 9 houskig Progrem'Ihat requires verification of income. The Ihdomhadon provided Will landan of Ihal#ln ad Pine only. Yourprompt reaPonse is txndal and greatty•appreciated. Return 00rm•To: gLei—` e-.-V65 'PLEASE COMPL'ETE'THIS FORM'ENTIRELYs NOTING -MW OR" NONE" WHERE APPLICABLE. Employee Name Job Tide: PresendyEmployed: YeeyL Oat%F49imployed, •2 0 No —�Last Gay,dEmployment CamentOross Wages) awwr: (CIRCLE'ONE) hourly wQ*Y semi nm monthly yearly Average #of regular 1100 per -Week •�q � YWMD4ete 6arNnge: •Jan. 1, 2007 thin . _[,J/2WT Overture Rate: S Per f Uh Average #.ot ova time hours per week: SMrtDdterendalRate: S• per has• Average# ofsMRtltferentialhotxaPerweek, Com bonuses, lips, other. S l , (CIRCLE ONE) hourly weakly DIY se(OWMlhly monthly yearly ,,SStt LIP 1� List any antelpsted oNnge in the employee's rate of pay vAhln the next 12 month3l;� : EffecBve if the employe9's work Is seaso" orsporatllc, please indicate the layoff pedoM-Id(s): Addido0al wnaeKs: r r r+ q1-t0 -5P q - ►��f�l ��a s 4 V-441 E-Mall FaXW U.(bM NOTBt Sidon 1001 atTide'18 of tho U.S. Code takes it a criminal offense to matt wdhful [also statements or misrepresentations to any Deputlmrw or Agency of thw,United Sates os to any tatter wlihin Itlyudadiclibn. Employment Verifiadon (Septen bxr 2000) T/V *d LiA TG S6tr6T:01 :WMA d60:20' 40W-,L2-(t0N Earned Income Calculation Worksheet Name Employer Most Recent Ending Pay Period Date 11.1 s , ND1 YTD Income divided b Start with hire date if at job for less than a year (how often paid) (x) Calculated Annual Income Hire Date 2-1) - 0'� Gross per Pay Period IT) divided by (how often paid) M- (=) Calculated Annual Income EMPLOYMENT VERIFICATION Date: 0 7 XXX-XX- Social Security Number Unit # (if assigned) Date The individual named r fly above Is n applicant/tenant of a housing program that requires veMiication of Income. The Information provided will remain confidential to ati action of that tated purpose only. Your prompt response is crucial and greatly appreciated. anf0.1 G.r)'La ProjectO ner/Management Agent 0�n�--/7 Return Form To: Employee Name: *PLEASE COMPLETE THIS FORM ENTIRELY, NOTING "NIA" OR "NONE" WHERE APPLICABLE. Job Title: Presently Employed: Yes _ Date First Employed No _ Last Day of Employment Current Gross Wages/Salary: $ (CIRCLE ONE) hourly weekly bi-weekly semi-monthly monthly yearly Average # of regular hours per week: Year-to-date earnings: ; Jan. 1, 2007 thru / / 2007 Overtime Rate: $ per hour Shift Differential Rate: $ per hour Average # of overtime hours per week: Average # of shift differential hours per week: Commissions, bonuses, Ups, other. $ (CIRCLE ONE) hourly weekly bl-weekly semi-monthly monthly yearly List any anticipated change in the employee's rate of pay within the next 12 months: ; Effective date: If the employee's work is seasonal or sporadic, please indicate the layoff period(s): Additional remarks: Employer's Signature Employer's Printed Name Date Employer [Company] Name and Address '57q �Li y1 Phone # Fax # E-mail NOTE: Section 1001 of Title 18 of the U.S. Code makes it a criminal offense to make willful false statements or misrepresentations to any Department or Agency of the United States as to any matter within its jurisdiction. Employment Verification (September 2000) Sending Conf ii'm Date : NOV-27-2007 TUE 02:04PM Name : Tel. . Phone 19495791447 Pages : 1/1 Start Time 11-27 02:03PM Elapsed Time 00'45" Mode : G3 Result : Ok Household Name: Development Name: ER $5,000 ASSET CERTIFICATY` N' For beholds whose combined net assets do not exce*000. Completp4,nly one form per household; include assets of children. Unit No. ail 1 City: Complete all that apply for 1 through 4: 1. My/our assets include: (A) (B) Cash lnt. Value* Rate sty sN (A*B) (A) (B) Annual Cash Int. (A*B) Annual Income Source Value* Rate Income Source $ • 02 Savings Account $�`�` Checking Account $ Cash on Hand $$ I VTR $�� Safety Deposit Box $ Certificates of Deposit $ $ Money market funds $ Stocks $ $ Bonds $ IRA Accounts $ $ 401KAccounts $ Keogh Accounts $ $ Trust Funds $ Equity in real estate $ $ Land Contracts $ Lump Sum Receipts $ $ Capital investments $ Life Insurance Policies (excluding Term) $ Other Retirement/Pension Funds not named above: $ Personal property held as an investment** : $ Other (list): PLEASE NOTE: Certain funds (e.g., Retirement, Pension, Trust) may or may not be (fully) accessible to you. Include only those amounts which Lm. *Cash value is defined as market value minus the cost of convening the asset to cash, such as broker's fees, settlement costs, outstanding loans, early withdrawal penalties, etc. **Personal property held as an investment may include, but is not limited to, gem or coin collections, art, antique cars, etc. Do not include necessary personal property such as, but not necessarily limited to, household furniture, daily- se autos, clothing, assets of an active business, or special equipment for use by the disabled. 2. ❑ Within the past two (2) years, Uwe have sold or given away assets (including cash, real estate, etc.) for more than $1,000 below their fair market value (FMV). Those amounts* are included above and are equal to a total of: $ (*the difference between FMV and the amount received, for each asset on which this occurred). 3. I/we have not sold or given away assets (including cash, real estate, etc.) for less than fair market value during the past two (2) years. 4. !!!(((]]]�� Uwe do not have any assets at this time. The net family assets (as defined in 24 CFR 813.102) above do not exceed $5,000 and the annual income from the net family assets is S • V .� . This amount is included In total gross.annual income. Under penal of peri r/we certify that the information presented in this certification is true and accurate to the best of my/our knowledge. The undersign urther u d(s) that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information may result ' t .t nation of a lease agreemen/. ApplG&W__I`en46C —Date—I� ApplicantMenant Date Applicant/Tenant Date Applicant/Tenant Date Under $5,000 Asset Certification (September 2000) 0 VILLA POINT II (Off -site Newport North Apartments) Unit No. 11 �2 CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtained.) IMe certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1 _ The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2007, the Total Annual Eligible Income* of the undersigned individual(s) was $ 3 71 !3 9, 1 J_; and, 3. During 2007, my total monthly rent payment to Villa Point II (Off -site Newport North Apartments) was $ l 4S,- /!• 65,— per month. * Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -Income Earning Household Member(s): Name Age Nisi 14&1-1L G2es5 W ,11S Signature(s) of Income Earning Household Member(s): A J9DwI M Signature Signature Date: 5 t15-.L2 e08 N1 �//P/b 3 VILLA POINT II (Off -site Newport North Apartments) Unit No. CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtained.) IMe certify to the management of Villa Point 11 (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2007, the Total Annual Eligible Income" of the undersigned individual(s) was $ and, 3. During 2007, my total monthly rent payment to Villa Point II (Off -site Newport North Apartments) wa $ per month. 1 v 1 k �R'o.S�Zw (t'1 * Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension.payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non income Earning Household Signature(s) of Income Earning Household Member(s): Member(s): Name Age Signatur Signature Signature Date: T / red iS r M/ VAID V VILLA POINT II (Off -site Newport North Apartments) Unit No. 'q7D P06atA­- CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtained.) INVe certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2007, the Total Annual Eligible Income* of the undersigned individual(s) was $ i 5� 39 ; and, 3. During 2007, my total monthly rent payment to Villa Point II (Off -site Newport North Apartments) was $ pe( month. • Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -Income Earning Household Member(s): Name Age Signature(s) of Income Earning Household Member(s): Signature Signature Date: 4) f / Nt qll f ? TENANT INOWE CERTIFICATI4 Ll Certification ❑ •_ ertification ..Other Date: Property Name: Newport North County: Orange BIN #: N/A Address: 2 Milano, Newport Beach, CA 92660 Unit Number:_ # Bedrooms: 1 k 1 .First HH Mbr# Last liame Name & Middle Initial Relationship to Head of Household Date of Birth (MM/DD/YYYY) FIT Student (YorN) Social Security or AlienRe.No. 1 �l HEAD ( 1 s), Q'1ov1'C-1111 2 3 4 5 6 7 :isAl2 - .%RtySStiWAII�T Olyt'n S� y\?7NEJJ)T.A14Tp: ;, PS',. _ HH Mbr—# (A) Em to nt or Wages (B) Soc. Security/Pensions _ (C) Public Assistance (D) Other Income 1 is is Add totals from (A) through (D), above TOTAL INME (E):WC $ l+ p "W9181 ts Hshld Mbr # (F) Type of Asset (G) C/I (H) Cash Value of Asset (I) An ual Income from Asset t ,v' L �"' • bw TOTALS: 1 $ Passbook Rate Enter Column (H) Total q l C If over $5000 $�� I� `1 - X 2.00% _ (J) Imputed Income Enter the greater of the total of column 1, or J: imputed income TOTAL INCOME FROM ASSETS (K) $ $ $ d ) C� (L) Total Annual Household Income from all Sources [Add (E) + (K)] P The information on this form will be used to detertnine maximum income eligibility. i/we have provided for each person(s) set forth in Part 11 acceptable verification of current anticipated annual income. Vwe agree to notify the landlord immediately upon any member of the household moving out of the unit or any new member moving in. Uwe agree to notify the landlord immediately upon any member becoming a full time student. Under penalties of perjury, Uwe certify that the information presented in this Certification is true and accurate to the best of my/our knowledge and belief. The u igred fu re understands that providing false represen nons herein constitutes an act of fraud. False, misleading or incomplete information may result in the tmi ration of to lase agreement. ipuratu Da) Signature (Date) (Da(e) Signature (Date) RECER TOTAL ANNUAIE.II4SISIHOI ILL(�Q v1 IF j Household•Meo .si . Current =84 ALL SOURCES: �I Income Restucltom Fromitem(L)eripage1 S 4' aat:— - Current Income Limit per Family Size: Household Income at Move -in: !P Tenant Paid Rent Utility Allowance S GROSSRENTFORUNTf: (Tenant paid rent plus Utility Allowance &��3 other non -optional charges). S Maximum Rent Limit for this unit $ ARE ALL OCCUPANTS FULL TIME STUDENTS? ❑ yes -o Limit x 140W. ❑ 60% ❑ 50% Household Income exceeds 140% at 40% ❑ 30% recertificati n: tkb % ❑yes 1�jlo Household Size at Move -in: 1 Rent Assistance: Other non -optional charges: Unit Meets Rent Restriction at ❑ 30`/° , ❑ 60% ❑ 50°/* ❑ 40% Eyes, Enter student explanation* (also attach documentation) Enter 1-4 *StudentExplanatiom I TANF assistance 2 JobTminmgProgmm 3 Single parent(dependent child 4 Mamed/jointreturn Muir the program(s) listed below (a. through e.) for which this household's unit will be counted toward the property's occupancy requirements. Under eachprogtam marked, indicate the household's income status as established by this cettificationlrecertiiAcation. a. Tax Credit ❑ I b. HOME ❑ ( c. Tax Exempt ❑ ( d. AHDP ❑ I e. Y t l0 19 (Name ofPmSrpm) See Put V above. Income Status Income Status ❑ 5 50°/* AMGI ❑ 50°/* AMGI ❑ 560%AMGI ❑ 60% AMGI ❑ 580°/*AMGI ❑ 80%AMGI CIOI** ❑ OI** Income Status ❑ 50%AMGI1�°meSYat ❑ 80°/a AMGI j� 0 ❑ 01** ❑ 113 OI** t ** Upon recertification, household was determined over -income (U1) according to engrdraty requrements or me pmg[amlai manCexl aouvc. t Based on the representations herein.and upon the proofs and documentation required to be submitted, the individual(s) named in Part H of this Tenant Income Certification is/are eligible under the provisions of Section 42 of the Internal Revenue Codc, as amended, and the Land Use Restriction Agreement (if Ple,,to live in aunit in this Project 7- /'nN� ✓ �a O S IG TUJU3OFOWNER/REPRESENTATWE JbATBI Tenant Income Certification (September 2000) .oaf 411Wce11L11call TELEPHONES NU�/M13ER: (� /�'!n/ �\ Initial Certification ( ) BIN it fl .b l7 � X / q7 v V Rc-ccrtificalion f 7 Cl ^ M#V-e. Vas Nn,"'— $MONTHLY GROSS INCOME ❑ Uwe am self employed (List nature of self employment) (use fieincome from business) ❑ Uwe have ajob and receive wages, salary, overtime pay, commissions, fees, tips, bonuses, and/or other compensation: List the businesses and/orcompanies that pay you: Name of Employer $ 2) $ 3) $ ❑ Uwe receive cash contributions of gifts including rent or utility payments, on an ongoing basis from persons not living with me. $ ❑ Uwe receive unemployment benefits. ❑ Uwe receive Veteran's Administration, Gl Bill, or National Guard/Military benefits/income. ❑ Uwe receive periodic social security payments. $ ❑ rA The household receives unearned income from family members age 17 or under (example: r Social Security, Tmst Fund disbursements, etc ). $ ❑ Uwe receive Supplemental Security Income (SSI). $ ❑ Uwe receive disability or death benefits other than Social Security $ q Vwe receive Public Assistance Income (examples: TANF, AFDC) $ ❑ Uwe am entitled to receive child support payments $ q G( r Uwe am currently receiving child support payments. $ If yes, from how many persons do you receive support? ❑ r/ Vwe amlare currently making efforts to collect child support owed tome. List efforts being Y' made to collect child support: ❑ Vwe receive alimony/spousal support payments ❑ Uwe receive periodic payments from trusts, annuities, inheritance, retirement funds or pensions, insurance policies, or lottery winnings. Ifyes, list sources: I) $ 2) $ ❑ I/we receive income from real or personal property (use ggt eamed income) $ ASSET INFORMATION u If yes, list bank(s) 1)IAI.A-G(�1o✓r�" sl�U ono $2XYD-- 21 _^Vu 1 $ 1• I ❑ ❑ Uwe have a savings aciciaunlr.:,W ACCOUNT NUMBER INTER -.fRATE CASH VALUE Ifyes, list banks) o inl R reel aJfPr io (0 lltor6f 320 _% $ 2) _°r° $ ❑ Vwe have a revocable trust(s) If yes, list bank(s) 1) _% $ I/we own real estate. Ifyes provide description• awl 1= L0 $(rD C»p p (/we own stocks, bonds, or Treasury Bills (ryes, list sources/bank names fl/k o f 1) 2) _% $ ❑ I/we have Certificates of Deposit (CD) or Money Market Account(s) If yes, list sourceAank names I) _% $ 2) $ ❑ Uwe have an IRA/Lump Sum Pension/Keogh Account/40I K Ifyes, list bank(s) 1) 2) _/a $ ❑ Uwe have a whole life insurance policy. Ifyes, how many policies $ ❑ Vwe have cash on hand. $ ❑ I/we have disposed of assets (i a gave away money/assets) for less than the fair market value in the past 2 years. (ryes, list items and date disposed I) $ ❑ Student financial aid (public or private, not including student loans) $ STUDENTSTATUS YES NO p Does the household consist ofpersons who are all full-time students (Examples: Colle eNniversi bade school etc.? ❑ Does your household anticipate becoming afull-time student household in the next 12 months? ❑ ❑ Ifyou answered yes to either of the previous two questions are you: ❑ ❑ Receiving assistance under Title IV ofthe Social Security Act(AFDCfFANF) ❑ ❑ • Enrolled in ajob training program receiving assistance through the Job Training Participation Act (1TPA) or other similar program p ❑ Married and filing ajoint mx return p ❑ • Single parent with a dependant child or children and neither you nor your children are dependent ofanother individual UNDER PENALTIES OF PERJURY, I CERTIFY TIIATTIIE INFORMATION PRESENYCIDO THIS TOM I UE AND ACCURATE TO THE BEST OF MY/OUR KNOWLEDGE Tile UNDERSIGNED PURTIIER UNDERSTANDS THAT PROVIDING FALSE REPRESENTATIONS HEREIN CONSTTPESA ALTOiFM D. ALBE, MIELEA NG ORINCOMPLETE INFORMATI 4WIL eR�ESULT IN TIIE DENIAL OP AP,/LICATON OR TEPAfINATIQN�T)IE LP,SSE]GR¢;M/�� L V rPfIRNI�/'ED/w/•,"A/AL ME O,/`lYA[A LGCA T`//PE/YNAYNT✓/'V/ SICNATU OFAPPWANANT DATE aap.„.\i.--, 111\)��" •i„CCI,CIIWNCC M PC.VSFNTATIVV1 DAT �� Earned Income Calculation Worksheet [,1Mit, - Employer Most Recent Ending Pay Period Date 3,�; -°-0(� YTD Income XA1- divided b Start with hire date if at job for less than a year (_) tip� a (how often paid) (x) I aNq Calculated Annual Income Hire Date \�-�4r ©� Gross per Pay Period G4. a3 (+) divided by (how often paid) (x) (=) Calculated Annual Income INC. /-k Fed StatuslAllows/Extra CA StatuslAllomiDeductslExtm 1305 SSN: xxx-xx-0291 Pay 02/2112008 - 03/05/2008 03/0712008 Compensation QtY Rate Current YTD $a ery 4,245.17 Commission 863.64 00.9 863.64 141.14 fors -Tax Deductions Current YTO SEO-1 5 32.50 Em to ea -Paid Taxes Current YTD slat '=Me Tax 9.00 57.00 Medicare 12.53 88.68 Social Security 53.55 378.74 CA - Income Tax 0.00 CA- Disability 691 48.87 81.99 573.19 Afteax Payments and Deductions Current YTD '10 o ra r-Tursement 637.10 Misc. Deductions-100,00-100.00 -100.00 537.10 Net Pay 681.65 6,072.