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HomeMy WebLinkAboutNEWPORT NORTH PROJECT- AFFORDABLE HOUSING 1 OF 2_AFFORDABLE HOUSINGRR Housing Issue E Pagel of 3 From: Subject: Date: To: rgomez@mdg-ldm.com RE: Housing Issue Tue, July 15, 2008 4:02 pm rmunoz@,,mdg-ldm.com Rudy, I finally had a chance to review everything we have and/or had for the mentioned property. (Newport North Apartments) Project #13 (Northford Project) mentioned that site address but was terminated on 5/l/98. Original recorded agreement shows it was initiated in 1987 and was for a period of only 10 years. Another project that we are still monitoring is project #23 (Villa Point 2) This project consist of an off -site mentioning the Newport North Apartments. This agreements was initiated in 1991 carrying a period for 20 years due to expire in 2011. The agreement specifies 7 one -bedroom units and 11 two -bedroom units only. The total of the 18 units must meet 80% ami. This was the only information available to us from the City for the mentioned property. I believe (reading the email), the agreement mentioned was initiated from CSCDA directly. I don't think the city had any involvement with their agreement. Thanks, Raul. > Gregg, > I will look into this and get back to you. > Rudy E. Munoz > MDG-LDM Associates, Inc. > 10722 Arrow Route, Suite 822 > Rancho Cucamonga, CA 91730 > 909.476.9696 ext. 103 > From: Ramirez, Gregg [mailto:GRamirez@city.newport-beach.ca.us] > Sent: Wednesday, June 25, 2008 11:57 AM > To: rmunoz@mdg-ldm.com > Subject: FW: Housing Issue > > Hi Rudy, `y https://email.powweb.com/sgmaillsrclprinter_friendly_bottom.php?passed ent_id=0&mailbox=INBO... 7/15/2008 RE: Housing Issue • • Page 2 of 3 > > Would it be possible for you to look into this? It looks like you and > Brandon may have helped her in the past but I can't tell if we ever gave > her > a final answer. Let me know if you can help. > Thanks, > > Gregg Ramirez > Senior Planner > City of Newport Beach > 949-644-319 > From: deloris matthews [mailto:deloris949eamail.coml > Sent: Friday, April 04, 2008 3:56 PM > To: Ramirez, Gregg > Subject: Fwd: Housing Issue > > Hello Gregg, > > I am not sure if you received this email, so I am forwarding it to you > again. Please send an adknowledgment of receipt and/or let me know if > there > I should contact another department or person for assistance. > Best regards, > Deloris Matthews >---------- Forwarded message ---------- > From: deloris matthews <deloris949emnail.com> > Date: Apr 1, 2008 10:22 AM > Subject: Housing Issue > To: aramirezmcity.newport-beach.ca.us > Dear Gregg, > Per our brief conversation last night about Newport North Apts. low income > housing requirements. I have attached two of the many emails and tons of > info I have received about this property. Long story short: I firmly > believe > that The Irvine Company and California Statewide Community Development > Authority have neglected to comply with the regulatory agreement and there > is a disconnect with state, county and city requirements. I have presented > my case with evidence to the Irvine Company & CSCDA. Interestingly enough, > they have not denied my claimes nor presented any evidence to the https://email.powweb.comisgmaillsrc/printer friendly bottom.php?passed_ent id=0&mailbox=INBO... 7/15/2008 RE: Housing Issue • • Page 3 of 3 > contrary. > The Attorney for the Irvine Company argued in count that I did not have > the > right to dispute the housing requirements because I was not a party to the > regulatory agreement. > The property originally (1985) had 20% of units for lower income, with > 10% > (50% of the total) on a priority basis for very low income. In 1995 & 1998 > the property bonds were refunded & the new regulatory agreement reads, 596 > of > the lower income units will be converted to very low income units. I read > this to mean that there should be 5% lower income (80% AMI)and 15% very > low > income (50%AMI). The Irvine Company & CSCDA interprets it as 15% lower > income and 5% very low income. Where are the original lot very low income > units? I can find no regulation or exception that states that the very low > income units are to be converted to lower income units and as I said they > have not denied that I am right. The County list 133 units as restricted > and > CSCDA lists 240 (Cynthia's email and their website). This fact alone > should > be cause for alarm. Newport North management also states that they have > 133 > units. I have contacted the county, the state, Public Law Center, Legal > Aid, etc. No one seems to be able to assist me in getting to the bottom of > this issue. I have since been evicted for trying to contest this issue. I > have copies of the 1985 & 1998 regulatory agreement and can forward them > to > you or whomever you think would be able to look into this matter. Thank > you > for listening to my complaint and agreeing to assist me in whatever way > you > can. Feel free to contact me if you have any questions. > Respectfully, > Deloris Matthews > 949-375-0118 https://email.powweb.comisgmaillsrc/printer friendly_bottom.php?passed ent id=0&mailbox=INBO... 7/15/2008 h Forwarded message From: deloris matthews <deloris9490gmail.com> Date: Apr 1, 2008 1 o:zz AM 5u6�ect: Housing Issue To: gramirez@city.newport beach.ca.us Dear Gregg, Per our brief conversation last night about (Newport (North Apts. low income housing requirements. I have attached two of the many emails and tons of info I have received about this Property. Long story short: I firmly believe that The Irvine Company and California Statewide Community Development Authority have neglected to comply with the regulatory agreement and there is a disconnect with state, county and city requirements. I have presented my case with evidence to the Irvine Company & C5CDA- Interestingly enough, they have not denied my claimes nor presented any evidence to the contrary. The Attorney for the Irvine Company argued in count that I did not have the right to dispute the housing requirements because I was not a party to the regulatory agreement. The property originally (I 985) had 20% of units for lower income, with 10% (50% of the total) on a.priority basis forvery low income. In 1995 & 1998 the property bonds were refunded & the new regulatory agreement reads, 5% of the lower income units will be converted to very low income units. I read this to mean that there should be 5% lower income (so%AMI)and 15%very low income (5o%AMI)• The Irvine Company & C5CDA interprets it as 15% lower income and 5% very low income. Where are the original 10% very low income units? I can find no regulation or exception that states that the very low income units are to be converted to lower income units and as I said'they have not denied that I am right. The County list 153 units as restricted and C5CDA lists 240 (Cynthia's email and their website). This fact alone should be cause for alarm. (Newport (North management also states that they have 135 units. I have contacted the county, the state, Public Law Center, Legal Aid, etc. No one seems to be able to assist me in getting to the bottom of this issue. I have since been evicted fortrying to contest this issue. I have copies of the 1985 & 1998 regulatory agreement and can forward them to you or whomeveryou think would be able to look into this matter. Thank you for listening to my complaint and agreeing to assist me in whateverway you can. Peel free to contact me if you have any questions. Kespectfully, Deloris Matthews 949-375-01 18 0 Herica Sanchez From: rgomez@mdg-Idm.com Sent: Monday, July 07, 2008 2:29 PM To: Hsanchez@mdg-Idm.com Subject: [Fwd: RE: Housing Issue] Attachments: untitled-2.htm untitled-2.htm (10 KB) Herica, Can you Please verify if we still monitorthis Project. If so, can you Please forward me the key Pages discussing the units. Thanks! Original Message 5u6ject: RE: Housing Issue From: "Rudy Munoz" <rmunozC&mdg-Idm.com> Date: Thu„ June 26, 2008 2:16 Pm To: "'Ramirez, Gregg"' <GRamirez@citg.newporB-6each.ca.us> Gregg: I will look into this and get back to you. Rudy E. Munoz MDG-LDM Associates, Inc. 1072z Arrow Route, (juite 8zz Rancho Cucamonga, CA 91730 9o9.476.9696 ext. 1 o3 From: Ramirez, Gregg [mailto:GRamirez@citg.newporb-6each.ca.usl Sent: Wednesday„ June 25, 2008 11:57 AM 5uliect: FW: Housing issue Hi Rudy, • Would it 6e Possible for you to look into this? It looks like you and gjrandon may Dave helped her in the Past but I can't tell if we evergave her a final answer. Let me know if you can help. Thanks, Gregg Ramircz Senior Planner City of Newport beach 949-644 3i9 From: delorls matthews (mailto:deloris949@gmail.com] Sent: Friday, April o4, z008 5:56 PM To: Ramirez, Gregg Subject: Fwd: housing Issue Hello Gregg, am not sure if you received this email, so I am forwarding it to you again. Please send an adknowledgment of receipt and/or let me know if there I should contact another department or person for assistance. 'jest regards, Deloris Matthews .r �EWPpo. • LJ April 17, 2008 CITY OF NEWPORT BEACH PLANNING DEPARTMENT Irvine Apartment Management Company 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 Maximum Rent Income Limit I Bedrooms Section 8 (OCHA) Section 8 (OCHA) I Bedrooms Section 8 FMR 2 Persons: $59,500 (HUD) ($1,330)* 3 Persons: $66,950 4 Persons: $74,400 2 Bedrooms Section 8 Section 8 (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/ Jason Di 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. eu-ITY OF NEWPORT BEACH 0 AFFORDABLE HOUSING AGREEMENTS AGREEMENT PROJECT NAME TERM BEGIN / END STATUS NO. SEASHORE TOWN HOMES Terminated: 5/26/96 1 127429 31'. Street 10 yrs. 1984-1994 Recorded: 6/14/96 SPINNAKER BAY Terminated: 9/26/95 2 406 East Bay Ave. Unit G' 10 yrs. 19854996 Recorded: 10/4195 BAYRIDGE PARK Terminated: 3/28/00 3 Hartford.Drive 15 yrs. 1985-2000 Recorded: Unkown ALLREAD Terminated: 5/26/95 4 743-765 Adelrwood 10 yrs. 1984-1994 Recorded: Unkown CORONA DEL MAR HOMES Terminated: 7/6198 5 602 Carnation Ave. 10 yrs. 19854995 Recorded: 9/29198 PLUMMER COURT No records in file. 6 309 Cypress 10 yrs. 1985-1996 Only Owner occupied. CANYON COVE Property sold to Vanessa 7 509 Morning Canyon 10 yrs. 1987-1997 & Christopher Chandler in 1995. Letter sent 5/13/1998 - no response in file. BIG CANYON 10 Terminated: 4/26/95 8 Off -Site Baywood Apts. 10 yrs. 1 19844994 Recorded: Unkown POINT DEL MAR Terminated: 12/16/98 9 Off -Site Baywood Apts. 10 yrs. 19884998 Recorded: Unkown BIG CANYON 16 Terminated: 3/28/99 10 Off -Site Baywood Apts. 10 yrs. 19894999 Recorded: Unkown Terminated: 5/26195 11 CORONA DEL MAR SENIOR 10 yrs. 1986-1996 Recorded: 6/14/95 NO AFFORD. HOUSING 12 DOMINGO DRIVE PROJECT NEWPORT NORTH APARTMENTS 1987-1997 'Terminated: 5/1/98 13 Northford 10 yrs: +15 mos. Recorded: Unkown JASMINE PARK Terminated: 5/26/95 14 Off=Site Baywood Apts. 19 yrs. 1988-1998 Recorded: 6/14/95 NEWPORT SEASIDE 15 15" Placentia 30 yrs 1988-2016 OPEN - SEASHORE APARTMENTS 16 849 W. 151h Street 30 yrs. 1 1988-2018 OPEN- NEWPORT HARBOR APTS. -1 17 1538 Placentia 30 yrs 1990-2019 OPEN - PACIFIC HEIGHTS OPEN — Need more docs. 18 881-887 15TH Street 30 yrs. Only Escrow Docs in File VILLA POINT-1 19 Off -Site Baywood Apts. 20 yrs. 1990-2010 OPEN - THE 28 IRSTREET MARINA PROJ. OPEN 20 2809 & 2811 Newport Blvd. 30 yrs. 1990-2020 No Docs or Rpts. Available VILLA DEL ESTE OPEN - 21 401 Seaward Rd. 35 yrs. 1992-2027 No Docs or Rpts. Available VILLA SIENA OPEN - 22 2101 15' Street 30 yrs. 1 1992-2022 No Docs or Rpts. Available VILLA POINT — II 23 Off -Site Newport North Apts. 20 yrs. 1991-2011 OPEN- NEWPORT HARBOR APTS. — II #? 1530 Placentia 30 yrs. 1993-2023 OPEN- NEWPORT SEACREST APTS. #? 843151h Street 30 yrs. 1986-2016 OPEN - Prepared by: LDM Associates, Inc. IRev. 10/31/02 00=650163 PLEASE RECORD AND RETURN TO: ) City r1Prk'c nff' - ) 3300 Newport B11rd- -- ) _NQwno tt Be arh r^ 92664 ) -- )� EXEMPT EXWff RECORDING REQUEST PER C13 RECORDED IN OFFICIAL RECORDS OF ORANGE COUNTY. CALIFORNIA i 4:00 DEC 111990 PM - Q. Recorder AN s AFFORDABLE HOUSING AGREEMENT FOR VILLA POINT (PHASE II) THIS AGREEMENT, effective as of jOyumay 13 , 1990, is between THE IRVINE COMPANY, a Michigan corporation ("Iry THE CITY OF NEWPORT BEACH, a California municipal corpoion ("City"), and is made on the basis of the following fa k AN 4 HE intentions and understandings: NEw rOF A. Irvine is the owner of the real property located at Villa Point Drive, Newport Beach, California and described in attached Exhibit A (the "Property") upon which Irvine intends to develop a multifamily residential project of 90 dwelling units (the "Project"). B. On April 23, 1990, the City Council of the City approved Irvine's application for Tentative Tract Map No. 14055 (the "Tentative Map") and approved Traffic Study No. 63 (the "Traffic Study"), Planning Commission Amendment No. 705 pertaining to the Villa Point Planned Community Development Plan, and Coastal Residential Development Permit No. 17 (the "Coastal Permit"). The City's approval was conditioned, among other things, on City and Irvine entering into an agreement to provide 18 units 110990 -1- 149009-20!1 (representing 20% of the units within the Project) on site or off -site as "affordable units." Irvine desires to provide the 18 affordable units off -site at the Newport North Apartment Project (the "Newport North Project") located at the intersection of Jamboree and University Drive within the City, as described on attached Exhibit B (the "Affordable Units"). Irvine is willing to provide the Affordable Units to satisfy that requirement, and to enter into this Agreement with the City for that purpose. The Affordable Units will be one -bedroom and two -bedroom units in proportion to the percentage of one -bedroom units (38% or 7 units) and two -bedroom units (62% or 11 units) in the Project. C. This Agreement shall encumber title to the Newport North Project only, and shall be binding on the successors and assigns of the Newport North Project. This Agreement shall not encumber title to the Property. NOW THEREFORE, in full satisfaction of all conditions to the approval of the Traffic Study, the Tentative Map, and the Coastal . Permit (the "Approvals") relating to the provision of Affordable Units, it is agreed as follows: 1. Before or concurrent with the occupancy of the first unit in the Project, Irvine will make all of the Affordable Units available for occupancy in complete and full satisfaction of the conditions to the Approvals as provided in this Agreement. 7 of the Affordable Units shall be one -bedroom units and 11 of the Affordable Units shall be two -bedroom units. 110990 -2- 149009-20 i 2. The Affordable Units shall be subject to the following affordability and eligibility criteria and requirements: 2.1 The Affordable Units shall be rented to persons or families earning eighty percent (80%) or less of the County annualized median family income as then currently published by the United States Department of Housing and Urban Development ("HUD") for the County based on family size using the HUD Sectioni 8 income table, as the same may be adjusted from time to time. If either the County or HUD no longer publishes the data referred! to above, then such equivalent source as the parties may agree upon shall be substituted. Because the Project is being developed in the Coastal Zone, the income criteria set forth in this paragraph 2.1 shall never exceed the moderate income standard for a family of two for one bedroom units, and for a family of four for two bedroom units as set forth in California Health and Safety Code Section 50093. The 18 units used to satisfy the conditions of this Agreement shall not be affordable ' units already identified or identified in the future to satisfy any other affordable housing requirement obligations. 2.2 The annualized rents chargeable for occupancy of the Affordable Units shall not exceed the then currently published HUD Section 8 fair market rents. The City agrees to support any application made by Irvine to HUD to secure approval of a 1110% exceptional rent schedule" (the "Schedule") for the 110990 -3- 149009-20 • Newport North Project. If the Schedule is approved, any Affordable Units rented at the rents provided for in the Schedule shall satisfy the requirements of this paragraph 2.2 as long as such Schedule is in effect. 3. Each Affordable Unit shall be maintained as an "affordable unit" as provided in the preceding paragraph 2 for 20 years from the date that unit was first made available as an Affordable Unit under paragraph 1. 4. At least 30 days before offering the Affordable Units for lease to the general public, Irvine shall provide the City and the Orange County Housing Authority ("OCHA") with written notice of its intent to lease the Affordable Units, specifying the location of the Affordable Units within the Newport North Project and the proposed rental, together with a proposed form of lease or rental agreement ("a lease"). 5. Irvine will be responsible for ensuring that persons or families who rent the Affordable Units properly qualify to occupy the units under the terms of this Agreement. Selection of the tenants of the Affordable Unit shall be made on the basis of criteria that are neutral as to age, race, religion, sex, creed and ethnic origin or any other Constitutionally impermissible standard. Irvine shall discharge its responsibility under this paragraph 5 as follows: 110990 -4- 149009-20 5.1 As Affordable Units become available for rent, unless there are qualified prospective tenants (under paragraph 2.1 above) who have previously submitted their names to Irvine, and which names shall be set forth on a interest list (the "Interest List"), Irvine shall advertise the availability of the Affordable Units on at least two separate occasions in a newspaper of general circulation,.within the County. The Interest List shall also show the date the qualified prospective tenant's name was placed on the Interest List. on each Qualification Date (see paragraph 5.5 below), and from time to time as requested by the City, Irvine shall make a copy of the Interest List available to the City. 5.2 Irvine shall accept applications for occupancy for a period of not less than 10 days after the last date on which the availability of the Affordable Units is advertised, unless there is an established Interest List or all of the Affordable Units are earlier leased to qualifying tenants. 5.3 Irvine shall require each applicant accepted for occupancy of an Affordable Unit ("Applicant") to certify that the gross income of the occupants of the Affordable Unit does not exceed the qualifying income limits specified in paragraph 2.1 above, and Irvine may rely upon such certification in qualifying that Applicant. 110990 -5- 149009-20' 0 5.4 As the Affordable Units become available for lease from time to time, Irvine shall make those Affordable Units available for lease to those qualified prospective tenants on the Interest List. Preference shall be given to HUD Section B Certificate and Voucher holders in the rental of the Affordable Units even if their names are not on the Interest List. OCHA shall be notified as Affordable Units become available for rent. 5.5 Irvine shall reserve the right under the lease for each Affordable Unit to terminate the tenancy for the Affordable Unit upon 30-days' written notice upon the occurrence of any or all of the following: (i) the discovery of any misrepresentation as to income available to the tenant, (ii) the discovery by Irvine that a material change in a tenant's income results in that tenant no longer qualifying for occupancy of the Affordable Unit (material shall mean an actual income exceeding the qualifying limits by 10%), (iii) if the Affordable Unit was rented to a non -qualifying tenant because of insufficient demand for the Affordable Units by qualifying Applicants, upon the request of a qualifying Applicant (either an Affordable Unit shall within a reasonable period of time be vacated and rented toi a tenant meeting the qualifying income standards specified in paragraph 2 above, or a replacement, vacant unit within the Newport North Project shall be rented to a tenant meeting the qualifying income standards described in paragraph 2 above, in Irvine's sole discretion), or (iv) the tenant is otherwise in default under the terms of the lease. 110990 149009-20 On each anniversary date of this Agreement (or such other date as agreed upon by City and Irvine) (the "Qualification Date"), Irvine shall make available at Irvine's office at the Newport North Project for review by the City during normal business hours (and photocopying at the City's expense), copies of documents and information upon which Irvine relied to qualify each tenant renting an Affordable Unit within a reasonable time after so qualifying that tenant. Once a tenant is qualified for occupancy of an Affordable Unit as provided above, that tenant shall be deemed to have qualified for occupancy until the next Qualification Date. Thereafter, each tenant must be requalified on each Qualification Date by having to recertify as to their income(s) as provided above, and information regarding recertification shall be provided to the City as soon as practicable following recertification. 6. Irvine shall provide City with a schedule of the rents for each Affordable Unit once every 12 months. 7. Once the termination date for this Agreement has been determined under paragraph 3 above, Irvine will record this Agreement as a matter affecting title to the Newport North Project only. This Agreement shall not affect or encumber title to the Property. Upon the termination of this Agreement and within 10 days after written notice from Irvine, City shall deliver to Irvine as instrument in recordable form sufficient to 110990 -7- 149009-20 remove this Agreement as a matter affecting title to the Newport North Project. The obligations of Irvine described in this paragraph and in this Agreement are subordinate to the rights of bona fide secured lenders providing construction or permanent financing for the Newport North Project in the ordinary course of business, and City agrees to execute any agreement or document that may be reasonably required by such lender to evidence such subordination. 8. Irvine acknowledges and agrees that it has received full and adequate consideration for its assumption of the obligation to provide affordable housing required by City as a condition to the Approvals. Irvine acknowledges that Approvals could not have been granted without an affordable housing requirement. Irvine specifically waives and gives up any right to contend, for any reason, including, but not limited to, its lack of any property interest in the parcel covered by the Tentative Map or the lack of any relationship between Irvine and the approval of the Tentative Map or Final Tract Map No. 14055, that: 8.1 Irvine is not legally required to comply with the provisions of this Agreement; or 8.2 That the remedy contemplated by this Agreement, such as specific performance, or interim or injunctive relief, should not be made applicable to Irvine or property other than that depicted in the Tentative Map. 110990 149009-20 9. The parties agree that any breach of this Agreement by Irvine will irreparably injure the City and that monetary damages, or any other legal remedy, would be inadequate to remedy such a breach. The parties further agree that the City, in the event of a breach of this Agreement by Irvine, may obtain an Order of the Superior Court, requiring Irvine to specifically perform in accordance with this Agreement, and that the City may seek interim injunctive relief pending the issuance of such an Order. 10. If either party is required to initiate litigation to enforce the terms and conditions of this Agreement or to seek damages by reason of the breach of the terms and conditions of this Agreement, the prevailing party in that litigation shall be entitled to recover reasonable attorneys' fees and costs incurred in conjunction with such litigation. 11. Notices required or permitted under this Agreement shall be sufficiently given if made in writing and, delivered either personally or by registered or certified mail, postage prepaid, to the following addresses, or to such other address as may be designated for formal notice: 110990 -9- 149009-20 0 City of Newport Beach City Manager 3300 Newport Boulevard P.O. Box 1768 Newport Beach, CA 92659-1768 The Irvine Company 550 Newport Center Drive Newport Beach, CA 92660 Attention: Treasurer Copy to: Such property manager as designated by Irvine, and to: The Irvine Company 550 Newport Center Drive Newport Beach, CA 92660 Attention: General Counsel Either party may designate a different mode or address for notice to it by written direction to the other. 12. This Agreement shall be binding upon and inure to the benefit of the parties and their respective successors and assigns. 13. No change in or addition to all or any part of this Agreement except as provided in this Agreement shall be valid unless in writing and signed by or on behalf of each of the parties. 14. If any portion of this Agreement is held by a court or arbitrator of competent jurisdiction to be invalid, void or unenforceable, the remainder of the provisions of this Agreement 110990 -10- 149009-20 RAMA= IRVINE APARTMENT MANAGEMENT COMPANY RECEIVED BY PLANNING DEPARTMENT CITY OF KjC1ArnnP i P-3EACI-I AM FEB 18 2003 PM 41819110i1ii1Si1�213i�15�6 December 16, 2002 City of Newport Beach P.O. Box 1786 Newport Beach, CA 92663-3884 Attn: Daniel Trimble Program Administrator RE: Affordable Housing Reporting — Newport North Project Agreements to Provide and Maintain Affordable Housing "North Ford Development Agreement" dated 4/22/85 Exp. 324/11 Dear Ms. Teague: Pursuant to the terms of the above referenced agreements, we, as agents for the owners of this property are responsible for qualifying residents as "Affordable Residents." There were no new move -in Very Low program households during December 2002. Should you have any questions, please do not hesitate to call me at (949) 450-4290. Sincerely, \N� MjNWn vette M. Machan Bond Compliance Auditor Irvine Apartment Management Company 43 Discovery, Suite 150, P.O. Box 57060, Irvine, California 92619-7060 • (949) 450-4262 • Fax (949) 450-5802 Property Name: NEWPORT NORTH CERTIFICATE OF CONTINUING PROGRAM COMPLIANCE AS OF December 2002 The undersigned, being an Authorized Borrower Representative of Irvine Apartment Communities, L.P. (the "Borrower"), has read and is thoroughly familiar with the provisions of the various documents associated with the Borrower's participation in the California Statewide Communities Development Authority's (the "Issuer") Apartment Development Revenue Bond Program, such documents including: 1. The Amended and Restated Regulatory Agreement and Declaration of Restrictive Covenants dated as of May 15, 1998 among the Borrower, the Issuer and U.S. Bank Trust National Association (the "Trustee"). 2. The Loan Agreement dated as of May 15, 1998, between the Issuer and the Borrower. 3. During the preceding month -0- Very Low Program applications were received from Restricted Tenants (as defined in the Regulatory Agreement): 4. As of the date of this certificate, the following percentages of completed residential units in the Project (i) are occupied by Restricted Tenants, or (ii) are currently vacant and are being held available for such occupancy and have been so held continuously since the date such unit was vacated, as indicated: 1 2 3 Studio Bdrm. Bdrm. Bdrm. Total Occupied by Original Low Income Tenants N/A 0 7 5 12 2.11 % Unit Nos.: Occupied by Lower 27 41 3 71 Income Tenants N/A 12.46% Unit Nos.. Occupied by Very 14 15 0 29 Low -Income Tenants N/A 5.08% Unit Nos.: Held vacant for Occupancy continuously N/A 1 1 0 2 Since last occupied: 0.35% Unit Nos.: Total Number of Units: 42 64 8 114 20_00% Unit Nos.: N/A Since last occupied: The undersigned hereby certifies that the Borrower is not in default under any of the terms and provisions of the above documents, and no event has occurred which, with the passage of time, would constitute a default thereunder, with the exception of the following: THE IRVINE COMPANY Irvine Apartment Management Company Contact Person: Yvette Machan Bond Compliance Auditor (949) 450-5841 11/A\C IRVINE APARTMENT MANAGEMENT COMPANY November 26, 2002 City of Newport Beach P.O. Box 1786 Newport Beach, CA 92663-3884 Attn: Daniel Trimble Program Administrator RE: Affordable Housing Reporting — Newport North Proieet Agreements to Provide and Maintain Affordable Housing "North Ford Development Agreement" dated 4/22/85 Exp. 324/11 Dear Ms. Teague: Pursuant to the terms of the above referenced agreements, we, as agents for the owners of this property are responsible for qualifying residents as "Affordable Residents." Enclosed you will find the income computations and certifications, as well as other documentation on which we have relied to qualify new residents as "Affordable." This reporting covers new move -in during September 2002. Should you have any questions, please do not hesitate to call me at (949) 450-4290. Sincerely, t� Y etto M. Machan and Compliance Auditor Irvine Apartment Management Company 43 Discovery, Suite 150, P.O. Box 57060, Irvine, California 92619.7060 • (949) 450.4262 • Fax (949) 450-5802 Newport North CERTIFICATE OF CONTINUING PROGRAM COMPLIANCE AS OF September 2002 The undersigned, being an Authorized Borrower Representative of Irvine Apartment Communities, L.P. (the "Borrower"), has read and is thoroughly familiar with the provisions of the various documents associated with the Borrower's participation in the California Statewide Communities Development Authority's (the "Issuer") Apartment Development Revenue Bond Program, such documents including: The Amended and Restated Regulatory Agreement and Declaration of Restrictive Covenants dated as of May 15, 1998 among the Borrower, the Issuer and U.S. Bank Trust National Association (the "Trustee"). 2. The Loan Agreement dated as of May 15, 1998, between the Issuer and the Borrower. 3. During the preceding,month, 2 applications were received from Restricted Tenants (as defined in the Regula;ory Agreement): 4. As of the date of this certificate, the following percentages of completed residential units in the Project (i) are occupied by Restricted Tenants, or (ii) are currently vacant and are being held available for such occupancy and have been so held continuously since the date such unit was vacafed, as indicated: 1 2 3 Studio Bdrm. Bdrm. Bdrm. Total Occupied by Low - Income Tenants 14.6% Unit Nos.: 0 26 49 8 83 Occupied by Very Low - Income Tenants 5.61 % Unit Nos.: 0 14 15 0 32 Held vacant for Occupancy continuously • 20 20 0.3% Unit Nos.: 0 0 0 Total Number of Units: 20% Unit Nos.: 0 42 64 8 114 e hkucd� 10130Io2 The undersigned hereby certifies that the Borrower is not in default under any of the terms and provisions of the above documents, and no event has occurred which, with the passage of time, would constitute a default thereunder, with the exception of the following: THE IRVINE COMPANY ITVll M Contact Person: Yvette Machan Bond Compliance Auditor (949) 450-4290 iy // Unu Number z 45 - __Ta'.esy Cer.'ificadon ✓ /ReeerB roerion.-,•__ - rJCOlIE COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designed to assist you in computing Annual Income in accordance with the method set forth in I tt he HUD Regulations. All Urban capitalized erms use he einlatlorls shal have th24 em elating set forthYou !d make in the Regul ory Agreemin that this ents at 211 times up to date v.• Re: (s` MME and ADDRESS of Apartment Building) Newport North - CSCD.A`. (POOL) I(We the undersigned stale that 1/we Iiave read and answered fully, frankiy and personally each of the fdilowing questions for all persons who are occupy the unit being applied for in the above apartment project. Listed below are the names of all pitrsonin thes who intend to reside unit: 1. 2. 3. 4. 5 Name of Members elHead of of the to Household Household Sk filar Frao1 Chid. Social Security Place of Age _ Number Employment tr'%•+413 — %40 t ' __ unr. IouorA,_ Income Computation 6. The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children under 18 years) listed above for the 12-month p beginning the earlier of the date that Uwe plan to mo4e into a unit or sign a lease for a unit is S �!5?'6 � . 5q .r Included In the total anticipated income listed above are: (a) all wages and salaries, overtime pay„commissions, fees, tips grid bonuses and other compensation for personal services, before payroll deductions: (b) the net income fmrn the operation of a business or profession or from the rental of real of personal property (without deducting expenditures for bus' expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets except for straight line•depreciation as provid Internal Revenue Service regulations); (c) irterest and dividends (including Income from assets included below and other net income from real or personal property); (d) the full amount of,periodic payments received from social security, annuities, insurance policies, retirement funds, pensions, disability or death bet and other similar types of periodic receipts, including any lump sum payment for the delayed start of a periodic payment; (a) payments in lieu of earnings, such as unemployment and disability compcnsation, work:rs' compensation and severance pay; cite (f) the maximum amount of•public assistance available to the above persons other than the amount of any assistance specifically designated for sh utilities plus the maximum amount that t:e public assistance agency could in fact allow for shelter and Ldlides; (g) periodic and deL•mivable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not res In the dwelling; (h) all regular pay, special pay d allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the }::ad of the house, t an spouse (or other persons whose dependents are residing in the units); and (1) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: ' (a) casual, sporadic or irregular gifts, (b) amounts which are specifically for or in reimbursement of medical expenses; menu under health and x:cidert insurance and svo: (c) lump sum additions to family assets, such as inheritances, insurance payments (including pay compensation), capital gams and settlement for personal or property losses; y'41! goy._ to a (d) amunts of educational meeting the ost$ of tuition, f:es,pbooks and equipmer. paid direct'), to the student Any amounts of Such scholarships or payments amour.Sto vpaleterans not used for •the above purgest to be included in income; (e) hazardous duty pay to a household member in the Am, ed Forces who is away from home and exposed to hostile fire; (r) amounts received under training programs funded by HUD; IS) foster child care payments; (h) amounts received by a disabled person that are disregarded for a-fla it:d time for purposes of Supplemental Security Ihcam: eligibility and banefirs bs th:y are set aside for use under a Plan to Atuin Self -Sufficiency; (i) income of a live-in aide; expenses it: (j) ?,mounts received by a pa:dcip ah: in o:her pcbiicall-v assisted proems which are specifically for or in reimbursement of out•obpocket and which are made.solely to allow participation in a specific program; (y:) a resident service stipend (a modest amount (not to exceed S200 per month) received by a resident for performing a service (or the owner, an n F- basis, tha: enhances the qualir/ of life in the development; cy of Lower Income Unit or a Very a?' If this font is being completed in accordance with mce:tlnca:ion or Lower Income Tenant's or Very Low Income Tenant's occupan Income Unit, raspwdvety, this form must be completed based upon the current income or the occupants. (i) compensation front state or local employment training programs and training or family member as resident management stalF; (in) reparation payments paid by a foreign government pursuant to claims filed under the Imes of that government by persons who were persecuted during Nazi era; (n) amounts specifically excluded by any other federal statute from consideration as income for purposes of determining eligibility or benefits under a categ orassistance programs that includes assistance under the United States Housing Act of 1937; (o) earnings in excess of S4S0 for each full -tern student IS years old or older (excluding the head of household and spouse); (p) adoption assistance payments in excess ofS480 per adopted child; and (q) deferred periodic payments of suplikmental security income and social security benefits that are received in a lump sum payment; (r) amounts received by the family in the forth of refunds or rebates under state or local law for property eaves paid on the dwelling unit; (s) amounts paid by a State agency to a family with a dcvelopmeatally disabled family member living at home to offset the cost of services and equipm needed to keep the developmentally disabled family member at home; and (t) amounts specifically excluded by an other f-deral statute frcm consideration as income for purposes of determining eligibility or benefits under a categ of assistance programs that includes assistance under the United States Housing Act or 1937. - 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment ( xcluding the values ornecessary items of personal proper• st as furniture and automobiles and interests in Indian trust land) Yes X No; or (b) have they disposed of any asses (other than at a foreclosure or bankruptcy sale) during the last two yens at less than fair market value? Yes `Y—NO (c) If the answer to (a) or (b) above is yes, does•the combined total value of all such asses owned or disposed of by all such persons total more than S r•: Yes J _No (d) If the answer to (c) above is yes, state: (1) the combined total value of all such asses: S (2) the amount of income expected to be derived from sue asses in the 12-month period beginning on the date of initial occupancy in the unit that y propose to rent: 5��, and (3) the amount of such income, irany, that was included In item 6 above: S ,tip 8. (a) Are all of the individuals who propose to reside in the unit full-time students*? 1'es --.:Y No *A full-time student is an individual enrolled as a full-time student duffing each of 5 calendar months during the calendar yew in which occupancy of t unit begins at an educational organization which normally maintains a regular faculty and curriculum and normally has a regularly enrolled body ofstude in attendance or Is an individual pursuing afull-time course of Institutional or farm training under the supervision of an accredited agent or such educational organization or of as tatc or political subdivision thereof. (b) If the answer to S(a) is yes, is at least 2 orthe proposed occupants of the unit a husband and wife entitled to file a joint federal Income tax return? Yes X • No , 9. Neither myself nor any other occupant of the unit 11 we propose to rent is the owner of the rental housing project in which the unit is located (hereinafter the "Ownet has any family relationship to the Owner; or owns directly or indirectly any interest in the Owner. For purposes of this paragraph, indirect ownership by Individual shall mean ottmership by a family member, ownership by a corporation, partnership, estate or trust in proportion to the ownership or beneficial inter - in such corporation, partnership, estate o ;Trustee held by the Individual are family member; and ownership, direct or indirect, by a parnerorthe Individuai. 10. This cenifi:ate Is made with the Itnottledg:'that h will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and I/ate decli that a!I information set forth herein is truer correct and complete and based upon information 1/ate deem reliable and that the statement of total anticipated incor contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. 11. 1/1Ve twill assist the Owner in obtaining any information or documents r-quired to verify the statements made herein, including either an income verifica:ior L-: my/our present erpfoyer(s) or copies of federal tax returns for the immediately preceding calendar year. 12. ' 1AVe acknowledge that Ihre have been advised ihbt the making of any misrepresentation or misstater„ent In this declaration will constitute a material breach my/our agreement with the Owner to iese the unit and will entitle the Owner to prevent or terminate my/our occupancy of the unit by Institution of en -:tier, I ejection or other appropriate proceedings. We declare under penalry of perjury that the foregoing is true aid correct. this 15+h day oC S e/vtiOPr .2002 in the City ofNeA.s?3 Y NOrTYI , Ca:iforn Applicnn: Applicant Rev. SM ISignnture or all persons (except children under the age or IS years) listed In number 2 above rcgnire •U, AMC M97 rCC.FOW FOR COMPLETION BY APARTMENT OWNER ONLY: Calculation of eligible income: a. Enter amount entered for entire household in 6 above: (1) If the amount entered in 7(c)above is yes, enter the total amount entered in 7(d)(2), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ e ); (2) Multiply the amount entered in 7(d)(1) tunes the current passbook savings rate as determined by HUD to determine what the total annual earnings on the amount in 7(d)(1) would be if invested in passbook savings ($ X ), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ Pam); (3) Enter at right the greater of the amount calculated under (1) or (2) above: C. TOTAL ELIGIBLE INCOME (line La plus line I.b(3): 2. The amount entered in l.c: Qualifies the applicant(s) as a Moderate -Income Tenant(s). X , Qualifies the applicant(s) as a Lower -Income Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenant(s). $ 1121965' . 54 y2rT65.541 Number of apartment unit assigned: 24 5' Bedroom size: 1 t1 Rent: $ I�.2 to 4. This apartment unit tiv /vas not) last occupied for a period'of 31 or more consecutive days by persons who-, asgregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartment u qualified. them as a Lower -Income Tenant(s). 5. Method used to verify applicant(s) income: )( Employer income verification. Manager Copies of tax returns. Other ( "J" gl�slo� Date INCOME RESTRICTED .FINANCIAL WORKSIIEET Project Waup f Nit_,r-Vk1 Unit No. 2 y5 Applicant's Name: Qo 6e_r-h FCza Annual Salary Others Residing in Unit: Annual Salary Annual Salary Annual Salary Commissions/Bonuses Savings Accounts: Bank Bank Bank Balance z' %_ Balance Balance _ S 4 21 gds, S S S Interest Bearing Checking Account Bank Balance x %= S Bank Balance• x %= S Stocks/Bonds: Type Anount x % = S r Trust Fund: Type Amount x % = S Other: (Alimony, Child support; retirement pensions, social security, disability payments, parental support, etc.) Show calculation, how Annual is arrived at? Type Annual S Type Annual S Type Annual S Property Owned By Resident: Address TOTAL ANNUAL ELIG IDLE INCOiYIE S 14 2, 8.65•, 5�i Maximum Annual Household Income Limit s 49 384 . Gb 07/17/2016 04:08 FAX Apartment # 24 5 Your employee has applied for a rental unit located on a property financed under the City Multifamily Rental Iioush:g Program. We are obliged to sttingently verify income statements on all prospective residents for suoh apartments. NOT_R TO X+'OYER: This form is an estimate of antioinated earninu solely for the purpose of determining income status. This form dope not cons a promise by the employer to the employee of guaranteed wages, bonuses or raises. Please indicate your employee's current annual income (numbers onI•from wages, overtime, bonuses, commissions or any ether form of compensation raceived.oi a regular basis: i'TD WAGES 'L'"1'D BONUSES M coNilk slms l OTAL CUR�F NT TNC-0mm 2.00. ow L $�Z t fF I hereby certify that the amounts above are true knowledge. and complete to the bast of my 8 mployer's Siteture Date 'Title lne•Yer. ry grant you permission to disclose my income in order that they may determine ome eligibility for the rental bf an apartment tinauced under the city's Multifamily Housing Program. Date -�, LQ-4 ,-=- , �S= 3,3a, i3 L� �_c: a,-cl IRVINE APARTMENT MANAGEMENT COMPANY BOND SUMMARY SEPTEMBER NEW MOVE IN OCTOBER RECERT 2002 NEWPORT NORTH OC85 Move -ins prior to 5/25/95 Apt. Address Resident Name Size # of Occ. M/I Date M/0 Date House Income Rent Recert Due 1. 1330 Delkash 2+2 3 1/20/90 $33,559 $1,1361 N/A 2. 2112 Lynch 2+2 1 6/17/92 $40,047 $1,361 N/A 3. 2132 Sinuch 3+2 4 12/27/93 $39,600 $1,417 N/A 4. 2202 Miller 2+2 3 4/22/95 $32,015 $1,361 N/A 5. 2204 Ohanesian 2+2 1 811191 $39,746 $1,326 N/A 6. 2242 1 Cona 3+2 3 6/13/87 1 $31,481 1 $1,451 N/A 7. 2342 Platt 2+2 1 12/26/87 $24,377 $1,280 N/A 8. 2401 Jolmson 2+2 1 11/7/89 $27,853 $1,200 N/A 9. 2454 Ode and 3+2 1 3/11/89 $35,250 $1,317 N/A 10. 2534 Cattaneo 3+2 7 12/17/94 $32,650 $1,392 N/A 11. 2600 Joshe ani/Mansoo 3+2 4 1/30/94 $35976 $1,417 N/A 12. 2731 Duli a 2+2 1 4/7/95 $42,006 $1,280 N/A IRVINE APARTMENT MANAGEMENT COMPANY BOND SUNDVARY SEPTEMBER NEW MOVE IN OCTOBER RECERT 2002 NEWPORT NORTH 26. 1100 Fiore 3+2 1 09/01/01 47691.6 1474 09/03 27. 1104 Mcconne 1+1 2 8/13/01 51172.6 1160 8/03 28. 1106 Meyer 1+1 1 7/08/00 35508.7 1160 7/03 29. 1107 Aviles 1+1 4 08/23/01 23416.2 884.25 08/03 30, 1108 Romero/Serrano 2+2 5 11/05/01 37,238 994.5 11102 31. 1118 Vacant 1+1 1 32. 1122 Hales 2+2 2 7/13/98 33262 1361 7103 33. 1128 1 DelFante 3+2 1 4 11/06/99 1 58134 1 1474 11/02 34. 1141 Holder 2+2 1 1/26/96 37600 1252 1/03 35. 1144 Se ehrband 1+1 1 11/16/00 37880 1150 11/02 36. 1145 Asehad 1+1 1 8/30/00 41424.2 1160 8/03 37. 1154 Collins/Collins/Col 2+2 3 7/29/99 26000 1361 7103 38. 1159 So/Esses 1+1 2 10/7/01 10/12/02 38014 1179 10/03 39. 1183 Pottter 1+1 2 611196 34907.7 1113 06/03 40. 1184 Olson/Ammami 2+2 2 6/7/02 45968.5 1361 06/03 41. 1200 1 Wood 2+2 1 3 08/04/01 1 48871.2 1 1361 08/03 42. 1203 Gallitano 2+2 1 1 11/07/01 41,684 1252 11/02 43. 1206 Thomsen/Hawle 2+2 2 2/18/01 43285 1361 02/03 44. 1207 Rkobbs/Fer uson 2+2 2 7/14/96 49945 1361 7/03 45. 1231 Lidia Mandelbaum 1+1 1 12/26/99 23060 1210 12/02 46. 1408 Amor 2+2 2 08/15/02 18258.3 1361 08/03 47. 1411 Loran er 2+2 1 02/22/02 40,491 1326 02/03 48. 1412 Fu'ioka 2+2 1 7/10/98 44371 1361 7/03 49. 1418 Lee, 1+1 2 7/12/02 1 34902 1160 07/03 50. 1441 Gerry 1+1 2 12/08/01 41873 1179 12/02 51. 1444 Douglas 2+2 1' 2/12/99 50147 1326 2/03 52. 1502 Smi i 2+2 4 3/31/96 64615.4 1306 03/03 53."1557 Graves 1+1 1 2/12/02 39500 1,179 02/03 54. 21.16 Zaharson 2+2 1 03/29/02 19280 1,326 03/03 55. 2123 •Ross 1+1 3 11/16/01 37515 1179 11/02 56. 2134 Huish 2+2 3 9111199 22574.2 1326 9/03 57. 2212 1 Riedelsheimer 2+2 1 3 08/20/02 1 37,604 1 1326 8/03 58. 2224 An ozian 1+1 1 5/27/98 35210 1160 5/03 59. 2225 Adams 1+1 1 04/06/00 36000 1210 04/03 60. 2226 Syrquin 2+2 1 12/17/96 24282 1326 12102 61. 2301 Altes/Mchugh 2+2 2 05/10/01 43254.3 1361 05/03 G2. 2309 Loczi/Milo 1+1 2 6/13/02 37200 1210 6/03 63. 2312 Nam 2+2 1 01/11/00 30000 1326 01/03 64. 2322 Marino 1+1 1 8/8/96 15840 1075 8/03 65. 2402 Mehrick 2+2 1 1 01/28/00 1 43428.7 1326 01/03 Malkin 2+2 2 8/23/96 24000 1280 8/03 McKee 2+2 2 6/4/02 21108 1020.75 6/03 Jones/Janisse 2+2 2 10/25/00 48054.4 1252 10/02 R Van Nieuwenhu se 2+2 3 08/08/02 44067.9 1361 08/03 Roshankar 3+2 3 12/10/01 52280 1474 12/02 Chun o 2+2 2 08/20/02 08/03 Brobst 1+1 1 2/14/99 53796.8 1065 2/03 73. 2720 1 Larson 1+1 1 1 1 10/10/99 1 56922.3 1150 10/03 New Certification / Reeerdrica6on Unit Number RNCONIE COMPUTATION AND CERTOICATION NOTE TO APARTMENT OWNER: This form is designed to assist you in computing Annual Income in accordance with the method set forth in Department of Housing and Urban Pro ect ("HUD") Regulations (24 CFR 813). You should make certain that this form is at all times up to date t the HUD Regulations. All cap!talize9 terms used herein shall have the meaning set forth in the Regulatory Agreement, Re: NIM E and ADDRESS of Apartment Building) Newport North. - CSCDA, (POOL) IlWe the undersigned state that Ihve have read and answered fully, frankly and personally each of the following questions for all persons who ar• occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit: 1. • 2. 3. 4. 5. Name of Members Relationship of the to Head of Social Security Place of Household Household AEe Number Employment e Sark �Inad 55 5 Le-7a-Q3gb Dr: Arthtr,- Vial k4e Income Computation 6. The total anticipated income, calculated In accordance with this paragraph 6, of ail persons (except children under 18 years) listed above for the 12-month p begirming the earlier of the date that I/we plan to move into a unit or sign a lease for a unit is S Z � Tr .� r Included in the total anticipated income Listed above are: (a) all wages and salaries, overdme pay, cortn!sstons, fees, tips and bonuses and other compensation for personal services, before payroll deduedoms; (b) the net income from the operation of a business or profession of from tie rental of real of personal property (without deducting expenditures for bus! expansion or amortization of capital irhebtedness or any allowances for depreciation of capital assets except for straight line depreciation as provid Internal Revenue Service regulations); (c) lnntefest and dividends (u;cludig income from assets included below aid other net income from real or personal property); (d) the full amount of.periodie payments received from social security, annuities, Insurance policies, retirement funds, pensions, disability or death ber and other simi!ar types of periodic receipts, including any lump sum payment for the delayed scar, of a periodic payment; (e) payments in lieu of eatii Ss, such as unemployment and disability compensation, workers' compensation and severance pay; (f) the maximum amount of public assistance available to the above persons other Lhan the amount of any assistance specifically designated for she;m utilities plus the maximum amour,: that the public assistance agency could in fact allow for shelter and utilides; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons no: res' in the dwelling; (h) all regular pay, special pay and z;Ici- 'a.,ces of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the househo spouse (or other persons whose dependents are residing in the units); and (1) any earned income tax credit to'the ex:ent that it exceeds income tax liability. Excluded fr6m such anticipated Income are: Y (a) casual, sporadic or irregular gifts; (b) amounts which are specifically for ol-m reimbursement of medical expenses; (e) jump sum additions to family assets, such as inheritances, insurance payments (including payments under health and accident insurance and worl compensation), capital gaits and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational invitudoa, and amounts paid by.the government to a veteran for u meeting the costs of tuition, fees, t co'xs and equipment. Any amourus of such • scholarships or payments to veterans not used for the above purpose. to be included in income; (e) hazardous duty pay to a household member in the Am, cd Forces who Is away from home and exposed to hostile fire; (f) amours received under training pcegrams funded by HUD; (g) foster child care payments; (h) amounts received by a disabled person a are disregarded for a 1•m!ted time for purposes of Supplemental Security Income eligibility and teneiis ten they are set aside for use under a P2n-n to Attain SelfSufBciency; (i) income or a live -it aide; Q) amounts received by a pardciparc it o`_xr publ!cal!y assisted programs which are specifically far or in reimbursement of out-of-pocket expenses in:t and which are made solely to allow participation in a specific program; (I:) a resident service sdperd (a mcdes: a:rount (rot to exceed S'_CO per mo^h) received by a resident for performer._; a service for the owner, on a ran: basis, that enhances the qualiv of life in the development; If dais form is being completed in accordance with «cenir=:.on of a Lower Income Tcruirt's or very Low Income Tenant's occupancy of a Lower Income Unit or a Very Low Income Unit. rapeetivety, this form must be eompleteu basil upon uic current income of the cecupanu. (in) reparation payments pain oy a romtgn government pursuant to emtms urea unaer me rows or tnat govemment by persons v+ho were persecuted during Nazi era; (n) amounts specifically excluded by any other federal statute from consideration as income for purposes of determining eligibility or benefits under a eateg of assistance programs that includes assistance under the United States Housing Act of 1937; (o) earnings in excess ofS4S0 for each full -term student 18 years old or older (excluding the head of household and spouse); (p) adoption assistance payments in excess ofS420 per adopted child; and (q) deleted periodic payments of supplemental security income and social security benefits that are received in alump sum payment; (r) amounts received by the family (n the form of refunds or rebates under state or local lave for property tares paid on the dwelling unit; (s) amounts paid by a State agency to a family with a developmentally disabled family member living at home to offset the cost of services and equipml needed to keep the developmentally disabled family member at home; and (t) amounts specifically excluded by an other federal statute from consideration as income forpurposes ordete,„mining eligibility or benefits under a Meet of assistance programs that includes assistance under the United States Housing Act or 1937. 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks,bonds, equity in teal property or other form of capital Investment (excluding. the values ornecessaryitems ofpersonal propertyse as furniture and automobiles and interests in Indian trust land) Yes x No; or (b) have they disposed of any assets (other than at a foreclosure or bankruptcy sale) during the last two yeas at less then fair market value? Yes __X_No (c) If the answer to (a) or (b) above is yes, does the combined total value of at such assets owned or disposed of by all such persons total more than SSJ:•0 Y'es_ C No (d) If the answer to (c) above is yes, state: (1) the combined total value of all such assets: S (2) the amount of income expected to be derived from such assets in the 12-month period beginning on the date of initial occupancy in the unit that y propose to rent: S 0 and (3) the amount of such income, ifany, that was Included in item 6 above: S .� S. (a) Are all of the individuals who propose to reside in the unit full-time students'? l'es W No 'A full-time student is an Individual enrolled as.a full-time student during each of 5 calendar months during t5e calendar year in which occupancy oft unit begins at an educational organization which normally maintains a regular faculty and curriculum and norna{ly has a regularly enrolled body of st..+er In attendance or is an individual pursuing a full-time course of Institutional or farm training under the supervision of an accredited agent of s_:h educational orgapization or of a state or political subdivision thereof. (b) If the answer to S(a) is • s, Is at least 2 of the proposed occupants of the unit a husband and wife entitled to file ajoint federal income tax return? Yes •No 9. Neither myself nor any other occupant of the unit Vwe propose to rent is the owner of the rental housing project in which the unit is located (hereinafter the "O+vnx has any family relationship to the Owner; or owns directly or indirectly any interest in the Owner. For purposes of this paragraph, indirect ownership by . individual shall mean ownership by a family member, ownership by a corporation, partnership, estate or trust in proponion to the ownership or beneficial intete in such corporation, partnership, estate or Trustee held by the individual or a family member; and ownership, direct or indirect, by a partner of the Individual. 10. This ceniFieate is made with the know•ledgt5 that it will be relied upon by the Owner to determine maximun income for e;igibiliri to occupy the unit; and Vxc decia that ell infometion set fonh herein is true,,gorect and complete and based upon information I/we deem reliable and that the statement crucial anticipated i, :on contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. 11. We will assist the Owner in obtaining any iafo,-aation or documents required to verify the statements made herein, including either aut income verification frc mylour present employer(s) or copies of Aderal tar returns Fat the immediately preceding calendar year. 12. IAVe acknowledge that Vw•e have been advised that the making of any misrepresentation or misstatement in this ded_•ation (vill constitute a material breach my/our agreement with the Owner to leas: the unit and will entitle the Owner to prevent or terminate my/our occupancy of the unit by institution or an a-0., f ejection or other appropriate proceedings. Me declare under penalty of perjury that the foregoing is true and correct. Exeeured this day of .20 02 in the City of I�i�y`i� I Ytt:rt . CnN.' :n`. Applicant Apple: nt Applicant Rev. 5,95 [Signmure of all persons (except children tinder the age of IS )"nrs) listed In number 2 above require' IUA\:Co-•v: ICC400.w1 FOR COMPLETION BY APARTMENT OWNER ONLY: 1. Calculation of eligible income: a. Enter amount entered for entire household in 6 above: b. (1) If the amount entered in 7(c)above is yes, enter the total amount entered in 7(d)(2), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ '_0"_ ); (2) Multiply the amount entered in 7(d)(1) times the current"passbook savings rate as determined by HUD to determine what the total annual earnings on the amount in 7(d)(1) would be if invested in passbook savings ($ 1010 ), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ Rf ); $ 23, 060,Fs0— (3) Enter at right the greater of the amount calculated under (1) or (2) above: $ 0' C. TOTAL ELIGIBLE INCOME (line i.a plus line 1.b(3): $ 230 069..90 — 2. The amount entered in I.c: Qualifies the applicants) as a Moderate -Income Tenant(s). i Qualifies the applicant(s) as a Lower -Income Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenant(s). 3. Number of'apartment unit assigned: _ Bedroom size: 1 +1 Rent: $�56 z. This apartment unit w vas not) last occupied for a period of 31 or more consecutive days by persons wh:s aggregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartment ca qualified them as a Lower -Income Tenant(s). 5. Method used to verify applicant(s) income: i� Employer income verification. Copies of tax returns. Other ( Manager 117/61 Date Project Neka : No Hh Unit No. 1 333 Applicant's Name: Others Residing in Unit: t`^ INCOME RESTRICTED FINANCIAL WORKSHEET Lea S64 - Annual Salary Annual Salary. Annual Salary Annual Salary Commissions/Bonus°s S Savings Accounts: Bank `- Balance x %= S Bank Balance Bank Balance x %= S Interest Bearing Checking Account Bank Balance z %= S Bank Balance, x %_ •S Stocks/Bonds:, Type Amount x • % = S r Trust Fund: Type Amount x % = S Other: (Alimony, Child support, retirement pensions, social security, disability payments, parental support, etc.) Show calculation, how Annual is arrived at! Type Annual S TyPc Annual S Type Annual S Property Owned By Resident: Address Cqu!ty x—%= S TOTAL ANNUAL I LIGIDLEINCOME S 2-340 e.