$5 , INC. Compensation City Rate Current YTD STry 923.08 4.246.17 Commission 1,031.33 923.08 5,277.50 Pre-Tu Deductions Current YTD 125 32.50 3150 Taxes Current YTO MVee-Pald l income Tax 12.00 4300 Medicare 12.91 76.05 Social Socudty 55.22 325.19 CA- Income Tax 0.00 CA - Disability 712 41.96 87.25 491.20 After -Tax Pa menu and Deductions Current YTD to e m ursement 138.50 637.16 Not Pay 941.83 5,390.90 , INC. SSN: xxx-xx-0291 Com ensation Q Rate Current YTO Sa ery 923.08 2,400.01 Commission 301.20 923.08 2,701.21 Eee•Paid Taxes Current YTD D 'cam,Tax 15.00 21.05 Medicare 13.39 39.17 Social Security 67.24 167.48 CA- Income Tax 0.00 CA -Disability 738 21.61 93.01 249.26 After -Tax Pa menu and Deductions Current YTO uto a mbursemenl 138.50 360.10 Net Pay 968.57 2,812.05 to a � a Lia 9 v� a Status1All..Mnducts1rxtm 1304 Pay Period: 02121/2008-03/05/2008 Pay Date: 03/07/2008 Pay Pedod: 01124/2008-02/06/2008 Pay Date: 02/08/2008 1164 , INC. SSN: xxx-xx-0291 Cam a ensalion Q Rate Current YTD my 923.08 3,323.09 Commisslon 1,031.33 923.08 4.354.42 Em Io ee-Paid Taxes Cu nt YTD e'I ncomo Tez 15.00 36.00 Medicare 13.39 63.14 Social Security 57.23 269.97 CA - Income Tex 0.00 CA- Disability 7.39 3484 93.01 403.95 Akar•Tax Payments and Deductions Current YTD ulo Re mbursemant 138.50 498.60 Net Pay 968.57 4,449.07 Pay Period: 0210712008 - 02120/2008 Pay *w9' o-�L 1253 Earned Income Calculation Worksheet I?Et"u Employer Most Recent Ending Pay Period Date F I YTD Income divided b Start with hire date if at job for less than a year (_)l,al° (how often paid) (x) I C-;� 'IZ Calculated Annual Income III Hire Date �1- \.- Q`1 Gross per Pay Period [!��: < ?D �y divided by (how often paid) (x)F � (=) Calculated Annual d-1 I a D r-�Cy,-73, ;S lip the Individual named remain co idanfialto; EMPLOYMENT VERIFICATION & X- 3eclal Secudty Number pllcantA�t of a housing program that mquirea vedfication of income. purpose only. Your prompt response is crucial and greatly appreciated. "PLEASE COMPLETE THIS FORM ENTIRELY, NOTING "WA" oR "NONE" WHERE APPLICABLE. 0 Employee Name: JohTitle: S a I e s {�Ii Presently Empoyed: Yes Date First Employed �� 6 , t7-3— No— Last Day of Employment Current GrossWagesMalary: S 17 12 CIRCLEONE) hourly weakly bl-weekly seml-monthly omh yearly Average-Sofregular hours %per week 0 Yearto-dateeaminjs .( 0 7c;(_:-Jaan.'1,,2�0011thni 3 7,,�f2001i OvarOmc Ratot pa' hour Awnigo $ of overtime hours par week: �! ShiftDifferential Rate: S 1 perrhho)ur Average i of shift differential hours Per week �L Commissions. bonuses, Ups. Omer $ 1 " " (CIROLE ONE) Irumly weaidy bi-weekly eemi•monitdy CM thi yaady✓i�� %t% f W Lf?f List any anticipated change in the empiayee's rate of pay within the neat 12 months: L o Nt i S 5 i ,i 17 S w(T J Etfr dafe: Ifthe empioyee's work is saasonal or sporadio, please indicate the layoff petiod(a): Additional remarks: e Empbyars stgnawre Employers Pdnted Name Date (11-- 1&,?7 /✓ 19! � aRI-2266 !iq9 el-- f & 00 71q 97el - 9 Q _. Far Mill Z ilo[ Mope* Fax# E-melt — NOTE: Section 1001 of'fide i8 of the U.S, Code makes Itacrimttvil ottenso to make WIIItlt1 rWosmtnments Ut mialoptweumtiom to my Uoportmont orAgof nnOy the Unired Slats as to my mamrwithin its jurisdiction. Employment YerMcatien (September 2000) z.• •a agar- 17 1 FoodCraft C*Ncch RNreahmert9crrkes March 7, 2008 To Whom It May Concern: 17149749B% 9496081914 PA k Mr. Rh traide Dr. 1637 No. O•Doanea Way Los Angeles. CA 90031 Orange, CA M7 Tel 323223-2391 TN 714974-1600 Fan3232276219 Fac714974-"96 wwwdooderaacom E-mail: foodera112QaoLemn This letter is to state that Amy Greenberg has been an employee of FoodCraft in Orange, CA. since November 2007. Her base salary is $2,000 per month and her commissions are $1150 per month and will continue to grow. If you have any questions please call me at 714-974-1600. SrI Jim Kolbeck Branch Manager 1637 O'Donnell Way Orange, Ca. 92867 TM. Th&Ra"rofdwrown4 v Amy M Greenberg Property Address 1061 Chanticleer Cherry Hill, NJ 08003 Appraised Value 339,000 - May 2007 Three Bedroom, 2 Full bath - 2 Half bath, 2 Car Garage, Full finished Basement, 3 Story, End Unit townhouse. Mortgage Amount GMAC 225,000 February, 2006' Monthly payment 1,538 Pr iLle- 1d-�, 1 �✓�'�ts f d- ��YES 1 Y Lease Monthly rent-2,350 one year lease began September 1, 2007 t 1 Y4J 1 7czWn AW WAV4.2TT anna OP JeLI LEASE Lanalo .4• and Tenant agree to lease the Rental Space for the Term and at the Rent stated, as follows: '(The words Landlord and Tenant include all landlords and all tenants under this Lease.) lesdlord: - Amy Greenberg c/o Gary L. Green, Esq., Archer & Greiner, P-C_, One Centennial Square Haddonfield, New Jersey 08033 Tenant: David A Weinstein & Corine Weinstein 2 Fieldstone Way Moorestgwn,NJ 08057 Rental Space: The land and improvements immediately surrounding same identified as 1061 Ch=ticleeA, sherry Bill, New Jersey 08003. Table of Contests 1. Possession and Use.................................................................................................2 2. No Assignment or Subldtting............. ......... _...................................... ................... 2 §. Rent and Additional'Rent... ......................... _.................... .............. ....................... 3 4. Securitv................. ...................................................................................................3 5. Liability Insurance .................................. _.............. ..._.. ................ ...... I .................. .., 6. Fire Insurance __..,............................................. ..................................... .3 ............... °7. Water Damage........................................................................................................4 S. Liability of Landlord and Tenant............................................................................4 9. Real Estate Taxes...................................................................................................4 10. Acceptance of Rental Space ...... _... ............... ...... ....... ......................... ................. 4 11. Quiet Enjoyment....................................................................................................4 • 12. Utilities and Services .............................................................................................4 13. Tenant's Repairs, Maintenance, and Compliance.................................................5 14. Landlord's Repairs and Maintenance..._............:..................................................5 15. No Alterations ............................ :.......................................................................... 5 16. Signs'.......................:..............................................................................................6 17. Access to Rental Space ...... ...... I .... 6 ....... ...... .......... ........:......................................... 19. Fire and Other Casualty ................. ............ ....... ............. ................... .................... 6 19. Eminent Domain ........................................ .................. ...... ..:............. ..I ................... 6 20. Subordination to Mortgage.......................:...................................... ... I ................ 7 21.Violstion, Eviction, Re-entry and Damages..........................................................7 ...........:....._._ Notices ............. _................................... ................_..............22_ ..._..7 23. No Waiver........................................... ............8 24. Survival........................_.......................................................................................8 25. End Term .................... ....................................... s cf ................................................ '26.Binding_....................... ......_......... ....... ................................... 8 -27. Full Agreement......................................................................................................8 28. Late Payment .......................... ......... :... _........................................ _........... I.......... 8 29. Brokers ............ ..............................:..........................................._..... ..................... _... _............. _......... 8 39. Landlord's Obligations/Liability ......... _............. __ ....... _....... ' 31.11oldover.................................................................................::....................I........9 32. Tenant's Improvements ................................................................................9 33. Lead Warning Statement..............................................................I........................9 M t� el YH 1-4rx=3QH-1 Aw W.J71, : T T nnn7 n7 Je W 14 Date of Lease: Term: August 13, 2007 One (1) year Beginning September 1, 2007 Ending August 31, 2008 Security Deposit: $ 3,525.00 Broker. Landlord and Tenant recognize that NO Broker brought about this Lease. Therefore no Broker's commission shall be due. Rent for the Term: The rent ("Rent') for the Rental Space, payable hereunder, shall be the sum of $2,350.00 per month. Tenant shall pay to Landlord all Rent on or before the lust (1st) day of every month for the term of this Lease. In addition, Tenant shall pay the utilities as set forth herein, in addition to the Rent specified. Rental Space: Residential Purposes 1. Possession and Use Landlord shall give possession of the Rental Space to Tenant for the Term. Tenant shall take possession of and use the Rental Space for the purpose stated above. Tenant may not use the Rental Space for any other purpose -without the written consent of Landlord. Tenant shall not allow the Rental Space to be used for any unlawful or hazardous purpose. Tenant is satisfied that the Rental Space is zoned for the Use stated. Tenant shall not use the Rental Space in any manner that results in (1) an increase in the rate of fire or liability insurance or (2) cancellation of any fire or liability insurance policy on the Rental Space. Tenant shall comply with all requirements of the insurance companies insuring the Rental Space. Tenant shall not abandon tho Rental Space during the Term of this Lease or permit it to become vacant for extended periods. 2. No Assignment or Subletting Tenant may not do any of the following without Landlord's written consent: (a) assign, or allow the assignment by operation of law, of this Lease to any party other than a family member or heir or executor of Tenant (which assignments are expressly permitted hereunder) (b) sublet all or any part of the Rental Space or (c) permit any other person or business to use the Rental Space. Except as expressly provided in subsection (a) of the immediately preceding sentenee, Tenant shall not, by operation of law, merger, or otherwise, assign, mortgage, Pledge or encumber in any manner by reason of any act or omission on the part of Tenant, this Lease, or the tern and estate hereby granted, or sublet or license the whole or any part of the Reantal Space or permit the Rental Space or any part thereof to be used or occupied by others. W 1.1 J'7 'rr nnn� n7 3. Rent and Additional Rent Tenant shall pay the Rent to Landlord at Landlord's address, If Tenant fails to comply with any agreement in this Lease, Landlord may do so on behalf of Tenant Landlord may charge the cost to comply, including reasonable attorney's fees, to Tenant as "additional rent". The additional rent shall be due and payable as Rent with the next monthly Rent payment All other payments in addition to the Rent due from Tenant to Landlord hereunder shall be deemed "additional rent". Non-payment of additional rent shall give Landlord the same rights against Tenant as if Tenant failed to pay the Basic Rent 4_ Security Tenant has given to Landlord the SecmIty stated above. It shall be deposited or invested by Landlord and bear interest or yield other earnings as required by law. The balance of the interest or earnings, after deduction of any Landlord's administration expenses allowed by law, shall belong to Tenant Tenant's portion of the interest or earnings shall be permitted to compound, or shall be paid to or credited for the benefit of Tenant as provided by law. The Security shall be held in trust by Landlord during the Tenn of this Lease, including any renewal or extension. It shall be used as security for Tenant's compliance with Tenant's obligations under this Lease. Landlord may deduct from the Security say costs resulting from TcmmVs failure to comply with any agreement in this Lease. Ifthe costs exceed the Security, Tenant shall pay the additional amount to Landlord. If Landlord uses guy of the Security during the Term, Tenant "I promptly restore the Security to its original amount. The Sorority is not to be used by Tsmant for the payment of Rent without Landlord's written consent Within 30 days after the end of the Term, Landlord shall return to Tenant (a) the Security, and Tenants portion of the interest or earnings, less any charges made under this cease, and (b) a statement itemizing the interest or earnings and any deductions. This shall be done by personal delivery, registered or certified mait If Landlord's iatemt in the Building is tnwsfierred. Landlord shalt (a) turn over the Security, Plus Tenant's Portion of the interest or earnings to the new Landlord and (b) notify Tenant of the name and address of the new Landlord. Notice must be given to Tenant within 5 days after the transfer, by registered or certified mail. Landlord shall then no longer be liable to Tenant for the Security , plus Tenant's portion of the interest or earnings. The new Landlord becomes liable to Tenant for the return of the Security, plus Tenant's portion of the interest or earnings is accordance with the tears ofthis Lease. 5. Liability Iusaraaee Landlord may obtain and maintain such liability insurance as he deems appropriate, but shall have no obligation to do so. There shall exist no obligation on Landlord's pad to maintain say insurance, whether liability, personal property or otherwise, on behalf of Tenant 6. FIM.Insuraace if, due to Tenant's use of the Rental Space, Landlord � Laanndlod�y cancel this Lease fire inS11rU1ZV On the building in the amount and form reasonably acceptable on thirty (30) days notice to Tenant xuj i �Irw�c Wn au LIA74 : T T Qnn7 a7 jew 7. WaterDamage Landlord shall not be liable for any damage or injury to any persons or property caused by the leak or flow of water from or into any part ofthe building located upon the Rental Space. S. Liability of Landlord and Tenant Landlord shall not be liable for injury or damage to any person our property unless it is due to the negligence of Landlord or Landlord's employ= or agents. Tenant is liable for any loss, injury or damage to any person or property caused by the act or omission of Tenant or Tenant's employees or agents. Tenant shall defend Landlord from and reimburse Landlord for all liability and costs (including reasonable attorneys' fees) resulting from any injury or damage due to the act or omission of Tenant or Tenant's employees or agents. 9. Real Estate Taxes/Association Foes. Landlord shall pay the yearly Municipal Real Estate Taxes and Association Fees on the Rental Space. 10. Acceptance of Rental Space Tenant bas inspected the Rental Space and agrees that the Rental Space is In satisfactory condition. Tenant accepts She Rental Space "as is": 11. Quiet Enjoyment Landlord has the right to enter into this Lease. If Tenant complies with this Lease, Landlord must .provide Tenant with undisturbed possession of the Rental Space. 