$O Maximum Annunl household Income Limit Employer's Signature Date Apartment # 1333 Applicant's Name Your employee has applied for a rental unit located on a property financed under the City's Multifamily Rental Housing Program. We are obliged to stringently verify income statements on all prospective residents for such apartments. NOTE TO EMPLOYER: Please indicate your employee's Start Date, current annual income (numbers one) from wages, overtime, bonuses, commissions or any other form of compensation received on a regular basis: START DATE YTD WAGES YTD OVERTIME YTD BONUSES a� aao2 YTD COMMISSIONS S TOTAL CURRENT INCOME $ 2' ECJ3 d e ��t� Qo� �i av y� I hereby certify that the amounts above are true and complete to the best of my knowledge. Title . I hereby grant you permission to disclose my income in order that they may determine my income eligibility for the rental of an apartment financed under the city's Multifamily Rental ousing Program, pp icant's Signature Date z� yG 3 .oa d.25= d, 922.Lt X12- = 2 3116g , S'1�v \% 1 6 1y Cus vnm- IRVINE APARTMENT MANAGEMENT COMPANY BOND SUM1vLARY SEPTEMBER NEW MOVE IN OCTOBER RECERT 2002 VERY LOW (Phase In- beginning 4/l/98) Apt. Address Resident Name Size # of Occ. M/I Date M/O Date House Income Rent Recert Due 1. 106 Lausen 1+1 1 4/11/98 $33886 $ 737 4/03 2. 122 Galla i 2+2 2 01/05/01 $10,523 $ 783 01/03 3. 126 Francis/Vidal 2+2 4 12/28/00 $40000 $ 829 12/03 4. 208 Tarta lini 1+1 2 04/01/01 $27,444 $ 696 04/02 5. 224 Rice/Harris 1+1 2 8/l/99 $30219 $ 737 8/03 6. 228 1 Jones - 2+2 1 2 5/8/99 1 $22,336 1 $ 829 5/03 7. 243 Batts 1+1 1 511199 $24,154 $ 737 5103 8. 301 Francis 2+2 2 2/08/02 $26399 $ 783 02/03 9. 318 Radford 1+1 1 7/8/99 $23430 $ 737 7/03 10. 320 McGinley1+1 1 4116199 $8,467 $ 737 4/02 11. 333 Sa'orowsld 1+1 1 2/3/01 $30,000 $ 737 2/02 12. 1180 Siroonian 1+1 1 4/7/02 $24,542 $ 737 04/03 13. 1323 .Buoncristian 1+1 3 11/10/01 $27684. $ 737 09/03 14. 1324 Hale 24-2 1 4/1/01 $25,819 $ 851 04/03 15. 1333 Stork 1+1 1 9/7/02 $23068 $ 756 09/03 16. 1419 Mino 1+1 1 5106101 $21,600 $ 696 5/03 17, 1530 Siddi i 1+1 3 6111100 $46249 $ 737 06/03 18. 2128 Johnston 2+2 2 6/8/00 $24636 $ 829 06/03 19. 2140 Vise 2+2 1 02/01/02 $24,000 $ 829 02/03 20. 2210 Rossi 2+2 1 12/07/01 $25,680 $ 829 12/02 21. 2300 Mohler 2+2 3 611199 $25,263 $ 829 06/03 22. 2408 1 Shoeibi/Mo i 2+2 1 2 5/12/02 1 25984 1 $ 851 05/03 23. 2425 'Uchida 2+2 3 04/11/01 $12,402 $ 783 04/03 24. 2428 Winslett 2+2 1 03/17/00 $23,500 $ 829 3/03 25. 2440 Afshar•. 2+2 2 05/06/01 $15,424 $ 783 05/03 26. 2450 Warfield 1+1 1 4/11/98 $8,827 $ 737 4/02 27. 2519 Cotter, 1+r 1 5/29/01 $25,410 $ 737 5/03 28. 2608 Vidal/Gaxiold 2+2 2 611199 $25426 $ 829 1 06/03 29. 2702 Delgado 2+2 4 1 3/l/02 $25,200 $ 829 03/03 1998 Phase in - 106-122-224-318-320-2450 1999 Phase in- 228-243-1180-2608-2300-126 2000 Phase in — 2428-1333-2519-1530-2128 2001 Phase in — 333-208-1323-2425,1419,2140,2440,305 2002 Phase in — 2210,2408,2140,2702,1324 Total number of apartments on this property: 570 % of property deemed Income Restricted (Low): 15.26% % of property deemed Income Restricted (Very Low): 4.74% TTP = Total Tenant Payment (Resident is on Certificate or Voucher) Total vacant as of 09/30/02- 23 IRVINE APARTMENT MANAGEMENT COMPANY BOND SUMMARY September 2002 Villa Point Apt. Address Resident Name Size # of Occ. M/I Date M/O Date House Income Rent Recert Due 1. 131 Co bill 2x2 2 11/05/00 29,000.00 1,046 9/03 2. 234 Galindo 2x2 2 10/2/98 34,000.00 1,046 9/03 3. 235 Wang 2x2 2 4/16/99 41,782.00 1,046 9/03 4. 242 Nelson lxl 1 9/13/97 28,500.00 845 9/03 5. 249 Daoud TTP $141 lx1 1 616191 8,544.00 845 9/03 6. 1214 Gross 2x2 1 2 8/15/97 1 28,000.00 1 1,046 9/03 7. 1334 Jennings , lxl 1 7/7/99 17,770.00 829 9/03 8. 1440 Yeager Ixl 1 9/12/98 24,672.00 845 9/03 9, 1528 Haskell lxl 1 7/24/97 22,500.00 845 9/03 10. 1558 Roman TIP $147 lxl 1 7/9/01 6,008.00 845 9/03 11. 2136 Caserta lxl 1 7/11/00 28,508 845 9/03 12. 2341 Klein 2x2 2 9/11/98 31,941.00 1,046 9/03 13. 2407 McNeill 2x2 2 2/9/95 32,516.00 1,046 9/03 14. 2409 Lee 2x2 4 1 06/10/00 1 1 37,200.00 1,046 9/03 15. 2503 Wiliams 2x2 2 8/24/99 35,200.00 1 1,046 1 9/03 16. 2605 Aguirre/Roseli 2x2 3 6/28/02 46,549.11 1,097 9/03 17. 2609 Hazewinkel 2x2 1 9/24/94 37,500.00 1,046 9/03 18. 2736' Nofal I 2x2 4 9/8/00 22,222.44 1 980 9/03 w NEWPORT NORTH APARTMENTS APT. # / 3 CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (When residents do not have Section 8 certificates/vouchers, income must be documented. Use this form to document the income.) We hereby certify to the management of Newport North Apartments that: 1. The undersigned is to be the only income earning occupant(s) of the leased premises, and 2. During 2001, the total annual *eligible income of the undersigned was $ *Included in the total annual eligible income are: wages, tips, overtime, bonuses, and commissions; net income from a business or rental of real property; interest and dividends; social security, retirement funds or pensions, and disability benefits; workers' compensation and disability pay; severance pay; alimony; child support; regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance.). J The undersigned acknowledge(s) that Newport North Apartments and the City of Newport Beach are relying on the accuracy of the information when an apartment is leased to the undersigned and in conferring on the undersigned the monetary Benefits of the Agreement which restricts the rents collectible for occupancy of the leased premises. ' The undersigned also 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. Names and Ages of Non -Income ' Earning Household Members: Date: Signature of Income Earning Nousehold 'NEWPORT NORTH ,2ARTMENTS APT. # 6,-5q . CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (When residents do not have Section 8 certificates/vouchers, income must be documented. Use this form to document the income.) I/We hereby certify to the management of Newport North Apartments that: The undersigned is to be the only income earning occupdnt(s) of the leased premises, and During 2001, the total annual *eligible income of the undersigned was $_L `o *Included in the total annual eligible income are: wages, tips, overtime, bonuses, and commissions; net income from a business or rental of real property; interest and dividends; social security, retirement funds or pensions, and disability benefits; workers' compensation and disability pay,, severance pay, alimony; child support; regular and special pay and allowances of a member of the Aimed Forces (to exclude hostile fire allowance.). The undersigned acknowledge(s) that Newport,North Apartments and the City of Newport Beach are relying on the accuracy of the information when an apartment is leased to the undersigned and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the leased premises. The undersigned also 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 penally of perjury in Newport Beach, California. Names and Ages of Non -Income Signature of, Income Earning Earning Household Members: Household Members: � iKG(7a3 a�i�e(� Date: 00// /© NEPORT NORTH APARTMENTS APT. # Z 3 S CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (When residents do not have Section 8 certificates/vouchers, income must be documented. Use this form to document the income.) I/We hereby certify to the management of Newport North Apartments that: The undersigned is to be the only income earning occupant(s) of the leased premises, and 2. During 2001, the total annual *eligible income of the undersigned was $ Z� 1, %V Z, . *Included in the total annual eligible income are: wages, tips, overtime, bonuses, and commissions; net income from a business or rental of real property; interest and dividends; social security, retirement funds or pensions, and disability benefits; workers' compensation and disability pay; severance pay; alimony; child support; regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance.). The undersigned acknowledges) that Newport North Apartments and the City of Newport Beach are relying on the accuracy of the information when an apartment is leased to the undersigned and in conferring on the undersigned the monetary benefits of theAgreement which restricts'the rents collectible for occupancy of the leased premises. The undersigned also 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. Names and Ages of Non -Income Earning Household Members: zS Date: 0 e Z Signature of Income Earning Household Members: NEWPORT NORTH APARTMENTS APT. # �(a' CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (When residents do not have Section 8 certificates/vouchers, income must be documented. Use this form to document the income.) I/We hereby certify to the management of Newport North Apartments that: 1. The undersigned is to be the only income eaming occupant(s) of the leased premises, and 2. During 2001, the total annual *eligible income of the undersigned was $ *Included in the total annual eligible income are: wages, tips, overtime, bonuses, and commissions; net income from a business or rental of real property; interest and dividends; social security, retirement funds or pensions, and disability benefits; workers' compensation and disability pay; severance pay, alimony; child support; regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance.). J The undersigned acknowledge(s) that Newport North Apartments and the City of Newport Beach are relying on the accuracy of the information when do apartment is leased to the undersigned and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the leased premises. The undersigned also 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. Names and Ages of Non -Income Signature of Income Earning Earning Household Members' Household Members: �r� C5;6-�9 Date: L't 2_ NEWPORT NORTH APARTMENTS APT. # -V L/ 9 - . CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (When residents do not have Section 8 certificates/vouchers, income must be documented. Use this form to document the income.) I/We hereby certify to the management of Newport North Apartments that: The undersigned is to be the only income earning occrtpant(s) of the leased premises, and 2. During 2001, the total annual *eligible income of the undersigned was $_ R $ 1/ 4/ *hichrded in the total annual eligible income are: wages, tips, overtime, bonuses, and commissions; net income from a business or rental of real property; interest and dividends; social security, retirement funds or pensions, and disability benefits; workers' compensation and disability pay; severance pay; alimony; child support; regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance.). The undersigned acknowledge(s) that Newport North Apartments and the City of Newport Beach are relying on the accuracy of the information when an apartment is leased to the undersigned and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the leased premises. The undersigned also 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. Names and Ages of Non -Income Earning Household Members:.. Date: 9 -- 1 — 0 ;:?, Signature of Income Earning Household Members: NEWPORT NORTH APARTMENTS APT. # ) 2 1 � . CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (When residents do not have Section 8 certificates/vouchers, income must be documented. Use this form to document the income.) I/We hereby certify to the management of Newport North Apartments that: The undersigned is to be the only income earning occupant(s) of the leased premises, and During 2001, the total annual *eligible income of the undersigned was $ Z S • 000 *Included in the total annual eligible income are: wages, tips, overtime, bonuses, and commissions; net income from a business or rental of real property; interest and dividends; social security, retirement funds or pensions, and disability benefits; workers' compensation and disability pay; severance pay; alimony; child support; regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance.). The undersigned acknowledge(s) that Newport North Apartments and the City of Newport Beach are relying on the accuracy of the information when an,apartment is leased to the undersigned and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the leased premises. , The undersigned also consents td thg delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. T This Certification is made under penalty of perjury in Newport Beach, California. Names and Ages of Non -Income Earning Household Members: Date: 09 / 13 / 2 002 Signature of Income Earning Household Members:0_12.09C OAXKe7�) NEWPORT NORTH APARTMENTS APT. # CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (When residents do not have Section 8 certificates/vouchers, income must be documented. Use this form to document the income.) I/We hereby certify to the management of Newport North Apartments that: 1. The undersigned is to be the only income earning occupant(s) of the leased premises, ands ate' 2. During 2001, the total annual *eligible income of the undersigned was $ *Included in the total annual eligible income are: wages, tips, overtime, bonuses, and commissions; net income from a business or rental of real property; interest and dividends; social security, retirement funds or pensions, and disability benefits; workers' compensation and disability pay; severance pay; alimony; child support; regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance.). The undersigned acknowledge(s) that Newport North Apartments and the City of Newport Beach are relying on the accuracy of the information when an apartment is leased to the undersigned and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the leased premises. The undersigned also consents to the d9livery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. a This Certification is made under penalty of perjury in Newport Beach, California. Names and Ages of Non -Income Earning Household Members: Date: HouseholdSignature of Income Earning I NEWPORT NORTH APARTMENTS APT. # I A 4 O. CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (When residents do not have Section 8 certificates/vouchers, income must be documented. Use this form to document the income.) I/We hereby certify to the management of Newport North Apartments that: 1. The undersigned is to be the only income earning occupant(s) of the leased premises, and 2. During 2001, the total annual *eligible income of the undersigned was $ 2, i & 7 A • 0 0 *Included in the total annual eligible income are: wages, tips, overtime, bonuses, and commissions; net income from a business or rental of real property; interest and -dividends; social security, retirement funds or pensions, and disability benefits; workers' compensation and disability pay; severance pay; alimony; child support; regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance.). The undersigned ackiiowledge(s) that Newport North Apartments and the City of Newport Beach are relying on the accuracy of the information when an apartment is leased to the undersigned and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the leased premises. The undersigned also 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. Names and Ages of Non -Income Signature of Income Earnirig Earning Household_ Members: Household Ivfembers: Date: 40o NEWPORT NORTH APARTMENTS APT. # / 5a 8 . CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (When residents do not have Section 8 certificates/vouchers, income must be documented. Use this form to document the income.) I/We hereby certify to the management of Newport North Apartments that: The undersigned is to be the only income earning occupant(s) of the leased premises, and 2. During 2001, the total annual *eligible income of the undersigned was $p, *Included in the total annual eligible income are: wages, tips, overtime, bonuses, and commissions; net income from a business or rental of real property; interest and dividends; social security, retirement funds or pensions, and disability benefits; workers' compensation and disability pay; severance pay; alimony; child support; regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance.). The undersigned acknowledge(s) that Newport North Apartments and the City of Newport Beach are relying on the accuracy of the information when an apartment is leased to the undersigned and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the leased premises. The undersigned also 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. Names and Ages of Non -Income Signature of Income Earning Earning Household Members: Household Members: Date: cr-� � 1 � n --)— � NEWPORT NORTH APARTMENTS APT. # IJ�� CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (When residents do not have Section 8 certificates/vouchers, income must be documented. Use this form to document the income.) I/We hereby certify to the management of Newport North Apartments that: 1. The undersigned is to be the only income earning occupant(s) of the leased premises, and 2. During 2001, the total annual *eligible income of the undersigned wasg *Included in the total annual eligible income are: wages, tips, overtime, bonuses, and commissions; net income from a business or rental of real property; interest and dividends; social security, retirement funds or pensions, and disability benefits; workers' compensation and disability pay; severance pay; alimony; child support; regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance.). ' The undersigned acknowledge(s) that Newport.North Apartments and the City of Newport Beach are relying on the accuracy of the information when an apartment is leased to the undersigned and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the leased premises. , The undersigned also consents to the delivery, of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. V This Certification is made under penalty of perjury in Newport Beach, California. Names and Ages of Non-Incorrid Earninn ousehold Membr s: I O Date: Signature of Income Earning Household Members: NEWPORT NORTH APARTMENTS APT. # ,,�21,55 4. CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (When residents do not have Section 8 certificates/vouchers, income must be documented. Use this form to document the income.) I/We hereby certify to the management of Newport North Apartments that: 1. The undersigned is to be the only income earning occupant(s) of the leased premises, and 2. During 2001, the total annual *eligible income of the undersigned was $ Z,g - 3 �. a U *Included in the total annual eligible income are: wages, tips, overtime, bonuses, and commissions; net income from a business or rental of real property; interest and dividends; social security, retirement funds or pensions, and disability benefits; workers' compensation and disability pay; severance pay; alimony; child support; regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance.). The undersigned acknowledge(s) that Newport North Apartments and the City of Newport Beach are relying on the accuracy of the information when an apartment is leased to the undersigned and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the leased premises. The undersigned also 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. Names and Ages of Non -Income Earning Household Members: Date: Signature of Income Earning Household Members: r NEWPORT NORTH APARTMENTS APT. # CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (When residents do not have Section S certificates/vouchers, income must be documented. Use this form to document the income.) We hereby certify to the management of Newport North Apartments that: 1. The undersigned is to be the only income earning occupant(s) of the leased premises, and 2. During 2001, the total annual *eligible income of the undersigned was $ 39 . c _. *Included in the total annual eligible income are: wages, tips, overtime, bonuses, and commissions; net income from a business or rental of real property; interest and dividends; social security, retirement finds or pensions, and disability benefits; workers' compensation and disability pay; severance pay; alimony; child support; regular and special pay and allowances of a member of the fumed Forces (to exclude hostile fire allowance.). The undersigned acknowledge(s) that Newport North Apartments and the City of Newport Beach are relying on the accuracy of the information when an apartment is leased to the undersigned and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the leased premises. The undersigned also consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made tinder penalt"y of perjury in Newport Beach, California. Names and Ages of Non -Income Earning Household Members: Date: Signature of Income Earning Household Members: NEWPORT NORTH APARTMENTS APT. # z 6'07 CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (When residents do not have Section 8 certificates/vouchers, income must be documented. Use this form to document the income.) I/We hereby certify to the management of Newport North Apartments that: The undersigned is to be the only income earning occupant(s) of the leased premises, and 2. During 2001, the total annual *eligible income of the undersigned was $ 24!�5F A. *Included in the total annual eligible income are: wages, tips, overtime, bonuses, and commissions; net income from a business or rental of real property; interest and dividends; social security, retirement funds or pensions, and disability benefits; workers' compensation and disability pay; severance pay; alimony; child support; regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance.). The undersigned acknowledge(s) that Newport North Apartments and the City of Newport Beach are relying on the accuracy of the information when an apartment is leased to the undersigned and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the leased premises. The undersigned also consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. • ' •i This Certification is made under penalty of perjury in Newport Beach, California. Names and Ages of•Non-Income Signature of Income Eariring Earning Household Members: Household Members: Date: Aa 6-. /x .t fl d z NEWPORT NORTH APARTMENTS APT. # CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (When residents do not have Section 8 certificates/vouchers, income must be documented. Use this form to document the income.) I/We hereby certify to the management of Newport North Apartments that: 1. The undersigned is to be the only income earning occupani(s) of -the leased premises, and 2. During 2001, the total annual *eligible income of the undersigned was $r 2 b D *Included in the total annual eligible income are: wages, tips, overtime, bonuses, and commissions; net income from a business or rental of real property; interest and dividends; social security, retirement Rinds or pensions, and disability benefits; workers' compensation and disability pay,-- severance pay; alimony; child support; regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance.). The undersigned acknowledges) that Newport North Apartments and the City of Ne«port Beach are relying on the accuracy of the information when an apartment is leased to the undersigned and in conferring on the undersigned the mohetary benefits ofthe Agreement which, restricts the rents collectible for occupancy of the leased premises. ' The undersigned also consents to the delivery of a� copy of this Certification of Continued Household Eligibility to the City of Newport Beach. This Certification is made undenpenalty of perjury in Newport Beach, California. Names and Ages of Non -Income Earning Household Members: C ck61' ceiW,IIf.AM-. Date: 1 ' 7, NEWPORT NORTH APARTMENTS APT. # CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (When residents do not have Section 8 certificates/vouchers, income must be documented. Use this forni to document the income.) I/We hereby certify to the management of Newport North Apartment§ that: 1. The undersigned is to be the only income earning occupant(s) of the leased premises, and 2. During 2001, the total annual *eligible income of the undersigned was $ big >-e' *Included in the total annual eligible income are: wages, tips, overtime, bonuses, and commissions; net income from a business or rental of real property; interest and dividends; social security, retirement fonds or pensions, and disability benefits; workers' compensation and disability pay; severance pay; alimony; child support; regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance.). The undersigned acknowledge(s) that Newport North Apartments and the City of Newport Beach are relying on the accuracy of the information when an apartment is leased to the undersigned and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the leased premises. The undersigned also consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. ; This Certification is made"itnder penalty of perjury in Newport Beach, California. Names and Ages of Non -Income Earning Household Members: QA&P b lei � Date: � -- t b -- Ya vy Signature of Income Earning Household Members: NEWPORT NORTH APARTMENTS APT. # ;Z6OR CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (When residents do not have Section 8 certificates/vouchers, income must be documented. Use this form to document the income.) MN Ye hereby certify to the management -of Newport North Apartments that: 1. The undersigned is to be the only income earning occupant(s) of the leased premises, and 2. During 2001, the total annual '"eligible income of the undersigned was $%Q. o 00 *Included in the total annual eligible income are: wages, tips, overtime, bonuses, and commissions; net'income from a business or rental of real property; interest and dividends; social security, retirement funds or pensions, and disability benefits; workers' compensation and disability pay; severance pay; alimony; child support; regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance.). The undersigned acknowledge(s) that Newport North Apartments and the City of Newport Beach are relying on the accuracy of the information when an apartment is leased to the undersigned and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible foroccupancy of the leased premises. The undersigned also consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. . 41 This Certification is made trader penalty of perjury in Newport Beach, California. Names and Ages of Non -Income Earning Household Members: Signature of Income Earning Household Members: NEWPORT NORTH APARTMENTS APT. # 23 . CERTIFICATION OF CONTINUED HOUSEHOLD ELIGIBILITY (When residents do not have Section 8 certificates/vouchers, income must be documented. Use this form to document the income.) I/We hereby certify to the management of Newport North Apartments that: 1. The undersigned is to be the only income earning occupant(s) of the leased premises, and 2. During 2001, the total annual *eligible income of the undersigned was $ 2Q Z_Z-` (Y . *Included in the total annual eligible income are: wages, tips, overtime, bonuses, and commissions; net income from a business or rental of real property; interest and dividends; social security, retirement fiends or pensions, and disability benefits; workers' compensation and disability pay; severance pay; alimony; child support; regular and special pay and allowances of a member of the Armed Forces (to exclude hostile fire allowance.). The undersigned acknowledge(s) that Newport North Apartments and the City of Newport Beach are relying on the accuracy of the information when an apartment is leased to the undersigned and in conferring on the undersigned the monetary benefits of the Agreement which restricts the rents collectible for occupancy of the leased premises. The undersigned also consents to the delivery of a copy of this Certification of Continued Household Eligibility to the City of Newport Beach. 0. • . This Certification is made under penaltybf perjury in Newport Beach, California. Names and Ages of Non -Income. Signature of Income Earning — Earning Household Members: Houuseho .Member- ��— AYM�,v N� F� t.-• A011, }�//°IeD N, FA L � AWzI A Nrd AL--. Mli 01 /f' 1Y . .6GSAye..J ItA FAL- M W= IRVINE APARTMENT MANAGEMENT COMPANY November 26, 2002 City of Newport Beach P.O. Box 1786 Newport Beach, CA 92663-3884 Attn: Daniel Trimble Program Administrator RE: Affordable Housing Reporting — Newport North Project Agreements to Provide and Maintain Affordable Housing "North Ford Development Agreement" dated 4/22/85 Exp. 324/11 Dear Ms. Teague: Pursuant to the terms of the above referenced agreements, we, as agents for the owners of this property are responsible for qualifying residents as "Affordable Residents." Enclosed you will find the income computations and certifications, as well as other documentation on which we have relied to qualify new residents as "Affordable." This reporting covers new move -in during October 2002. Should you have any questions, please do not hesitate to call me at (949) 450-4290. Sincerely, ZeYtd .Mac an Bond Compliance Auditor Irvine Apartment Management Company 43 Discovery, Suite 150, P.O. Box 57060, Irvine, Californla 92619-7060 • (949) 450.4262 • Fax (949) 450-5802 EXHIBIT C Property Name: Newport North CERTIFICATE OF CONTINUING PROGRAM COMPLIANCE AS OF October 31, 2002 The undersigned, being an Authorized Borrower Representative of Irvine Apartment Communities, L.P. (the "Borrower"), has read and is thoroughly familiar with the provisions of the various documents- associated with the Borrower's participation in the California Statewide Communities Development Authority's (the "Issuer") Apartment Development Revenue Bond Program, such documents including: 1. The Amended and Restated Regulatory Agreement and Declaration of Restrictive Covenants dated as of May 15, 1998 among the Borrower, the Issuer and U.S. Bank Trust National Association (the "Trustee"). 