12. Utilities and Services Tenant shall arrange and pay for all utilities and services required for the Rental Space, including the following: (a) Heat (b) Hot and cold water (c) Electric (d) Gas (e) Sewer Landlord shall pay for the following utilities and services: NONE. It is, however, acknowledged by Landlord and Tenant that the water and sewer bills for the Rental Space shall remain in the name of Landlord and that the brills for those services will be forwarded to Landlord. Upon Landlord paying those bills, Landlord shall supply the bills to Tenant and Tenant shaft re4mbnrac Landlord within ten '(10) days of receipt. Tenant's foilare to do so shall be considered a default under this Lease. Landlord is not liable for any inconvenience or harm caused by any stoppage or reduction of utilities and services beyond the control of Landlord. This does not excuse Tenant from paying Rent 4 JJJ. 1!TT Onnl Oil .1P9.1 0 10 13. Tenant's Repairs, Maintenance, and Compliance Tenant shall: (a) Promptly comply with all laws, orders, rules and requirements of governmental authorities, insurance carriers, board of fire underwriters, or similar groups. (b) Maintain the Rental Space and all equipment and fixtures in it in good repair and appearance. (c) Make all necessary repairs to the Rental Space and all equipment and fixtures in it, except structural repairs. (d) Maintain the Rental Space in a neat, clean, safe, and sanitary condition, free of all garbage. (e) Keep the walks, driveway, and parking area clean and free from trash, debris, snow and ice. (f) Use all electric, plumbing and other facilities in the Rental Space safely. (g) Use no more electricity than the wiring or feeders to the Rental Space can safely carry. (h) Promptly replace all broken glass in the Rental Space. (i) Do nothing to destroy, deface, damage, or remove any part of the Rental Space, G) Keep nothing in the Rental Space which is inflammable, dangerous or explosive or which might -increase the danger of fire or other casualty. (k) Do nothing to destroy the peace and quiet of Landlord, other tenants, or persons in the neighboKhood. (1) Avoid littering in the building or on it grounds. (m) • Make all structural repairs. (n) Make necessary repairs and replacements of the plumbing, cooling, heating and electrical systems. (o) Make all other repairs and perform all maintenance required to the Rental Space. Tenant shall pay any expenses involved in complying with the above. 14. Landlord's Repairs and Maintenance Landlord shall not be required to make any repairs, replacements or other maintenance of, or with respect to, the Rental Space during the tetra of this Lease. 15. No Alterations Tenant may not make any material changes or additions to the Rental Space without Landlord's written enusent, which shall not be unreasonably withheld. Any material changes or additions made without Landlord's written consent sball be removed by Tenant on demand. Nothing in this Lease, or in 5 any consent to the making of alterations or improvements contained shall be deemed or construed in any way as constituting authorization by Landlord for the making of any alterations or additions by Tenant within the meaning of 13.J.S.A. 2A:44-69 or Section 3 of the Construction Lien Law (P.L. 1993, c. 318) or any amendment thereof, or constituting a request by Landlord, express or implied, to any contractor, subcontractor or supplier for the perfotmance of any labor or the furnishing of any materials for the use or benefit or Landlord. 16. Signs Tenant shall obtain Landlord's written consent before placing say sign on or about the Rental Space. Signs must conform with all applicable municipal ordinances and regulations. 17. Access to Rental Space Landlord shall have access to the Rental Space on reasonable notice to Tenant to (a) inspect the Rental Space, (b) make necessary repairs, alterations, or improvements, (c) suppler services, and (d) snow it to prospective buyers, mortgage lenders, contractors or insurers. Landlord may show the Rental Space to rental applicants at reasonable hours on notice to Tenant within six (6) months before the end of the Teem. Landlord may enter the Rental Space at any time without notice to Tenant in case of emergency. 18. Fire and Other Casualty Tenwa shall notify landlord at once of any fire or other casualty in the Rental Space. Tenant is sat ro4uirud 10.M Rent when the Rental Space is unusable. If Tenant uses part of the Rental Space, Tenant must pay Rent prrrrata for the usable part. l( 40 Rtow sw= ,r by.&v or other s,mdty. Ijmdlord shall repair it as soon as pntMe. nkl :ltwbu bs 1#,dal aga•V,otW 8eutstl $ptwartcll?awoa itt4iOW by Landlord.' Landlord need not repair or replace anything instailed.by'temt& i'-4 wr patty oft oars( thin Ji m irdw Agntpl dpacu Aktr.S+d*ftssW by fire or other casualty that w�itt 3tl E► If thro WtW **mot ttV^ 4a xg Won of a contractor chosen by Landlord and Tenant will be binding on W& pkdm 'iitia Let w shall end if the R*dd $+pace is totally dcstmyc& Tenant shall pay Rent to the date of If the fire or other omoly 'i4 caused by tho x*vr owisslarr of T'aaaat or irgnlnt'ss Rmpk7em Tenant shall pay fm all r aq.aii-tt0W 40006W,: 19. Embaeot Domain Eminent domain is the right of a SOV009* ta-lttwiPAY UMOMm-Wl 40ka priV*V Are' x i`rac public use. Fair value must be pai4 &rube preVertir. Tk'WUft 00W Qllb M by * t of * dewd' :iv1Ue1G' coa nuu»8'ppiY• f# }' rst #ire bui3t{ing 1 Orr Rattal $POW 4 t AMA by eminent :(tq..p+p�'s�Y*I.'t�tjs•(�D€r3R:x:a�ieertrt;(taa�et 't�fortlre talriag �1lbt��•'�ia�ta�ts(�xarsciiri�•+6c�rrrbrbt�6airiacenst• pactofttrai'Raa� o•d VUJ I7PWS Cu- Ju I.IJCL _ T T Onn•J O7 21L Subordination to Mortgage rn it forcclosurc nalc all mwtgWO which now or in the fatute aMrIt the Rental SPnce have priority ov4r this Lease, and Tonant AA dp all p Vc:m treed to give airy mortgage priority over this Lease; provid#4 howtn'cr, that. thiA AubordiFA*"n is oownrmt kwa thf• Tnartwfc wdt+*'?• q�raaTl�.nt that this Leas,on4ollpf'S'eaant'a•riglstrrhrtufl .,sfutlloarbad{s4xrrtzrx)<+ra cfac6ataFde•rrtaaeltc+PrttneFc f(pmlosW, au tog M-rmp +t is not in dgault hereunder beyoad mW wlicpble grace or cure periods. 21. violattoty EvkdwG l her wPd v%ft*p* l.nntiltxtl Mwvjas.u• riot of v"ntq whit AWNS, 1 wtillvld to and OF Low and re -eater the aRit Sjteies 1Ff ercmk f la tt► s tu►�r rtgttxgna�R do this i tea. This 4 4o" )3f*. 6.vtetton is a court procedures tooantrvc a tP+tar�i. Fr�itsc is stDat�. ity t�:. CtXipg ef's�n�+�>riairi5� r'� wu�+�t��xvir� u� a sumaagtes-ttcusief�.r of ecawr�,. �,d�# n!em •+r�seairsi'�a+ant fi�+tny amcoaE`tf,�t�cs $�ttds 4k vw,imm ova" i)y • 0WIL, AIN WWI m1w of s.�r� I, * t+ 4 a art:} i e s, wrNumt of .t�+u+gr-r Ara#ta adc txian's�dmto€ ne:t�,e el ewe- # I w: eSwevicomis aoa pep 4a . *DOs»: OW' tlo� l►tkk� kr the .sty '1�a►s# � f�$sf s�tfx� it?�i 4 � � there is�rotfitsac�peta.ctr%trf�arasfir�g�eta'�+ttfire�daysrap•6y'•�at:h�u+¢�' .a cwv** oar V*wo. 'x uu p% 45 ? row ail dummilm zwfto by Towes- Afso* of ony �ti4t�#i�tge. is�}ade}t�avcsdt"3�•txtr4ai. �iLare<ti�K+tts,'�aanamdt�atl Pay the li�atlbr terra mow« 4e a't •ta�u#�t r'sra'Yl r . t€ rrut+r l# �tk tx�n,,�a RCPW Spree zmu .Amu.pw ote, aw"ame, too ov coda thc.0 m: •irr arrdtl'i -i. ltred.60 i e,s+rtvc+st'xtwy.1ies+v >wwdt ��+a r�+�3w+wR+w Lease OF �bG+Mfe]r �ew•� os: i �.��'T�« art ,� cx •� sx '1'r, ari►ac sar.?h �w.eattt i&x• �? ' awidat>Ifa!t .�6,eFaty[l�te�:�•tts�i'ea�t�atid�„ #xi'. sh#�1Fx[el�cn�'��.'�t[kAs,�i•'�ttt•�A�+4�r� wMgt#ty` � 22. l od= to yR wnY•'• �*�•1F�i�t-{!1F ��IIF � J%Ni�•'�t�+r �'��• l� Ts�`i .As�HWI N7�Mt.WBAArt.•1�i'a� agelt ���wYfid ilt rove• w+rt►tir�i'h�lltdiM��b,� i�Aw. �eiv�t�Fa�it+: ft.%, Was. taaop*tictrikk Alt xrot't�s > qt� t�'� •� irr: l ��'•"• tee .notices give, by the 466A. �' � Doa rS; -C.wm � .9� ►sV w ate wrdd�cs�ts'2eva aitltta�+egr�a�cltn"t':�xta!4talt^1- a•a Yua i ar>I=Icun AM W.J 6-6 i T T ann;7 ap je W r—V 23. No W2iver iaadloWg failure to enforce any agmement in this Lease shalt not prevent Landlord from p�{p't}u.�Iyrquplry�plFttous accturmg at a Istp'tinna. 24. Survival if say ngreemtxit in this Lease is contrary to law, the rest of the Lease shall remain in effect 25. End of Term .�: dw =U, Write: Tuts t`�temt n?ustl (u) lguv�'thd itetuai Space +elefln,'(b) remove all of Tenant's paalxsty,c) xaa;oxa alI£�g`ax qt sesiat> �xt ptt6ar+ cp3 tfea'il 4n which they were placed, (d) repay all �+y va=4 bw toi. Ui4 (�) r-9i & ft. ti; iwl'• Sw iiiLvXdkwd it 60couaim qS itwas ����tlAa Taai,xeaKs�tetw; 3i f •xacz v, : «.3 •f» i4} ir. i-::"«;am e; %40dw *W 44) diepme of it aw charge T .Orlb)tOw AASMbedOw 4v+6 w 26 Aim Th& 3jM& twWW #A d Teat►nt and OU part= who lawfully succeed to their rights and *blxs. 27. Fnll Agreement 'I�. •prx a #ave.t;rattibia LOW. S csmtains their felt ,agreement. It may notbe changed except 28. Lott IrsYftolt trts%l"axtar,.u:#:',�.'atimlV99VCW;."�etlAft OWAW4Wther+ofor,Tenantshallpay ta�sNa'irz6ce�pe�'Le+oi;�l�i*tto �+drli<ap�c�c�tona�eLf (I.1n55) An adlwiisj s>ade� AaditclFaL�e�maff y� 4, Bro W= Tenant repreaeW 04 irr k tires *r1MpIt fW": J=: QU 4� �" t'` cy:.oe consultaBoMuswltlts�esp9et l�Nrl tar tr�a•t a!!� � atli= tkc .�'0r -arcy �arR aa! $pj" �..���'QF'S�i!'•� tbb SI •LU `. `M tiCr. i .?w�,s�Inm 4+>w*4t!4* -1446 4 IVOM A + A 114WO y wrA. alkd"Pom, iipiel5ctigsg'�"ir�e&almui newt ae !auE'e� aa� raPi�� or UVA�h of gty' t War d&Arftle. 30, E4uctd�#>i"s/igOff� LD #q&r4Ay p1'***MSi '�ty� >�`d'E?r`�I oftimethat 0 EM nr -el uuj i 7rw=IQ 1 au i.IAe,. e T T onn� oo _Jpi.i ib4 :;ttuity ;Xj"taftrd ira i#cw.Iti uWi Sao of which the Rent+il Space farru a part far the satisfaatio4 of scaulog ip'feaaut 08 a teaeh of the breach of any action of tills Leuc byLaediow& 31. Holdover In th4 evl tt �. f0 kataatsc 44+ Scastuf :.R .s� t;s:• y4. 'a WA"' ; tsr. ujV-4 1 -W eariiertam"matiaao€ffi�,��iys�8:�e.'i`+taTlxFtatsatf'Pr"vLa•t.�ntTfetscfdoxt�rti+tks: �'taardnr�tiax�k•c¢�tT>ie jG3Y'�'iL�isi: �.tvr t3XT TT.tDia T gt4in'' V.;Wl' dmi !A:;-= vx�AG4t, -or IVv- a7'.s%iiti4e W; rd-�i3i".�+u� ti-:l.:i •9i *YCt1t ` •"i' R "61AYC'#' Y {i l "d1ry1F'�,�,,,,,ri, 'al t•'GTit ape arG4 atarTal (fgC/iOLl13Ai%�tlf t'dttlR�' �'•' . ' g,'}^a-_*r :'i$T.dwsiiF•' F:l:?S!4'rU•'..'is%t> �i �iCh�w�i Lti :iCei �°9.64 %7�:ti�'tY%3t� i%+il c{� date hetnoA%D1'1%rlid+fe'acs �iritrOB3` lYiaCNCiIH �iS+Uft l�ilQk, ufflbFA. Dt i5 iiWtiixa +{4gt•. a' JLTK4W &Ottrt'#r$ u iao�t %i;�c 'i+4ikF2 97saiiUxT i}EtF Nstj'S#JNvNivil tap �t .Sphc� .��Id��llto t� cifJ�•fl� $".�e[� �"►ai fiYOf9 rip4 trx a .dr�t"©m fMM fMt 4hW Mit QWbW 4W a VMW Of" VWb 33. swd� pq t Emy pownVA # *Ap*ltps- *a lot *a3. Ir, 1VeAma u,: ;- sa yam,. -.; jmA( Gt.:v�"i`.;.=;: N :4"��i�•�.�,: dwcUbg was. bWO, POW to IMis'0at SM cwb OWWY slAy msent �"r+e' I*-k#A 00m kWk.: •i«4�:Sw �rTY. i�#�ki 1 # "°"c ;�.li;� su[.A'1;iz �. z`it�. .�i ««,.rr Qibilt�3�+�.s�=rAY1"ti�'�inTF+'>'yia�Yn�Txfi�71.5s7: nt :.C+�3t%`r�': ��7"�i'y«w'ic�rNh`X:�n1�56`S �,:kY3a'7L.R.�?LY4�y9T�i' asgw iR#•��• �'4�Q�WrrQB C7r�"UTi'fF'�J1tkV'ER�'YA'�rt7iR�Tf�ii']�!'�fi'i rECttllrY�'l�i �}t��'. ill LYYiF tnwmg W44 iteiir sLi+xo rlr, i+ ice t �aprwt* �rxr+h Xb at NeF aaT,capP� �'"� �+.c•gsayMrat +aka x i� t�erra'imae ba sr ei r t ni N. t :P`Y5T w n,a,=;r ac* oar bv�tow A rip * 3�asead it.� ss I.R' *oil 'Whm ecd: AAm i.a�otd Witaessed: An ttr Tarrant *,a.'to TauLat "twdPoMtapdaainra ittrbRtaiNwaWttrastpr"trittanddesaFa6ra� 9 ` WW4 Iaf'Nq_RW I fIH WAS+,:Ii RnnR RR JeW APPLICATION TO RENT �� APARTMENT COMMUNITIES (AND RECEIPT FOR APPLICATION SCREENING FEE) Please wmplalo (his form entirely in Ink, nollrg'WA' or 'none' wfiosa applicable Do not use white out. The, (nfanno9on you provide well be voe9M prior t TICAC'a approval to rent an apartment to you in an apartment community wmatl by altllar The Irvino Company, Irvmo Apartment Communibea, L P or Irvm CommomAol Property Company (cailoc9voly,'OwnoY'). � + , PA- Il2anbHlsto' -•�; =t�'% '"_>' '`.�-_<<•� - - IV ��p%�� Address Commumly. �i Vj rQpM12Aj �/' pyy BMfl•IplaoNnm fta2 Fur IITPf �� ,THE IR• •f MPANY BELT RKET RENT UNIT city ICAAM PM1AP^^ ny Xnemalteat. Fkatl`-d qlL qr�/\.� Data q,i�a`lJ I�Nu�O/—�/ Others 13 or S�APARIRMN COMMMMPIT 6. Reason for relocal on• I-Pl n AM `t- 0—t 7. How many vehicles do you own/drive? / t Make 4 Year Oy unmaa Year Llcam.0 Note: Parking of recreational vehicles, boats or trailers Is not permitted In the Community. B. Do you have Rental's Insurance? �Ye. El 9. Consent to Verification of Credit and Other Information: I am maklne els Applkallonvoluntarl ykr Me purpose of obtakingTICACle approval to rent an apartment h Me openeentcommmiry Morro above. I acknaMatlpemtthmpthe Notltt to Applicant Regarding Inveseee We Camumer Reports and endkol, oulhedae TICAC, CwneA and Maker ... dva employees and aeenh (cagamehy. Me 71CAC Parbmj, to any Me aedh and other Information prodded by me in Mb Application and W obtain uedd rep". ImmbgnW a consumer repwb, and other reports ham a eGt repartee agendas. tenant friearld,W,na Informlth.conbredidngamboNCamdraft. kedrust, ndandother pnam.wen.ber...ulwmadoneardi bthN Appgutlen. Islid aueodc<Ma TICAC und.mi is provide In.... M n conninad N eh AC Pruan b esdom but,.hb might teasel gwemmeal agendoo. , .Meerdeeal bowatlm vadut. law en(wamenr gentle.. 1 rmdenhnd Matu I lease MN apOr myLe se TICAC ora meni have a %nenuInand e st ttview my wear hfwmatlon, payment hMtary, euuperrcy hhlory and other In(ematlen In liar yppgution for purpesea tasted m my Lease and/or for amen bath durhp end aAer the term of my lease I hereby raiders and hold harmless The Irvine Company, IMne Apartment Communities, L P ,IMne Commercial Papery Company. The Who Crum., Apmment Commundlm, Ina, and all of Meb map.ctive omen., employees and scents from any and all11.ehw.local pmceednea and cash, indudlng Wromt .Ism, addng out of Me.0.11cn serer us. e( Me Ifwmatlon eonbined In this Appgeadm, Inch ding the release ofsucb Information to list perk.. I warrant Met, to Me beat of my knoMedoo,OR of Me efwmadm provided In Me AppYollon(Including but of sell to Me sMemant of my anandal omdtlon) h We. O..W. complete and cants m of Me dale of My Appacaden. If any hfwmatlon p.W.d by me 1. dakmJned b be Use, audit testa vestment we be pound. Iw dhepprowd of my Apphcatien or Imentsbar of an Lease WIN Prow. I .Rae 0 mtlly TICAC it arty of Me Infwmatlea moWded In his Application chances during Me Application proms. or during my tenancy. I No urdenland Mat TICAC key rdaIn NO Applicant alone with any wherhformation podded by me, Wrother as not Mh Application be approved A non-rofundable Application Screening Foe of S35.00 (as Romized below) le required from each Applicant to proems this Application and to check the Inform such provided. A separate Application to Rant must be signed by each Applicant who will occupy the apartment before this Application will be considered by TICAC. AN APPLICATION SCREENING FEE WILL NOT BE CHARGED l..sa' Data App m ulgm m on Me dot.belm, TICAC lcodyud$350 hem Me MWmlgned Apparent In eonnad. with Applomr. Appycatlon W Ram an epadmarat tom Caner I The soma..be[he to be ..ad feewmn A pliant with ,cards to east history and seer background Information. The amount charged Is Usual as follows- 1. Adual coats of each report unlawNl deWnw(adetbn) march, mdor other seeming mparb 1 Cast obtde. proms and wrilyraeeNng Infeen.