2. The Loan Agreement dated as of May 15, 1998, between the Issuer and the Borrower. 3. During the preceding month 5 applications were received from Restricted Tenants (as defined in the Regulatory Agreement): 4. As of the date of this certificate, the following percentages of completed residential units in the Project (i) are occupied by Restricted Tenants, or (ii) are currently vacant and are being held available for such occupancy and have been so held continuously since the date such unit was vacated, as indicated: 1 2 3 Studio Bdrm. Bdrm. Bdrm. Total Occupied by Original Low Income Tenants N/A N/A N/A N/A N/A 0.00% Unit Nos.: Occupied by Lower Income Tenants - N/A 28 49 8 85 14.91 % Unit Nos.: Occupied by Very ' Low -Income Tenants N/A 14 15 0 29 5.09% Unit Nos.: Held vacant for Occupancy continuously N/A 0 0 0 0 Since last occupied: 0.00% Unit Nos.: Total Number of Units: 20_00% Unit Nos.: N/A 42 64 8 114 Since last occupied: The undersigned hereby certifies that the Borrower is not in default under any of the terms and provisions of the above documents, and no event has occurred which, with the passage of time, would constitute a default thereunder, with the exception of the following: w 1' I I• SIZI Contact Person: Yvette Machan Bond Compliance Auditor (949) 450-4290 OCTOBER 2002 MOVE IN NOVEMBER 2002 RECERTS NEWPORT NORTH OC85 Mnvw_inc nrinr to 5l25/9.ri Apt. Address Resident Name Size # of Occ. M/I Date M/O Date House Income I Rent Recert Due 1. 1330 Delkash 2+2 3 1/20/90 $33,559 $1,1361 N/A 1RVINE APARTMENT MANAGEMENT COMPANY BOND SUADJARY OCTOBER 2002 MOVE IN NOVEMBER 2002 RECERTS NEWPORT NORTH 26. 1100 Fiore 3+2 1 09/01/01 47691.6 1474 09/03 27. 1104 Mcconne 1+1 2 8/13/01 51172.6 1160 8/03 28. 1106 Meyer 1+1 1 7/08/00 35508.7 1160 7/03 29. 1107 Aviles 1+1 4 08/23/01 23416.2 884.25 08/03 30. 1108 Romero/Serrano 2+2 5 11/05/01 56534.9 994.5 11/03 31. 1118 Feldhaus 1+1 1 10/04/02 39862 1160 10/03 32. 1122 Hales 2+2 2 7/13/98 33262 1361 7/03 33. 1128 DelFante 3+2 1 4 11/06/99 83456.1 1 1474 11/03 34. 1141 Holder 2+2 1 1126196 37600 1252 1/03 35. 1144 Se ehrband 1+1 1 11/16/00 14022 1150 11/03 36. 1145 Axelrad 1+1 1 8/30/00 41424.2 1160 8/03 37. 1154 Collins/Collins/Col 2+2 3 7/29/99 26000 1361 7/03 38. 1159 Farrell 1+1 1 10/15/02 42000 1210 10/03 39. 1183 Power 1+1 2 611196 34907.7 1113 06/03 40. 1184 Olson/Ammann 2+2 2 1 6/7/02 1 45968.5 1361 1 06/03 41. 1200 Wood 2+2 3 08/04/01 48871.2 1361 08/03 42. 1203 Gallicano 2+2 1 11/07/01 37729.53 1252 11/03 43. 1206 Bottiaux 2+2 2 10/19/02 34927.08 1361 10/03 44. 1207 Robbs/Fer uson 2+2 2 7/14/96 49945 1361 7/03 45. 1231 Lidia Mandelbaum 1+1 1 12/26/99 23060 1210 12/02 46. 1408 Amor 2+2 2 08/15/02 18258.3 1361 08/03 47. 1411 Loran er 2+2 1 02/22/02 40,491 1326 02/03 48. 1412 Fu'ioka 2+2 1 7/10/98 44371 1361 7/03 49. 1418 Lee 1+1 2 7/12/02 34902 1160 07/03 50. 1441 Gerry1+1 2 12/08/01 41873 1179 12/02 51. 1444 Douglas 2+2 1 2/12/99 50147 1326 2/03 52. 1502 Smith 2+2 4 3/31/96 64615.4 1306 03/03 53. 1557 Graves 1+1 1 2/12/02 39500 1,179 02/03 54. 2116 Zaharson 2+2 1 03/29/02 19280 1,326 03/03 55. 2123 Ross 1+1 3 11/16101 49894.73 1179 11/03 56. 2134 Huish 2+2 3 9/11/99 22574.2 1361 9/03 57. 2212 Riedelsheimer 2+2 3 08/20/02 37,604 1326 8/03 58. 2224 An ozian 1+1 1 5/27/98 35210 1160 5103 59. 2225 Adams 1+1 1 04/06/00 36000 1210 04/03 60. 2226 S uin 2+2 1 12/17/96 24282 1326 12/02 61. 2301 Altes/Mchugh 2+2 2 05/10/01 43254.3 1361 05/03 62. 2309 Loczi/Milo 1+1 2 6/13/02 37200 1210 6/03 63. 2312 Nam 2+2 1 01/11/00 30000 1326 01/03 64. 2322 Marino 1+1 1 8/8/96 15840 1075 8/03 65. 2402 Mehrick 2+2 1 01/28/00 1 43428.7 1326 01/03 66. 2423 Malkin 2+2 2 8/23/96 24000 1280 8/03 67. 2426 McKee 2+2 2 6/4/02 21108 1 1020.75 6/03 68. 2507 Jones/Janisse 2+2 2 10/25/00 48054.4 1252 09/03 69. 2612 1 Van Nieuwenhu se 2+2 3 08/08/02 44067.9 1361 08/03 70. 2628 Roshankar 3+2 3 12/10/01 52280 1474 12/02 71. 2633 Chun o 2+2 2 08/20/02 40636.3 1280 08/03 72. 2719 Brobst 1+1 1 2/14/99 53796.8 1065 2/03 73. 2720 Larson 1+1 1 10/10/99 56922.3 1150 10/03 IRVINE APARTMENT MANAGEMENT COMPANY BOND SUMMARY OCTOBER 2002 MOVE IN NOVEMBER 2002 RECERTS NEWPORT NORTH VERY LOW (Phase In - beginning 4/1198) Apt. Address Resident Name Size # of Occ. M/I Date AVO Date House Income Rent Recert Due 1. 106 Lausen 1+1 1 4/11/98 $33886 $ 737 4/03 2. 122 Galla i 2+2 2 01/05/01 $10,523 $ 783 01/03 3. 126 Francis/Vidal 2+2 4 12/28/00' $40000 $ 829 12/03 4. 208 Tarta lini 1+1 2 04/01/01 $27,444 $ 696 04/02 5. 224 Rice/Harris 1+1 2 8/l/99 $30219 $ 737 8/03 6. 228 Jones 2+2 1 2 5/8/99 1 $22,336 1 $ 829 5/03 7. 243 Batts 1+1 1 511199 $24,154 $ 737 5/03 8. 301 Francis 2+2 2 2/08/02 $26399 $ 783 02/03 9. 318 Radford 1+1 1 7/8/99 $23430 $ 737 7/03 10. 320 McGinley 1+1 1 4/16/99 $8,467 $ 737 4/02 11. 333 Sa orowski 1+1 1 2/3/01 $30,000 $ 737 2/02 12. 1180 Siroonian 1+1 1 4/7/02 $24,542 $ 737 04/03 13. 1323 Buoncristian 1+1 3 11/10/01 $27684. $ 737 09/03 14. 1324 Hale 2+2 1 4/1/01 $25,819 $ 851 04/03 15. 1333 Stork 1+1 1 9/7/02 $23068 $ 756 09103 16. 1419 Mino 1+1 1 5106101 $21,600 $ 696 5/03 17. 1530 Siddi i 1+1 3 6111100 $46249 $ 737 06/03 18. 2128 Johnston 2+2 2 6/8/00 $24636 $ 829 06/03 19. 2140 Vise 2+2 1 02/01/02 $24,000 $ 829 02/03 20. 2210 Rossi 2+2 1 12/07/01 $25,680 $ 829 12/02 21. 2300 Mohler 2+2 3 611199 $25,263 $ 829 06103 22. 2408 Shoeibi/Motta hi 2+2 2 1 5/12/02 25984 $ 851 05/03 23. 2425 Uchida 2+2 3 04/11/01 $12,402 1 $ 783 04/03 24. 2428 Winslett 2+2 1 03/17/00 $23,500 $ 829 3/03 25. 2440 Afshar 2+2 2 05/06101 $15,424 $ 783 05/03 26. 2450 Warfield 1+1 1 4/11/98 $8,827 $ 737 /02 27. 2519 Cotter 1+1 1 5/29/01 $25,410 $ 737 /03 !03/03 28. 2608 Vidal/Gaxiola 2+2 2 611199 $25426 $ 829 6103 2+2 4 3/l/02 $25,200 $ 829 1998 Phase in-106-122-224-318-320-2450 1999 Phase in- 228-243-1180-2608-2300-126 2000 Phase in— 2428- 1333-2519-1530-2128 2001 Phase in — 333-208-1323-2425,1419,2140,2440,305 2002 Phase in — 2210,2408,2140,2702,1324 Total number of apartments on this property: 570 % of property deemed Income Restricted (Low): 15.26% % of property deemed Income Restricted (Very Low): 4.74% TTP = Total Tenant Payment (Resident is on Certificate or Voucher) Total vacant as of 10/31/02- 21 Now Cerdflcadon _X_ / Recerdfrcaaw. Unit Number 10 4 INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designed to assist you in computing Annual Income in accordance with the method set forth in the Department of Housing and Urban Project ("HUD") Regulations (24 CFR 813). You should make certain that this form is at all tortes up to date with the HUD Regulations. Allcapitalized terms used herein shall have the meaning set forth in the Regulatory Agreement. Re: (NAME and ADDRESS of Apartment Building) Newport North - CSCDA (POOL) I/We the undersigned state that I/we have read and answered fully, frankly and personally each of the following questions for all persons who are to occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit: 1. 2. 3. 4. 5. Name of Members Relationship of the to Head of Social Securiy Place of Household Household Age Number Employment Sirr w rz-4r 1.,. li s 1;1 _ (.14 - h_ 216r) ^ 12nr ks Income Computation 6. The total anticipated income, calculated in accordance with this -paragraph 6, of all persons (except children under 18 years) listed above for the 12-month period beginning the earlier of the date that Uwe plan to move into a unit or sign a lease fora unit is $ 3 g'� 666 • SS Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (b) tie net income from the operation of a business or profession or from the rental of real of personal properry (without deducting expenditures for business expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets except for straight line depreciation as provided in Internal Revenue Service regulations); (c) interest and dividends (including income from assets included below and other net income from real or personal property); (d) the full amount of periodic payments received from social security, annuities, insurance policies, retirement funds, pensions, disability or death benefits and other similar types of periodid'receipts, including any lump stun payment for the delayed start of a periodic payment; (e) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (0 the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter and utilities plus the maximum amount that the public assistance agency could in fact allow for shelter and utilities; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not residing in the dwelling; (h) all regular pay, special pay and allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the household or spouse (or other persons whose dependents are residing in the units); and (i) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; (b) amounts which are specifically for or in reimbursement of medical expenses; (c) lump sum addidons to family assets, such as inheritances, insurance payments (including payments under health and accident insurance and workers' compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational institution, and amounts paid by the government to a veteran for use in meeting the costs of tuition, fees, books and equipment. Any amounts of such scholarships or payments to veterans not used for the above purposes are to be included in income; (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (0 amounts received under training programs funded by HUD; (g) foster child care payments; (h) amounts received by a disabled person that are disregarded for a limited time for purposes of Supplemental Security Income eligibility and benefits because they are set aside for use under a Plan to Attain Self -Sufficiency; (i) income of a live-in aide; Q) amounts received by a participant in other publically assisted programs which are specifically for or in reimbursement of out-of-pn ket expenses incurred and which are Bade solely to allow participation in a specific program; (k) a resident service stipend (a mcdest amount (not to exceed $200 per month) received by a resident for performing a service for be owner, on a part-time basis, that enhances the quality of life in the development; If this form is being completed in accordance with recertification of a Lower Income Tenant's or Very Low Income Tenant's occupancy of a Lower Income Unit or a Very Low Income Unit, respectively, this fora must be completed based upon the current income of the occupants. a.Antc.ossracc•ronst (1) compensation from state or local employment training programs and training of a family member as resident management staff; (m) reparation payments paid by a foreign government pursuant to claims filed under the laws ofthnt government by persons who were pcmcuted during the Nazi era; (n) amounts specifically excluded by any otherflodartil statute from consideration as income for purposes of determining eligibility orbenclits undera category of assistance programs that includes assistance underthe United States Housing Act of 1937; (o) eamings in excess ofS480 for each full -term student 18 years old or older (excluding the head of household and spouse); (p) adoption assistance payments in excess ofS480 per adopted child; and (q) deferred periodic payments of supplemental security income and social security benefits that are received in a lump sum payment; (r) amounts received by the family in the form of refunds qr rebates under state or local law for property taxes paid on the dwelling unit; (s) amounts paid by a State agency to a family with a developmentally disabled family member living at home to offset the cost of services and equipment needed to keep the developmentally disabled family member at home; and (t) amounts specifically excluded by an other federal statute from consideration as income for purposes of determining eligibility or benefits under a category of assistance programs that includes assistance under the United States Housing Act of 1937. 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necessary items of personal property such as furniture and automobiles and interests in Indian trust land) Yes Li_No; or (b) have they disposed of any assets (other than at.a foreclosure or bankruptcy sale) during the last two years at less than fair market valve? Yes X No (c) If the answer to (a) or (b) above is yes, does the combined total value of all such assets owned or disposed of by all such persons total more than S5,000? Yes No . (d) If the answer to (c) above is yes, state: (1) the combined total value of all such assets: S (2) the amount of income expected to be derived from such assets in the 12-month period beginning on the date of initial occupancy in the unit that you propose to rent: S V and (3) the amount of such income, if any, that was included in item 6 above: S .� S. (a) Are all of the individuals who propose to reside in the unit full-time students*? Yes No *A full-time student is an individual enrolled as a full-time student during each of 5 -calendarmonths during the calendar year In which occupancy of the unit begins at an educational organization which normally maintains a regular faculty and curriculum and normally has a regularly enrolled body of students in attendance or is an individual pursuing a full-time course of institutional or form training under the supervision of an accredited agent of such an educational organization or of a state or political subdivision thereof. (b) If the answer to 8(a) is yes, is at least 2 of the proposed occupants ofthe units husband and wife entitled to file a joint federal income tar return? Yes_�No ' 9. Nei ther myself nor any other occupant of the unit Ywc propose to rent is the owner of the rental housing project in which the uhit is located (herchnaller the "Owne r"), has any family relationship to the Owner; or owns directly or indirectly any interest in the Owner. For purposes of this paragraph, indirect ownership by an individual shall mean ownership by a family member, ownership by a corporation, partnership, estate or trust in proportion to the ownership orbeneficial interest In such corporation, partnership, estate or Trustee held by the individual or a family member; and ownership, direct or indirect, by a partner ofthe individual. 10. This certificate is made with the knowledge that (twill be relied upon by the Owner to determine maximum income for eligibility to occupy the uni; and Uwe declare that all information set forth herein is true, correct and complete and based upon information I/wc deem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. 11. IRS•e will assist the Owner in obtaining any information or documents required to verify the statements made herein, including either an Income verification from my/our present employer(s) or copies of federal tax returns for the immediately preceding calendar year. 12. I/1Ye acknowledge that I/we have been advised that the making of any misrepresentation or misstatement in this declaration will constitute a material breach of my/our agreement with the Owner to lease the unit and will entitle the Owner to prevent or terminate my/our occupancy of the unit by institution of an action for ejection or other appropriate proceedings. IAVe declare under penalty of perjury that the foregoing is true and correct. Applicant 20,�r'/4 in the City of WL_UtDr + a-ev-_ t .California Applicant Applicant Rev. 8/95 [Signature of all persons (except children under the age of 18 years) listed In number 2 above required] a n FOR COMPLETION BY APARTMENT OWNER ONLY: 1. Calculation of eligible income: a. Enter amount entered for entire household in 6 above: b. (1) If the amount entered in 7(c)above is'yes, enter the total amount entered in 7(d)(2), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ _ 0 — ); (2) Multiply the amount entered in 7(d)(1) times the current passbook savings rate a-s determined by HUD to determine what the total annual earnings on the amount in 7(d)(1) would be if invested in passbook savings ($ le ), subtract from -that figure the amount entered in 7(d)(3) and enter the remaining balance ($ (3) Enter at right the greater of the amount calculated under (1) or (2) above: C. TOTAL ELIGIBLE INCOME (line La plus line l.b(3): 2. The amount entered in l.c: $ $��66c.s8 Qualifies the applicant(s) as a Moderate -Income Tenant(s). i( Qualifies die applicant(s) as a Lower -Income Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenant(s). 3. Number of apartment unit assigned: I G 4 Bedroom size: f +I Rent: $ - L j 40 4. This apartment unit was not) last occupied for a period- of 31 or more consecutive days by persons whose aggregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartment unit qualified them as a Lower -Income Tenant(s). S. Method used to verify applicant(s) income: Manager Employer income verification. Copies of tax returns. Other ( A vilyw- Date OJ.ANC.0991:ICC-FORM Apartment # 1 D 4 Your pmployee has applied for a rental unit located on a property financed under the City's Multifamily Rental Housing Program. We are obliged to stringently verify income statements on all prospective residents for such apartments. NOTE TO EMPLOYER: This form is an estimate of anticipated earnings solely for the purpose of determining income status. This form does not constitute a promise by the employer to the employee of guaranteed wages, bonuses or raises. Please indicate your employee's current annual income (numbers on] vl from wages, - overtime, bonuses, commissions or any other form of compensation received on a regular basis: YTD WAGES YTD OVERTIME YTD BONUSES YTD COMMISSIONS TOTAL CURRENT INCOME $ NA $ /NA. e /V-4 I hereby certify that the amounts above are true and complete to the best of my Employer's Signature Date Title I hereby grant you permission to disclose my income in order that they may determine my income eligibility for the rental of apartment financed under the city's Multifamily ffiffil i/li% / 1 61 yu3..W -, ;Z= � 3,221.74 X 12 = j39146o. sfsl� . r1 INCOME RESTRICTED j FINANCIAL WORKSHEET Project Kir-%,vp r'i- 4.1o^µ1 :UnitNo. bC Applicant's Name: Sln•la'1 hv15 Annual Salary Others Raiding in Unit: Annual Salary Annual Salary Annual Salary. . Commissions/Bonuses $ Savings Accounts: Bank Balance — x %_ $ Bank Balance x %_, $ Bank Balance x %_ $ Interest Bearing Checking Account Bank Balance x %_• $ Bank Balance x %_ $ Stocks/Bonds: Type Amount x % = S Trust Fund: Type Amount x % = S Other: (Alimony, Child support, retirement pensions, social security, disability payments, parental support, etc.) Show calculation, how Annual is arrived ail Type Annual S Type Annual $ Type Annual $ Property Owned By Resident: Address . Equity X_%= $ TOTAL ANNUAL ELIGIBLE INCOME $ S'$ Maximum Annual Household Income Limit $ 4 2, 336 • oci Ngw Cerdfrcadon X 1 Reeerafrn - Unit Number. 313 it Y INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designed to assist you in computing Annual Income in accordance with the method set forth in the Department of Housing and Urban Project ("HUD") Regulations (24 CFR 813)_ You should make certain that this form is at all times up to date wiE the HUD Regulations. All capitalized terms used herein shall have the meaning set forth in the Regulatory Agreement. Re: (NAME and ADDRESS of Apartment Building) Newport North : CSCDA (POOL) I/We the undersigned state that Uwe have read and answered fully, frankly and personally each of the following questions for all persons who are to occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit: 1. 2. 3. 4. 5. Name of Members Relationship of the to Head of Social Security Place of Household Household Age Number Employment Shr1'rlw�r>.n�rP,rYa 1-1� P__ - 562 - 62-02T ScCgh. , la C—ki Id 17 ✓1/a nla Income Computation 6. The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children under 1S years) listed above for the 12-month pe rd beginning the earlier of the date that Uwe plan to move into a unit or sign a lease for a unit is $ 4131275, 16 Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real of personal property (without deducting expenditures for business expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets except for straight line depreciation as provided a Internal Revenue Service regulations); (c) interest and dividends (including income from assets included below andother net income from real or personal property); (d) the full amount of periodic payments received from social security, annuities, insurance policies, retirement funds, pensions, disability or death benecq and other similar types of periodid'receipts, including any lump sum payment for the delayed start of a periodic payment; (e) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (f) the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter and utilities plus the maximum amount that the public assistance agency could in fact allow for shelter and utilities; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not res:d- in the dwelling; (h) all regular pay, special pay and allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the household rr spouse (dr other persons whose dependents are residing in the units); and (I) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; (b) amounts which are specifically for or in reimbursement of medical expenses; (c) lump sum additions to family assets, such as inheritances, insurance payments (including payments under health and accident insurance and workers compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational institution, and amounts paid by the government to a veteran for use meeting the costs of tuition, fees, books and equipment. Any amounts of such scholarships or payments to veterans not used for the above purposes a_e to be included in income; (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (f) amounts received under training programs funded by HUD; (g) foster child care payments; (h) amounts received by a disabled person thafare disregarded for a limited time for purposes of Supplemental Security Income eligibility and benefits beca•_R they are set aside for use under a Plan to Attain Self -Sufficiency; (i) income of a live-in aide; () amounts received by a participant in other pubiicaily assisted programs which are specifically for or in reimbursement of out-of-pocket expenses loci-e- and which are made solely to allow participation in a specific program; (k) a resident service stipend (a modest amount (not to exceed $200 per month) received by a resident for performing a service for the owner, on a part -tee basis, that enhances die quality of life in the development; if this form is being completed in accordance with recertification of a Lower Income Tenant's or Very Low Income Tenant's occupancy of a Lower Income Unit or a Very Low Income Unit, respectively, this form must be completed based upon the current income of the occupants. 01.AMCASW:ICC•F0RM (1) compensation from state or local employment training programs and training of a family member as resident management staff; (m) reparation payments paid by a foreign government pursuant to claims filed under the laws of that government by persons who were persecuted during the Nazi era; (n) amounts speciflcally excluded by any other federal statute from consideration as income for purposes of determining eligibility or benefits under a eategor:. of assistance programs that includes assistance under the United States Housing Act of 1937; (o) earnings in excess of$480 for each futl-tent student 18 years old or older (excluding the head of household and spouse); (p) adoption assistance payments in excess of$480 per adopted child; and (q) deferred periodic payments of supplemental security income and social security benefits that are received in a lump sum payment; (r) amounts received by the family in the form of refunds or rebates under state or local law for property taxes paid on the dwelling unit; (s) amounts paid by a State agency to a family with a developmentally disabled family member living at home to offset the cost of services and equipmen: needed to keep the developmentally disabled family member at home; and (t) amounts specifically excluded by an other federal statute from consideration as income for purposes of detemminipg eligibility or benefits under categon of assistance programs that includes assistance under the United States Housing Act of 1937. 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necessary items of personal property such. as furniture and automobiles and interests in Indian trust land) e? Yes No; or (b) have they disposed of any assets (other than at.a foreclosure or bankruptcy sale) during the last two years at less than fair market value? Yes __A_No (c) if the answer to (a) or (b) above is yes, does the combined total value of all such asses owned or disposed of by all such persons total more than S5,000? Yes _ANo (d) If the answer to (c) above is yes, state: (1) the combined total value of all such asses: $ 25.47 (2) the amount of income expected to be derived from such asses in the 12-month period beginning on the date of initial occupancy in the unit that }oc propose to rent: S G.50 and (3) the amount of such income, if any, that was included in item 6 above: $ 0 .GO S. (a) Are all of the individuals who propose to reside in the unit full-time students*? Yes___X.No *A full-time student is an individual enrolled as a full-time student during each of 5 calendar months during the calendar year in which occupancy of the unit begins at an educational organization which normally maintains a regular faculty and curriculum and normally has a regularly enrolled body of students in attendance or is an individual pursuing a full-time course of institutional or farm training under the supervision of an accredited agent of such an educational organization or of a state or political subdivision thereof. (b) If the answer to 8(a) Is yes, is at least 2 of the proposed occupants of the unit a husband and wife entitled to file a joint federal income tax return? Yes __,X_No 9. Neither myself nor any other occupant of the unit IAve propose to rent is the owner of the rental housing project in which the uhit is located (hereinafter the "Owner"), has any family relationship to the Owner; or owns directly or indirectly any interest in the Owner. For purposes of this paragraph, indirect ownership by m Individual shall mean ownership by a family member, ownership by a corporation, partnership, estate or trust in proportion to the ownership or beneficial interest in such corporation, partnership, estate or Trustee held by the individual or a family member; and ownership, direct or indirect, by a partner of the Individual. 10. This certificate is made with the knowledge that it will be relied upon by the Osier to determine maximum income for eligibility to occupy the unit; and Uwe declare that all information set forth herein is true, correct and complete and hued upon information Ihve deem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upon such investigation as,the undersigned deemed necessary. 11. I/We will assist the Owner in obtaining any information or documents required to verify the statements made herein, including either an income verification Lora my/our present employer(s) or copies of federal tax returns for the immediately preceding calendar year. 12. I/We acknowledge that Uw•e have been advised that the making of any misrepresentation or misstatement In this declaration will constitute a material breach of my/our agreement with the Owner to lease the unit and will entitle the Owner to prevent or terminate my/our occupancy of the unit by institution of an action to. - ejection or other appropriate proceedings. Me declare under penalty of perjury that the foregoing is true and correct. Executed this �•nfl day of CAO)22r' .200'_7_inthe City of &-,act .California r Applicant Applicant Applicant Rev. 8195 [Signature of all persons (except children under the age of 18 years) listed in number 2 above required] FOR COMPLETION BY APARTMENT OWNER ONLY: Calculation of eligible income: a. Enter amount entered for entire household in 6 above: b. (1) If the amount entered in 7(c)above is yes, enter the total amount entered in 7(d)(2), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ (� ) (2) Multiply the amount entered in 7(d)(1) times the current passbook savings rate as determined by HUD to determine what the total annual earnings on the amount in 7(d)(1) would be if•invested in passbook savings ($ _�—)+ subtract from -that figure the amount entered in 7(d)(3) and enter the remaining balance ($ ); r (3) Enter at right the•greater of the•amount calculated under (1) or (2) above: c. TOTAL ELIGIBLE INCOME (line 1.a plus line I.b(3): 2. The amount entered in I.c: Qualifies the applicants) as a Moderaie-Income Tenant(s). XQualifies the applicant(s) as a Lower -Income Tenant(s). $ y3 276.16 $ le-11 Qualifies the applicant(s) as a Very -Low Income Tenant(s). 3. Number of apartment unit assigned: 413Bedroom size: 14 L Rent: $ 1 .2__ , _LO was not) last occupied for a period• of 31 or more consecutive days by persons whose 4. This apartment unit (EP aggregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartment unit qualified them as a Lower -Income Tenant(s). 5. Method used to verify applicant(s) income: Employer income verification. Copies of tax returns. Other ( 10121oZ Date Manager EMPLOYEE NAME I EMPLOYEEUMBER ORO II IOX OCLLL 5 CO Y NO. I NO. OF DEP. RHOMBERG, SHERRY WFSEP99183432 0002 02 562-02-4728 ,n�M Mot ' M01. PER BEG I PER END I CK DATE I CK NUMBER I MISCELLANEOUS 0&26502 ogoBaz o9lOD2 00012384 EARNINGS/COMPENSATION DEDUCTIONS/TAXES/MISCELLANEOUS VPEI DESmotfdR• -RA'3E R pi 1£S AA dol: YEAR TO DATE TYPE tlssc U llgy AMOIN; YVAR TO OATb EN EN REGULAR COMMISSION 8.6000 5875- 5052 41:51 8,68486 457�7 TX TX FED. W/H FICA/OASI 18,4 33!1 226 566A ' TX MEDICARE 731a 13257 TX CA ST W/H 129 12J s TX CA ST SDI liz 822g 5 > _ 5 ter..,•• • • , ' 3 TOTAL EARN 54683 9,742 ::::.i:GRCiSS' � :..:I,GSS .PRC-T/1X .'ii�XAA •�.•17VlLQGa' . `C��`S 'iA9C�8.• ], $;3-A!~4UCTIQN .. .3VBT;, AY, • . cuRr+Nr. 546.83 66.1,0 .00 ;;,e.Fu�t3;t, ; _546.83 —128.0 VACATION HOURS BALANCE SUPERCUTS 6 SHELBY, IRVINE CA 92620-6211 �q�142•g'3. •=•S.2S= �q,gpS•2x(2=(3,2A8'-66/�. EMPLOYEE NAME I EMPLOYEE NUMBER I DEPT. O G IZATION I SOCIAL CU I NO. I NO. OF DEP. RHOMBERG, SHERRY WFSEP99183432 0002 02 562-02-4728 nm,.L MO1 n�,c MO1 PER BEG PER END CK DATE CK NUMBER I MISCELLANEOUS 09.1202 0825�2 06.27D2 00012346 EARNINGS/COMPENSATION DEDUCTIONS/TAXES/MISCELLANEOUS TYPE OE6CRIPTfON RATE "' RSiUNliS AMDUN7 YEAR -To b47E *ot bElo IP1;YDfl ADUNT. YEAR 70 DATE EN REGULAR 8.6000 5600 481$0, 8,'l 111 1 TX FED. W/H 11&1 20837' EN COMMISSION 4 TX FICA/OAST 2g9$6 532aq5 TX MEDICARE �i9$ 124b7+ TX CA ST W/H 5R 116 ' TX CA ST SDI .03 77:3 i > .y TOTAL EARN 481*60 8,59600 ' GROSS LESS PRE TAX ITAXA13LE WAGES LESS '.-FAXES ' LESS DEEIUCTtt3N fli; f PAY CURRENT• 487.60 481.6ol 53.62 .00 -128.0 VACATION HOURS BALANCE SUPERCUTS 6 SHELBY, IRVINE CA 92620-6211 EMPt Y t m P NU G I 1 S I Y NO. MO. OF D. RHOMBERG, SHERRY WFSEP99183432 0002 02 562-02-472$ �,v. Mot n.T Mot PER BEG PER END CK DA7E r CK NUMBER MISCELLANEOUS ' 07p1502 072802 O730A2 00012264 EARNINGS/COMPENSATION DEDUCTIONS/TAXES/MISCELLANEOUS 'SYRE 9EOOR N - R}.7E HN3J UR'8 UNF YEAR MY DATE 0 #5£3CR VON A OU0 YEAR 76 6A7£ EN REGULAR 8.6000 5* 490�0 7,227:1fi'TX FED. W/H 126 EN COMMISSION 375$6 TX TX TX TX FICA/OAST MEDICARE CA ST W/H CA ST SDI 32k 71 4 1821j 4716 110030 �$iF 5 • a i 3 i i i z . • ne9c TOTAL EARN 5 496�O 7,607g2: CyROSS - LES$ PAE TAX ITAXA13LE WAGSSJ LESS TAXES LESS DEDU� � NET PAY. tlRRENT 49o.201490.20 55.32 .00 - - 44X -128•.0 VACATION HOURS BALANCE SUPERCUTS 6 SHELBY, IRVINE CA 92620-6211 MARITAL SETTLEMENT AGREEMENT DAVID ROBERT RHOMBERG, referred to in this Agreement as Husband, and CHERRY LYNN RHOMBERG referred to in this Agreement as Wife, have entered into this Marital Settlement Agreement on April, 1st 2002 in Newport Beach, California. 1. Effective Date. This Agreement shall become effective on the date of execution. 2. Purpose. The primary purpose of this Agreement is to settle the parties' rights and obligations with regard to their property, debts, and duties of support to each other and custody and support of the parties' minor children. t' RECITALS This Agreement is made in light of the facts stated below. 3. Marriage. The parties were married on November 20, 1983 in San Louis Obispo, California, and ever since have been, and are now, Husband and Wife. ' 4. Separation. Irreconcilable differences have arisen between the parties, and as a result they have lived seliarate and apart since May 1, 2001. They now intend to live apart permanently. 5. Legal Proceedings. An action for dissolution of marriage has been filed by Husband and is now pending in the Superior Court of the State of California, Orange County, Case No. 01D009441. 6. Children of the Marriage. The parties have one minor child, Jessica Rhomberg, age 14, date of birth September 23, 1985. - 1 - STIPULATION AND WAIVERS The parties waive their rights to notice of trial, findings of fact and conclusions of law, motion for new trial, and the right to appeal and stipulate that this matter may be heard as an uncontested matter. CHULD CUSTODY The parents shall have joint legal custody of their minor child, Jessica, born September 23, 1985. The parents shall have joint physical custody, which means that each of the parents shall have significant periods of physical custody. Joint physical custody 'shall be shared by the parents in such a way as to assure the child has frequent and continuing contact with both parents according to the following parenting plan: The child shall reside primarily with Mother, except for the periods of time in which child shall stay with Father as the child desires. CHILD SUPPORT Father shall pay W Mother the sumo $1084.0(5er month as'and for child support. Child support is payable on the first day of each month commencing May 1, 2002 and shall continue on the first day of each month thereafter until further order of the court, or until the child marries, dies, is emancipated, reaches the age of 19, or reaches the age of 18 and is not a full-time high school student residing with a parent, whichever occurs first. Health insurance on behalf of the minor child shall be maintained by the Father through his employment. Unreimbursed health, medical, psychological, drug, dental and vision expenses shall be shared equally between the parties. The parties declare that: i) They are fully informed of their rights concerning child support. 1,08-y X -2- ii) The order is being agreed to without coercion or duress. iii) The agreement is in the best interest of the child involved. iv) The child's needs will be adequately met by the stipulated amount. v) The right to support has not been assigned to the county pursuant to Section 11477 of the Welfare and Institutions Code and no public 'assistance application is pending. SPOUSAL SUPPORT Husband shall pay to Wife as spousal support the sum o $1414.00 per onth. Said sum shall be paid on the first day of each month commencing May 1, 2002 and continuing thereafter until death, remarriage of Wife, or further order of the court. DIVISION OF ASSETS Assets Awarded to Husband. Wife hereby affirms to Husband, as his sole and separate property, the -following separate property, and/or transfers and assigns to Husband, as his sole and separate property, all+of Wife's right, title and interest in and to the following property, subject to any encumbrances or unpaid balances due thereon, which the Husband hereby assumes and agrees to pay, and to indemnify and hold the Wife free and harmless therefrom: All items set forth on Exhibit A. Assets Awarded to Wife. Husband hereby affirms to Wife, as hers sole and separate property, the following separate property, and/or transfers and assigns to Wife, as hers sole and separate property, all of Husband's right, title and interest in and to the following property, subject to any encumbrances or unpaid balances due thereon, which the Wife hereby assumes and agrees to pay, and to indemnify and hold the Husband free and harmless therefrom: All items set forth on Exhibit B. 141 cI I x 12 7 461 A6C-/r—c^ WE DIVISION OF DEBTS Husband shall assume the debts set forth in Exhibit C. Wife shall assume the. debts set forth in Exhibit D. Each party shall defend and hold harmless the other party for the debts assumed by each. OBLIGATIONS OF THIRD PARTIES Allocation of Obligations to Third Parties. Separate and community obligations are presumed to accompany the assets each party receives pursuant to the division of their property. When obligations are unrelated to assets, the obligations are listed in this agreement in order to indicate the allocation of responsibility for the obligations. To the best of the knowledge of the parties, the community is liable for no obligations other than those listed in this Agreement. If any community debts have been omitted from this Agreement inadvertently, each party shall be liable for one-half (1/2) of the debt. Payment shall be made as promptly as possible. Each party waives the right to be reimbursed for any payments made on community obligations after the date of separation. Except for the debts and obligations specified in this Agreement, each party agrees to hold the other harmless from liability on and to pay all separate personal debts and obligations. as set forth in this Agreement, and all debts and obligations incurred on or after May 1, 2001, the date of separation. If a party incurs any expenses as a result of an attempt, whether well founded or not, to obtain payment of an obligation that the other party has assumed, or an obligation which is the separate debt of the other party, the party who is responsible for the obligation shall defend and fully indemnify and hold harmless the other party with regard to the obligation, including attorney's fees and costs. EQUALIZATION PAYMENT The parties agree that there has been an equal division of the community estate. No equalization payment shall be payable by Wife to Husband or by Husband to Wife. WARRANTIES AND GENERAL PROVISIONS Full Disclosure. Each party expressly warrants that he or she hds made a full and fair disclosure of all of the real and personal property belonging in any way to each of them, and of all debts incurred in any manner by each of them. Transfers for Adequate Consideration. Each party expressly warrants that he or she has not made a gift or any other transfer of community property for less than adequate consideration, without the other's knowledge and consent. A party who breaches any warranty shall pay the other party one-half (1/2) the fair market value of the undisclosed or unilaterally transferred community property. This value shall be the highest of the amounts ascertainable as of the time the agreement was executed, the time the breach was discovered, or the time the breach was established in a legal proclieding. This agreement shall not impair the availability, in a court of competent jurisdiction, or any other remedy arising from the undisclosed disposition. Further Acts to Implement Ageement. On the demand of the other.party, each party shall promptly execute any document or perform any other act reasonably necessary to implement the terms of this Agreement. A party who fails to comply with this provision shall pay all attorney's fees and other expenses resulting from noncompliance. Right to Confirmation of Compliance. Each party shall have the right, and the other party shall cooperate by performing all reasonable acts, and supplying all relevant documents, to confirm, on a continuing basis, compliance with the provisions of this Agreement. Such confirmation rights shall include a party's right to inquire of the insurance carrier about the %M existence and terms of medical and life insurance, to the extent either one is provided for in this Agreement, as well as the identity of beneficiaries. A covered party may also request direct notification from the insurance carrier of any failure to receive premiums or any other lapse in coverage for any reason. Insurance on Specific Property. A party receiving specific property under this Agreement shall be entitled to, and the other party shall transfer and assign to him or her,'all right, title and interest in the property. A party receiving specific property shall be entitled to existing insurance on the property and any benefits of premiums previously paid on the insurance. The party receiving the property rnay decide, in his or her sole discretion, to maintain the policy, and if so, he or she shall be solely responsible for the payment of all premiums due thereafter under the policy terms. Social Security Rigjits. The parties agree that each shall retain his or her respective rights to social security payments as separate property. Under current ,law, one party may have derivative rights to direct.payment from the social security system due to employment by the other party during the marriage. Any such payments made directly to a party shall constitute the sole and separate property of the recipient. Durable Power of Attorney for Health Care. If either party executed a Durable Power of Attorney for Health Care pursuant to Probate Code section 4665, and has specified the other party as the designated agent, that spouse shall become ineligible to act as the designated agent upon entry of the judgment in this action for dissolution of marriage: Both parties acknowledge that it may be necessary for either of them to appoint a new designated agent for purposes of a Durable Power of Attorney for Health Care. 6 Release of All Claims. Except as otherwise expressly provided in this Agreement, 'each party releases the other from all claims, liabilities, debts, obligations, actions, and causes of action that have been or will be asserted or incurred. This release does not apply to any obligation incurred under this Agreement, under any document executed pursuant to this Agreement, or under any decree or other issued incident to the Agreement.; The release is binding on each party's heirs, executors, administrators, and assigns. Termination of Charge Accounts and Credit Cards. All existing charge accounts and credit cards in the names of the Husband and Wife, or in the name of either of them under which the other can make pufchases, shall be terminated as of the date of the execution of this Agreement. karate Property Acquisitions. Any and all property acquired by either of the parties hereto from and after the parties' date of separation, shall be the sole and separate property of the one so acquiring same, and each of said parties hereby respectively grants to the other all such acquisitions of property asihe sole and separate property of the one so acquiring the same. Right to Dispose of Properties. Each party shall have an immediate right to dispose of, or bequeath by Will, his or her respective interest in and to any and all property belonging to him or her form and after the date hereof, and said rights shall extend to all property set over to either of the parties hereto under this Agreement. Waiver of Rights in Estate. In regard to the other parry's estate; each party waives any right to inherit, to receive property by bequest or devise, to claim a family allowance or probate homestead, or to act as a personal representative, whether upon intestacy or under a will, unless nominated by a third party legally entitled to make the nomination. IWR Waiver of Rights in Will. The parties acknowledge that each party may have executed a Last Will and Testament. The parties agree that upon the entry of the decree terminating their marriage, neither party shall have further right, title, interest, or claim in the provisions of the will of the other party and the other party waives and renounces any such interest in accordance with the provisions set forth above. All Beneficiary Designations Voided. All beneficiary designations executed by either party in'favor of the other party prior to execution of this Agreement with respect to any asset, benefits, contract, policy, or plan are hereby voided unless specifically reaffirmed in this Agreement. Reservations of Jurisdiction Over Omitted Assets. The court shall reserve jurisdiction over any property of the parties not disclosed and divided pursuant to this Agreement. Either party may, by notice of motion or order to show cause, request the court in this action to resolve any disputes regarding any property not listed in this Agreement, including, but not limited to characterizing the property as separate or community, valuing it, and disposing of it in accordance with the Family Law Act. A party opposing a notice of motion to resolve a dispute regarding omitted property may raise affirmative and equitable defenses. Effect of Reconciliation. Any reconciliation between the parties after they execute this Agreement shall have no effect on the Agreement unless the parties modify or cancel it in writing signed by both parties. Breach. If any provision of this Agreement is breached, the non -breaching party has a right to act to remedy the breach. If the breach involves an amount of money that is due, the non - breaching party has the right to collect the money as well as legal interest on it. Should an action for breach be brought and a breach be proved, the•breaching party shall pay all reasonable attorney's fees and other expenses that the non -breaching party has incurred in bringing the action. No waiver of the breach of any of the terms of this Agreement shall be a waiver• of any other previous or subsequent breach of any other provision of the Agreement. Either party's failure to insist upon the strict performance of -any provision of this Agreement shall not be construed as a waiver of the provision, which shall continue in full force. No breach or claimed breach shall affect or impair any rights or obligations that the parties have under this Agreement. Governing Limits This Agreement shall be interpreted according to the laws of the State of California. Partial Invalidity. If a court of competent jurisdiction rules that any part of this Agreement is illegal, void, or unenforceable, the rest of the Agreement shall remain valid and unimpaired. Modification in Wfitine. No modification or rescission of this Agreement shall be effective unless it is written and signed by both parties. Captions and Titles. The captions of the parties and the titles of various paragraphs in this Agreement are for the convenience of the parties only, and none of the titles are intended to be used, relied on, or referred to in construing any of the provisions of the Agreement. Full Satisfaction of Rights. Each party does and shall accept the provisions herein made as full satisfaction of their respective right to the community property of the respective parties hereto, and of any interest that each party has, or might claim to have, in the separate property of the respective parties hereto, and in full satisfaction of the right for support and maintenance by either party. Reservation of Jurisdiction to Administer and Enforce/Damages for Breach/Joinder/Attomev's Fees and Costs on Enforcement or Breach/Reservation of Jurisdiction to Value and Divide Non -Disposed Assets. The parties hereby agree that the court shall, in the pending proceeding for dissolution of marriage by and between the parties, reserve jurisdiction to administer and enforce the provisions of this Marital Settlement Agreement: In addition, the court shall reserve jurisdiction to award damages for breach thereof, and to.order joinder of any person reasonable or necessary to carry out its provisions. In any action to enforce this Marital Settlement Agreement, or to obtain damages on account of a breach thereof, the court shall order the non -prevailing party to pay to the prevailing party reasonable attorney's fees and costs incident to such action. The parties further agree that the court shall reserve jurisdiction in the pending proceeding for dissolution of marriage to value and divide any community assets and liabilities not disposed of in this Marital Settlement Agreement; provided, however, that the same shall be done only on the basis that the estate herein divided is equally divided, there being no jurisdiction reserved to devalue any assets disposed of herein. Entirety of Agreement. This Marital Settlement Agreement contains the parties' entire understanding. It supersedes all other oral and written agreements relating to the parties' marital rights and obligations, and any court orders made prior to the effective date of this Agreement for which performance was not required before the effective date of this Agreement. Extrinsic Evidence. The parties agree that in any subsequent proceeding in this action for dissolution of marriage, extrinsic evidence shall not be admissible to prove the parties' intentions concerning ambiguous language in this Agreement. -10- Subsequent Changes in Law. Any subsequent changes in California or federal law that create or give rise to additional or altered rights and obligations of the parties shall not affect this Agreement. No Inducements. The parties each declare that neither has made any promises to the other, or agreements with the other, except as set forth herein, that either df them has relied upon as an inducement to enter into this Agreement, and that this- Agreement has been made voluntarily by each party, free from duress, fraud, undue influence, coercion, or misrepresentation of any kind. Merger of Agreement. If either party obtains a judgment of dissolution of marriage, this Agreement shall be incorporated into the judgment for the purpose of merging with the judgment as an operative part of it. The parties shall ask the court to approve the Agreement as fair and to order each of them to comply with all of its provisions. Dated: April 1, 2002 QA DAV]D RbkEft.RmYEILIRG Dated: April 1, 2002 -11- Customer Relationship Inquiry Name: (SHERRY L RHOMBERG M/F: F Customer ID: 1114890542 Cust Since: 0 17394 Type: REG VIN: TIN: 562-02-4728 Close -Up CONSUMER SAVINGS ACCOUNT Account C/A Last $ Available Bal: `' 25:4 ACT Type/Product Rel Activity Account Bal: 7 Average Bal: 25.45 Status: INACTIVE Open Dt: 07/98- CIF DDA/ACK 06908-04018 OWN 09/20/02 FIT Withhold: Stmt: 06/30/02 SDA 06907-00131 OWN 08/30/02<- Product Code: C Info Restrict: N *VTL/VCV 257298935 - TRANSFERRED Flags: VTL/VCV 301199808 bwLULLaL y Avail Deposits: Total Loan Bal: Offer: OVERDRAFT PROTECTION IRA 241.84 0.00 * - Closed # - Divested ! - Message t' 'Nilw CeiVfrcalion X /Hecetil n UnIt Number INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designed to assist you in computing Annual Income in accordance with the method set forth in the Department of Housing and Urban Project ("HUD") Regulations (24 CFR 813). You should make certain that this form is at all times up to date with the HUD Regulations. All capitalized terms used hereitt'shall have the meaning set forth in the Regulatory Agreement. Re: (NAME and ADDRESS of Apartment Building) Newport North - CSCDA (POOL) I/We the undersigned state that I/we have read and answered fully, frankly and personally each of the following questions for all persons who are to occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit: 1. 2. 3. 4. 5. Name of Members Relationship of the to Head of Social Security Place of Household Household Age Number Employment Royledd &P iihatds nd 94 216-36-4759' Eer,o4r�� Income Computation 6. The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children under 18 years) listed above for the 12-month period beginning the earlier of the date that I/we plan to move into a unit or sign a lease for a unit is $ 3 �i, 9'6 2. Gc#A Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, fees, tips and bormses and other compensation for personal•services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real of personal property (without deducting expenditures for business expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets except for out line depreciation as provided it,, Internal Revenue Service regulations); (a) interest and dividends (including income from assets included below and other net income from real or personal property); (it) the full amount of periodic payments received from social security, annuities, insurance policies, retirement funds, pensions, disability or death benefits and other similar types of perio hH receipts, including any lump sum payment for the delayed start of a periodic payment; (e) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (f) the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter and utilities plus the maximum amount that the public assistance agency could in fact allow for shelter and utilities; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not residing in the dwelling; (h) all regular pay, special pay and allowances of a member of the Armed Forces (whether or not living in the dwelling) who Is the head of the household or spouse (or other persons whose dependents are residing in the units); and (i) any earned income.tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; (b) amounts width are specifically for or in reimbursement of medical expenses; (c) lump sum additions to family assets, such as inheritances, insurance payments (including payments under health and accident insurance and workers' compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational institution, and amounts paid by the government to a veteran for use in meeting the costs of tuition, fees, books and equipment. Any amounts of such scholarships or payments to veterans not used for the above purposes are to be included in income; (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fie; (0 amounts received under training programs funded by HUD; (g) foster child care payments; (h) amounts received by a disabled person that are disregarded for a !united time for purposes of Supplemental Security Income eligibility and benefits because they are set aside for use under a Plan to Attain Self -Sufficiency; (i) income of a live-in aide; (j) amounts received by a participant in other publically assisted programs which are specifically for or in reimbursement of out-of-pocket expenses incurrec and which are made solely to allow participation in a specific program; (k) a resident service stipend (a modest amount (not to exceed $200 per mouth) received by a resident for performing a service for the owner, on a part-time basis, that enhances the quality of life in the development; If this form is being completed in accordance with recertification of a Lower Income Tenant's or Very Low Income Tenant's occupancy of a Lower Income Unit or a Very Law Income Unit, respectively, this form must be completed based upon the current income of the occupants. 0I.AMC.M.1tGFe0.,1 • (1) compensation from state or local employment training programs and training of a family member as resident management staff; (m) reparation payments paid by a foreign government pursuant to claims filed under the laws of that government by persons who were persecuted during Nazi era; (n) amounts specifically excluded by any other federal statute from consideration as income forpurposes of determining eligibility or benefits under a categt of assistance programs that includes assistance under the United States Housing Act of 1937; (a) earnings in excess ofS480 for each full -term student 18 years old or older (excluding the head of household and spouse); (p) adoption assistance payments in excess of$480 per adopted child; and (q) deferred periodic payments of supplemental security income and social security benefits that are received in a lump sum payment; (r) amounts received by the family in the form of refunds or rebates under state or local Iry for property taxes paid on the dwelling unit; (s) amounts paid by a State agency to a family with a developmentally disabled family member living at home to offset the cost of services and equipment needed to keep the developmentally disabled family member at home; and (t) amounts specifically excluded by an other federal statute from consideration as income for purposes of determining eligibility or benefits under a category of assistance programs that includes assistance under the United States Housing Act of 1937. 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necessary items of personal property such as furniture and automobiles and,interests in Indian trust land) Yes ___,6_No; or •• (b) have they disposed of any assets (other than at a foreclosure or bankruptcy sale) during the last two years at less than fair market value? Yes �_No • (c) If the anssser to (a) or (b) above is yes, does the combined total value of all such assets owned or disposed of by all such persons total more than 55,000? (d) if the answer to (c) above is yes, state: (1) the combined total value of all such assets: S_ (2) the amount of income expected to be derived from sue assets in the 12-month period beginning on the date of initial occupancy in the unit that you propose to rent: $.V , and (3) the amount of such income, if any, that was included in item 6 above: S14( 8. (a) Are all of the individuals who propose to reside in the unit full-time students'? Yes � No •A full-time student is an individual enrolled as a full-time student during each of5 calendar months during the calendar year in which occupancy of the unit begins at an educational organization which normally maintains a regular faculty and curriculum and normally has a regularly enrolled body of students In attendance or is an Individual pursuing a full-time course of institutional or farm training under the supervision of an accredited agent of such an educational organization or of a state or political subdivision thereof. (b) If the answer to 8(s) is yes, is at least 2 of the proposed occupants of the unit a husband and wife entitled to file a joint federal income tar returp? Yes __2�._No 9. Neither myself nor any other occupant of the unit Nsse propose to rent is the owner of the rental housing project in which the unit is located (hereinafter the "Owner"). has any family relationship to the Owner; or owns directly or indirectly any interest in the Owner. For purposes of this paragraph, indirect ownership by an individual shall mean ownership by a family member, ownership by a corporation, partnership, estate or tryst in proportion to the ownership or beneficial interest in such corporation, partnership, estate or Trustee held by the individual or a family member; and ownership, direct or indirect, by a partner of the individual. d 10. This certificate is made with the knowledge that it will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and 1/ssc declare that all information set forth herein is true, correct and complete and based upon information I/ we deem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. 