&n(may Induda staff. time and other Mated cosh) g. Total let chwped(my not exceed US hot Applicant) i awlhcatlm of hfwmatlon suppled by Applicant il o.be)I Data 5T so $28 00 $on m gMfl �AwloRnb Raw flry tl T.m 2 WY Tax Paid Mall This Portion -with Your Paumentr Mg1Ba9ePaynrenl-..TOW Amtoua (Amount weYvim umRrO1 GMAC 16 G ys AFTEue OMa 31,638.68 33,12a.08 31,594.36 Mortgage J ,l�eeaa i6 - Sign lxretocnro8in monthiyACK full payments) t6ec badsfwdabac) ADDOIDmftdpal ADDMONALBaow Ii..LJddI,�,JI„..Idl,l.,,,dl„II„LI,,,IL,LL� �Ild Late Chafge S GMAC MORTGAGE OtherFees (pkatespecHy) < PO BOX 79135 PHOEENIXAZ86062-813S Total Amount Endosed ` I11.11116.1111„II„I1,IIId„111,1.IL61IIL.I,ILI m 02 0258 11511890504 00153868 04570 22222 8 I :OVER PAGE =11Ing Checklist For 2007 Tax Return Filed On Standard Forms 2repared on: 02106/2008 07:58:45 pm Return: CtDocuments and SettingslMatt%My-Documents%TaxCutlAmy Greenberg 2007 Tax Return.T07 ro file your 2007 tax return, simply follow these Instructions: step 1 -Sign and date the return if to sign your ris eturin To do this, youocantiveuse Faor rm 2848, Power of Attou must have a orneyrof and attorney of Representative. attached that lly authorizes the representative � Step 2 -Assemble the return These forms should be assembled behind Form 1040 —U.S. Individual Income Tax Return - Schedule A -Form 5329 -Form 2106 -Form 3903 Staple these documents to the front of the first page of the return: Form W-2: Wage and Tax Statement 1st (SUN VENDING INC) 2nd (FOODCRAFT INC) 3rd (CAPITOL BEVERAGE SERVICE INC) Step 3 -Mail the return Mail the return to this address: Department of the Treasury Internal Revenue Service Center Fresno, CA 93888.0002 We recommend that you use one of these IRS -approved methods to send your return. Retain the proof of mailing to avoid a late fling penalty: - U.S. Postal Service certified mail. -DHL Same Day Service, Next Day 10:30 am, Next Day 12:00 pm, Next Day 3:00 pm, or 2nd Day Service. - FedFx Priority Overnight, Standard Overnight, 2Day, International Priority, or International First. -United Parcel Service Next Day Air, Next Day Air Saver, 2nd Day Air, 2nd Day Air A.M., Worldwide Express Plus, or Worldwide Express. Step 4 - Keep a copy Print a second copy of the return for your records. We recommend that you also print and retain these supporting forms, which don't need to be sent to the IRS: -- Background Worksheet -- Form 1099-INTIOID --Form 1099-G --Home Mortgage Interest Worksheet --Non•W2 Wages -• Vehicle Worksheet 2007 Tax Return information. Keep this for your records. Here Is some additional information about your 2007 return. Keep this information with your records. You will need your 2007 AGI to electronically sign your return next year. - Quick Summary Total (Gross) Income $36,007 Adjusted Gross Income 31.57 Taxable Income 529 Total Federal Tax ,2 Total Payments 2.106 Penalties Refund Amount 690 Amount You Owe $0 POOR.. QUALITY .T ORIGINAL (S) Department of the Treasury —Internal Revenue Sorvice Label I.r2rr.3,A(SeeEinst"Cllons.) u I Use the IRS Hlabel. (O N m r+ t � 4 7��piri EnSN$NE x a 10 N log a fi 3� V ov ee tpCNt e z vo Id •u o 0 dU� d ad 6Ad if z �PF C • G S V i NqN xw� z a q „«7 ,ai s4 r�nu 1 no a � a � — o a ' o Ro o — N z N�i yy t;d it t .r Paperviork have a Apt. no address, see In."( 92660-3285 218-62-0291 Spouse's social security number . You must enter . your SSN(s) above. Checking a box below will not change your tax or refund ► ❑ YOU ❑ Spouse S I V,If 4 Ma o1 neusunma twin, yua6ymg person). ( as re . t Ues the qualifying person Is a child but not your dependent, enter IIr,a,d Income) this child's name here. ► is SSN above 4 5 ❑ Qualifying vadow(er) with dependent child (see Instructions) �u as a dependent. do not check box 6a .... .. l eo.acchocx.d 1 1 ona..nasb ... No. of children on 6c who: ' I I.1aopondonr. sW al.oanly MXnbof Imlalm hip , 2hllx�ir silo IXO0l ,too NiV, I 1 I f ° •lived with ro. _ ' • did not live with oiieeappmm-a wc. (se.lmtrucdons) 13 1.d.nl. on sC not .meNa^bM.. F............... ............ ...� .�.... 30, 603 it, W-2 ........... .. ...... ... . hquired ............ ..... Be®� 50 1 line Be ............ 86 0 IY! lif required go 0 .......... .. .. ........0 t 96 1................ . dale and local tncoma taxes (see instructions) ..... 10 0 ( ................ ...... 11 rdule C or C-EZ ................. 12 0 indeed If,wtmWeea modklnm ... ..... , ► ❑ 13 0 P7... .................. . . . 14 I 15a le Taxable amourittsee mst) 151, 5, 354 16a b Taxable amount (see inst) 166 0 t Ips,S corporations. trusts, etc. Attach Schedule E ..... 17 IsF.................. ....... .. 18 0 19 I I20al Ib Taxable amount(see trial,) 20b ke insWcbons) ___21 0 t tar Ilnes 7lhrou h 21 This is ourtotal Income . ► 22 6, 00 t 23 0 fa, performing artists, and 24 0 iFonn 2106 or 2106-EZ ...... . pch Form 8889 ..... 25 1 26 �h Schedule SE .......... 27 Illfied plans . ...... 28 0 ion(see instructions) .... 29 0 t 30 .. ...... ....... 1311.1 t 32 0 �structions) .. ........ 33 (m $917 1 34 on. Attach Form 8903 1 35 0 19h 35. . ..... .............. ... 36 4,750 ouradjusted gross income ............... ► 37 31,257 -tion Act Notice, see Instructions. Form 1040 (E007) F............... ............ ...� .�.... 30, 603 it, W-2 ........... .. ...... ... . hquired ............ ..... Be®� 50 1 line Be ............ 86 0 IY! lif required go 0 .......... .. .. ........0 t 96 1................ . dale and local tncoma taxes (see instructions) ..... 10 0 ( ................ ...... 11 rdule C or C-EZ ................. 12 0 indeed If,wtmWeea modklnm ... ..... , ► ❑ 13 0 P7... .................. . . . 14 I 15a le Taxable amourittsee mst) 151, 5, 354 16a b Taxable amount (see inst) 166 0 t Ips,S corporations. trusts, etc. Attach Schedule E ..... 17 IsF.................. ....... .. 18 0 19 I I20al Ib Taxable amount(see trial,) 20b ke insWcbons) ___21 0 t tar Ilnes 7lhrou h 21 This is ourtotal Income . ► 22 6, 00 t 23 0 fa, performing artists, and 24 0 iFonn 2106 or 2106-EZ ...... . pch Form 8889 ..... 25 1 26 �h Schedule SE .......... 27 Illfied plans . ...... 28 0 ion(see instructions) .... 29 0 t 30 .. ...... ....... 1311.1 t 32 0 �structions) .. ........ 33 (m $917 1 34 on. Attach Form 8903 1 35 0 19h 35. . ..... .............. ... 36 4,750 ouradjusted gross income ............... ► 37 31,257 -tion Act Notice, see Instructions. Form 1040 (E007) Form 1040(2007) Amy - M Greenberg 218-62 Tax and 38 Amount jfrom line 37 (adjusted gross income) ...................... ..... Check You were born before January 2, 1943. Blind. Total be 0 10r- Credits 39a if. Iq Spouse was bowl before January 2, 1943, E]� Blind. } checked ► 39. Ln return, or you wem a dual-smtusollen,eoe unu,aaa°e,amedrhem ►39bL Standard b Ifyourspouse temiaes on a separate Daducllon foP- 40 Itemized deductlons (from Schedule A) or your standard deduction (Soo left margin) .. . . People Who = km�kKM 41 42 Subtract line 40 from line 38 ................. ... ........ ... If line 38 is $117.300 or less, multiply $3.400 by the total number of exemptions claimed on line . 6d If line 38 is over $117,300, see the worksheel In the instructions ..... . 399 or 391,or who on be 43 Taxable Income. Subimct line 42 from line 41. If line 42 is more than line 41, enter -0• ...... . clalmed ea a dependent 44 Tax (see Instruction) Check If any tax is from see list[. a [] Fom4s) sett b []Form 4972 e [] Ferrll(s) 8889 •All others: 45 Alternative minimum tax (see Instructions). Attach Form 6251 Single or 46 ................ Add lines 44 and 45 .. • • • • • • • • • • .. ' • ► ee7ellln9 Y 47 . . Credit for child and dependent care expenses. Attach Ferm 2441 .- 47 $5,350 48 Credit for the elderly or the disabled. Attach Schedule R ......... 48 Married fling jointly, or 49 Educatlon credits. Attach Form 8863 .......... ...... 49 Qualifying 50 Residential energy credits. Attach Form 5695 ............ 50 0 widow0 51 Foreign tax credit Attach Form 1116 ifrequired - 51 62 Child tax credit (see instructions). Attach Form 8901 if required ..... 52 Head of household, 63 Retirement savin,8.s, contributions credit. Attach Form 8880 ....... 53 0 0 E7,850 64 Credlt5 from:af Form 8390 bB Form 8859 ceormFotm e839 54 65 0 55 rm 3800 b Fomiee Othercredils:a ❑Fo0t c F_ 66 Add lines 47 through 55. These are yourtotal credits ....................... . 22 0 Other 58 Self-employment tax Attach Schedule SE ...... .......... ...... -- 0 Taxes 59 unreported social security and Medicare tax from: a [] Form 4137 b [] Forth 8919 59 60 Additional tax on IRAs, other qualified retirement plans, etc. Attach Form 5329 if required BO BB 9 61 Advance eamed Income credit payments from Form(s) W-2, box 9 .... - • 61 0 62 Household employment taxes. Attach Schedule H ............. ... 62 0 Pa menu 64 Federal Income laXwithheld from Forms W2 and 1099 .. ..... 8youhavea 65 2007 estimated lax payments and amount applied from 2006 return.. qua11M°9 66a Earned income credit(EIC)....................... Mild. aeach sdredule EIC. b Nontaxable combat pay election ► 6sb 67 Excess social security and tier 1 RRTA tax withhold (see instructions) 68 Additional child lax credit. Attach Forth 8812 ............... 69 Amount paid with request for extension to file (see instructions) ... 70 Paymentsfrom: a []FOM 2439 b [] Farm 4136 c ElFormBOBS .. 71 Refundable credit for prier year minimum tax from Form 8801. line 27.. .... _. __ --. ._-.1_.._l-, r,._____.._...._,_r ...,...,,...,.. O4 66 - --- 2. 106 66a 0 67 68 69 76 71 vo s. Refund 73 If line 72 Is more than line 63, subtract line 63 from line 72. This Is the amount you overpaid 73 1 0J Dlreci depoalt? 74a Amount of line 73 ou want mfunded to you. It, 88B8Is attached, check here ..... ► ❑ 74a 69 Sea In m"Mons ► b Routing number %XXXXXXXX ► e Type: []X Checkmg [] Savings aml fill in 74b, 74c. and 74d, ► d Account number XXXXXXXXXXXXXXXXX or Form 8880. 75 Amount of line 73 you want applied to your 2008 asfimatedtax ► 1 75 0 Amount 76 Amount you owa. Subtract line 72 from line 63 For details on how to pay, seethe instructions ► 76 You Owe 77 Estimated tax penalty (see Instructions) 7T Third Party Do you want to allow another person to discuss this return with the IRS (see instructions)?[] Yes Complete the following No Designee Deslgnces Phone Persons indenUlkadon name ► W. ► _ number(PINI ►� Here Joint return? See inevuabne Preparers Paid signature Preparer's Firm's nan Use Only yours8sel Daytime phone number 949-254-5454 SCHEDULESA&B Schedule A —Itemized Deductions Oman. 15450074 2007 ) (Formil( (Schedule B Is on page 2) D•pelmmlo(aw Tmeay IMrnYReronue 9ervka ► Attach to Form 1040. P. See Instructions for Schedules A&B (Form 1040). Attachment Sequence No. 07 Name(s) sham on Form ism Amy M Greenberg Twr•WY •.cudrynumb. 218-62-0291 Medical Caution. Do not include expenses reimbursed or paid by others. o and 1 Medical and dental expenses (see instructions) 1 Dental 2 Enter amount from Form 1040, line 38 .. 2 31, 257 2,344 Expanses 3 Multiply line 2 by 7.5%(.075) ........ 3 ........... 0 4 Subtract line 3 from line 1. If line 3 is more than line 1 enter-0- ........ .... 4 5 State and local (check only one box): am Taxes You a x❑ Incometaxes,or g 862 ; Paid rb 0 General sales taxes } . . . . . . . . . . . . s 8 7,496 (See 6 Real estate taxes (see instructions) ..... . . . 0 Instructions.) 7 Personal property lazes ............. . , . , , .. , , 7 0 8 Other taxes. List type and amount _______________ g ___________________________________ 9 Add lines 5 through 8 ...... ....... ..... .. ...... 9 8, 358 report... Interest 10 Home mortgage interest and points ed to you 10 12,487 You Paid on Form 1098 ........................... 11 Home mortgage interest not reported to you on Form 1098. If paid (See Instructions.) to the person from whom you bought the home, see Instructions and show that person's name, Identifying no., and address ► ----------------------------------- ----------------------------------- Nola: _-- 11 0 _____________________ petwml 12 Points nal reported to you on Form 1098 See instructions la 0 Interest for special rules .....................'..... 12 13 0 deductible. 13 Qualified mortgage insurance premiums (See Instructions) ... 14 Investment Interest. Attach Form 4952 if required. (See instructions.) ........................... 14 15 15 Add lines 10 throw h 14.................................. 12,487 Gifts to 16 Gifts by cash or check. if you made any gift of $250 or 6' Charity more, see Instructions ..................... . If you made a 17 Other than by cash or check. If any gift of $250 or more, 17 ginandgota see instructions. You must attach Form 82831f over $500 .. . 1,enemlfor0, 18 Carryover from prior year ..................... 18 am lnifirmtlons. 19 Add lines 16 through 18 Casualty and 0 Theft Losses 20 Casualty or theft loss es . Attach Form 4684. See instructions. ...... ..... 20 Job Expenses 21 unreimbursed employee expenses —job travel, union - and Othor dues, job education, etc. Attach Form 2106 or 2106-EZ Miscellaneous if required. (See instructions.)►Form 2306 ---------------- Deductions (Sea ___________ - - - - - - - - - - - - - - - - - - - - - - - - Instructions.) 22 Tax preparation fees ...................... . 22 23 Other expenses —investment, safe deposit box, etc. List type and amount ► _______________________ 0 24 Add Tines 21 through 23 24 2,408 25 Enter amount from Form 1040, line 38 ... 25 31,257 625 ; 26 Multiply line 25 by 2% (.02) .................... 26 1,783 27 Subtract line 26 from line 24. If line 26 is more than line 24, enter-0. .......... 27 Other 28 Other —from list in the instructions. List type and amount ►_______________ Miscellaneous--------^-----------r----------T-----------ram Deductions 2g 0 Total 29 Is Farm 1040, line 38, over $156,400 (over $78,200 if married filing separately)? Itemized ❑X No. Your deduction Is not limited. Add the amounts in the far right column Deductions for lines 4 through 28. Also, enter this amount on Form 1040, line 40. P. 2s 22, 628 30 I,.J Yes. Your deduction may be limited. See instructions for the amount to enterJ fyou elW to itemize deduclionn even though they are Iess than your standard deduction, check here ... ► KIA For P,sper,vork Reduction Act Notice, see Form 1040 instructions. ,. - Schedule A (Form 1040) 2007 Additional Taxes on Qualified Plans .5329 (Including IRAs) and Other Tax -Favored Accounts ► Attach to Form 1040 or Form 1040NR. p.o.nmwdu»Treuw W-,ui Y,w.wxCnnY'e ► See separate Instructions. OMB No 1545.0074 2007 AI aMment Seauenw No. 29 Amy M Greenberg 218-62-0291 Fill In Your Address Only Home addoms(number and abaaq,arP.O. box llmailis notdelihmed toyourhome Apt no. If You Are Filing This 1228 Alicante Form by Itself and Not Clry, torn orpost orate, stale, am ZIP code If this is an amended With Your Tax Rc Newport Beach CA 92660-3285 return, check here ► ❑ If you only owe the additional 10% tax on early distributions, you may be able to report this tax directly on Form 1040, line 60, or on Form 104ONR, line 55, without filing Form 5329. See the instructions for Form 1040, line 60, or for Form.1040NR, line 55. Additional Tax on Early Distributions i Complete this part if you took a taxable distribution, before you reached age 5942, from a qualified retirement plan (Including an IRA) or modified endowment contract (unless you are reporting this lax dlrectty on Fan 1040 or Form 104ONR—sea above). You may also have to complete this part to Indicate that you quality for an exception to the additional lax an early distributions 1 Early distributions included in Income. For Roth IRA distributions, see instructions ....... .. 1 2 Early distributions Included on line 1 that are not subject to the additional tax (see Instructions). Enter the appropriate exception number from the Instructions: 0 3 Amount subject to additional tax. Subtract line 2 from line 1 ..... .... 3 5,354 4 Additional tax. Enter 10% (.10) of line 3. Include this amount on Form 1040, line 60. or Form 889 1040NR. line 55............................................. 4 Caution: If any part of the amount on line 3 was a distribution from a SIMPLE IRA, you may have s to include 25% of that amount on line 4 instead of 10% (see instructions). Additional Tax on Certain Distributions From Education Accounts Complete this part if you included an amount in income, on Form 1040 or Form 104ONR, line 21, from a Coverdell education savings account (ESA) or a qualified tuition program (QTP). 5 Distributions Included in income from Coverdell ESAs and QTPs ................... 0 6 Distributions included on line 5 that are not subject to the additional tax (see instructions) ...... 6 7 Amount subject to additional tax. Subtract line 6 from line 5 7 0 8 Additional tax. Enter 10% (.10) of line 7. Include this amount on Form 1040, line 60. or Fan 1040NR, lino 55 8 0 Additional Tax on Excess Contributions to Traditional IRAs this part if you contributed more to your traditional IR4for2007 than is allowable or you had an amount 9 Enter yourexcess contributions from line 16 of your 2006 Form 5329 (see instructions). If zero, 9 goto line 15........................................... ... 10 If your traditional IRA contributions for 2007 are less than your maximum allowable contribution, see Instructions. Otherwise, enter-0- 11 2007 traditional IRA distributions Included In Income (see Instructions) .. 11 12 2007 distributions of prior year excess contributions (see Instructions) ... 12 13 Add lines 10, 11, and 12........................................ 