11. Me will assist the Owner in obtaining any information or documents required to verify the statements made herein, including either an income verification from my/our present employer(s) or copies of federal tax returns for the immediately preceding calendar year. 12. We acknowledge that I/we have been advised that the making of any misrepresentation or misstatement in this declaration will constitute a material breach of my/our agreement with the Owner to lease the unit and will entitle the Owner to prevent or terminate my/our occupancy of the unit by institution of an action for ejection or other appropriate proceedings. Me declare under penalty of perjury that the foregoing is true and correct. Executed this "l�h day or 0Q j001— .20G I- in the City of b Ony+California A I• ant Applicant Applicant Applicant Rev. Sr95 (Signature of all persons (except children under the age of 18 years) listed in number 2 above required] a MCOM lee•ra0.W a M ' n FOR COMPLETION BY APARTMENT OWNER ONLY: Calculation of eligible income: a. Enter amount entered for entire household in 6 above: $ 31061 .00 — b. (1) If the amount entered in 7(c)above is yes, enter the total amount entered in 7(d)(2), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ (2) Multiply the amount entered in 7(d)(1) times the current passbook savings rate as determined by HUD to determine what the total annual earnings on the amount in 7(d)(1) would be if invested in passbook savings ($ subtract from -that figure the amount entered in 7(d)(3) and enter the remaining balance ($ e ), (3) Enter at right the greater of the amount calculated under (1) or (2) above: $ C. TOTAL ELIGIBLE INCOME (line l.a plus line Lb(3): $ 39 i St62 • oo- 2. The amount entered in 1.c: Qualifies the applicant(s) as a Moderate -Income Tenant(s). Qualifies the applicant(s) as a Lower -Income Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenant(s). 3. ' Number of apartment unit assigned: 1119 Bedroom size: - 14-1 Rent: "$ 6b 4. This apartment unit/was not) last occupied for a period- of 31 or more consecutive days by persons whose aggregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartment unit qualified them as a Lower -Income Tenant(s). 5. Method used to verify applicant(s) income: Employer income verification. �( Copies of tax returns. Other ( Date W.AMC.0997.ICC•FOW e A r\ I l SCHEDULE! C-EZ Net Profit From Business (Form 10110) (Sole Proprietorship) ► Partnerships, joint ventures, etc., must file Form 1065 or 1065-B. Department of tr a Treasury Internal Revenue Dorvlce (0) ► Attach to Form 1040 or 1041. ► See instructions on back. Name of prop) lfRor laeneral Information You May 1. I* Schedule O-Ez Instead of Schedule 0 Only If YotI: or • Had business expenses of $2,500 or less. • Use the cash method of accounting. • Did not have an Inventory at any time during the year. AndYou: • Did not have a net loss from your business. • Had only one business as a sole proprietor. product or service 2001 • Had no employees during the year. • Are not required to file Form 4562, Depreciation and Amortization, for this business. See the Instructions for Schedble C, line 13, oa page C-3 to find out If you must file. • Do not deduct expenses for business use of your home. • Do not have prior year, unaliowed passive activity losses from this business. B Enter &a „u" I DI Employer Il number (EII), Itany C B sin�+lu name. If no se ar to usine s erne, leave blank. VOL" jVCiL UGC }ur�ij/(n�D� �nts address Oncluding suite or room no.). Address not required if same as on Form 1040, page 1. or post office,,state, and ZIP Figure Your Net Profit 1 Gros I. vecelpts. Caution. If this income was reported to you on Form W-2 and the "Statutory empli:yee" box on that form was checked, see Statutory Employees in the instructions for Schedule C, line 1, on page C-2 and check here . . . . . . . . . . . . 2 Total expenses. If more than $2,500, you must use Schedule C. See instructions , . 3 Net lu+ofit. Subtract line 2 from line 1. If less than zero, you must use Schedule C. Enter on p Forn 1040, line 12, and also on Schedule SE, line 2. (Statutory employees do not report this 0 to % amot -it on Schedble SE line 2 Estates and trusts enter on Form 1041 line 3.) 3' ° . Information on Your Vehicle: Complete this part only if you are claiming car or truck expenses on line 2. 4 Wher (lid you place your vehicle In service for business purposes? (month, day, year) ►F?�.I.-(.:T C: w 5 Of th I+ total number of miles you drove your vehicle during 2001, enter the number of miles you used your vehicle for: a Busir ass �7z~p--------- b Commuting --------------------------- c Other ........................... 6 Do yi: ,l (or your spouse) have another vehicle available for personal use? . . . . . . . . . . . ❑ Yes No 7 Was ,our vehicle available for personal use during off -duty hours? . . . . . . . . . . . . . Yes ❑ No 8a Do y->.I have evidence to support your deduction? . . . . . . . . . . . . . . . . . . 5—rees ❑ No b If "YE*," is the evidence written? . 9-1;s ❑ No For Paperv�urk Reduction Act Notice, see Form 1040 Instructions. Cat. No. 14e74D Schedule C-F2 (Form 1040) 2001 Page 2 Schedule C-E: (Form 1040) 2001 Instructions You may lose Schedule C-EZ Instead of Schedule C if you operated a business or practiced a profession as a sole proprietor:;hip and you have met -all the requirements listed in Part I of Schedule C-EZ. Line A Describe • •1e business or professional activity that provided your principal source of income reported on line 1. Give the genen : field or activity and the type of product or service. Line B' Enter the I:ix-digit code that identifies your principal business or professional activity. See pages C-7 and C-3 of the Instructiolos for Schedule C for the list of codes. Line D You need !In *employer identification number (EIN) only if you had a qualified retirement plan or were required to file an empio;4•nent, excise, estate, trust, or alcohol, tobacco, and firearms tax return. If you need an EIN, file • - Form SS:4, Application for Employer Identification Number. If you do not have an EIN, leave line D blank. Do not enter you' SSN. Line E Enter you- business address. Show a street address instead of a box number. Include the suite or room number, if any. Line 1 r Enter gral:s receipts from your trade or business. Include amounts you received in your trade or business that were properly ;,hown on Forms 1099-MISC. If the total amouhts that were reported in box 7 of Forms 1099-MISC are more than the total you are reporting on line 1, attach a statement explaining the difference. You must show all Items of taxable income actually or constructively received during the year (in cash,'property, or services). Income is construct •,rely received when it is credited to your account or set aside for you to use. Do not offset this amount by any losse:i. Line 2 Enter the total *amount of all deductible business expenses you actually paid during the year. Examples of these expenses nclude advertising, car and truck expenses, commissions and fees, insurance, interest, legal and professio •lal services, office expense, rent or lease expenses,, repairs and maintenance, supplies, taxes, travel, the allow,!,71e percentage of business meals and entertainment, and utilities (including telephone). For details, see the instrd::tions for Schedule C; Parts II and v, on pages C-3 through C-6. If you wish, you may use the optional worksheel: below to record your expenses. ' If you c laim car or truck expenses, be sure to complete Part III of Schedule C-EZ. Optional Worksheet for Line 2 (keep a copy for your records) a Busineos meals and entertainment . . . . . . . . . . . b Enter r :mdeductible amount included on line a (see the instructions for lines 2!Ib and 24c on page C-5) . . . . . . . . . . . . . c Deducible business meals and entertainment. Subtract line b from line a . . . . . . . ................ ................................................................... f-------------------------------------------------------------------------------I -...--------.._-----_--------- 9--------------------------------------------------------------------------------------------------------------- h---_---..-.----------------------------------------------------------------- i...__.....•-----------------1-..---......_ j Total. •,dd lines c through i. Enter here and on line 2 . jr U.S Qovem nuns Printing Office: 2001-47+558 ® Printed on recyciodpupor Schedule C-EZ (Form 1040) 2001 OMB No. 1545.0074 SCHEDULES A&B Schedule A —Itemized Dedu LIOnS (Form 1040) (Schedule B is on back) 2@01 Department at'he Treasury at.n eTreas (t) Internal RoverDepartment ►Attach to Form 1040. ►See Instructions for Schedules A and B (Form 1040). Attachment Sequence No. 07 Name(s) ,T on IFoormm 1040 A Your lal aec Ity nu bar Medical Caution. Dondtinclude expenses reimbursed orpaid byothers. and 1 Medical and dental expenses (see page A-) ( ,tr. - 1 3 3 3 Dental 2 Enter amount from Form 1040, line34. 2 2rr Ag r Expensci> 3 Multiply line 2 above by 7.5% (.075)' . 4 Subtract line 3 from line 1. If line 3 is more than line 1, a' 4 O "— er -0- . Taxes Y:iu 5 State and local income taxes . . . . . . . . ' . 5 Paid - 6 Real estate taxes (see page A-2) . . . 6 (See 7 Personal property taxes . . . 7 page A-2.) .8 Other taxes. List type and amount ► ................... 8 9 ............... .-------------- -- 9 Add lines 5 throw h'8. �� Interest 10 Home mortgage interest and points reported to you on Form 1098 10 You Pail 11 Home mortgage interest not reported to you on Form 1098. If paid (See to the person from whom you bought the home, see page A-3 page A-3.; and show that person's name, Identifying no., and address ► ............. ----------------------------------•---------------- •.... .. . ..... . ........ ......... . ... . .. .. . ...... ... .... •--...... _ Note. ... ............................................................. 11 Personal 12 Points not reported to you on Form 109% See page A-3 Interest is not for special rules . • , 12 deductible. 13 Investment Interest. Attach Form 4952 If required. (See page.A-3.) . . . . . . . . 13 14 • d 14 Add lines 10 through 13 . . . . . . . . . . . . . . . . . . . Gifts to 15 Gifts by cash or check. If you made any gift of $250 or Charity more, see page A-4 . . . . . . . . . . 15 If you madtl a 16 Other than by cash or check. If any gift of $250 or more, glft and gcI a see page A-4. You must attach Form 8283 if over $500 16. benefit far 11, 17 Carryover from prior year . . . . . . . 17 5 i see page),-4. 18 Add lines 15 through 17 . . . 18 Casualty und Theft LOI mes 19 Casualty or theft loss(es). Attach Form 4684. (See page Job Expenses 20 Unreimbursed employee expenses Job travel, union and Most dues, Job education; etc. You.must attach Form 2106 Other or 2106-EZ if required. (See page A-5.) ►............... Misceliaiioous................................................................ 20 p Deductlol:3I..................................... 21 ......................... 21 Tax preparation fees . . . . . . . . . . . . (See 22 Other expenses —investment, safe deposit box, etc. at page A-5 l,)r type and amount ► ......................................... expenses to 22 23 deducthe•a.)--------------------------------------------------------•-----_. 23 Add lines 20 through 22 . . 24 Enter amount from Form 1040, line 34. 24 25 Multiply line 24 above by 2% (.02) . . . . 25 26 Subtract line 25 from line 23. If line 25 is more than line 23, enter -0- 26 Other 27 Other —from list on page A-6. List type and amount ► .............................. Miscellamious..................................................... Deductio'is 27 r� Total 28 Is Fq'm 1040, line 34, over $132,950 (over $66,475 if married filing separately)? Itemize l:l 9 No. Your deduction is not limited. Add the amounts in the far right column 28 Deductions for lines 4 through 27. Also, enter this amount on Form 1040, line 36. . ► ElYes. Your deduction may be limited. See page A-6 for the amount to enter. For Pape l•nork Reduction Act Notice, see Form 1040 instructions. Cat. No. 11330X Schedule A (Form 1040) 2001 Schedules A&B ;Dorm 1040) 2001 ' _ _ • - OMB No. 1545-0074 Page 2 Name(s) shown m Form 1040. Do not enter name and social security number It shown on.other side.. Your social security number Schedule, B—Interest and Ordinary Dividends Attachment o. 08 1 List name of payer. If any Interest is from a seller -financed mortgage and the Amount Part I buyer used the property as a personal residence, see page B-1 and list this Interest Interest first. Also, show that buyer's social security number and address No - (See page B-1..____..................•---...----.._............__._._-•----......__._......._._..•-----_.. andthe...................................•--..._._._._............_.._...__.._......__..__......_. Instructions for Form1040,............................................................. .._........ line8a.) ________________;._..__._.-•---..._-----..._.._.._....._.._-•---._.. _________________________ - - - -------------•----. _._........_. _ __.. ___.... ___... _.:'------•--.._.. _.._•: ............... 1 -_...: _-......•---•-----•-...----: •--•.................................................•:•- Note. If you received a Form ........ .......................................................... 1099-INT, Font. .._................:............................................•._....._._..-_...._...------ 1099-OID; or..................................:......................................................... substitute statement fror a'brokerage fin'i,..................................•--•--------••-•---_._._._. listthe firm's.......................... :.............. I-------•-•-•••----- ---•---- name as the payer and entur thetotalinterent.......:..................:.......•--•---..._..__...-•-•--•-------•--....._......._..__._... shown on that 2 Add the amounts on line 1 . . . . . . . . . . . . . . 2 form. 3 Excludable interest on series EE and I U.S. savings bonds issued after 1989 from Form 8815, line 14. You must attach Form 8815 . . . 3 w c„ti+ra..+ a.,a a frnn, iina 9 Pntar fha rasidt hares and on Form 1040. line 8a ► •4 Part II 5 List name of payer. Include only ordinary dividends. If you received any capital gain distributions, see the instructions for Form 1040, line 13 ► ................ . OrdinarY:................................................................................. Dividendi-i....................................................................:..........:............ (See page B-1•-••-••-=•-•---•••-----••--•----•-----••-•-•---•--•---•---••-__------••-•••-----•••••-•-•--- andthe -------------------------------------------------------------•--•••._._.._..__._....--•--.. Instructions fo • Form1040,-••-••....._--•----•-•..............••---•--._........_....-----...._._.......__._.__..._... line9.).._.-•_____:•-----•-•................................................ ....................... ............................................................................................ •............................................................................................ •......................:........:.......................:..........:......................... Note. If you received a For•n 1099-DIV or ...................................... -..................................................... substitute..............................................................•....__...I.._..__......-----• statement fror i ' abrokerage ntm, ....................................................................................:....... listthe firm's•........................................................................................... nameas the ..................... .......................................................... :............ payer and enter theordinary ............................................................... ............................. dividendssho,un............................................................................................ onthat form............................................................................................. --- ::........................................................................................ 6 Add the amounts on line 5. Enter the total here and on Form 1040, line 9 . ► 6 F;Tf IZ111111 You must complete this part if you (a) had over $400 of taxable interest or ordinary dividends; (b) nad a Yes No Part III foreign account; or (a) received a distribution from, or were a grantor of, or a transferor to, a foreign trust. Foreign 7a At any time during 2001, did you have an Interest in or a signature or other authority over a financial Account: account in a foreign country, such as a bank account, securities account, or other financial and Trusin, account? See page B-2 for exceptions and filing requirements for Form TD F 90-22.1 . . (See b If "Yes," enter the name of the foreign country ►....................................................... P 8 During 2001, did you receive a distribution from, or were you the grantor of, or transferor to, a page B-2.) forei n trust? If "Yes," you may have to file Form 3520. See page B-2 For PaperworI; Reduction Act Notice, see Form 1040 instructions. Schedule B (Form 1040) 2001 Department of thc._ aury--Internal Revenue Service /)/n1ir i i In this Label (See L InstructicnE A on page 19d E Use the VIS L label. H Otherwise, E please pd'It R or type. E President ill Election C ldnpaign 1 Filing Sl:ittUS 2 3 Check on t 4 one box. 5 _ 6a ExempliGns b c If more thm six dependeiils, see page 20. Incorrim Attach Forms %4: and W-2G he•i1. Also site I:h- Form(s) '1099-191 If tax we:. . withheld If you dic riot get a W- , see page 21. Enclose, but do not attach, any payment Also, please u oa Form 101104. Adjus•I(Bd Gros:! Income d 7 8a b 9 10 11 12 13, 14 15a 16a 17 18 19 20a 21 23 24 25 26 27 28 29 3o 31a .32 the year Jan. 1-Doc. 31, 2001, or other tar first name and initial — spouse's first name and initial I last name a P.O. box, $ee page Is. • I Apt. no. 3!�tuode. LvAu have a f0 Ign address, see dree page 19. .— Note. Checking "Yes" will not change your tax or reduce your refund. Do vou, or your spouse if filing a joint return, want $3 to go to this fund? ► Alk Important! it You must enter your SSN(s) above. You Spouse 1Aanled filing joint return (even if only one•had income) Married filing separate return. Enter spouse's social security no. above and full name here. ► Head of household (with qualifying person). (See page 19.) If the qualifying person is a child but not your dependent, enter this child's name here. ► ..e.,, +..hue !veer snnuee died ► I. (See Datte 19.) _ If your parent (or someone else) can claim you as a dependent on his or her tax return, do not check box 6a . . . . . . . . . . . . . . LJ Spouse . Dependents: (2) Oependeht's (1)Oependent's relationship to (4) dquairynp child for child tax (1) First name Last name social security number you credit sea page 20 Ej Ej Wages, salaries, tips, etc. Attach Form(s) W-2 . . . . . . , • • • • • Taxable Interest. Attach Schedule B if required . . . � 8b I •--U'� I Tax-exempt Interest. Do not include on line Be . . 'Ordinary dividends. Attach Schedule B If required . . . Taxable refunds, credits, or offsets of state and local Income taxes (see page 22) . Alimony -received . . . . . . . . . . . . . . . . . . . . . Business Income or poss). 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 . . . . , . . . . . Total IRA distributions . 15a b Taxable amount (see page 23) Total pensions and annuities 16a b Taxable amount (see page 23) Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E Farm income or (loss). Attach Schedule F . . . . . . . . . . . . . . Unemployment compensation Social security benefits , . 120a I I I to Taxable amount (see page 25) Other Income. List type and amount (see page 27) .................................... Add the amounts In the far right column for lines 7through 21Tincome ► .�ael IRA deduction (see page 27) . . . . . . . . Student loan Interest deduction (see page 28) . . . Archer MSA deduction. Attach Form 8853 . . , . Moving expenses. Attach Form 3903 . . . . One-half of self-employment tax. Attach Schedule SE Self-employed health insurance deduction (see page 30) Self-employed SEP, SIMPLE, and qualified plans Penalty on early withdrawal of savings . Alimony paid It Recipient's SSN ► Add lines 23 through 31a . . . . 24 '- 26 p 27 28 29 — 30 —O --' !come . . . ► No. of hazes checked on fie and sh No. of your children on tic who: • lived with you • did not live with you due to divorce or separation (see page 20) ._ Dependents suite not entered above ._ Add numbers entered an Ilnes ahove ►. --1 0 e 1 r V, ._ 11 10 ._ 0 '--" U r.- 15b "o"" 16b rXrX' 17 -'U'- 18 19 —r 0.-- 20b — v For Disc ..-sure, Privacy Act, and Paperwork Reduction Act Notice, see page 72. Cat, rio.11a2o6 arm 104 (2001' 4.1• " Amount from line 33 (adjusted gross Income) . . . . . . . , , •34 Tax and `1i° ' Check If:•i] You•wgre,65 or oldet; �,(] Blind; El Spouse, was 65 or older, ❑ Blind: Credits )•�• •P.ddSherSitrnbgr_'of.6tixes:ohecke rabpVeanderi,�er:ihe•tota,"Ihere. "�'';•.�•�5a _ ;;::r_•'. ..,.;w„; -:� ..-.;rc...<:. ,,.-..;K.;n':,;,:.v_,.y.,::;z'.; :...,,.. Standard r•;1 ' Deduction.; .If you2ie'•Gnarr{ediflllggjseparateiy_and•yoyfspouse,ftemzes;d_BduCti�o,B8 9 y-�.,:•-tY• �'' ,• ' `for- ,:�I . ; ou(weres"dual sfetusialfen;' ee;' a e` a'rid%c'ieo:-era•;=",-,..,.z,,.'•„ y c.,; 35p.:❑=' Y. ,..7.v5:.'.-:.::«:-' < 0 People who , .a.•tS:;.:Ps:9c` {•::; ,,._Y••: ylon,(,. ,60 Qbr):z•-. �-'•�i e�faf'�_-•;iiaC9fn) •-�a„�• checked any 3ti� t : ItArrjized,deduotions;tffof}tSchedUle-A�•o�•'��,ouh`standard;,daadctlon.(s, i <e5,:• - ;. •i-�.•�.x•;.";;:-,ram: ✓s.: �' ;,`;i. i ^c,eG:�+�cr,-`~ I'srei"l _ t 3 ,,nn r 326 "box on lined y35aor35bor •: be , �;SJlbfrac�Iine.86�fra ,line-3,4s�`-i_'z•'!. ;s'f,:y=;;3.,,=•,,€:r• c:Jr�,,•w=-> ;,..y;;_ Y ' •�:sF,•-+.� .':i`;ty^r'„:vr"s 5r:a ;;# If Iil}e•94;Tsr$99J7 5tci<Jess; h t z�o3Al niYm�bf. of jc t p ns.cfdmedo;.� r. who can • claimed as a ;;I ':! ,1. ymu(tfF #.$2:900 4 ` i ::.11ne 6d If he Zfltl ovei$99,_725 sea�tflee s aef`'oP Page ;Z�sx,, •-' ' i ,, t t ;•;; a �� K, %3 w` _ ; see p ge 31. y S ;:texabie in `otne SubtracLie;98 from line,53 s1Ilr�e38>is:mPamakiZrne� U; f Allothers 41i Tg>t(seepage33)C{ecl�8an taw(sYfromat��o (s)881,4Qs'�ora�9/�FY�' r.,;T40, page 3b) ' Single,i ��-At { w ,.• N .-ap " r. t'.✓ti'n.^�e £wv r"te � �'w'".wr�'t!•tE'°� 'G 3'"%RS,F �`';Ya I6-r4etiye minimum tax (see sa a 3Q,1l.fAttac Form 62$Y�i^fi �; y' ; : r>)�,�t °'«4,�'• '� .t�i:' "' p �„ f $4,550 ,-GAy;, �: ih,`-'=+»x>`;,r3:;;;"r`zrYi'4.C'.'Y'i:E.Y.�TL:M•"�•�i , °Head of-:;i9&d.l(ties,"4gant1,41:`•"�5:==-;`'... household, 1;••��pSetgn•ta�rpY�dlCiAftecl;� := Fop1,1'176'iequlred:..=.:,,, -. r•• 1 $6,650 .= z ..:+-. -.:r :+-`.v-i;r�': `b::4 •+ p ^��`eaiEfol�chflcfandde_en`deriicaie,"-ex�ensas`:`Aitac"h•Fcim;'2�iiwt t ,.��'�II ? Married filing i �•� e-�xh :s t•2:: ;:s•�-.= u:�"~^y jointly or Qualifying�EdiTcaf�op'creCits.%A)tacF,Forrtj,8963 ;lI i r. z M •r•, r':• - v .:{ fes,. w° ,:•i;�- '^ }. f.s, 0 }:*�,;,"'�TM•-;z!`� . ;:':'._M� ^`4M18i , wi dow(er), ' ' t z� ,:e"%'• 'r.� - = r-ax•; „;.: , .?4'7J .. te-radtiotibn credit; S@e.the$G7d"r(Ssh'eehnp�page'36> ;:,,-,,-•-.;;� -$600 7, ' Married , ! .. .-.-.tea.,,.,-. V'✓: i�;�, 4_Ni1 ``:y y.J.T;'Rs �.pl -re iid.TaxMeaff. e`9:,P,a9a3� :: ? :•'`y;, ,..: _':_N :" °� �:48'r,' `=, '-„�-�+=r::.e: ' filing %41) do)i�loa.credit. A}tacfj Fo`• Bf339'�,?":' ''� '',•r•-- d •`4ip, '"rum nf:a';.�V=rxj,;;:a�---r'^ separately, '$3,800 • 7`�l(:'A 1 ..: ;�" • . :bth a:creifits f� qf;• -',a n Rofm� BOOc•- w` Q, ortt1,8396 a d. ., p 3 ' f4�sdx' 1-•+Se kr:3,.::�.• oQFPS1-y?8f101;,',, r(Q,Fortn_(speclj) •50. i. ':K• •E'f-AA . . atd3,{I�iigh;5o:liiesa:are:YctUr�tal c .'Add�neroo Jill �diCss•_�:. „.-: '' �.,'-•::�.r..-�.�• - -:en .si.: - � Eiht • 7.Subfract'Iiita �_Ilne?d2;: iillrie_51;7s.p14Se t strain'e 4 er;.0';;:;�,.:�,"• r:;:,...., .: ••►-'; °S2 ` �xl��• ,SV--.kc pelf:em-Io�mentti;uf.fAttecl�;So}i2;dule"SE`�-� �"'}r�'> sv'�`-``•:�t�'�"'`��+�`s`����' PAY, .-, .._: r: ,: :'=<,., 4 :�. •r r fX yP. �.i';i. "•�^ - —i �� Other ;��,�,•,•t«, l({u,, ,., Y.ti s, Y.: Sociel."secpr[ity'tendMedideeltax;onttip.((ncomg:r.jok'repotted,:toeopin r Qt�acfi'.F.or 3T:;. �• >;:_< •i' 5� '65 �c;> — f Taxes a `I .m51f;1; : r :. y' 2 F •it'' r'rkd' ,• olheide�x-faieii Q$Co`uj�ts.AttQh Fpim3PET1 egalrQd�,y;;�r,• , 11; ,'j`a>;oji'giialffleci;pl�tisl'IriglutlfOtJdf_As+end ;i - -5.: ,4 •.°;�:- ,r5 ..•. _'Sr u �.'�'ii! }'C_.i �..,_:A,P; �"`r2"+c Adv oe'rearr�ed,`[ncome,credf[,payihr is fCom F9rtn �,?L rc :, ' :u 5071 > z' ,',' r:a_ ->G' a 7 ,�7�_; `, sI t•'�1 °,-rr,-..,'.r t :-.6''; A�'ntjfia�b�ehn: e7."• i,s�5,�1(tI '`"., .. .-;•i-}AHotldu1.sD,renfie;ysqf�i5f. 2;mibPisld?yiio tSosct"ahtwecdu'�:iS's-,�r,$;>. ,,;.:`i.'-.::;.`";�,._���^�-,- #6 :..•ti,:x;.._-4:, Payments x9n'fje,Afi7t4t�aC)z�ErPt.`ss',ro:.ls - s- ' =2001ebtigntJalyehsiand'mo6nYa plfedf It you have a-6'I je' '.,, w :•'u ,- Z�;r_ e tip';;.';;,jy'i',,;,•��,i=.-•-i'F•'r+y,'>;sy,s�.c.•r. -t'Eame�lncotne c!<edlt,(EIC) _x y&18' r' 17 T qualifying�r3 . : child,ahach ;„ Schedule EIC. •IJI 1 •'NtinCezable;famed?Incorjie-tK,�r F.._-„ _._,,,,_�-•,•, Excess;social•sgatii�ty'?and:FiRTq.'tazya'ftfjt(8f>c(�(see':page 8;� Addltiohelychlldaax cre�i{ Atteclj`FoTm;86i2 6+l! Amo�It•paidwlfh,regtie'st-oeeMenslon;o,file,'isee'page5l}: 6!j • Other payments. Cfteck'if irbfn a Qrpdr`m'2439`p;Q'`oim"A136' "85' payments,;,,;.• ,;,.: ..►•^ ::66' fi IL. , Add Jfnes 59, 60, file, and 62 throti h'65: These Ore yqur--total ova aid-' Refund 8jla If Ilge BS Is'more titan IIne 8t3o 'trapt 1166 8 frori jive 68: This isahe amopnf, t(o"v,d• e rp. _ ' ST Z f •r:rs�•r'•az..,.. ..., -U,.. .:. -.. ;..,,;•'v:�21+:K.-d,.' ►.".63a° 6llfl Amour'toil'n8,67You';wahtrefi4nded'to'Y9'i�«=�r•:'•..;'•:;.�: :,.�:-,;, ' Direct ,,}_, deposit? See ► : a Routing number ' ► c'Typc: L1 Checklifg a'❑ savings fpi0 In 68bend ► •ill Account number71 68c,and 68d. fill Amount of line67 youwant applied to your2002estimated tax ► '69 ' 70- Amount 7:1, Amount•you owe.,Subfrabt Iih"e'Bfi from Ifna'S8.`Fyr details on how to pay- ale 52 ► You Owe 7i•: Estfrnafed tax penalfy. •Also include'on line 70 .'. 71' G•(D ''- .-.,exxase�.�• Third Parry •ao you want to allow anotge%person to'discuss this iptufp:wlth the IRS:(see peige,,;o�,r • Li Yes. yompleir +ne�r'yonnwu!,api=r ,Y Designee's Phone Persona ► I IIdentification Designee I I I I name ► no. ► ( ) number (PIN) Sign1i r penalli of perjury, I declare that I have examined this return and accompanying schedules and statements, and to the best of my knowleido4 dhd Here 1 ell , they true, correct, and c Declarallon of preparer (other than taxpayer) Is based on all Information of which preparer has any knowledg`e:: lour I ature D to Yo occupation Daytime phone number Joint return? See page 19, -/D D }V/t:3I Keep a copy '• use's signature. If a joint retum, both must sign. IDate pouse's occupation for your records. Preparer's //}} Date L Check if Per's S Nor PTI Paid nignature' �c�y7c wj I self-employed ❑ /0 Preparer's ' Firm's name (or Use Onl '^ours if self-employed), Only_:,,ours and ZIP code Phone no. ( 1 Form 1040126'o1) INCOME RESTRICTED FINANCIAL WORKSHEET Project _1j wpar4 NOA'A Unit No. III g Applicant's Name: plortaw FnI[1kay$ Annual Salary Others Residing in Unit: Annual Salary Annual Salary Annual Salary. Commissions/Bonuses Savings Accounts: Bank Balance x %_ Bank Balance Bank Balance _ $_ 3q, 262. ar, - $ 1 Interest Bearing Checking•Accounl Bank, Balance x %_:„$ ' Bank Balance Stocks/Bonds: Type Amount x % = S. ' Trust Fund: Type Amount x % _ $ Other: (Alimony, Child support, retirement pensions, social security, disability payments, parental support, etc) Show calculation, how Annual is arrived ati Type Annual S Type Annual $ Type Annual $ Property Owned By Resident: Address_ Equity x_%= S TOTAL ANNUAL ELIGIBLE INCOME S 3G,1.62. aG — Maximum Annual Household Income Limit Ste,1U . Qt — > t ' Nqw Cert{fica8ar / Recertg-rcarfon _ Unit Number-1 1 5,q INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designed to assist you in computing Annual Income in accordance with the method set forth in the Department of Housing and Urban Project ("HUD") Regulations (24 CFR 813). You should make certain that this form is at all times up to date wide the HUD Regulations. All capitalized terms used herein shall have the meaning set forth in the Regulatory Agreement. Re: (NAME and ADDRESS of Apartment Building) Newport North - CSCDA (POOL) I/We the undersigned state that Uwe have read and answered fully, frankly and personally each of the following questions for all personsaho are to occupy the unit being applied for in the above apartment project. Listed below are the names of allpersons who intend to reside in the unit: 6. 1. Name of Members of the Household 2. 3. 4. Relationship to Head of Social Security Household Age Number uet.rl 2_ - 436-31-I61(3 Income Computation 5. . Place of Employment iGt Y S The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children under 1S yens) listed above for the 121-month period beginning the earlier of the date that Itwe plan to move into a unit or sign a lease for a unit is $ 42, ono , OG 1 Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other compensation for personal services, before payroll detiuctions: (b) the net income from the opemdon of a business or profession or from the rental of real of personal property (without deducting expenditure for business expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets except for straight line depreciation as provided in Internal Revenue Service regulations); (c) interest and dividends (including income from assets included below and other net income from ieal or personal property); (d) the full amount of periodic payments received from social security, annuities, insurance policies, retirement funds, pensions, disability or &xth benefls and other similar types of periodio'receipts, including any lump sum payment for die delayed start of a periodic payment; (a) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (f) the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter zd utilities plus the maximum amount that the public assistance agency could in fact allow for shelter and utilities; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not resdL-g in the dwelling; . - (h) all regular pay, special pay and allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the heusehe!d or spouse (or other persons whose dependents are residing in the units); and ' (i) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; (b) amounts which are specifically for or in reimbursement of medical expenses; (c) lump sum additions to family assets, such as inheritances, insurance payments (including payments under health and accident insurance mi w•or:e:s' compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational institution, and amounts paid by the government to a vemmn for tue in meeting the costs of tuition, fees, books and equipment. Any amounts of such scholarships or payments to veterans not used for the above purposes a:e to be included in income; (e) bazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (f) amounts received under training programs funded by HUD; (g) foster child care payments; (h) amounts received by a disabled person that are disregarded for a limited time for purposes of Supplemental Security Income eligibility and be-.eiirs beca•+==e they are set aside for use under a Plan to Attain Self -Sufficiency; (i) income of a live-in aide; 0) amounts received by a participant in other publically assisted programs which are specifically for or in reimbursement of out-of-pocket expewcs b==--f and which are made solely to allow participation in a specific program; (k) a resident service stipend (a modest amount (not to exceed $200 per month) received by a resident for performing a service for the owner, cm a basis, that enhances the quality of life in the development; If this form Is being completed in accordance with recertification or a Lower Income Tenant's or Very Low Income Tenant's occupancy of a Lower Income Unit or a Very Lcz Income Unit, respectively, this form must be completed based upon the current income of the occupants. OI.AMc.M.icc-F0M1 (1) compensation from state or local employment training programs and training of a family member as resident management staff, (m) reparation payments paid by a foreign government pursuant to claims filed under the laws of that government by persons who were persecuted during the Nazi era; (n) amounts specifically excluded by any other federal statute from consideration as income forpurposes of determining eligibility orbenefits under a category of assistance programs that includes assistance under the United States Housing Act of 1937; (o) earnings in excess of$480 for each full -term student 18 years old or older (excluding the head of household and spouse); (p) adoption assistance payments in excess of $480 per adopted child; and (q) deferred periodic payments of supplemental security income and social security benefits that are received in a lump sum payment; (r) amounts received by the family in the form of refunds or rebates understate or local law for property taxes paid on the dwelling unit; (s) amounts paid by a State agency to a family with a developmentally disabled family member living at home to offset the cost of services and equipment needed to keep the developmentally disabled family member at home; and (t) amounts specifically excluded by an other federal statute from consideration as income for purposes of determining eligibility or benefits under a category of assistance programs that includes assistance under the United States Housing Act of 1937. 7. Do the persons whose Income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necessary items of personal property such as furniture and automobiles and interests in Indian trust land) Yes _,X_No; or (b) have they disposed of any assets (other. than at bankruptcy a foreclosure or banuptcy sale) during the last two years at less than fair market value? ' Yes No. (c) If the answer to (a) or (b) above is yes, does the combined total value of all such assets owned or disposed of by all such persons total more than $5,000? Yes _No (d) If the answer to (c) above is yes, state: (I) the combined total value of all such assets: S (2) the amount of income expected to be derived from such assets in the 12-month period beginning on the date of initial occupancy in the unit that you propose to rent: $ and (3) the amount of such income, if any, that was Included in item 6 above: S A, 8. (a) Are all of the individuals who propose to reside in the unit full-time students*? Yes x No •A full-time student is an individual enrolled as a full-iime student during each oF5 calendar months during the calendar year in which occupancy of the unit begins at an educational organization which normally maintains a regular faculty and curriculum and normally has a regularly enrolled body of students in attendance or is an individual pursuing a full-time course of institutional or farm training under the supervision of an accredited agent of such an educational organization orofa state or political subdivision thereof. (b) If the answer to 8(a) is yes, is at least 2 of the proposed occupants of the unit a husband and wife entitled to file a joint federal income tat return? Yes ... k_No 9. Neither myself nor any other occupant of the unitI/we propose to rent is the owner of the rental housing project in which the uhitislocated (hereinafter the T%Nner"), has any family relationship to the Owner; or owns directly or indirectly any interest in the Owner. For purposes of this paragraph, indirect ownership by an Individual shall mean ownership by a family member, ownership by a corporation, partnership, estate or trust In proportion to the ownership or beneficial interest in such corporation, partnership, estate or`rrustee held by the individual or a family member; and ownership, direct or indirect, by a partner of the individual. 10. This certificate is made with the knowledge that it will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and Uwe declare that all information set forth herein is true, correct and complete and based upon information I/we deem reliable and that the statement of total anticipated Income contained in paragraph 61s reasonable and based upon such investigation as the undersigned deemed necessary. 11. We will assist the Owner in obtaining any information or documents required to verify the statements made herein, including either an income verification from my/our present employer(s) or copies of federal tax returns for the immediately preceding calendar year. 12. Me acknowledge that Uwe have been advised that the making of any misrepresentation or misstatement in this declaration will constitute a material breach of my/our agreement with the Owner to lease the unit and will entitle the Owner to prevent or terminate my/our occupancy of the unit by institution of an action for ejection or other appropriate proceedings, Me declare under penalty of perjury that the foregoing is true and correct. Executed this J��h day of ri C406or . . 20,AZ_ in the City of �kw 0�2r4— Apnt_� . California App rcant Applicant Applicant Applicant Rev. 8/95 [Signature of all persons (except children under the age of 18 years) listed In number 2 above requiredi FOR COMPLETION BY APARTMENT OWNER ONLY: Calculation of eligible income: a. Enter amount entered for entire household in 6 above: b. (1) If the amount entered in 7(c)above is yes, enter the total amount entered in 7(d)(2), subtract from that figure the an ount entered in 7(d)(3) and enter the remaining balance ($ ); (2) Multiply the amount entered in 7(d)(1) times the current passbook savings rate as determined by HUD to determine what the total annual earnings on the amount in 7(d)(1) would be if invested in passbook savings ($ , subtract from -that figure the amount entered mn 7 d)(3) and enter the remaining balance ($ (3) Enter at right the greater of the'amount calculated under (1) or (2) above: C. TOTAL ELIGIBLE INCOME (line l.a plus line l.b(3): 2. The amount entered in l.c: x Qualifies the apphcant(s) as a Moderate -Income Tenant(s). Qualifies the applicant(s) as a Lower -Income Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenant(s). $ y2, 600.00— $ y21o%o aG- 3. Number of apartment unit assigned: Rent: $ d, 2 l - - 4. This apartment unit was vas not) last occupied for a period, of 31 or more consecutive days by persons whose aggregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartment unit qualified them as a Lower -Income Tenant(s). 5. Method used to verify applicant(s) income: Employer income verification. Copies of tax returns. • ..••.u.' .li '■ Manager N A.M.M : CC.FORM fulls/4 Date MICros7 September 19, 2002 Catherine Farrell 3553 N Missouri Ave. Portland, OR 97227 Dear Catherine: MICROS Systems, Inc. 7031 Columbia Gateway Drive Columbia, MD 21046.2289 443.285.6000 Telephone www.micros.com MICROS Systems, Inc. is pleased to offer you the position of -Implementation Specialist. In this position you will report to Cindy DeNardo. Your compensation package will be based on an annual salary of $42,000 paid biweekly. Enclosed you will find a summary of the benefits available to you and an I-9 form. Please review the benefits summary and be prepared to make choices on the benefits package you will elect. The Benefits"Administrator or your General Manager will complete section 2 of the I-9 Form during your new -hire orientatign. Please complete section 1 and bring the form and identification.requirements with you oil yourfirst day of employment. Do not mail the form back with your acceptance. Upon completion of a 90-day probationary period your manager will -conduct a performance review with you. The purpose of this initial review is to evaluate your performance, and to assi§t in clarifying and focusing your duties and responsibilities. This offer is contingent upon your signing below and returning this offer letter to my attention in the Human Resources Department within fourteen (14) days of the date of this letter. A self addressed, stamped envelope has been enclosed for your convenience. Congratulatioris,and we look forward to you joining the MICROS team) Sin rely,• Karen A. Suter MIC QS Systems, . Catherine F Start Date: October 14, 2002 micros• • ° Project Nalm `4' NOA Unit No. 1 tj%i INCOME RESTRICTED I+INANCIAL WORKSKEET Applicant's Name: t^A"K1erint? Rowe.) _Annual Salary Others Residing in Unit: Annual Salary Annual Salary Annual Salary. . CommissionsMonuses $ 4Zl G00. dG Savings Accounts: Bank Balance — x %_ $ Bank • • •' , ' Balance x %_. $ Bank Balance x %= $ Interest Bearing Checking Account Bank-- Balance x %=„ $ Bank Balance x % = $ Stocks/Bonds: Type Amount x % _ $ Trust Fund: Type Amount x % _ $ Other. , (Alimony, Child support, retirement pensions, social security, disability payments, parental support, etc.) Show calculation, how Annual is arrived at! Type Annual $ Type Annual $ Type Annual $ Property Owned By Resident: Address . Equity x_%= $ TOTAL ANNUAL ELIGIBLE INCOME $ 442j QO d. oG — Maximum Annual Household Income Limit $ LU, 33e-oo- 4 , _ Ngw Cert(Tcafran_/Recernfrcadon Unit Number 12M INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designed to assist you in computing Annual Income in accordance with the method set forth in the Department of Housing and Urban Pro ect ("HUD") Regulations (24 CFR 813). You should make certain that this form is at all times up to date with the HUD Regulations. All capitalize terms used herein shall have the meaning set forth in the Regulatory Agreement. Re: (NAME and ADDRESS of Apartment Building) Newport North - CSCDA (POOL) I/We the undersigned state that I/we have read and answered fully, frankly and personally each of the following questions for all persons who are to occupy the unit being applied for in- the above apartment project. Listed below are the names of all persons Who intend to reside in the unit: 1. 2. 3. 4. 5., Name of Members of the Household Pahl I.;0*jnl0i E112n p.+h AoMtalix Social Security Age Number Z -1 - 607-0.9 -5502 2_ 547-61 - 6472 Place of Employment DeS;resl+no n /ci r Income Computation 6. The total anticipated Income, calculated in accordance with this paragraph 6, of all persons (except children under IS years) listed above for the 12-month period beginning the earlier of the date that Uwe plan to move into a unit or sign a lease for a unit is $ 341 r q 27 .09 Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real of personal property (without deducting expenditures for business expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets except for straight line depreciation as provided in Internal Revenue Service regulations); (c) interest and dividends (including income from assets included below and other net income from real or personal property); (it) the full amount of periodic payments received from social security, annuities, 'assurance policies, retirement funds, pensions, disability or death benefits and other similar types of periodid'receipts, including any lump sum payment for the delayed start of a periodic payment; (a) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (f) the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter and utilities plus the maximum amount that the public assistance agency could in fact allow for shelter and utilities; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not residing in the dwelling; (h) ` all regular pay, special pay and allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the bousehold or spouse (or other persons whose dependents are residing in the units); and (i) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; (b) amounts which are specifically for or in reimbursement of medical expenses; (c) lump sum additions to family assets, such as inheritances, insurance payments (including payments under health and accident insurance and workers' compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational institution, and amounts paid by the government to a veteran for use in meeting the costs of tuition, fees, books and equipment. Any amounts of such scholarships or payments to veterans not used for the above purposes are to be included in income; (a) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (t) amounts received under training programs funded by HUD; (g) foster child care payments; (h) amounts received by a disabled person that are disregarded for a limited time for purposes of Supplemental Security Income eligibility and benefits because they are set aside for use under a Plan to Attain Self -Sufficiency; (i) income of a live-in aide; Q) amounts received by a participant in other publically assisted programs which are specifically for or in reimbursement of out-of-pocket expenses incurred and which are made solely to allow participation in a specific program; (k) a resident service stipend (a modest amount (not to exceed $200 per month) received by a resident for performing a service for the owner, on a part -note basis, that enhances the quality of life in the development; If this form is being completed in accordance with recertification of a Lower Income Tenant's or Very Low Income Tenant's occupancy of a Lower Income Unit or a Very Low Income Unit, respectively, this form must be eomplemi based upon the current income of the occupants. W.AMC099MCC•rORM i• (1) compensation from state or local employment training programs and training of a family member as resident management staff,, (m) reparation payments paid by a foreign government pursuant to claims filed under the laws of that government by persons who were persecuted during the Nazi era; (n) amounts specifically excluded by any other federal statute from consideration as income for purposes of determining eligibility or benefits under a category of assistance programs that includes assistance under,the United States Housing Act of 1937; (o) earnings In•excess of$480 for each full -term student18 years old or older (excluding the head of household and spouse); (p) adoption assistance payments in excess ofS480 per adopted child; and (q) deferred periodic payments of supplemental security income and social security benefits that are received in a lump sum payment; (r) amounts received by the family in the form of refunds or rebates under state or local law for property taxes paid on the dwelling unit; (s) amounts paid by a State agency to a family with a developmentally disabled family member living at home to offset the cost of services and equipment needed to keep the developmentally disabled family member at home; and (t) amounts specifically excluded by an otherfederal statute from consideration as income forpurposes of determining eligibility or benefits under a category of assistance programs that includes assistance under the United States Housing Act of 1937. . . 7. Do the persons whose income or contributions are included in item 6 above: • ' (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necessary items of personal property such as furniture and automobiles and interests in Indian trust land) Yes X No; or (b) have they disposed of any assets,(other than m a foreclosure or bankruptcy sale) during the last two years at less than fair market value? Yes X No (c) If the answer to (a) or (b) above is yes, does the combined total value of all such assets owned or disposed of by all such persons total more than 55,000? Yes �_No (d) If the answer to (e) above is yes, state: / (1) the combined total value of all such assets: S le (2) the amount of income expected to be derived from such assets in the 12-month period beginning on the date of initial occupancy In the unit that you propose to rent: $ and (3) the amount of such income, if any, that was included in item 6 above: $ .d 8. (a) Are all of the individuals who propose to reside in the unit full-time students*? Yes_�No *A full-time student is an individual enrolled as a full-time student during each of 5 calendar months during the calendar year in which occupancy of the unit begins at an educational organization which normally maintains a regular faculty and curriculum and normally has a regularly enrolled body of students in attendance or is an individual pursuing a full-time course of institutional or farm training under the supervision of an accredited agent of such an educational organization or of stale or political subdivision thereof. (b) If the answer to 8(a) is yes, is at least 2 of the proposed occupants of the unit a husband and wife entitled to file a joint federal income tax return? :Yes __No 9:• Neither myself nor any other occupant of the unit ]hue propose to rent is the owner of the rental housing project in which the unit is located (hereinafter the "Owner"), has any family relationship to the Owner; or owns directly or indirectly any interest in the Owner. For purposes of this paragraph, indirect ownership by an Individual shall mean ownership by a farry'1y member, ownership by a corporation, partnership, estate or trust in proportion to the ownership or beneficial interest in such corporation, partnership, estate or Trustee held by the Individual or a family member; and ownership, direct or indirect, by a partner of the individual. 10. This certificate is made with the knowledge that it will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and lAve declare that all information set forth herein is true, correct and complete and based upon information Itwe deem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upon such investigation as -the undersigned deemed necessary. 11. We will assist the Owner'in obtaining any information or documents required to verify the statements made herein, including either an income verification from my/our present employer(s) or copies of federal tax returns for the immediately preceding calendar year. 12. VWe acknowledge that Uwe have been advised that the making of any misrepresentation or misstatement in this declaration will constitute a material breach of my/our agreement with the Owner to lease the unit and %sill entitle the Owner to prevent or terminate my/our occupancy of the unit by institution of an action for ejection or other appropriate proceedings. Me declare under penalty of perjury that the foregoing is we and correct. Executed this PIK day of rX&J'aec _ 20_,�_ in the City of l.)2.w✓.o ± Agnr1-7 , California Applicant Applicant Rev, 8195 ISignature of all persons (except children under the age of 18 years) listed in number 2 above required] FOR COMPLETION BY APARTMENT OWNER ONLY: 1. calculation of eligible income: a. Enter amount entered for entire household in 6 above: $ 34, a27 09 b. (1) If the amount entered in 7(c)above is yes, enter the total amount entered in 7(d)(2), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ 0— ); (2) Multiply the amount entered in 7(d)(1) times the current passbook . savings rate as determined by HUD to determine what the total annual earnings on the amount in 7(d)(1) would be if invested in passbook savings ($ 10, ), subtract from -that figure the amount entered in 7(d)(3) and enter the remaining balance ($ (3) Enter at right the greater of the amount calculated under (1) or (2) above: $ C. TOTAL ELIGIBLE INCOME (line La plus line l.b(3): 2. The amount entered in I.c: Qualifies the applicant(s) as a Moderate -Income Tenant(s). X Qualifies tire applicant(s) as a Lower -Income Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenant(s). $ 3u Q27.aS 3. Number of apartment unit assigned: 1206 Bedroom size: 2+.2 Rent:o�- 4, This apartment unit ( vas was not) last occupied for a period, of 31 or more consecutive days by persons whose aggregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartment unit qualified them as a Lower -Income Tenant(s), 5. Method used to verify applicant(s) income: x Manager W,ADIC.0941.ICC•F00.N `/ /\1 Employer income verification. Copies of tax returns. Other ( __ fo/191ct2 ' Date POOR .R QUALITY ORIGINAL (S) �t OCT-10-200'2 14:43 --nRS SENSORS r, ,¢ a+�^* •""a DRS SENSORS & TAROEnNOi SYSTENS, INC. dR5 3500 TORRANCE BLVD. • r1pMa,*.pJ TORRANCE,CA90503 Taxable Marital Status: Marred Exemptions/A30wantes: Federal: 0 cn 0 Sodal Security Number 607-05.6502 Lraminas rate hours this poriod rear to date Regular 23.6770 80.00 1,s86.16 19,403.86 Bonus 3,760.00 Holiday 1,320.31 Sick 188.62 26.195.30 Dedtu_ tlons income Tax -197,08 3,292.34 Social Security Tax < -115.73 1,610.64 Medimm'Tax -27.06 378,55 CA State Income Tax -38.69 670.92 CA SUI/SDI Tax -16.79 234.82 Other Checking 1 -700.00 Checldng 2 -469.03 Mad Pre Tax -20.89t 104.45 Savings 1 -150.00 401K Basic -113.17* 1,571.7z 401 K�Syu+pplement -37.772(4' 523.87 �`�. r.1if',pi,.. . 'f�n�czM•"'ti, y py a a... iiY ZFi. w�!!� 714 762 7700 P.02i02 Earnft,_4 Statement 1> > a Period Ending:K-0-Aii-90021) Pay Date: AUL J 80771AUX 1439 0 CORONA, CA 92982 Other Elaneflts and Information d is pef od total• to data G.T.L. 1.36 16.32 Excess Vac Bal. 11.50 Sick Sal. -8.00. Vacation pal_ 80.00- * Excluded from federal taxable wagon Your federal taxable Wages this period are $1,715.74 26,195,3G Q = Zgil�Sx l2 = 34 927.0eh y'1a:�7.i -t,. d';• "11 L•Cq'2:%"v v' :. ;"t.:5-^. "^ vr" r�.((.�,�,...,n./- " lit:. '.. •K+... ,�yn. .✓•'{•-, M'•^,.: :: ,,.a A M'._,e�l a 5�' '.ti*h �:n �e< n.J:•, :'! =•,'1` .. .2 � 1 j 7'::`-n`It�.°0;•':it ii C'6J.• 3.^.,.�1'.rl3'f°�.�i � "GP -.k J.;.. ��'Y::�..•�,'•'af;�l': �. •I'C,S �t�. a;,,_ .•F�ruaarti:^m;;p:a .:'.s%aerl :Esau; w;t.,ieen�v��'�cx�,�;�g,C,�';3i�s' sr .�-.ta n.+_ _• trin.'"' S ��.r i�' .5. '. .Lit' y i-'v'.4 . _ 'i. �' i,�i.Y':: - .,., � M`L b' : .Yu .r.n • :'7: .,, c •�5oda��N�.-��_ ..'i�t?�f 5r.'s;, .; i� ��.-..rM;:.�' r.,', a%t�: � �:-:t,..,:,, �,axaJx'•.:-. ~~<k. • �'. r � » .. e. ,_.. d'.i'_- t i�Y'„ pmt '�7^._,.��T. t • ,�a�•1' .. M1. .. i,'�� " ,.t a 1 try ' . i'FYl;g •";1J+C .. 1w • �% :'f0 YEb t9=3 .•. "G` A ✓'..'"'.• 'a; `•: �s^:•w...,M-"'t_;� '-`•,x7 #; tr. "r.:. ry '•,. y �Yi ^' �p 10z,5i:, ' •;'?' itµ:: ' : ? / '; 1. .. -0'. � i,° 1 Y, ..; r €"�.�•t..j lj. '. ;•j t; �r -;i i '<,^'n..<i e't �i <,. .r �� x; DeaosltedtDttiadcaottritot;:::'seeoutilriuml�9r%�•,lsgsh•3A •n-'" tfrtaunt PAUL J BOTTIAUX s 400131JAS719 Yl?2 820� 0 S700.00. _ '• = 40G131t58701 :'"3222 8200' $469.03;_ c: - 500131158073 3222 8200 $150.00;' NON-RESLE TOTAL P.02 Oki; >r.rCK. ,i",>.;.ry •i:i: .; � :•:vT�if•;:'. .t �i!h�3 G^ FIE.£ b50T. '.;GIC T7}ir..>.^ --y: { fi •; ir�a" C2 -'•' .'�vx}� i,=�•.-'CJ7i�i.�: s �- �.yf •t�4i� %' e• A , PRA f100422 TGTeOs b22 0000980171 r, ;i, i .. :Farr, :;;t, •1,�' ;rr' ,gs .Statement' o;o Sm.ft':.iTiMF, :- DRS SENSORS & TARGETING SYSTENS, INC. Period Ending: 09/15/2002 3500 TORRANCE BLVD. Pa Date: __09/20/2002 /«�Hcruu,ra TORRANCE, CA 90503 Taxable Marital Status: Married `t PAUL J 'BOTTIAUX Exemptions/Allowances: :` 1439 W..ONTARIO - Federal: 0 CORONA, ' CA 92882 CA: 0 ; . ... .._.. ._. .. Social Security Number, 607-05.5502 , • „='' �'r. _.Lvr>a•':yTs•e....r-,v.. _ • • • r ""' • 'ili• t'. •.' • ,. ' ��� .`•%ifral 'CA State:'Income.Taxrd:' `1C7 CA`SUI/SDI Ta�F. =`•J ` '>.`; 15 c Checking :2 =3444. E Me'cl Pre,;,Tax•; ; 20 8 Savingngs•.1 ;, •:-• 160ro .401K Basic _;.,: -ibiA 901,K ,Supplement •; • ; , s3'9 *'Exbluded from federal taxable',iki& -- x',pYpOr:federal=taxab le,wages.lhis,:penoi _ < x _ W 4 uyt:" 0 RANG Cff .90503 '"'r, .:ii:';�« >'i )' �.. s # F sS . i. ,•'l .'t\:tit;, „f' 1+ � ;Deposited to the accbiiht'of F >` 'PA1JA. J BOTTIAUX , SC •S �Si . -.xxu:/ r.. .. .vim. •�._-; ,.'v�_. 11� , / OOUOff380�174- ..,. 400131158719_ is`. 13222 821 400131158701:. '�3222 82( 500131158073 " ,3222 ,82( :'NON=NEG 1.50 8.00 0.00 •. `'t•�:� amount $344.60 $150.00 )TIABLE _, DECLARATION OF NO INCOME APPLICANT NAME: SOCIAL SECURITY # In order to continue processing your application for housing, and occupancy of an affordable apartment, the following "Declaration of No Income" must be signed by the person named below. Thank you! TO BE COMPLETED BY APPLICANT I,� I'fiUl�!c�J V I n ,do hereby certify that I do NOT (Applicant Name) receive income from ANY source. I understand sources of income include, but are not limited to the following: Self Employment SSI Retirement Funds Alimony Income.from Assets Educational Grants AFDC General Assistance Disability Union Benefits Family Support Work Study Employment by Other Unemployment Compensation Social Security Worker's Compensation Child Support Annuities/Pensions I understand that should I become gainfully employed or begin receiving income from any sources I must report the information to the Resident Manager immediately. I certify that the foregoing information is true, complete and correct. Inquiries may be made to verify the statements therein. I also understand that false statements or omissions are grounds for disqualification and/or prosecution under the full extent of California law. Date Witness Signature �' �= Date (7r -4, jc )9, 20 INCOME RESTRICTED FINANCIAL WORKSHEET Project isIPA nri- NOt-•i•rl Unit No. Off' Applicant's Name: PWttl BA. i &D X Annual Salary Others Residing in Unit: E12ra6egi Y3uWinii X Annual Salary Annual Salary Annual Salary, $ 341g27.59 a' Commissions/Bonuses S Savings Accounts: Bank — Balance — x %= $ Bank Balance x %=, $ Bank Balance x %= $ Interest Bearing Checking'Account Bank Bank Stocks/Bonds: Type Trust Fund: Type Balance x %_.'