13 14 Prior year excess contributions. Subtract line 13 from line 9. If zero or less, enter-0- ... .. 14 15 Excess contributions for 2007 (see Instructions) ............................ 15 0 16 Total excess contributions. Add lines 14 and 15 ............................ 16 0 17 Additional tax. Enter 6%(.06) of the smaller of line 16 or the value of your traditional IRAs on December 31, 2007 includin 2007 contributions made in 2006 Include this amount on Form 1040, line 60. or Form 1040NR, line 55 17 0 offl Additional Tax on Excess Contributions to Roth IRAs Complete this part if you contributed more to your Roth IRAs for 2007 than is allowable or you had an amount on line 25 of your 2006 Form 5329. 18 Enter your excess contributions from line 24 of your 2006 Form 5329 (sea instructions). If zero, go to line 23 .. 18 19 If your Rath IRA contributions for 2007 are less than your maximum allowable contribution, see instructions Otherwise, enter-0. ...... 20 2007 dislribulipns from your Roth IRAs (see instructions) .......... 20 ¢, 21 Add lines 19 and 20........................................... 21 22 Prior year excess contributions. Subtract line 21 from line 16. If zero or less, enter-0. ....... 22 23 Excess contributions for 2007 (see instructions) ... ... 23 0 24 Total excess contributions. Add lines 22 and 23 ........................... 24 0 25 Additional tax. Enter 6% (.06) of the smaller of line 24 or the value of your Roth IRAs on December 31. 2007 (including 2007 contributions made in 2008). Include this amount on Form 1040, line 60, or Form 1040NR, line 55 1 25 1 0 - KIA - For Privacy Act and Paperwork Reduction Act Notice, see the instructions. _ Form 6329 (2067) ' Forth 5329 (2007) Amy M Greenberg 218-62-0291 Page 2 Additional Tax on Excess Contributions to Coverdell ESAs Complete this pan if the contributions to your Coverdell ESAs for 2007 were more than Is allowable or you had an amount on line 33 of your 2006 Form 5329. 26 zero, Enter the excess contributions from line 32 of your 2006 Form 5329 (see InstrutA go to line 31..................................zero ..... 2627 28 30 If the conlrihutions to your Coverdell ESAs for 2007were Tess than the maximum allowable contribution, see instructions. Otherwise, enter-0- 2007 distiibuuons from your Coverdell ESAs (see instructions) .......29 Add Imes 27 and 28 Prior year excess contributions. Subtract line 29 from line 26. If zero or less, en...... , Excess contributions for 2007 (see Instructions) ....................... Total excess contributions. Add lines 30 and 31 ....................... 29 3031 3132 32033 33 0 Additional tax. Enter 6% (.06) of the smaller of line 32 or the value of your CoAs onDecember 31, 2007 (including 2007 contributions made in 2008). Include this aForm1040, line 60, or Form 1040NR, line 55 .... ......... ............. 181111 Additional Tax on Excess Contributions to Archer MSAs Complete this pan if you or your employer contributed more to your Archer MSAs for 2007 than is allowable or you had an amount on line 41 of your 2006 Form 5329, 34 Enter the excess contributions from fine 40 of your 2006 Form 5329 (see instructions). If zero, go to line 39 ............................ .................. 34 36 If the contributions to your Archer MSAs for 2007 are less than the 35 maximum allowable contribution, see Instructions. Otherwise, enter A- . . 37 36 37 38 39 40 2007 distributions from your Archer MSAs from Form 8853, line 10 .....1 36 Add lines 35 and 36 ............ .. .......................... Prior year excess contributions. Subtract line 37 from line 34. If zero or less, enter-0- ....... Excess conlributtons for 2007 (see instructions) Total excess contributions. Add Imes 38 and 39 ... ... ................... 38 39 0 40 0 41 Additional tax. Enter 6% (.06) of the smaller of line 40 or the value of your Archer MSAS on December 31, 2007 (Include 2007 contributions made in 2008). Include this amount on Farm 1040, line 60, or Form 1040NR, line 55................................. 41 0 Additional Tax on Excess Contributions to Health Savings Account (HSAs) Complete this part if you, someone on your behalf, or your employer contributed more to your HSAs for 2007 than is 42 Enter the excess contributions from line 48 of your 2006 Form 5329. if zero, go to line 47 ....... 4z 43 If the contributions to your HSAs for 2007 are less than the maximum p allowable contribution, see instructions. Otherwise, enter-0- 43 ��I 44 2007 distributions from your HSAs from Form 8889, line 16 ......... 44 k' 45 Add Imes 43 and 44 ........... ............ .............. , 45 46 Prior year excess contributions. Subtract line 45 from line 42. If zero or less, enter -0. ........ 46 47 Excess contributions for 2007 (see Instructions) ............................ 47 48 Total excess centnbutions. Add lines 46 and 47 ............................ .48 0 49 Additional tax. Enter 6%( 06) of the smaller of line 46 or the value of your HSAs on December 31, 2007 (including 0 2007 contributions made in 2008). Include this amount on Form 1040, line 60. or Form 1040NR, line 55 49 90MIR Additional Tax on Excess Accumulation In Qualified Retirement Plans (Including IRAs) 50 Minimum required distribution for 2007 (see instructions) ........ so 51 Amount actually distributed to you in 2007 . . .................... ...... 51 52 Subtract line 51 from line 50. If zero or less, enter-0......... ................. 52 0 53 Additional tax. Enter 50%(.501 of line 52. Include [his amount on Forth 1040. line 60. or Pon 1040NR, line 55 . 53 0 Please I and belief, it is We, correct, and complete, Declaration of preparer(oNerthan taxpayer)a based on all information o(whlch preparer has any knMirsage Sign Here ' Your signature ' Date Paid Preparers ' Date Check if self- ❑ Preparers SSN or PnN signature employed e s U Only Use Only �n710oY�)�urs' Phone no. Pho address. and 21P code so., KIA •• Farm 6329 (2007) n Fenn 2106 r y Employee Business Expenses OMa No. 154"014 207 0 ► See separate Instructions, gtlaca0 een'No oepultleNoruw Treasvy MsmM Rave,ue 5erviw ► Attach to Form 1040 or Form 1040NR. se uerm 54 Yourname O, paOon In which youinwrted espartos umber sac1 security 62- 291 218-62-0291 pray M Greenberg Sales Employee Business Expenses and Reimbursements Column A Column B Step 1 Enter Your Expenses Other Than Meals Meals and and Entertainment Entertainment 1 Vehide expense from line 22 or line 29. (Rural mall carriers: See 1 2,408 'Instructions.) ........................ n . . . . . . 2 Parking fees, tolls, and transportation, Including train, bus, etc , that 2 0 did not Involve overnight travel or commuting to and from work . . 3 Travel expense while away from home overnight, including lodging, 3 airplane, car rental, etc. Do not Include meals and entertainment . . 4 Business expenses not Included on Imes 1 through 3. Do not 4 0 Include meals and entertainment ......... .... . 5 Meals and entertainment expenses (see instructions) ......... 0 _ 6 Total expenses, In Column A, add lines 1 through 4 and enter the I 6 I 2,408 result. In Column B, enter the amount from line 5 .......... . Note: If you were not reimbursed for any expenses in Step 1, skip line 7 and enlerthe amount from line 6 on line B. Step 2 Enter Reimbursements Received From Your Employer for Expenses Listed in Step 1 7 Enter reimbursements received from your employer that were not reported to you in box 1 of Form W-2. Include any reimbursements reported under wde "L" In box 12 of your Form W-2 (see Instructions) 7 0 Stop 3 Figure Expenses To Deduct on Schedule A (Form 1040) 8 Subtract line 7 from line 6 If zero or less, enter -0-. However, If line 7 is greater than line 6 in Column A, report the excess as 1:2, income on Form 1040, line 7 (or on Form 1040NR, line 8) ...... . Note: If both columns ofline 8 are zero, you cannot deduct employee business expenses. Slop here and attach Form 2106 to yourretum. 9 In Column A, enter the amount from line 8. In Column 8, multiply line 8 by 50% (.50). (Employees subject to Department of Transportation (DOT) hours of,service limits: Multiply meal expenses incurred while away,from home on business by 75% (.75) instead of 50%. For details, see instructions.) . ........... 10 Add the amounts on line 9 of both columns and enter the total here. Also, enter the total on Schedule A (Form 1040), line 21 (or an Schedule A (Form 10401JR), line 9). (Reservists, qualified performing artists, fee -basis state or local government officials, and Individuals with disabilities: See the Instructions for special rules on where to enter the total ) ......... . KIA For Paperwork Raduceon Act Notice, see instructions 0 2,408 Form 2106 (2007) • , M( complete this section if you I (a) Vehicle 1 (b) Vehicle 2 11 Enter the date vehicle was, placed In service . ... . ... . ........ " emu' " ' 12 Total miles the vehicle was driven during 2007 ........ . . ..... 12 ?, 862 miles miles 13 Business miles included on line 12 .......... . ........... 13 4, 964 miles miles 14 Percent of business use. Divide line 13 by line 12 ........... . .. 14 63.14 -A15 Average daily roundidp commuting distance ...... .... 15 24 miles I miles 16 552 .11.91 miles 16 Commuting miles Included on line 12 .................... 17 2, 346 miles miles, 17 Other miles. Add lines 13 and 16 and subtract the total from line 12 ..... X 18 Do you (or your spouse) have another vehicle available for personal use? ................ .: ❑ ,Yes No 19 Was your vehicle available for personal use during off -duty hours? ... ,. ................. 9 ❑Yes X No 20 Do you have evidence to support your deduction? .... . .............. . ............ Yes X No 21 If"Yes," is the evidence written? .................... . ..... ... . .... . ..... Yes No 22 Multiply line 13 by 48.50 (.485) .... , ...... . ............ ( 22 I 2,408 23 Gasoline, oil, repairs, vehicle Insurance, etc. 24a Vehicle rentals , ........ . b Inclusion amount (see Instructions) . c Subtract line 24b from line 24a . . 25 Value of employer -provided vehicle (applies only if 100% of annual lease value was Included on Form W-2—see instructions) 26 Add lines 23, 24c, and 25 ... . 27 Multiply line 26 by the percentage on line 14 . , . , . . 28 Depreciation (see Instructions) . . 29 Add lines 27 and 28. Enter total here and on line 1 ....... . 30 Enter cost or other basis (see Instructions) .... ... .. . 30 31 31 Enter section 179 deduction (see Instructions) ...... . 32 Multiply line 30 by line 14 (see Instructions If you claimed the section 179 deduction or special allowance) ... .. . 32 33 33 Enter depreciation method and percentage (see Instructions) 34 34 Multiply line 32 by the percentage on line 33 (see instructions) ... 35 Add lines 31 and 34 ....... 36 36 36 Enter the applicable limit explained In the line 36 instructions ... 37 37 Multiply line 36 by the percentage on line 14 ..... 38 Enter the smaller of line 35 or linb 37. If you skipped lihes 36 and 37, enter the amount from line 35. Also enter this amount on line 28 above .... 38 ;r7 9 0 Form V OMB No. 1545-0074 Form$903 I Moving Expenses 2007 ► Attach to Form 1040 or Form 1040NR. aA =6e No. 62 ewxM•Natlw Tnwry ,,,,..,,da seeudw numbor 9am•(•) anorm on rayon 1218-62-0291 Amy M Greenberg begin: •See the Distance Test and Time Test in the instmchons to find out if you can deduct your moving Before you expenses. • See Members of the Armed Forces in the Instructions, if applicable. 1 Transportation and storage of household goods and personal effects (see Instructions) ..... . 1 4,500 2 Travel (including lodging) from your old home to your new home (see instructions). Do not Includ` 2 250 the cost of meals .4...:. 3 4,750 3 Add lines l and ........................................... 4 Enter the total amount your employer paid you for the expenses listed on lines 1 and 2 that is not Included in box 1 of your Form W2 (wages). This amount should be shown In . 4 0 box 12 of your Form W-2 with code P ............. . ................ 5 Is line 3 more than line 47 No You cannot from line 4 and deduct include the result onpForms1040, line 7I or Form ess than line 1040NR, linec8line 3 ® Yes. Subtract n4nMR. line 26 This is your moving expense deduction 40, line 26, or 5 q, 75C n 0 KIA For Paperwork Reduction Act Notice, see Instructions am Je OJ (2001) ne' at �.avu -rm „ ur emu.. u�..�. r ..� P• VILLA POINT If (Off -sits Newport North Apartments) Unit No. fss AL(n1 G11� k°Qi URGEN1 CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in poaeuion of a Section $ certificate or voucher, income documentation must be obtained.) Me certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned istare the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2007, the Total Annual Eligible Income* of the undersigned individual(s) was $ 90°f23.5-L • and, 3. During 2007, my total monthly rent payment to Villa Point ii (Off -site Newport Forth Apartments) was $ S 21. SO per month. (,eidwf d I sc6V-r+F " Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -Income Earning Household Mamber(s): Name Age Signature(a) of Income Earning Household Member(a): Signature Sipneture Signature Dater. ��I o/u oq 7.7 /: 71 $94b. Fa'Idddci0.�,,a?elq fl✓tieunaBPsi . "ah. <'_:^��._`z.%c'=. .. a,.,f _ ...._ Y a-^:F =_ F a_ 4^' :.:.�, --•- ... _.. _ "=_- . - -' - •' - �� ('�aaotkD to �R4 =oil ~ �'-iian __ ._. .:•.-,.,.. _ Foam VW-2 Wage and Tax 9tateinent ('•..^-.CopynG�. Far E'MPLO'V Y.,..ROS'. Employees pope oroMa heTmasu74^on°I Rn'e^ao5e'4 Thlsnfo maha reNm.ar Copy drel .I Rovanuo Swim Iryouarereauledtonbama kxabk andyoi 2007 olhar apshan mny ba ImPaaodo^you It assiocoma's owe No 1664a008 u, ry'pb115j0.85E trm{turVa10 n+^!?t;„"�--«.� asw. it1'.IVS gTAkSU State oopy2-Toaa Filed With Employee's State, My or Lowl income 2007 Form W-2 Wage and Tax Statement Filing Copy Ratum paPamnaneatbeTroasuq-mten81 Ra�e,wa Bpi, oacr oampensodon sennao 2Fedomllzomo OMH Wo t6A$7 eh sochl security nUmbor bErnployer ldonldlatbnnumber (EIN) 75pdal eecantyllps tWaBasr 40423.52 .0 20.0397577 a Albated npe 35oda1 sccurdywaBas ASoPWl sdwmyl a n0, eddloss, and ZIP c 40531.53 _ Apartment Communities [EMMOYee$,,�ro BAdwr¢o El PaYmonl SMadiamw+pa eM bpstgs 40531.53 BModkam lmtw novation Drive . CA 92617 tOOepandeM care brnefi5 -72a Soa instrudmnsbr bmt t2 100.01 12b nonm end llNWl Lest wma Sutt it NOMnlualmed phM p� i2e 12d NICIIOI.A3 K, HERWICH 13 SbaUt R in n" True-wM vnPlq. yna O"M 14 rnher CA -SDI 243.19 1558 VALENCIA NFWW BEACH. CA 92660 ❑ Q ❑ _ fE 'saddresv end ZIPcode t75tate incomo but tB Local vices. Vps, ale 7B Lowlinwmsbs 281ttaeryn S Slak EniployeraSmto lD No lB bhna wages,Is otc 40423.52 1410.64 CA 44 7 FOEfn W-2 Federal Copy6-Ta PIIcd With Employee's FU ttia�e and Tax Statement Filing Copy paPaMmntaffieTmaaary-Internal Re+em .._ __.. e Fmp fsnama, atl msc, on code unuoam�W. - 40531.53 Irvine Afyrt*ent Cl:Wunities ante _I .paymuM 5 dlaiewamasard Ops efAcdlam mxr 40531.53 110 Innovation Drive Irvine, CA 92617 to opendentearo snohts 12a Sao mshanpne to box 121, io6.o1 San. it Nonquabried plans p t2c 124 e Empbyea'611RLnama mid lN[lal Lit nomo I NICIKKAS K. IIEBDRICIi isa am""10At T^°bpan y"e J4 CA -SDI 2M13.19 1558 VALENCIA NENPOBT BEACH. CA 92660 ❑ ❑ ❑ f 'co emsond ZlPcoda 17 care mmne tea 10Lx wages, tlps, as 78 t�alincmetas 2D Loaety Now EMOMIIe Satps,eloN iustatowai;mtac 40423.52 1410.64 - 43942364 - — famished m i ipanalvor i Pon IL 587.71 I I VILLA POINT II (Off -site Newport North Apartments) Unit No. C23_�1_A1PrP(_a CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtained.) Me certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2007, the Total Annual Eligible Income* of the undersigned individual(s) was $ and, 3. During 2007, my total monthly re t pay nt to Villa Po II (Off -site Newport Noqdr Apartments) was $ A' er month /3�� 2' * Total Annual Eligible Income includes: wages, tips, ove , bonuses, commissions, net income from AV6ZN a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point If (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -Income Earning Household Member(s): Name Age Signature(s) of Income Earning Household Member(s): Signature Signature /,/,- Signature Date: �`d / V t T X, 9//IfP VILLA POINT II (Off -site Newport North Apartments) Unit No. `24�() CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtained.) Me certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2007, the Total Annual Eligible Income* of the undersigned individual(s) was $ 43 DO ; and, 3. During 2007, my total monthly rent payment to Villa Point II (Off -site Newport North Apartments) was $ 1 4f 9 1 ' °'" _ per onth. 1'k�,'� k tad ,t ooi, ciI, * Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -Income Earning Household Member(s): Name Signature(s) of Income Earning Household Member(s): Age S&A�/ tare Signature Signature Date: Mi 9//s/o a till" 1-, 2007 w-z anG tAKNINUZtUMMAMY FART! UwatWW.1govee.7 -lbyiV 1`14for8bc0 Uppy ...... i, 7 is 1;10 v u -mmarysecuoirminciticiect e,4e.jersp,sidi�:iiiclddesg'�neihilin'toi�iti"O'I jolkMa"YaiiQ-6hd1helpful," rM 9 111 lonreff�ects y6ur,final 2GO7I navifLb.cluianviluitfn1e-1�1 ta in� 6mifted 6Y- youiih0loye 4�081 ef-olW I `a-AI 'a --fornna;i- Gyi- Y, ,414?qvG§ Social Secudy 23b9T CA 1037:63 Cop. EmpI1oKue anI 001 86IONL2 [__mr 10j A 16 Tox-Vithililid B6x176f,W-2- vox,4o(W2 0VUlli ­ o EmpWittesnanurouldress,andZIPoodo axj4ofW,_ ANNELIESES PRESCHOOL INC ".Fra�orrcome 47,17',39� Mireddh�Tax 547. 14 758 MANZANITA DR. -TikWitlihild. Wittifield LAGUNA BEACH CA 92651 da :2 bfV_2 T6x6ofW­2, your i3i'66t F.Ity"allagitiked isfollowAto-oroduce,YburW-2-Statement. Batch #02165 Wnge's,Tlidspother Sociall6ecurftY 'lilglicare Wages;, Conriperisatiod wades Wages Tios, Etc. Box I of W-2 Box 3 of W-2 Box 5 of W. 2 Box46-ofV-2 all EmphaiNte's mine, address, and ZIP code LISA MARIE BRANIGAN 2407 NAPLES Grosiptly 41.496.65- 41,495.65 411i,495,65: 41,i495.65• NEWPORT BEACH CA 92660 Less 461 (k) (D-Pox 12) 2,489.76 N/A 'N%A 2,489,.76 -S-SAIRIMER Less Other Cafe425 3,762.00 3,762. bid 3,762,.09 - 3,762:001 Reported W-2'Wages 35,243.89 37,733,65 37,7334.65 35,2�13. 1119 b g pl,%, T r a EMP102Y" .3663439 55-0018 35243.89 4717.39 3 SmIal socially wages 4 social security tax withheld 37733.65 2339.49 5 Medicare wages and tips 6 Medicare tax withheld 37733.65 547.14 3o ims urltytipo 8 A110001KII'mr - 3. Employee W,4 Profile. To change your Employ" W-4 Profile information, file a new W-4 with your payroll dept. 9 AdIvems, Ere Payment - to Dependent Care benefft LISA MARIE BRANIGAN Social Security Number: 258-SS-0018 17 Prowtim,1101*1 plans Iga re n I Or �I Taxable Marital Status: SINGLE 2407 NAPLES 7 _01tW_ _ 121, - 4 NEWPORT BEACH CA 92660 ExemptionatAlimances: J11:88 W/ FEDERAL: 0 T35totem ReLpar parlysIckpoi nw�x STATE: 0 16 Starial Employees state ID no, 16 state W49M tips, alm CA 213.3347-1 35243.89 t7 stow them m W 1037.63 0 M7 ADP. INC 19 Local Income hot 20 Locality mum, - - - - - - - - - - - - - - - - - - - - - - ---------------------------------- - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - as", him, ~ come 2 FedarellmometaXYnth mid so d Wage., tips, otFe-r comp. 2 Federal[ ornotaxwIthheld I Wages,tip.,otbercomp. 2 FederelinconnotaxwIthheld 1 35243.89 4717.39 4717.39 352,a 9 4717.39 3 social asourity3wer 4 socialseculffirmwn7h-eld 35243.89 Withheld 4 Socialsecurhytomwithhetc! 3 -smisleurityw-ges 4 4 bocuunocurn"Affi.,65 2339.49 2339.49 T 33.65 2339.49 5 Medicare 8 Modicaret xwIthhold wme-UMM., 37733.65 5 Medicarewoliesandtip3 d 5 medicarawages and tips 6 ModicaretaxwIthheld 5 medicaretaxwIthmi 5 7. 547.14 65 6 Medicare t-wRhh.ld 4 547.14 377313 65 547.14 Dept. Corp. 37733.65 d control number Dept -corp. I Employerussonly d controinumber L C Employer use only d Contra! numb" 1 001586 10jYL2 101 I Amplayertissonl6y 1 6 16 L2 101 A 16 001586 10/YL2 101 1 A 001586 10/Y I c Employees name, acidness, and MP cc" 1 0 Employer's name, address, and ZIP Code ANNELIESES PRESCHOOL INC a Employees now, addrares, and 23P code ANNELIESES PRESCHOOL INC ANNELIESES PRESCHOOL INC 758 MANZANITA DR. 758 MANZANITA DR, i 758 MANZANITA DR. LAGUNA BEACH CA 92651 LAGUNA BEACH CA 92651 LAGUNA BEACH CA 92651 b Era in bar •_-Emplowl's 55A nu in PV1194M F_ a SA n r b es FED 0 numb" SSA number "a ho Employs 0018 b EmplommFED tuber eNssVonounbe rerp".05i8-SIVID0118 663V ' 2 TS "- 0 8.55-0018, I 8004111sects"tip, 8 Allocated tips " 7 Socialsecuritytipa 8 Allocoted 7 so0alsocurillytips TA_11�tedflps led tips ace Etc payment 10 Dopentlont "to benefits ;Empi 9 Advance lCpayment 0.Fo Bipndent _-.benfrt. I flt Advance Etc payment to Dependant"re benehis it monq"iom piano l2as"Inseticto a o X12 1 11 Nonqualifled plans 112A 89 24 M6 1 1211 D 2489.76 D 2489.76 D 1 14 other 1 1 14 Other T4-6h-.r I 226.40 SDI 1 1 1 226.40 CA SDI 12d 12C 226.40 CA SDI 3762.00 INS 12d i 1.20 M 3762.00 INS 13 Star my RA �n party sick pay 1 1 I 3762.00 INS ia slot w1karnIm pimyy.vc, m 13 Staternp.1ketl4nr party alci -eF_Em0.y*v.n.m-, -hit" a Emp.W. name, address and ZIP Code N Employee's name, address and ZIP code LISA MARIE BRANIGAN LISA MARIE BRANIGAN LISA MARIE BRANIGAN 2407 NAPLES i 2407 NAPLES 2407 NAPLES NEWPORT BEACH CA 92660 NEWPORT BEACH CA 92660 NEWPORT BEACH CA 92660 Is _810, 6statewag".ti �15'243.89 15 Welllmg!cger 3irtelDno. T6 state wag-", tim, etc. 7. 35243.89 to am 16 State wages, Ups, etc. 35243.81 CA McNaVIle'u;F-T� 18 Local wages, tips, atc. .1 wag., tlpa� CS A 3 if Stets Local Wag-, - 1. Local Wag", Ups, m1c. s 1.1 ormt a 1-. 17 Sure IncomOUX 17 Whols, Income tax [18_c� ,.t.. i, 1037.0 1037.63 TS---L..l in... tax Locaurynam. :1037.63 Is Localincometam 2D Locally name 19 Local 1 tax2 is Locallmoorm, tax 20 Locality name bar. nto .,;,e W �X orenCe 0, 0. ."M 11, tote a am Wai�td % �tiii hi00'/• 2w 0 me t MU C,JYU4 Stot"Jig n 16 OWK04*0 LO IiCcoe�it a 7 11 May 12 2008 4:50PM HP LRSERJET FRX NCOl& CERTIFICATION ffective Date: (YS 1 ) TENANT I ave-m Date: C�—! t OtherN %1:11 itial Certification ❑ k artification AMD/YYYY _^ Newport North " : `' County: Oranee 'BIN If. N/A Property Name: Unit Numbent b # Bedrooms: Address: 2 Milano NewDott Beach, CA 92660 • First Name & Middle Relationship to Head Date of Birth F/T Student • Social Security Alien Re.No. HH Mbr # Last Name I •tial f Household (MM/DD/YY) tYorl� or oYY HEAD 2 A 3 4 5 6 7 = (D) HH Mbr # (A) E to torwa es (13) Sec. Securit /Pensions (C) PublicAssistacc Other Income $ [ $ VT'AT T7U Miz /Fl• f .�•'t \ O.�CQ Add totals from (A) th ougll (L ), above (H) Hshld (� (G) Asset CA Cash Value of Asset Annual Income from Asset Mbr # e of G Z C— TOTALS: $ 543 $ Enter Column (H) Total Passbook Raw X 2.001K _ (J) Imputed Income S If over $5000 S Eater the greater of the total of column I, or J: imputed income TOTAL INCOME FROM ASSETS (!q g t, (L) Total Annual Household Income from all Sources (Add (E) + (K)] �(.pili•b',"^3-r' ei';a:��.r '"r"(.���)IY :1•: �a+ -r ..�1- - - n..w n . w.t.l.ln �rriflenrin Theinformationmmthisform will be used to detemdnemaximumincomeelig/bility.I/we have provided for eachpersootsr—<vr-....-.r—•-•--•----- orcurrent anticipated annual income. Uwe agree to notify the landlord immediately upon any member of the household moving out of the unit or anynew member moving bL Ywe agree to notify the landlord immediately upon any member becoming a full time student. tfnda peaalues of perjury, Uwe c "fy that the information presented in this Certification is true and �accuraw to the best of my/our knowledge and belief. undersigned further understands providing false repmcmaiiow herein constitutes an act of fraud. False, misleadi or incomplete information may radii in tetTnination of lease agree f' ���' ( te) Sigrtatum reJ signature a 1 T (Dare) (Date) Signawre Signature TOTAL ANNUAL HOUSEHOLD INCO L SOURCES:ME FROM AL70,1 From item (L) on page I $ Y� Current Income Limit per Family Size: $ �jj v o O `V P� Household Income at Move -in: $ t%� 1 •2 RECERTIFICATION ONLY: Current Income Limit x 140W Household Income exceeds 140% at ref�'ircaln: ❑ Yes Io Household Size at Move -in: a — ` Tenant Paid Rent �"� Rent Assistance: $ $a Utility Allowance $ _ Other non -optional charges: GROSS RENT FOR UNTO: Utility Allowance & j Unit Meets Rent Restriction at ��— (Tenant paid rent plus 14L3 ❑ 60% ❑ 50% ❑ 40% ❑ 30%% other non -optional charges) $ �i Maximum Rent Limit for this unit: $ ;•r -. ,G.SIUDENT;STAxIS _ :.• *Student Explanation: ARE ALL OCCUPANTS FULL TIME STUDENTS? If yes, Enter student explanation* (also attach documentation) I 2 TANF assistance Job Training Program 3 Single parent/dependent child ❑ yes'11 0 lilsl� 4 Married/joint=turn Enter 1-4 a. Mark the program(s)listed below (a. through e.) for which this household's unit will be counted toward the property's occupancy requirements. Under each program marked, indicate the household's income status as established by this cer6fication/recettiftcation. Tax Credit ❑ ( b. HOME ❑ I c. Tax Exemp[ El d. AHDP ❑ e' Wame of t—slt 1 See Part V above. ** Income Status Income Status ❑ 550%AMGI ❑ 50%AMGI ❑ 560%AMGI ❑ 60%AMGI ❑ s80%AMGI ❑ 80%AMGI ❑ OI** ❑ OI** Income Status ❑ 50%AMGI _ImeSttOtlus% ❑ 80%AMGI 1rj —u=�-- ❑ O[** ❑ OI** Based on the representations herein and upon the proofs and documentation required to be submitted, the individual(s) named in Part II of this Tenant Income Certification istare eligible under the provisions of Section 42 of the Internal Revenue Code, as amended, and the Land Use Restriction Agreement (if appli able , to live in a unit in this ProjecL SIG OF OWNER/REPRESENTATWE D TE Tenant Income Certification (February 2004) CERTIFICATION WORKSHEET Income Calculations: Multiply the rate by the appropriate number to equal the Anticipated Annual Income. Factor overtime pay, pay increases, and other employment compensation separately. The intent is to clearly show calculations that support the amounts listed on tenant certification. Do not include Asset income here. Income Applicant Source ®Rate Iirs Period (12,24,26,52) Anticipated Annual Income X $ X x x X x X X X x 4X#= X }{ X X = _ _ _ $ $ $ $ $ $ $ Sum Total from Anticipated Annual Income Column $ 5a� LINE AA Certification Worksheet m SPECTRUM ENTERPRISES 2000 Page I of Asset Calculations: Factor appropriate amounts as needed. Current value for all assets except checking, which uses a six month average balance. Type of Account Source / Account Number Balance Cash Value Or Share Value l f'1 X X % Rate or Dividend X X Period — — - Income $ $ $ $ $ N$ $ $ $ Sum Total ofBalance or Cash Value Column Sum Total of Income Column = ` Z� $ 1 LINE C L B When the Net Family Asset aggregate exceeds $5000 you must calculate Imputed Income from Assets at 2% and use the greater of Actual Income from Assets (line C) or the Imputed Income Amount (Line D). IMPUTED Asset Income = $ X 2% _ $ LINE D LIN B ►L pluva��+r. LINE A Greater of LINE C or LINED I I GROSS ANNUAL INCOME Certification Worksheet m SPECTRUM ENTERPRISES 2000 Page 2 of 2 May 12 2008 4:50PM HP LASERJET FAX • p.2 VILLA POINT 11 (Off -site Newport North Apartments) Unit No. CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession of a sections certificate or voucher, income documentation must be obtained.) I/We certify to the management of Villa Point it (Off -site Newport North Apartments) that: 1. The undersigned islare the only income earning occupant(s) of the above indicated leased premises; and, 2. During220&; the Total Annual Eligible Income" of the undersigned individual(s) wes $ _ 5a �Ol?S ; and, 3. During 2097; my total month) rent payment to Villa Point II (Off -site Newport North Apartments) was $ t'� `gam per month. " Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers, compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point ii (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach, This Certification is made under penalty of perjury in Newport Beach, Califomia'on the date indicated below: Names and Agee of Non -Income Earning Household Member(s): Name Age Signature(s) of Income Earning Household ��tyy signature Date: DNA p.3 May 12 2008 4:50PM HP LRSERJET FRX •UPUIISK 4'510Jilli usehol(b whose *_ rn Di net assets do not 0 i $5,000. h useh Id include a sse&,affchildren• complete onlyoneloan Per o c / Complete all that apply for 1 through 4: 1. Wour assets include: (B) WB) Int Annual �T Rate I pc2tsScarce t s I G b SavingsAccount S Cash on Band S certificates ofDeposit S Stocks S mA Accounts S Keogh Accounts S Ecluityinreal estate S LUMP Sum Receipts (A) Cash g Life haurance policies (excluding Term) Unit No. —city �✓t Int. (A•B) Annual V4to $ ncomc Source N _ Checking Accom mac— 8 Safety Depos t B $ Other Rearement/Pension Fords not named above: $ personal propmLyheld as an investment': g Other (list): $ MoneymadmtA $ Bonds S 401KAccounts $ Trust Funds $ Land Contracts $ Capitai i"vest°" t whichlm gl,gpggNOiE: t7atant llatds (e.y„ ltstiretrtenp Passion, 71ast)any or trmYnot 6e (Nlly) uoesst-We to Yea. Include otrly those tanoaats • aCash•talaa•is deQued u tmttud vstue sntnus 8to cast of converting dtc asset m cash, such as broker's fees, setflanmecogs, outstmding ImT• eady withdmval l etc 4K�au1 ptePt W held as an itryalbMt nmy iuclode, but is not Uudwd to, t%m ol or coin eleotions, aN, antigun wa, ow Do not indudeneceesatypaaousl Prof Auni/ue. dsiig•useautos,clotl>it�. assets ofsa active business,a•epeclsl.equipment for use by the disabled. K banot tteeaw'ib"limited tg hwse}wld b I 2. 13 VYithin the past two'(2) years, Vivo have sold or given away easels (Including wish, real estate, eta) for more than SI,000 e far marloet value (FMV).77tose amounts* are included above and we equal to a ttrtal Of- $• diffete m between PMV and the amount received, for each asset on which this ooctured). Thve have UM sold or g'm away assets (including cash, real. esta%etc.) for Leas than fairmarlaet value during the past two (2) y Vwe do not have any assets at this time. - Tke pkftmi Y assets (as 8 GG 77 . This Under penalty of lx undmAgned further mayresult itPe W ia1A CFR 813.102) shore do not exceed $5,000 and the aanaat 1nCeme from the net fats" assats 1s j4 included in total gross anneralluoon f, tify that the information presented in this certification is true and accurate to the best of my/our ]mewled "pmviding false represeatatlons herein oonsdtutm an ad of fraud. False, misleadatg or incmtgdtxe utfi ease agreeatent 2 Date AppHtbnt �� rent Date Appllcmt/Tenant Date Appficant/Ten"t Date IIndcr$5,000 Minot COWIcstioa CJcPtea Ll hvkre Spectrum Betio Terra Irvine, CA 92604 Huntington Beach, CA 92647 Wednesday, April 09, 2008 Newport North Apartments 2 Milano Newport Beach, CA 92660 To whom it may concern: This letter is to state and affirms that Sarika Arora and Kawaljeet S. Bewli (Husband/Wife) are self employed in our family business. The business we own is called The Bead Factory/Bella Beads in Irvine, California & Huntington Beach, California. We have been in the business since July 2006 and are growing. We have estimated our business to generate a net income of $52,000 in next twelve months. Please feel free to contact us if needed at 949-289-2640. Sincerely, gl-j; we/ Ojjwe4:� .� `I s Sarika Arora S. Bewli 0 PXJA 1 <wa C 7i jvlfhrE SpECVUM Cowrd' Nawalleel S. DO SarlRa 0. Mora 2204 Brindisi Newport Beach, CA 9200 \. J State of California ) County of Orange ) On_y i-aajkbefore m G personally appeared who proved to me on the basis of satisfactory evidence to be the person(s) whose names) isfeeeUbscribeqtq the within instrument and ack wledged to me that he/she/ttCeydxecuted the same in his/her/ it thorized capacity(ies), and that by his/her, eir, signature(s) on the instrument the person(s), or the entity upon be alf of which the person(s) acted, executed the instrument. I certify under PENALTY OF PERJURY under the laws of the State of California that the foregoing paragraph is true and correct. WITNESS m hand and official seal. 1@DONNAL.HOKANSOICOMM. #1650851NOTARYPUBLIC-CALIFORNIA�Signatu a (Seal) mORANOECOUNTY My comm. Expire" March 20.2010 • 0 Department of No Treasury — Internal Nevenuo Service Label (see instructions.) Year rust name Kawal'eet MI S Last name Bewli It a pint return, spsaso's first name MI Last name Use the IRS label. Sarika G Arora Otherwise, ;o ddmss(number and street). It you have a P.O. be&sae midndlons Apartmenlno. please print or type. 2204 Brindisi Presidential lftw2ort Beach CA 92660 Election Campaign 11s Check here ifyou, or your spouse if filingjointiy,want $3 to go to this fund? (see instructions) .......... ► Filing Status 1 Single 4 LJ Head of household (with quell Ua not write or naple In NIe apace OMB No. 1545-0074 Your social security number 212-25-6455 Spouse's social security number 620-47-1081 You'must enter your social security number(s) above. Checking a tax be changeyourtaxor 2 X Married flmIljoinlly (even donly one had Income) Instructions.) If the qualifying person is a child but not your dependent, enter this child's Check only 3 Manled filing separately. Enter spouse's SSN above & full name here ► one box. name here. ► 5 n qualifyingvddow(e0 with dependent child see Instructions) Exemptions ed 2 an If more than four dependents, see instructions. Income Attach Form(s) W-2 here. Also attach Forms W-2G and 1099.R it tax was withheld. If you did not get a W-2, see instructions. Enclose, but do Wallach. any payment. Also, ;lease use Form 10404. Ba X Yourself. If someone can calm you as a dependent, do not check box 6a........ , eoze. checz on as andeb .. . ..y ...P ... . . b X Spouse . •_ Na, of d Total number of exemptions claimed ................................. above . 7 Wages, salaries, tips, etc. Attach Form(s) W-2 ......................... 7 8 a Taxable Interest. Attach Schedule B If required ................. . ...... 8 a b Tax-exempt Interest. Do not include on line 8a ........ I 8 b 9a Ordinary dividends. Attach Schedule B if required ....................... 9a b qualified dividends (see Insirs) Gill ° 10 Taxable refunds,credits, oroffsets ofstate and local income taxes (see Instructions) ............. 10 11 Alimony received ........................................ 11 12 Business Income or (loss). Attach Schedule C or C-EZ..................... 12 13 Capital gain or (loss). All Sch D if regd. If not read, ck here ............... ► 13 14 Other gains or (losses). Attach Form 4797 ....... ................. 14 15a IRA distributions ...... 15a b Taxable amount (see instrs) .. 15b 16a Pensions and annuities .. 16a b Taxable amount (see instrs) .. 16 b 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E .... 17 18 Farm income or (loss). Attach Schedule F ........................... 18 19 Unemployment compensation ................................. 19 20aSocial security benefits...... 1 20al 1bTaxableamount(seelnstrs) .. 20b 21 Oherincome NET OPERATING LOSS 21 23 Educator expenses (see instructions) .. ...... .... . Adjusted 24 Certain business expenses of reservists, performing artists, and fee�basis Gross government officials. Attach Form 2106 or 2106-EZ ........... Income 25 Health savings account deduction. Attach Form 8889 ..... 26 Moving expenses. Attach Form 3903.............. 27 One-half of self-employment tax. Attach Schedule SE ..... 28 Self-employed SEP, SIMPLE, and qualified plans ....... 29 Self-employed health insurance deduction (see Instructions) ....... 30 Penalty on early withdrawal of savings ............. 31 a Alimony paid to Recipient's SSN... ► 32 IRA deduction (see Instructions) .... . ........... 33 Student loan Interest deduction (see Instructions) ....... 34 Tuition and fees deduction. Attach Form 8917 .........35 Domestic production activities deduction. Attach Form 8903....... , 36 Add 0 23 31 d 32 23 24 25 26 27 28 29 30 E34 ties - San .35. . 37 Subtract line 36 from line 22. This Is your adjusted gross Income... . ►[ BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see Instructions. FDIA0112 12a VO7 Form 1040(2007) /' ° INCOME CERTIFICATION NAME: Vw wA Learn y Initial Certification J �l p Re -certification ❑ Other TELEPHONE NUMBER: BIN N @MOv !11 r,ROV%TNCOME Yes No ❑ Uwe am self employ ed. (List nature ofself employtpent) } — t2y {cam p51� (i3'3N S%MItD�, (use ne income from business) $ Lo p Vwe have ajob and receive wages, salary, overtime pay,commissions, fces, ups, bonuses,and/or other compensation: List the businesses and/or companies that pay you: Name of 8mnlovcr 1) $ 2) $ 3) $ p Uwe receive cash 20 Unbutians of gifts including rent or utility payments, on an ongoing basis from persons not living with me. $ ❑ Vwe receive unemployment benefits. $ ❑ Uwe receive Veteran's Adminisuntion, OI Bdl, or National Guard/Mthmry benefits/income. ❑ Vwe receive periodic social security payments $ p The household receives uncameo income from family members age 17 or under ("ample Social Security, Trust Fund disbursements, etc.). $ ❑ Vwe receive Supplemental Security lnceme (SSI). $ ❑ Uwe receive disability or death benefits other than Social Security. $ Uwe receive public Assistance income (examples. TANF, AFDC) S ❑ ❑ q/ Uwe am entitled to receive child support payments. $ Uwe am currently receiving child support payments. $ If yes, from bow many persons do you receive support? Uwe am/arecumently making efforts to collect child support owed tome. List efforts being ❑ made to collect child support. p Vwe receive alimony/spousal support payments p Vwe receive periodic payments from trusts, annuities, inheritonce, retirement funds or pensions, insurance policies, or lottery winnings If yes, list sources, 1) 0 z> Vwe receive income from real or personal property. (use pgl earned income) $ If yes, list banks) O ^/o $ 1Oo�-� l) W-AsEtlNT0" MV77i7. t}7L11St SS39 u, 2) g p F Ac 1 oV yq^-2p -2 1 —�% $ i Uwe have a savings account( ACCOUNTNUMBER INTERES E CASHVALUE Ifyes, list bank(s) S 2) _% $ (3 Q/ Uwe have a revocable trusts) If yes, list bank(s) I) _/ $ p Uwe own real estate. If yes, provide description $ Uwe own stocks, bonds, or Treasury Bills If yes, list sources/bank names $ 2) p Uwe have Certificates ofDeposit(CD) or Money Market Account(s). Ifyes, list sources/bank names I) $ -- $ 2) D Uwe have an IRAILump Sum Pension/Keogh Account/401 K If yes, list bank(s) 2) -- D I/we have a whole life insurance policy. If yes, how many policies $ 0 I/we have cash an hand. $ 0 Uwe have disposed of assets (I e. gave away money/assets) for less than the fair market value in the past 2 years. If yes, list items and date disposed, $ 1) Student financial aid (public or private, not including student loans) S STUDENTSTATUS yes to either of the previous two questions are you: D D I Receiving assistance under Title Iv Of the Social Security Act (AFDCfTANF) D p Enrol led in a job training program receiving assistance through theJob Training Participation Act (JTPA) or other similar program D D I Married and filing a Joint tax return D p I • Single parent with a dependant child or children and neither you nor your child(ren) are dependent of another individual UNDER PENALTIES OF PENURY, I CERTIPYTIIAT TIIE INFOnA1AT10NPRESENTED UNTHIS FORM Is T0.U¢ AND ACCUMTETO THE SM OF MVIOURKNO WLEUUE. TIRE UNDEESIUNED FURTnER UNDROURTANDSTHAT PROVIDING FALSEEEPRESENTATIONS MHOUNCONnITU 'A (. OC FALS N000.1NCOMPL¢T¢INP�ATIONWILL O^LT�THE DENIAL OF 7RIN ERMINATi NOF E.V�DATE k1E OFA ICA PLICANF/fENANT AtIY\) y DATBY(SIGNATURE OFOWNER/REPRESENTATIVE) INCOME NAME' A 9-09F„r Initial Certification ❑ Re -certification TION QUESTIONTU(E TELEPHONE NUMBER: O BIN H Unit CMONTm y GROSS INCOME YES No ❑ Uwe am self employed. (List nature of self empl ent) (use rLq incomefrom business) 'it-W!gWjfzy 1=(c2ct (bp�KDMAV-E) $ 9LIop•vo ❑ I/we have alob and re etve wages, salary, overtime pay,commissions, fees, ups, bonuses, and/or other compensation: List the businesses and/or companies that pay you: Name of Employer I) $ 2) $ 3) $ ❑ I/we receive cash contributions ofgitis including rent or utility payments, on an ongoing basis from persons not living with me $ ❑ 0; Uwercceiveunemploymentbenefits ❑ R/ Vwc receive Velemn's Adminisuatian, GI Bill, or National Guard/Military benefiWincome. ❑ d/ Vwe receive penodle social security payments. $ ❑ 4 : The household receives unearned income from family members age 17 or under (example: Social Security, Trust Fund disbursements, etc.). $ ❑ B/ Vwc receive Supplemental Security Income (SSI). $ ❑ 0/ Vwe receive disability or death benefiu other than Social Secunty. $ ❑ a/ Vwe receive Public Assistance Income (examples: TANF, AFDC) $ Uwe am entitled to receive child support payments. $ ❑ *r,' I/we am currently receiving child support payments. Ifyes, from how many persons do you receive support? Vwe am/are currently making efforts to collect child support owed to me. List efforts being ❑ made to collect child support: Vwe receive alimony/spousal support payments ❑ Uwe receive periodic payments from trusts, annuities, inheritance, retirement funds or pensions, ❑ insurance policies, or lottery winnings. If yes, list sources: 1) s ❑ 2> Vwe receive income from real or personal property. ( use �ie(eamed income) $ If yes, list bank(s) 1) imAcSH• MVII)A-L i$i0/t� S 2$a- ;ia $ Ii02 a 2) 43 0E A • ❑ Vwehave a savings accounts ACCOUNTNUMEER INTER E CASH VALUE If yes, list bank(s) 7 p I Ihve have a revocable trust(s) Ifyes, list bank(s) p Vwc own real estate If yes, provide description: $ p (� Vwe own stocks, bonds, or Treasury Bills If yes, list sourcesibank names I) % —' $ 2) p Vwe have Ccrtdreates of Deposit (CD) or Money Market Account(s) . If yes, list sources/bank names 1) % $ 2) p Vwe have an IRA/Lump Sum Pension/Keogh Account1401 K. If yes, list bank(s) $ -- 2) ❑ Vwe have a whole life insurance policy. Ifyes, how many policies $ I/we have cash on hand. p 8� Vwe have disposed of assets (i.e. gave away money/assets) for less than the fair market ❑ value in the past 2 years. If yes, list items and date disposed: $ 1) Student financial aid (public or private, not including student loans) ❑ are p Dees your household anticipate becoming a lull -time smue,¢ ..• •••. ••-••• •- months? ❑ ❑ If you answered yes to either of the previous two questions are you' p ❑ Receiving assistance under Title IV of the Social Security Act(AFDCffANF) p ❑ Enrolled in ajob training program receiving assistance through the Job Training Participation Act (JTPA) or other similar program p ❑ . Married and filing ajont tax return p ❑ • Single parent with a dependant child or children and neither you nor your chdd ren are dependent of mother individual Itxn¢RpmALVnOFPEMURY.ICERTI"THATTHEIRFORMATIONItEEENTEDONT1115 FORM IS vUEev•��eAn�NeDaTiNHC uE rOFMY/OUR"O,tEDGE. TREUNDERSIGNEDFURTHER iheLET¢INFORMATION WILLREEULTINTIIEDENIALOF ArrgC Vgl,1 OIIAEMIN TION rwcnc LEASE ............... .••-...-_.__--_---- �� A!! CATIO O��R//T.. E��RMINATI/O1N�OFTI/I�E.LEASE �A�Cp�E¢/Iyt}¢NT. �M41C--Mr 6 1. `I—v' • ' DATE PRINTED NA OFAPPL[�ANTfrE NT SIGNATURE OFAPPLICANT/CENANT WIT ESS4 Y(SIGNATURE OF OWNER/REPRESENTATIVE) 1 1 1P DATE BELOW MARKET RENT UNIT ��STTHE IRVINE COMP APPLICATION ENT %APARTMENT COMMUNIT (ANORECEIPTFORAPPLICATIONSCRE FEE) Pkese mmplata 01s farm entirely In Ink, noting "N/A' or'nona' where eppllwblo. Do not use whtto auL The infomlatlon you provido will bo upload prior it owned by either Tho Imne Company, IIWne Apartment Communities, LP, or Imn iICACa appfoval to rcnl an apartment to you in an aWrMenl community Cammerdal PfoPadY Company (colledively,'Ovmel') y yy��r ViN ,' I.u',. # -?• 4 "�i,RSs:• w.. '�, v ' " � r GW tt 'f+'ppr�:Idn.4 •1 .Jf .0 3•W1 r" '•'l. ommunity. Nr'i.uFoRt' N�� Address. Z BRINI)ISl fy•�� CA92 CO MIApplanysfugMme (Leal. Fkal, MddIo 1MWQ dMSr. +la of Sodal SaaMy Number DavoletkafMe/ 212 25-645� BG�2$938 5e wL,) KAWAL G S. �3 N.. '�:=�.: •lr:n(�..L"W�N'h'Y•i?i.1.L.. ?hFn "�."i.' ,a t. ilhv"}.•�. a.. rnAk\,{ ..ry .. ar past FhtF�M.did�dlo lNbag lLa[t Fk[t MkIdW INtWp Mast Flnl, FkaMaIMWfr / A�" SAelKA N (last, Fire. MWM INlial) (W[I. FN:I,MWOW INtIop (Last, Fifsl, MidNOlnillDl) avm Ph«,as 4q• 64 6 I ones. Appiacataft Prewnl Addross: At ND) " AroCrigin EMaRAtlMaw' NEJAdPof-•r B CA 26 I_ 1 Rant 00 Fop�clr Damrhedfamayhoma ❑ AlNdmdfamgyhamg• Apaamant E_ payments 1654• w ToM radoyaumokoprymon10 welIIF T NO4TH PhMe N ProsaM Lef MaUa Name 6 AGheu Nlad et* N01� 9- Nl1 L/} MO NEWPORT &CH GA g1-Gr M a ONm omnly Pmyraanl Da..' ImNon mMgele Prior Addruw (d tees 1 yr al above) Fmm A- a Rent. $ Ti P bnoa Imne W le PrbrLanderas Nome a Aadroaa trim pp)ouomlepelt� uYas No NumbMINPots: Type. &� AdWI PM WC19K u. A R �.?W" SG: }`"+':F': r (i?.1',r.:vGyt4 f�;•.•��� d'',... R Data March Proposed DuvpenU��lLa^^sl.., F�,M,sl. AadMOlNllel) Data M BW, (WI, FY¢I. Marco t.) i"/iR•vh��� S 1 SSN' eL�Y-Y5 % ( SS' Data IN Dam Data SSN (lash Fiat, Made lNGaa Date of Bath Feet Middle Inner) hR-o[-IE SA�Fe(K�k � 8 SSN: 6'.�._ '.T �. IOFS Dalo al8N4 SSN (Last FWt Mitldb lnllel) Data of aim (u[t Fke4 Mitldb INaM) SSN. SSN. i� G, k;; 4'77,:`Vi �`ir"H,�l (•?^..$)•' .iN'i} k •T ei' `4%P '•"iav'',�!',a'Rir.N+ntft`I C''n5J'4 "".r �+'r r l Inpeyer(dss2empbyMd, name of buseew)Swbess Addrosa (Indutlkp LP Codo) :42 •FoE X.I14• TFIE QL=hil G.tcToAtj (31 LA SeADS ZIWWE Ch �12618 of auallow POWion run �5' Na ID Supa q • i4�2s1�O�•IQs" J harm /e.. pl• 3ELe,ctly (Diser. HuS 61kr�0 Owns-YL SQ ., 7a � 1.26yo FsA t Inmme Stapp App&a t.,aap &2wsMa CORM N/A N AY Phunaa �e1' Ircoma (mmaMela Pdor Empaya'Addre. pntlu?ng ZIP Coda) Fmm T. Nb L`Cr.' f•� 'G;d 1l i:f14i"'yi °.'j.M1' a1'�9^nie{Y., nt4Y^. 6�1 8I BBWMa: •bank MWlnaMh(kiWde cdpSlae) N•BLEf CA 011" T7-1i5155'3 slwo-' MU'iUk1— 1A7h5H(N N aMRMe' Arta SavkgN bwk ant bratM(YrAWa COISato) Have you ever Nod for bankajtW pfpfotvalWn9 vas Caunyandstat.MereaWd ty°0m— Havoyouevabad-wPatft Yes �Fo lMulyca?_ mood subs' lens, kalgmann er H.0youoverbeenavet.0 El Yos No oyoueverdafaulladmaleasei El Yos 1. oys Heve you avor boon convidadgf a(abny NalLj Yos No Re /INga WvWrad. attamo agawt peparty, Pam.n,. povefnmMd ofadals. or that kNalvad rne... Repel drugs.. ..... Mmosi . .�,.0 ;E� � e � tax a:I..I..yr l....y.4 R% ") 9 3" T�rw "NnM.`)i a..lS4ryw'Ae•"':`rl'=:.fit �'tiai!'Da' �' brhra8i! ;~•'?• ".."%'>"t.RA y ,'•*�r, J \ '1. Rnr; l inuw INemamma. pleasorMit)^. (LaW name. edba 6 rev rMm A(/fq•q?$: RCIaIIanMip, qoq `y(c pab0fwpoFR C �FtMI Ly FR•t t3ND ., H If"Plowo, pam"to phono rwmbon ( ) ( ) MeaN.Num Fam.M1Nan. ' By rovidinoan e,mall address, 1 am ClIeC1122 to rewhe e-maa from The Inino Cormarmy and He athlialea. aMR.ApFfutanbfl.M 1 a.v. 1=7 Y APARTRXNTECOMPIAN TI • S. Reason for relocation: G7(A-N i—E T' 7. How many vehicles do you ovMdriv�el?��/ 'Z Maka rs/ 10�Yea ��tb� Lkwuo/ fdako_ a^NDR _�lViC— Yow �Ev" 1 usnaa/ Note: parking of recreational vehicles, boats or trailers is not permitted In the Community. 8. Do you have Renters Insurance? Yta MNe 9. Consent to Verification -a I am mednB lNSApplkelbn vOWnbtly loh,M1u:', •v:• 'w 'w "d•i{"•lT"Y :Ova 'TICAC emwMnt NONOthe pgxp d 0y. No •TICAC Panios•), It vody lM1e b ApplcW RtgadbB InvesllpeWa Cansl- 4' ` '-p' M'' ' •; ✓ - - a calm wtls mpa"Lg OBaMm. tenant weds and am, Wom new pwlded q ), n• - - ,., •a AppacaBan I WwamMdm IId TICAC Was,bnks (mt• _ an valaus b, Onfarcemma Upmdos 1 saaliq seMce camp S . - - ..i ' • - - pages to pawds Wamabn s0e<Y Wtory and OdaY Woaaln N Ws ANpjakaUxlaalnd Netpllasauto au to mn41„+• � ,-- -s - ; -_',;:..try Ibn fapaposos ramYLcr -,r.,: - ,. •�. , s',, 1 ,.., ;i L• IMmwaosesoadhcdhTMM. aTmpdb�yeoa and news.- can, any and B-'solely.isolely.ly, ie-91 pOceaaus an'�°�-. - „acmei r tcs. als�kagoos oWf BHoMvaanNs,ouw Csolallor uosa.1the and A of Net attractive a Mamallon combined In Bdt Appacalbn, bldndaBNer eua of such Woaatbnioolhtt patios. I waaW But to that boat a W knmlodgo, a/ of the Information p Weed In Ws ApplicaBw includes but not gmlled 10 Bd atalemorn of my mandal concision) le We, aceurole, complete and Owed as a tat dole a 1W Appawgom 11 wry WamaBon pmNda l by me Is colermbMd to be (also. such Is" Monsoon'wU asBmads to( 0lsappo al of my Apptica'an a wradenten of my U. wen Oaaoc. 1 scene, b noW T,,C a any of Bd Wamance pOvdad b Wf Apptwtbn chaotic. do" the Appaealbn poeess a aelac ny t"aac' 1 ou" uMastad met TICAC wilt mbkl thb Appacellm along vsh say OBxY WOmabn p"a"ead by me, w`na` or not WS AepP lbe U appmvaL A Application cant to ss this Application and to check the Infatuationlprovided. AeparatelAppliation to Rent most be signed by each Applicant who will l occupy the paonmant before this Application will be considered by TICAC. AN APPLICATION SCREENING FEE WILL NOT BE CHARGED FOR RECERTIFICATONS Oh 1.1 02; Vale 1woes elywtuoc On Non dell Wkee, TICAC necows,$M W ham tieuacclaimed Applicant in mvroWon wn Applicants AppficaBw to Rent n spa eat local Owrar. Tp above emaW b Nba usod loaaeen PppBwmwllh mgarde to°odd hbloryard aNarbockplwM Nbnnalbn. Tho smmml Wryad b aemUed as lulowe' ST.BO 1. Actual costs oluaNl repn,uNawlW 2 Coabobbin, powas advellfy aaadeWllqaMleamkl(rda oat nil rcpab sale ("indWO blfa Be.ad.Naroblod Cash) tea aO Sgd OB �. TaW feetlegod (meymlexwad SgdpaApPiicnl) Nls Appacalkn through wall W aBnB OBwtlos, pamonal mfomnw checks end other Nlam lira aouroos. Data Applkonte algwlult The Irvine Company Apo nt mu ties, Inc. et cua.Aph tbntea"a new,. i}qt BELOW MARKET RENT UNIT fAP RTME'NTEOMMUNII APPLICATIONRENT (AND RECEIPT FOR APPLICATION SCRIWG FEE) Please mmpleta this form entirely in Ink noting war or Patine where applicable. Do not use white ouL The information you provltle well be vented prior t TICAC's approval to rent an apartment to you in an apartment community owned by either The Irvine Company, Was Apartment Communities, LP. or Irvin Commerelal Property Company (collectivoly, "Comer). Community: NEWOr Address: 9-1-0�iRINOISI AI'BcH �q Prim AgAcanYsfJl name (Ian, Ftn. MIdM.INaaQ;(U$I, Dateef Boat S 13. aiy Number others Mc. 0 11-fe" SARL14A GO ell 6w-4��10`� (Iasi, First. MIWM Ini at, Wy1`0lMaag (Last, Fai Media ehbQ BcwLl I-AWAL7ftfT S (WL Pw. MAAe Initial) (Ian. FYaL MItlWe IMIbQ (last, FksL wife m1w) App�BraanYa P�ratanl Address: O,m ❑ p PMnoM l q. Qatar , EMaIAtlWoes:' (� iLa-o 1r DIS^- Fmnr�rr,� M � CA °I2.66a �Rrnl T. rl�a-' e p DebchodfemiliMmo:AIIaNad M fisn mo Apartment' Merely Payments 16Sz1 • CA To whom tla you make payments? r4eWfoltr fj0jZq14 Present LBma.rda N.M. a M".. EWPbertjoAfH4- MIt_WO r'6CH eA 9240.80 phonat w "Cl Immsene Pinar Mdmss press dun t yr. at above) L:J o..m MomNY Payment was F. h• M Rent s T. ImmeWats Pdor-L/i;i Nam. a Addms: pho"sw Doyou war ap�'eYfr! Yes ©Ne Numbcrof Pets' TYPs. Bi.ed ry AdW Pel WalpM .�`'�' f')i rlir Mpy,N f.r�. ryi' n r.� YV �yJ3'1'•I�ni �a. i.�1}4�.,ltvf'�•S�•uty4k�t`a1u�Yl.i'ri���.'i'4„r .xr .n�f"�•i"i Proposed Bawprnts (Last, FMaL NAtltlI.ImtI.Q Bal. of BMh (Lodi, Fasl,MMtlb InI11N) Bala of B4e AQORA ( O1 I SSN, LID— —It7� SSN. tWLpitaL,�a�b leas) Bab al With(LWt, S. Flat, fads. Wall) BaleofBM 1... I'C.aT}E L'J 2 SSN. 9 (i-^'-i•^�. SSN (teat, Felt,Mitldb Initial) Bata of BlM (Lost, Phil, Mesa lnitim) Bam of Binh SSN: SSN .b. .S"�J�(iti�rr��`} Itt': j af'1 KN`•112'•l :.i 3':��) « `, `1 f`r �:.,�'r1 �i`nT��,` EmpbYarlY seaampby.d,n.mam Wseaea)Buseose AtlWess ((e,d�u�tlainp�LP Code) '��- �Oa--a.. Nf.: ' YI1tE �AUa2 YTTT• 6EL(A ,S�)°IRn VICE �.* 9.M ng(�A9 Phoasw 91(01, Tygeol Busaleaa rcwf7t-9 (�tSEr. P.narn WI Ft= O LD. osl104 Suparvkw Iq 11, 9 Z,", Ircom. 9-100•Ccim ra QFCSLrT. A• phar I.M. space Ap*.l ManpcMre3paY rtWs I CMAe1 Ih / ImmeWab PerEmpleyerAtltlmsa(InduWng LP Code) paprew ales, Want, Farm To M. ra BtIbIY7it}:'•}A�Ic i`•ili:•''Y;'{.J�;h'Si'✓J 4�i �;'C b".i �`kl:�? �'b? t�':(:IF.EFt. � �'' N. V .Y .iSi - i✓1ia`ti^ti'.iYS.:.�`,$�$'.yk,: .71`.Ti':���.ci�"a(n CWdj,, Lv.nch (htdutle CNylStelo) g M6c1-i 0e Bobtgo: Ai iiYF9s2�� aNsk'o. srvlrga• bankeMbmMb(htluda ClylSlole) r3'FINK N,6u„J Iw y'1I`r ` l LFT Aaouniw $1Bill7r.W whsilAt{V WW1TV'A-L. Nave you averabd lorbnnMiplrypmledbnT Yes [allo CMay,WSww,h.M,bsM: vWtyeol/_ Ibve you ever Mtl uryp.bae Yes E No Y.Tat>ean� More suns, lens. Iuegmenta or rop.ssessbns? Have you aver boon ovbiotly Yea 191('e ri Nave you everdofaubatl oneb.aa? El Yea [No a Novoywavmbecnwmkledof.fobny sal Y.a No Revbw IN hwlvednoacna.eoparesis,, fea.ns, W gowmmem olndob, a eel f Ivdvetl fmarma, Blognl Wigs, oraeaawx MmeaT 6';`l:IlyeT prfl>C iJlt(G �2i161F:fii� v). v.T1!.��,i"}i5Y"fu'.e' •.'v�"il gA2 A'J„a, rt {i%',ys. rain'I}��,:�t G4L .i n�•.}N�.,�"v�1-.�,�r Incaeam ememrnry, please rotdy (Loral as ou ...&ph RolallonsNO: Pw--26 1 Rh'l "ih'Uti Ht aappaoNe, pemnle pYam rumba i. Feeds Nam. a1WMrr Mum a B, mvidina an o-mail address. I am clecting to receivo ¢-mall from The Irvine Company and its affiliates BMR�AnFRaaa•to Rem R. tLU] APARTME'NTECpMOM UN ITl • B. Reason for relocation: i HA- fk!:!� 7. How many vehicles do you own/drive? 2— Wien ?IheA 07?,�Y..A� Yen, %�� License Nako-_-I�I4-IL�, W/T Year 2i001 Lkmaoa Note: Parnng of recreational vehlales, boats or trailers is not permitted in the Community. 8. Do you have Renters Insurance? Yea ❑No 9. Consent to Verification of Credit and Other Information: We valonhry fa W avposa INa0lakaeg TfACa pp,oval-roN rn apamnont N No oPamnrnl wmmWry dxam esovo. I WAna'dedp reace" the Notice wastigshve ConsumerRopons arN 0XTkW' mnhc"ed TCAC, Ovmon add geM respodNv emplo)eoa crop aprne (wecaNeN• ue MCAC Parkes), to ve" M ,Pn provdod by me m We Appgratbn aM to obtain etodt mpn"e, kona ng-W- wnsumol -puts, end scar rams I-m are mpones aga acs, honest ,as,bpks(Indoi sk,,,,,tests veAAcaYonl. empiayam and other persona or rnlXksvA hfom-Wn room, to WS Apptl not,, 1 aW manano the TIM tallish contained In thin Application to Yankee local. shoo ander (aderai 9-ca moM News$. InduMs Without Intention. emeus hw wto reme of agrees. I , this eponm.nt• No TCAC Panloa she, have a continuing tight to review my credit Womah h, payment Nolan, cowpana, history and other Woemahon in INS m1md Io my Lori. amYor for monam rosdow both dudes aM after Uw lam of my Lee,.. iboldh'tolsase and hod healossTo 1v ComPotY•IrJao Aia"moN CommWlbn,LP., Irvhr Commerclol P-yo"y ComPaW.TabvNa ComIneYAnnummaammuess-'Ina, and Y of Me on,odvo oaken, employees and agents. from ary and a. lubaly, logal Pencea a gs W cosh, hdedks an maye lees, runs an d the vamcN"` rddor use of the k,omNlon WAnW kl WS Appiru0an, Wades ftmeans IN sub kdomalkn to ctha Panne I Wei that, to the best of my W*M.0go, a9 of m Motmocon amended In age Appacelkn pace" but not Ymned to No -in""' of my financial announce) Is bun, -weal', compete and cored as of the date of No A 111-11 a 11 any Wom ellea pnn ded by coo a de nnuand to W false, such fat- ahemont w as weeds la d, a, der IN my n.noApplication1er tudasleM that TICAC M octain INe Application, dos Win eM otherdfomanon PMWed M coo. e`h°Ilwr W not Nle Appllaagen is pplewd I, a" at ft klomm,ho, �MW In has Appoefice chances during the Ilan pocoes otlumleq my tones, INK iApplication Screening bellow) tholnformatlon provldod.Ae parateAppliation to Real must bo ale edby each Appllcantwho willoccupyApplicationant to Process this py the apartment before this Application will be considered by TICAC, AN APPLICATION SCREENING FEE WILL NOT BE CHARGED FOR RECERTIFICATIONS 041 Da a er. signal. On the data bolo.,, TCAC mwNed SM W Inc, aw ademsrmd Applicant in ca re ache vMh Appe unt's APPma W e to Rent an ePMmem tom Onner- Tn above am., N to as used to scan AapGunl Won Made lu cmhk Nstory toot OW backgmaak Wunnauen. The ameam de„se 4 lambse w lotion's. f. Actual costa of aadn repo", unlawAA dalaker(ovlatkrt) soamh, ender omen ech"a"as mpons S3-rn $28.00 3. Coot to cash, p-weaand vo"ryaavoMs kfonsetion(moylewtuda emlra ono and Omar -toed ware) S350 3, Tons, No due en, han, na hoonod Mpa, Applicant) au0adas, vnationalism Wamatiw suPPWd byApticanlrn MAppacdrn through credit -Pros a,mitlea, Pen cod memrew alacka and allay Woman espumes Date to The Irvine Apppram. d,eeWe Inc. Dun-Aagr+honro Raat 3 VILLA POINT II (Off -site Newport North Apartments) Unit No.O URGENT CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtained.) INVe certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2007, the Total Annual Eligible Income* of the undersigned individual(s) was $ q4 2 l /P ; and, 3. During 2007, my total monthly rent payment to Villa Point II (Off -site Newport North Apartments) was $, per month. * Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -Income Earning Household Member(s): Name -Age Signature(s) of Income Earning Household Member(s): Signature Signature Signature Date: I Q n ,%t qW6 � • 9 ago VILLA POINT II (Off -site Newport North Apartments) Unit No. O URGENT CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not' possession of a Section 8 certificate or voucher, income documentation must be obtained.) I/We certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2007, the Total Annual Eligible Income* of the undersigned individual(s) was $ d.(1%_; and, 3. During 2007, my total monthly rent payment to Villa Point II (Off -site Newport North Apartments) was $ / ���— per month. * Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -Income Earning Household Member(s): Name Age %� 'l i'LA 461t iv>'z 16 I"�112::r. 3 Signature(s) of Income Earning, Household Member(s): Signature Date: �Z4 • 0 VILLA POINT 11 (Off -site Newport North Apartments) Unit No. 260-9-1 CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtained.) INVe certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2007, the Total Annual Eligible Income" of the undersigned individual(s) was $ ; and, 3. During 2007, my total monthly rent payment to Villa Point II (Off -site Newport North A artments) p was $ %� er mont p � ' Total Annual Eligible Income includes: wages, tips, vertime, bonuses, commissions, net income from a business or rental property, interest and dividen social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s),that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -income Earning Household Member(s): Name Age Signature(s) of Income Earning Household Member(s): Signature Signature Date: if f/ /a VILLA POINT II (Off -site Newport North Apartments) Unit No. �(' /,N CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtained.) IMe certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and,' 2. During 2007, the Total Annual Eligible Income* of the undersigned individual(s) was $ l, © (v a cc11,, a �o it. W (,A Ce 3. During 2007, my total monthly rent payment to Villa Point II (Off -site Newport North Apartments) was $ � 3I ' e0 V per month. " Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Nan -Income Earning Household Member(s): Name Age Signature(s) of Income Earning Household Member(s): Signature Signature Signature Date: `r a mi a h? Form e Department of the Treasury— Internal Revenue Service 1040EZ Income Tax Return for Single and Joint Filers With No Dependents 2007 Label ame MI last name OM8 No. 1595.007r Your social security numbor (See Instmctiens) �ETTA L RUSSELL 551-77-6008 Use thelRS 8turn, spouse's first name MI LastnameSpouses social securitynumber label. �Otherwise, print Hess (number and sheep. If you have a P.O. box, see insWctions. rt Apt no.please or type. E RAN MARCO You must enter our post office. If you have a foreign address, see insbuctions. State ZIP codePresidential SSN(s) abover Election T BEACH, I 92660 Checking a box below will not change your tax or refund. Campaign ' (see Instrs) Check here if you, or your spouse if a joint return want $3 to go to this funds ► n You nSpouse Income 1 Wages, salaries, and tips. This should be shown in box 1 of your Form(s) W-2. Attachyour Forms) W2................................................................. 1 2 Taxable interest. If the total is over $1,500, you cannot use AttachForm 1040EZ Form(s) ............................................................................ 2 W2 here. 3 ployment corn ensation Unemployment p and Alaska Permanent Fund Enclose, dividends (see instructions).. ......... I..................... a but do not attach, any payment. ■ If someone can claim you (or your spouse if a •oint r applicable box(es) below and enter the amoun� from You F1 Spouse If no one can claim you (or your spouse if a joint return), enter $8,750 if single; $17,500 if 11ing jointly. Seeinstructions... . .. .............. line 5 from line 4. If line 5 is larger than line 4, enter .0-. This is your rcome........................................................ 01. Payments ............. - "' and tax 7 Federal income tax withheld from box 2 of your Form(s) W-2 7 8a Earned Income credit (EIC)................................... 8a b Nontaxable combat pay election 8b 9 Add lines 7 and Sa. These are your total payments P. 9 10 Tax. Use the amount on line 6 above to find your tax in the tax table in the instruction 0 booklet. Then, enter the tax from the table on this line 10 Refund ............... ................. 11 a If line 9 is larger than line 10, subtract line 10 from line 9. This is your refund. 0. Have it directly d sited See If Form 8888 is attached, check here ►EE ................... , , , ► 11 a ............... 0 Instn¢Iions and Instructions fill in 11c, and11dorForm ► b Routing number.... ► c T e:ECheckingSavings ni8e. ► d Account number... Amount youowe 12 If line 10 is larger than line 9, subtract line 9 from line 10. This is the amountyou owe. For details on how to pay, see instructions.......... ► 12 0. Third party Do you want to allow another person to discuss this return with the IRS (see instruc0ons)?................... X Yes. Complete the following. No designee Designee's _ Phone.11�Personal ID name ► Preoarer no. o (PIN) ► Sign here Under penalties of penury, I declare that I have examined this return, and to the best of my knowledge and belief it is W e, correct, and accurately lists all amounts and sources of income i received during the tax year. Declaration of preparer (other than the taxpayer) is based on all information of which the preparer has any knowledge. signature Date Your occupation Daytime phone no. JoinYour Beat return? Beat instrue. ' — IRETIRED I 'loos ;Keep Spouse s signalu a if a lot t rei rn both must sign. Date Spouses °ccunahnn un .,....._.,. Preparees 111, Dale Preparees Paid signature Check it , self employed preparers Firm's name (or yours LIEN NGUYEN CPA, INC. use only if address, ), 14180 BROOKHURST ST address,antl ZlP code EIN 33-08941 BAA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see instructions. FDIA0201L 11116107 Form 1040EZ (2007) 'NAWHousing & Community Services Department OPANGLC_oUN Y HOUSING AUTHORITY 1770 North Broadway, Santa Ana, CA 92706-2642 T010Ph0ne (OCHA): (714) 480-2700 FAX: (714) 480-2812 N F O R M A T 1 O N S H E E T Date: 2/6/2008 Subsidy Number: PI-17919 Tenant's Name: Henrietta Russell Address: 2615 San Marco {p City: Irvine CA 92660''� Owner Name: -Newport North A artments Effective Date: 2/1/08 End Date: M2M RENT Tenant Portion $ 231 OCHA Portion $ L007 Total Rent $ 11238 PRO -RATED RENT Pro -Rate for days of Tenant Pro -Rate $ OCHA Pro -Rate TOTAL PRO -'RATE $ Field Representative: carolyn chin Telephone Number: (7141 480-2073 a�l0 ,�c-91tEsi VILLA POINT II (Off -site Newport North Apartments) Unit No. 027496' ©URGENT CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession of a Section 8 certificate or voucher, income documentation must be obtained.) IN11e certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2007, the Total Annual Eligible Income* of the undersigned individual(s) was $ 4qC 6d l7U and, 3. During 2007, my total monthly rent payment to Villa Point II (Off -site Newport North Apartments) was $ ' , o ° per mgn'tnh. * Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -Income Earning Household Member(s): Name Signature(s) of Income Earning Household Member(s)- Age 9 0 VILLA POINT II (Off -site Newport North Apartments) Unit No. 2 CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (For tenants not in possession or a Section 8 certificate or voucher, income documentation must be obtained.) I/We certify to the management of Villa Point II (Off -site Newport North Apartments) that: 1. The undersigned is/are the only income earning occupant(s) of the above indicated leased premises; and, 2. During 2007, the Total Annual Eligible Income* of the undersigned individual(s) was $ 00 ' % ; and, 3. During 2007, my total monthly rent payment to Villa Point II (Off -site Newport North Apartments) was $ AYd q. 00 per month. * Total Annual Eligible Income includes: wages, tips, overtime, bonuses, commissions, net income from a business or rental property, interest and dividends, social security payments, retirement fund or pension payments and distributions, disability benefits, workers' compensation and disability pay, severance pay, alimony, child support, all regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance). The undersigned acknowledge(s) that Villa Point II (Off -site Newport North Apartments) and the City of Newport Beach are relying on the accuracy of the provided information in the leasing of an apartment to the undersigned; and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the above indicated leased premises. The undersigned consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made under penalty of perjury in Newport Beach, California on the date indicated below: Names and Ages of Non -Income Earning Household Member(s): Name Age w Signatures) of Income Earning Household Member(s): Sig atu e�� S na e Sig lure 1 , D-3 Date: e a Atl 9���oa