$ Balance x %= S Amount x %= S Amount x Other: (Alimony, Child support, retirement pensions, social security, disability payments,' parental support, etc.) Show calculation, how Annual is arrived atl Type Annual S Type Annual $ Type Annual $ Property Owned By Resident: Equity x,_%= $ TOTAL ANNUAL ELIGIBLE INCOME $_ 311 / R'2 %. G S' Maximum Annual Household Income Limit $ y$, 354, 00, 11/A\C IRVINE APARtMENT MANAGEMENT COMPANY December 16, 2002 City of Newport Beach P.O. Box 1786 Newport Beach, CA 92663-3884 Attn: Daniel Trimble Program Administrator RE: Affordable Housing Reporting — Newport North Proiect Agreements to Provide and Maintain Affordable Housing "North Ford Development Agreement" dated 4/22/85 Exp. 324/11 Dear Ms. Teague: Pursuant to the terms of the above referenced agreements, we, as agents for the owners of this property are responsible for qualifying residents as "Affordable Residents." Enclosed you will find the income computations and certifications, as well as other documentation on which we have relied to qualify new residents as "Affordable." This reporting covers new move -in during November 2002. Should you have any questions, please do not hesitate to call me at (949) 450-4290. Sincerely, -Ujo ' - vette M. Machan and Compliance Auditor Irvine Apartment Management Company 43 Discovery, Suite 150, P.O. Box 57060, Irvine, California 92619-7060 • (949) 450.4262 • Fax (949) 450.5802 EXHIBIT C Property Name: NEWPORT NORTH CERTIFICATE OF CONTINUING PROGRAM COMPLIANCE AS OF NOVEMBER 31, 2002 The undersigned, being an Authorized Borrower Representative of Irvine Apartment Communities, L.P. (the "Borrower"), has read and is thoroughly familiar with the provisions of the various documents associated with the Borrower's participation in the California Statewide Communities Development Authority's (the "Issuer") Apartment Development Revenue Bond Program, such documents including: 1. The Amended and Restated Regulatory Agreement and Declaration of Restrictive Covenants dated as of May 15, 1998 among the Borrower, the Issuer and U.S. Bank Trust National Association (the "Trustee"). 2. The Loan Agreement dated as of May 15, 1998, between the Issuer and the Borrower. 3. During the preceding month 2 applications were received from Restricted Tenants (as defined in the Regulatory Agreement): 4. As of the date of this certificate, the following percentages of completed residential units in the Project (i) are occupied by Restricted Tenants, or (ii) are currently vacant and are being held available for such occupancy and have been so held continuously since the date such unit was vacated, as indicated: Studio Bdrm. Bdrm. Bdrm. Total Occupied by Original Low Income Tenants N/A 0 7 5 12 Unit Nos.: 2.11 % Occupied by Lower Income Tenants N/A 28 42 3 73 Unit Nos.: 12.81 Occupied by Very Low -Income Tenants N/A 14 15 0 29 Unit Nos.: 5.09% Held vacant for Occupancy continuously N/A 0 0 0 0 Since last occupied: Unit Nos.:' 0.00% Total Number of Units: Unit Nos.: 20.00% 42 64 8 114 Since last occupied: The undersigned hereby certifies that the Borrower is not in default under any of the terms and provisions of the above documents, and no event has occurred which, with the passage of time, would constitute a default thereunder, with the exception of the following: THE IRVDM COMPANY Irvine Apartme t Manag ent Company By4riconler an Sch fen Contact Person: Yvette Machan Bond Compliance Auditor (949) 450-4290 IRVINE APARTMENT MANAGEMENT COMPANY BOND SLWY ARY NOVEMBER 2002 MOVE IN DECEMBER 2002 RECERTS NEWPORT NORTH OC85 Apt. Address Resident Name Size TO Occ. M/I Date M/O Date House Income Rent Recert Due 1. 1330 Delkash 2+2 3 1/20/90 $33,559 $1,1361 N/A 2. 2112 Lynch 2+2 1 6/17/92 $40,047 $1,361 N/A 3. 2132 Simich 3+2 4 12/27/93 $39,600 $1,417 N/A 4. 2202 Miller 2+2 3 4/22/95 $32,015 $1,361 N/A 5. 2204 Ohanesian 2+2 1 8/1/91 $39,746 $1,326 N/A 6. 2242 Cona 3+2 3 6/13/87 $31,481 $1,451 N/A 7. 2342 Platt 2+2 1 12/26/87 $24,377 $1,280 N/A 8. 2401 Johnson 2+2 1 11/7/89 $27,853 $1,275 N/A 9. 2454 Ode and 3+2 1 1 3/11/89 $35,250 $1,317 N/A 10. 2534 Cattaneo 3+2 7 12/17/94 $32,650 $1,392 N/A 11. 2600 Joshe ani/Mansoo 3+2 4 1/30/94 $35976 $1,417 N/A 12. 2731 Duli a 2+2 1 4/7/95 $42,006 $1,280 N/A OC95 M ft 5/25/95 ove- as a Apt. Address er Residen Name 1. 102 Guthrie/Fletct 2. 104 Etchells 3. 108 Chen/Milue 4. 112 Halstead/Girt, 5. 124 Szaz 6. 125 Momeny 7. 138 Perez/Malone 8. 146 Ahnore[Wats, TTP=547 9. 214 OTA 10. 218 Rivera 11. 220 Cushnie/Bolt 12. 236 Balcazar 13. 237 Hoan 14. 239 Lain ernar 15. 244 Barr 16. 245 Fe el 17. 251 Ritchie 18. 302 Won on 19. 304 Yutan 20. 308 Faldiouri 21. 311 Elliott/Dorn 22. 312 Golden 23. 313 Rhomber 24. 314 Jones/o'Dow 25. 315 Ochoa IRVINE APARTMENT MANAGEMENT COMPANY BOND SUMMARY NOVEMBER 2002 MOVE IN DECEMBER 2002 RECERTS NEWPORT NORTH 26. 1100 Fiore 3+2 1 47691.E 1474 09/03 27. 1104 Mcconne 1+1 2 51172.6 1160 8/03 28. 1106 Meyer 1+1 1 35508.7 1160 7/03 29. 1107 Aviles 1+1 4 K7/13/98 23416.2 884.25 08/03 30. 1108 Romero/Serrano 2+2 5 56534.9 1026.75 11/03 31. 1118 Feldhaus 1+1 1 39862 1160 10/03 32. 1122 Hales 2+2 2 33262 1361 7/03 33. 1128 DelFante 3+2 4 11/06/99 83456.1 1512 1 11/03 34. 1141 Holder 2+2 1 1126196 37600 1252 1/03 35. 1144 Sepehrband 1+1 1 11/16/00 14022 1160 11/03 36. 1145 Axelrad 1+1 1 8/30/00 41424.2 1160 8/03 37. 1154 Collins/Collins/Col 2+2 3 7/29/99 26000 1361 7/03 38. 1159 Farrell 1+1 1 10/15/02 42000 1210 10/03 39. 1183 Pottter 1+1 2 611196 34907.7 1113 06/03 Olson/Ammann 2+2 2 6/7102 45968.5 1361 06/03 Wood 2+2 3 08/04/01 48871.2 1361 08/03 Gallicano 2+2 1 11/07/01 37729.53 1280 11/03 K Bottiaux 2+2 2 10/19/02 34927.08 1361 10/03 Robbs/Fer on 2+2 2 7/14/96 49945 1361 7/03 Mandelbaum 1+1 1 12/26/99 35627.51 1210 12/03 Amor 2+2 2 08/15/02 18258.3 1361 08/03 47. 1411 Loran er 2+2 1 02/22/02 40,491 1326 02/03 48. 1412 Fdioka 2+2 1 7/10/98 44371 1361 7/03 49. 1418 Lee 1+1 2 7/12/02 34902 1160 07/03 50. 1441 Gerry 1+1 2 12/08/01 60834.24 1210 12/03 51. 1444 Douglas 2+2 1 2/12/99 50147 1326 2/03 52. 1502 Smith 2+2 4 3/31/96 64615.4 1306 03/03 53. 1557 Graves 1+1 1 1 2/12/02 39500 1,179 02/03 54. 2116 Zaharson 2+2 1 03/29/02 19280 1,326 03/03 55. 2123 Ross 1+1 3 11/16/01 49894.73 11 99 11/03 56. 2134 Huish 2+2 3 9/11/99 22574.2 1361 9/03 57. 2212 1 Riedelsheimer 2+2 3 08/20/02 37,604 1326 8/03 58. 2224 Aniozian 1+1 1 5/27/98 35210 1160 5/03 59. 2225 Adams 1+1 1 04/06/00 36000 1210 04/03 60. 2226 Syrquin 2+2 1 12/17/96 21458.48 1326 12/03 61. 2301 Altes/Mchugh 2+2 1 2 05/10/01 43254.3 1361 05/03 62. 2309 Harney 1+1 1 1 11/23/02 39418.03 1210 11/03 63. 2312 Nam 2+2 1 01/11/00 30000 1326 01/03 64. 2322 Marino 1+1 1 8/8/96 15840 1075 8/03 65. 2402 Melnick 2+2 1 01/28/00 43428.7 1326 01/03 66. 2423 Malkin 2+2 2 8/23/96 24000 1280 8/03 McKee 2 6/4/02 21108 1020.75 6/03 Jones/Janisse 2 10/25/00 48054.4 1252 09/03 Van Nieuwenhu se 3 08/08/02 44067.9 1361 08/03 K1.2 Fa azfar P2+2 1 12/10/O1 43583.62 1474 12/03 Chun o 2 08/20/02 406 U 1280 08/03 Fuller 1/10/0250001160 6/03 Larson 1 10/10l99 56922.3 1160 10/03 IRVINE APARTMENT MANAGEMENT COMPANY BOND SUMMARY NOVEMBER 2002 MOVE IN DECEMBER 2002 RECERTS NEWPORT NORTH VERY LOW (Phase In - beginning 4/1/98) Apt. Address Resident Name Size # of Occ. M/I Date M/O Date House Income Rent Recert Due 1. 106 Lausen 1+1 1 1 4/11/98 $33886 $ 737 4/03 2. 122 Galla i 2+2 2 01/05/01 $10523 $ 783 01/03 3. 126 Francis/Vidal 2+2 4 12/28/00 $49393.92 $ 845 12/03 4. 208 Tarta lini 1+1 2 04/01/01 $27,444 $ 696 04/02 5. 224 Rice/Harris 1+1 2 8/1/99 $30219 $ 737 8/03 6. 228 'Jones 2+2 2 5/8/99 $22,336 $ 829 5/03 7. 243 Batts 1+1 1 5/l/99 $24,154 $ 737 5/03 8. 301 Francis 2+2 2 2/08/02 $26399 $ 783 02/03 9. 318 Radford 1+I 1 1 7/8/99 $23430 $ 737 7/03 10. 320 McGinley 1+1 1 4/16/99 $8,467 $ 737 4/02 11. 333 Sa orowski 1+1 1 2/3/01 $30,000 $ 737 2/02 12. 1180 Siroonian 1+1 1 4/7/02 $24,542 $ 737 04/03 13. 1323 Buoncristian 1+1 3 11/10/01 $27684.77 $ 737 09/03 14. 1324 Hale 2+2 1 4/1/01 $25819 $ 851 04/03 15. 1333 Stork 1+1 1 9/7/02 $23068 $ 756 09/03 16. 1419 Mino 1+1 1 5106101 $21600 $ 696 5/03 17. 1530 Siddi i 1+1 3 6111100 $46249 $ 737 06/03 18. 2128 Johnston 2+2 2 6/8/00 $24636 $ 829 06/03 19. 2140 Vise 2+2 1 02/01/02 $240 00 $ 829 02/03 20. 2210 1 Rossi 2+2 1 12/07/01 12/31/02 $25680 $ 829 12/02 21. 2300 Mohler 2+2 3 611199 $25263 $ 829 06/03 22. 2408 Shoeibi/Motta hi 2+2 2 5/12/02 1 25984 $ 851 05/03 23. 2425 Uchida 2+2 3 04/11/01 $12402 $ 783 04/03 24. 2428 Winslett 2+2 1 1 03/17/00 $23500 $ 829 3/03 25. 2440 Afshar 2+2 2 05/06/01 $15424 $ 783 05/03 26. 2450 Warfield 1+1 1 1 4/11/98 $8827 $ 737 1 4/02 27. 2519 Cotter 1+1 1 5/29/01 $25410 $ 737 1 5/03 28. 2608 Vidal/Gaxiola 2+2 2 6/1/99 $25426 $ 829 06/03 29. 2702 Delgado 2+2 4 1 3/l/02 $25200 $ 829 03/03 1998 Phase in - 106-122-224-3 18-320-2450 1999 Phase in- 228-243-1180-2608-2300-126 2000 Phase in - 2428-1333-2519-1530-2128 2001 Phase in - 333-208-1323-2425,1419,2140,2440,305 2002 Phase in- 2210,2408,2140,2702,1324 Total number of apartments on this property: 570 % of property deemed Income Restricted (Low): 15.26% % of property deemed Income Restricted (Very Low): 4.74% TTP = Total Tenant Payment (Resident is on Certificate or Voucher) Total vacant as of 11/31/02- 21 011--ollf" NewCerdfrcation X /Recerkjrca UnftNumber 162 INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designed to assist you in computing Annual Income in accordance with the method set forth in the Department of Housing and Urban Protect ("HUD") Reputations (24 CFR 813). You should make certain that this form is at all times up to date with the HUD Regulations. All capitalized terms used herein shall have the meaning set forth in the Regulatory Agreement. Re: (NAME and ADDRESS of Apartment Building) Newport North - CSCDA (POOL) I/We the undersigned state that I/we have read and answered fully, frankly and personally each of the following questions for all persons who are to occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit: 1. 2. 3. 4. 5. Name of Members Relationship of the to Head of Social Security Place of Household Household Ake Number Employment V ivan Gen RCIMA ' 225" 522— 23- 2g44 A,vtnM412�T 0 mily1P _Q=MM&Ae .24_ 661-Jsq-565S NaAps Income Computation 6. The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children under 18}}''ears) listed above for the 12-month period beginning the earlier of the date that Uwe plan to move into a trait or sign a lease for a unit is $ L17f 317. R W,.' Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real of personal property (without deducting expenditures for business expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets except for straight line depreciation as provided in Internal Revenue Service regulations); (c) interest and dividends (including income from assets included below and other net income from real or personal property); (d) the full amount of periodic payments received from social security, annuities, insurance policies, retirement funds, pensions, disability or death benefits and other similar types of periodic receipts, including any lump sum payment for the delayed start of a periodic payment; (a) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (0 the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter and utilities plus the maximum amount that the public assistance agency could in fact allow for shelter and utilities; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not residing In the dwelling; (h) all regular pay, special pay and allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the bead of the household or spouse (or other persons whose dependents are residing in the units); and ' (i) any earned income tax credit to the extent that it exceeds income tax liability, Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; (b) amounts which are specifically for or in reimbursement of medical expenses; (c) lump sum additions to family assets, such as inheritances, insurance payments (including payments under health and accident insurance and workers' compensation), capital gains and settlement for personal or property losses; (it) amounts of educational scholarships paid directly to the student or the educational institution, and amounts paid by the government to a veteran for use m meeting the costs of tuition, fees, books and equipment. Any amounts of such scholarships or payments to veterans not used for the above purposes are to be included in income; (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (f) amounts received under training programs funded by HUD; (g) foster child care payments; (h) amounts received by a disabled person that are disregarded for a limited time for purposes of Supplemental Security Income eligibility and benefits because they are set aside for use under a Plan to Attain Self -Sufficiency; (i) income of a live-in aide; (j) amounts received by a participant in other publically assisted programs which are specifically for or in reimbursement of out-of-pocket expenses incur: ed and which are made solely to allow participation in a specific program; (k) a resident service stipend (a modest amount (not to exceed $200 per month) received by a resident for performing a service for the owner, on a part-dr: e basis, that enhances the quality of life in the development; If this form is being completed in accordance with recertification of Lower Income Tenant's or Very Low Income Tenant's occupancy of a Lower Income Unit or a Very Low Income Unit, respectively, this form must be completed based upon the current income of the occupants. a.&W.omr.1cc•rowt (1) -compensation from state or local employment training programs and training of a family member as resident management staff; (m) reparation payments paid by a foreign govemment pursuant to claims filed under the Imes of that government by persons vvho were persecuted during tt Nazi era; - (n) amounts specifically excluded by any other federal statdte from consideration as income for purposes ofdetemining eligibility or benefits under a catego, of assistance programs that includes assistance under the United States Housing Act of 1937; (o) earnings in excess ofS480 for each full -term student 18 years old or older (excluding the head of household and spouse); (p) adoption assistance payments in excess ofS430 per adopted child; and (q) deferred periodic payments of supplemental security income and social security benefits that are received in a lump sum payment; (r) amounts received by the family in the roan of refunds or rebates understate or local law for property tares paid on the dwelling unit; (s) amounts paid by a State agency to a family with a developmentally disabled family member living at home to offset the cost of services and equipm., needed to keep the developmentally disabled family member at home; and , (t) amounts specifically excluded by an other federal statute from consideration as income for purposes of determining eligibility or benefits under a eategoi of assistance programs that includes assistance under the United States Housing Act of 1937. 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necessary items of personal property suc as furniture and automobiles and interests in Indian trust land) I Yes x. or , .No; (b) have they disposed of any assets (other than at a foreclosure or bankruptcy sale) during the last two years at less than fair market value? Yes X No (c) If the answer to (a) or (b above is yes, does the combined total value of all such assets owned or disposed of by all such persons total more than 59,00C Yes X No (d) If the answer to (c) above is yes, state: (1) the combined total value of all such assets: S (2) the amount of income expected to be derived from such assets in the 12-month period beginning on the dale of initial occupancy in the unit that yc propose to rent: Sa,_. and (3) the amount of such inepnk, if any, that was included in item 6 above: S E, S. (a) Are all of the individuals who propose to reside in the unit full-time students*? Yes_No *A full-time student is an individual enrolled as a full-time student during each of 5 calendar months during the calendar year in which occupancy crti unit begins at an educational organization which normally maintains a regular faculty and curriculum and normally has aregularly enrolled body ofswilan in attendance or is an individual pursuing a full-time course of institutional or farm training under the supervision of an accredited agent of such a educational organization or ora state or political subdivision thereof. (b) If the answer to 8(a) is yes, is at least 2 of the proposed occupants of the unit a husband and wife entitled to file a joint federal income tax return?' 1'es X No 9. Neither myself nor any other oecupan:of the unit Bwe propose to rent is the owner of the rental housing project in which the unit is located (hereinafter the "Owner" has any family relationship to the Owner; or owns directly or indirectly any interest in the Owner. For purposes of this paragraph, indirect ownership by a individual shall mean ownership by a family member, ownership by a corporation, partnership, estate or trust in proportion to the ownership or beneficial intere I, • in such corporation, partnership, estate orTrustee held by the individual or a family member; and owncrship, direct or indirect, by a partner ofthe individual. 10, This certificate is made with the knowlecife that it will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and I/wc daclah that oil information set forth herein is true, correct and complete and based upon information i/sse deem reliable and that the statement of total anticipated incorr contained in paragraph 6 is reasonable and based upon,sueh investigation as the undersigned deemed necessary. 11. lf%Ve will assist the Owner in obtaining any irfomiation or documents required to verify the statements made herein, including either an income verification f of mylour present ern�ioyer(s) or copies of Rderal tax returns for the immediately preceding calendar year. 12. I/We acknowledge that Vwc have been advised that the making of any misrepresentation or misstatement in this declaration will constitute a material breach r my/our agreement with the Owner to lease the unit and will entitle the Owner to prevent or terminate my/our occupancy of the unit by institution of an action f, ejection or other appropriate proceedings. ' iN'- declare under penalty of perjury that the foregoing is true and correct. Executedthis Zgr day of N/xr2_rY)E) .20-0j_intheCityof ).k�, le2f"f Peeae�'t Cali(orr: Applicant App!icaa: Rev.819; Applicant J1> J Applicant isignawre trail persons (except children under the age of IS years) listed In number 2 nbove rcgtrrc W µ•tiny: Ire-rov4 FOR COMPLETION BY APARTMENT OWNER ONLY: 1. Calculation of eligible income: a. Enter amount entered for etitire household in 6 above: b: (1)' If the amount entered in 7(c)above is yes, enter the total amount entered in 7(d)(2), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ irl ); (2)' Multiply the amount entered in 7(d)(1) times the current passbook savings rate as determined by HUD to determine what the total annual earnings on the amount in 7(d)(1) would be if invested in passbook savings ($ 16 ), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ -ec (3) Enter at right the greater of the amount calculated under (1).or (2) above: C. TOTAL ELIGIBLE INCOME (line 1.a plus line I.b(3): 2. The amount entered in 1.c: S x Qualifies the applicant(s) as a Moderate -Income Tenant(s). Qualifies the applicant(s) as a Lower -Income Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenant(s). S 117, 377. LI9 0. IJ 471 377. 619 Number of apartment unit assigned: 103 Bedroom size: 2 t 2 ' Rent: This apartment unit tivas was not) last occupied for a period of 31 or more consecutive days by persons whose aggregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartment uni; qualified them as a Lower -Income Tenant(s). Method used to verify applicant(s) income: Manager Employer income verification. Copies of tax returns. X Other ( u S ) _ IIlZ5 Date DECLARATION OF NO ISCOME APPLICANT NAME: 4krjr A • Nt urJ SOCIAL SECURITY # In order to continue processing your application for housing, and occupancy of an affordable apartment, the following "Declaration of No Income" must be signed by the person named below. Thank youl TO BE COMPLETED BY APPLICANT I, s ro,-& f ° \ 1 I 1 do hereby certify that I do NOT (Applicant Name) receive income from ANY source. I understand sources of income include, but are not limited to the following: Self Employment SSI Retirement Funds Alimony Income from Assets Educational Grants AFDC General Assistance Disability Union Benefits Family Support Work Study Employment by Other Unemployment Compensation Social Security Worker's Compensation Child Support Annuities/Pensions I understand that should I become gainfully employed or begin receiving income from any sources I must report the information to the Resident Manager immediately. I certify that the foregoing information is true, complete and correct. Inquiries may be made to verify the statements therein. I also understand that false statements or omissions are grounds for disqualification and/or prosecution under the full extent of California law. Witness Signature Date l( ? 1 �7--- Date lltTTU L Nov-21-2002 10:42am From-AMERIQUE6T'"7TGAGE COMPANY +T14-660-0602 ^•' T-222 P.002/002 F-231 t• l�lllp'igq�c lYloYtgage Co11ipNny - Ilk Uwm-& Gagfp At4 $g1to IS6n Ot10�1,[[♦ RN6fl - ` »7 NNltalirwftkirPAY rta4p liumunip QNAMC Pt0'boQnUua lot,S16ao1 4Wrke,l: elvAls ' 1� Qara plasm Aavicr uma: 11 am v11Wr Chin yd9 w Asth M Apt a Fnplalwt DtPaanWm r 00606.5z= TA AYAi F Cw Aar, C� tlot 8ZLW 6lgpto iittk, ar orr Yfib t � Vwf)MVW4. t:A Pusjs:czt(71n; drx606 1 Agg7WrmY: 1 I Jap T4Ial Amglni fX0641e j Aft jtt.: SN: Blyl4w. $29091 00 Am Am. . K-Aqwi24= a DQtcri Ba113t 11aAta Itn0w0. Hon pa ! tta4 G9mm T AcgolprTpy b600a9 nn .EO n irn 9: • Cetn7NLrtpg 140046 9,116.0 4et1 MEhp:F, a7,99 1t6.19 flo1MnY fl ll0 3i-0a a37.6o Fed D&SOURB 1693a 91"1 CA'Withiaunq 135 76 M413 • GIOAHouers A1,37 1]R,3S anm sxs. 6 o.nn li of n Ta t: gA ac $•!f..^tl^_^ .^_a hat ' 7 Atari tia 7 [Nttrpf Y9'0 Diaq lisp chirreAr VTjr 7rLalail lVdaraRDv :1 aq 75,90 2 Gn:7p T.rm lire 1upme gent 1.♦f5 S•l3 pin:glllglvatlon 7.bq 7.9n ; I' I '@ntlt ' i7•Aa Y1.itl :' • 1 t ' am 0 * Tcsft -' 11")`.ftYV ..iAQ Ir`.Wm •4 J iLC A WWI t n,'SYRrin 3.559.11a I I xdp,36 '17iSn 1.7 '-1'J i!: 4�o1d:73 7.9=111 3.031.51 8x3 1 •07313 �nba}nCtX g.a INOVEM AdvtStypQ9 1 UfW137576' � 1,79Ad0 Abfl NglapHt ' .B I R baYgadt R.3 -{� Estnca: u - Tgiolf TgYCn: i'alal• I703,19 •F � A 'aocnenu: eaa nee• a :q j ? almxe: g1 VIv1m�W Cs heq :#3,: ; �`-: f•.; '�,=,.,;;, : •1 Employee lD: 028404 .::'-,. -z_�; :.. +tr 4ro;:(F• t.! ` • ��z,'.t.' tj e5'`t"11,• 7A.[ U I *,..wteneRl +%•• :tJf stare -. Single' -M - Single, Married , Ci Depir nteni a 005606•Santa Ana` CA t; � 8.49 W lath St,Apt Gy - `:It C - t' -', fl•+?t �+ `'�' ' hluital SraNs:I or with i Ne "oit'Beach?CA'YL667:•� ';,}., :t`,ia>?.,,j,i �d I:acuioni;`",s'OU5606;. i = xliouanees: p;. �.,:-•�-.,"_�_. :.. +_r=.nos.;;. lob 77ile:;;iAicount �ecutive ;:.jt;,y',�.•.>�.�;r��liyr AddliPu.:� -7_,:;y: .�..; s�ti;,,. SSN: "522.23-2944 -i. an_i:. iv.,�,;3:.;;;c':i?=Pav Rated"�'328,U80.00 Annuzl''`?'.V�3-r_iv ti•S;.:r-`�'Abdl. •?.tvi.�:'.i:'l Am`t.:`.�=�<, •.i••, -i�il.''tb.'Y$'." Jji.>/�v 4..� _..: J.l`.'>4,�X�oiii: •`T .[:?� si>: `lYin,nl:Y `'�ii.t:.ii•. ht ... .� '"'• '•-. ,:� Destti tion' ..••�: -S•,' _.: C&ien[. -•%- YC. r.i,. _ ; � ,•, .. ..,.. _. Curtent..,p - 'YfD.. a�.c •'o1�6^':n - ":. t;.y� .. ri:_ w .l x: -r �:' i:��FarnSn s • :"Iio'u[s ::r'•'�:"Eamin sf"" . t)eseii'doii n,': �•�`'F= :r'niC 12ate. ,'.•:':� Houis ,.:; .. • Regular PaY�Yi.;,: 3i �"536.00 �;:;7 ,SO.,W u` k g 1.70 '141.9 ;iva 5,1.7F: •.�',3fi:�;:r`.'fN ': COtNI115atOn�li7,, yr7hyi1�0nSOl 6.�{ = bit" ecdblED/EE �': ,: "• '' ,-�26.12 '' 'Jt 1 t r .: r ^•1 «t ,�f,K' Holiday ° Z e 1f iS J, ! c�a t . ;yl2 •,• •r ,,• 000 , 2400 1r32400, . •, Fed OASDllEE'•- .. - 111.67 E06.7 . _ i, < •%' ;ri, '``"lam s } " :'„ +=:•s if ^. y ^,: -r. x1 ". '^• i ' = '7'?' • ,<"„ .5 .:_ 1 "" 'K•t;4 CA Fithpaldn '} it %,: $2.83 367A y;'-Na,' '",-.%• '>'-o-it"; .'i''."' i'• ` •. :'ii ;,+i. ..L'.:ai y. 6';'• - . r�:�t'a'.-•S�i'; _ }•.. :_ 5 ;;.� s�•1Fest<is. CA OASbYM,S -:m n �f1621 83.0 _pie :' a�. J%%' e?ri` ,, ;?rt, + ,;'7t'• ,- i s 4 S. Gr T'F'' ;?,>:Y" < ~;_:.,p...,,r, E.S: +;`.i „Y •' •ti, %C �.A/.±. :L.: n, i 4. i �'n ,� � r.Sii '�' .<=%' "tf (.mot, x .r'. 'f; -• .{Y.- 3G•'."`,'vJ a �4 .J .'' t \`: .j�'j { :t�'"�'^Qji.,'„' 1,^--�'). �.AV 'lr,-• .:�. Y4 T( ,4i�,'!•^�". .:V)' -��': :-eT.... •t� iti'. �° J tq., `v}}L'.� ;"h• .&: ,r-°' :�CS^aY T', :i.'•. �_'•' -. '� ' - -. :" t->'''> �}r i�+' '.1:: A,1`,•".�•'� q '. •ry,: ,. 1. !6'•. ;'�i°h f+'� e :,ti .},`:: ..C-J .�' .:':r •` fr+"_ �•.t ' J:' t c , t ,eye.;, • - Total: .: - SO.00 -' " U0123 S6D.OD 94786M . ' ' Total: 52853 25892 ' AE1ibR1:1'1`JSA`•T?LD1JC3'SaiES I •: -> \E<".>t'•.',A>:'1'BRLrAOC.D ONS. .... ;:',i:�> •- .�cd3r1.t3YHR1aATD8ENBi'FCS ' Descri tion Current :' YTD Description'. Current'Y[D Description Current YT[ Total: OCO OAO Total: 0.00 000 •Tatahle ' .''•rtlTA:.GRa55:�.•<'EHD TAiAIiLE.GROSS% ,Current: :' .'•.:.Jl'a2AI"rA'±ES .,' 70TA-17—MU0?49 ,;;., :,, ;` > MT PAS i '1,80123 • •52853 OAO 1272.7C YTD: 94786468 9,786.68 238929 0.00 7,1973S \'AC HO :':; T271 DUR5- ::,' �TRh ,NU'pAY Li17ON •'. •. Advice R'OOOOOOM0178732 1,272.7C Start Balance: OD Start Balance: OA + Earned: + Earned Total: 1272.7C • Taken: - Taken: + edtu<nnsmr + Adittamvnre- ,meriquest Mortgage Compa w„ . k 'e •a. , •,t;.., m1s a. , ••- Pa; • �A100 TotynkCobnlry�Rd Suite j360 u' �°•�"���"•'g.•''; l••Y.'ry`,i: �s�t:x ^..�s;���? . psOra`rige'CA292868"-.:./�:..'ir'aTr S.`le`,a+,s:='.''"i?E'2>JF'7 e fir, x;-�.s-t•XS�'-i$•,^`•;i Y.. iS =1 +i 1ii,: n'vY.[ii, •u-:+.: �t=::: •.i:.wT ,1�3:•."::�;: Pay j:.1 H'�'2 �'•-:•1'�y:IV .. :'•Ml: in'.•i::'.:i`v.,::..1L;, n'n'iU,Ir f.: `. �ryt'.a:r •C1�n -'' �4 '4 •� 1 018158. s VIHnnWCheti ,--.,•+..v ,,,�'•r _�+'•.�. .¢>fi'^•wary+ tt". BmployeerD: 028404;^" �'+;•+;:�tzt;,,;y,, j.t^.:`;• •7 's. rS',, TAX ATA•- Fedcml'.w'G DATA:. pCtAC;P.�a: _. :6:'.6'3 ,.,•;, •t.tr>;;,• ainen:-00560fiSauta'Ana. D1se"pc MaritalStatus: >Single• - S.ugle;oth. ared with NSAe9?;'WPo. rt15Bihea,Sclthse:.t. '9'2r��ti3:;5�'s .�.-=•,..«;:;°,%,F ' �•m+'a':'nR.�.o-,.•�,.7.",`rq: t-:`;=;,ilC,4.iI. . "_• .;005606 owances:aon:Y_RSyxm.tcer., ' �7 • 1 Yr%_; F,... .'Ar 7o6.Ttdev `-�Accouni FxecudVe"t•::'"s ". •`e'. Y 't "r.'`" w• ,:. Addl. Pet: .G" .,- "I",' SSiVi;522.23=2944';±>4;1r..,;?sa_,•.s,� F;•Y �.,r,;c • r f Pa, Raie. +`•�'528,080.00 Annual r' ''"��� •• Addl. Amt.: .' -c-= •;;a• �r r �` `HO: D7d: �a..,frt. _ +� �.. •ij DF.D 'tl' $' .L:. •Lr?_�—.,,rg .n. mot. •(.Ly ---'•YTD •�•: •• Dc'scrt•tian",r',...rvr-ar;t'Rate '.' :,:' f`-i '+1'sr;;. ;.u. ' ¢`, .4.� ., �:. :F„.;,;.�:.• ' ,1?. •.zf,.•:,,o. • ='Flours Earnin¢s .•. `.Haitrs "• .. F�mfn's.. IRsc don Current • s .. }T Regular PaY ,:''' •13500000., e- ; '-$0.W 1,08D.00 F - 616.00 +; •'_8,�I6.00 v '..,.•. •.. Fed Withholdng• - 114.09 1,4M Commission •, t; • ODO . •-+., .c .;,::.-;2,2','6,68 • FedMID/EE :75.27 ••i: 1371 _ Holltlay i�= , ;?(�.'.i''•7+,. •000 24.00 �`r: ,',374 Fed OASDM , ' n�,1,.. : . r r CA Wlthholdng ' 24.11 . 3911 . ;:t-r':•. ,^'>r . `-:'ti - CA OASDI/EA `4 -. 9L2 _ _- Total:.00 ,866.68 10 ToW: 2'B258'2LR'6 , ' YaB:YII X:;fDr; :AFAFRR-D� BFSTS'28175 i • Description Current YTD Description Current YTD Description Current Yfl Medical Insurance 25M • 25.00 - Group Term We Insurance• 1A5 1.0 Dental Deduction 2.50 ' 250 , Tom]: 2750 2150 7ota1: 000 0.00 • Taxable • TOTAT.'GROSS a:•'r'.ItEt?'fSXABLE 14VAClIOWZS:, GROSS ;a�`aa TO.TAI<TARES ..-''lC3TA:'DEbiiCT1O3€5a"<, a "?eETPAY Current: IA80.OD I.W353 22826 27A 82324 YTD: 102M.68 10,8•f023 2SI755 2750 8.021.63 - a.' Y-= SI ii0UR5 '.,, •a• .YM1 INEF<?A1''}SISIRIBDTtON a' "' . Start Balance: 0.0 Start Balance: 0.0 Advice#000000000181581 82424 + Earned: 3.1 + Earned: 37.4 • Taken: - Taken: I Total: 82424 + Ad ustmegts: + Adjustments: End Balance: 3.1 End Balance: 37.4 . Nov-13-2002 02;52pm From-AMERIQUES7 'IRTGAGE COMPANY +714-560-060" T-104 P.008l010 F-842 1UPERVTSO�R�Y�EC WTTEB ITU NION 9EATTLE, NA598111-3574 This is an archived copy of the original statement. Refer to the original for information not included on this Copy. All transactions are as they appeared on the original statement. ME 29501 E T4H'UI B=CF 86GPTU.'C I Offimi3 vDa APT C 01SEP02 30SEP02 81683 CA 92663 STATWE URIOD Dent Mnv d am 044 4e10a nm as nm w ma do➢nod or cr➢dd64 1. Y.W.GGnnnL DATE ^TE I s ' DESCRIPTION AMOUNT SALnNCS i $ PERTOAivO]N1�5EP2002- 30SEP2002 50j00 09 1 09 0 9i0 9 0__NEW PREVIOUS BALANCE BALANCE -- - - --------`---------------------------------- 5-11 EASYy START CHECKING -- ----5000- 09 1 91 PERIOD• D1SEP2002- 30S4PZOOZ PREVIOUS ! 17$768 09}3 9 3 :BALAN� p EpLE5'PRMORPAF L D16PF8SZT 0 0937 9t2 0 02 RHOSTRONIC �S DEPOSIT 9088843 12720 ERIQUEST MORPAYROLL 028404 02 922 1 09 3 TOTAL DDgEEPOSITS = 2 WITHDRAWAL ZRIRNN00pS55928 211660 326p7 2 S gg ggyy 09�3 9pp 918D0300 7�Oi�NEWPORT EC�pp�gSO5�ggggC3 E. 9 W1�1� xxWWSTRCL2800 2y hiE9S0039001 43068 7905191r, 095 ODfi9 �p�p �q 201SOR80RDER86 HOOIr6�&MLRTSIC COSTA iOrS FDEWTROIT CARD CA 12 8 09 5 2263 053 90g1g00RSEPEORA6SCOAST PPLLATZ'ACOSTA MES + 09 5 43 ELECTRgO�NIICFRCRoU2N�D.5 WITRDBAW 9 2610 CA 0P697O Do DtIND9EWITFD]RA COSTA ME 09 4 CTRONICCF 20 09'06 pp9}II1Tg4g 9D4 BOLD O LIN& PMTEB B BIDDS C '02 LECTRONICNFCTNDS WITHDRAWAL 904 1390 0 8 20300 TOKY LOBBY T[YSTIN FAR DEBIT CA i 09�05 9& 5 UNWITEDDRAWAL 2636 50 R�7L7,,E5C5TRR1OOgNICll A�7A 01860071330 EAST4106840 0055928 I! 099 -)0 9P3 09 71 EL S�ROVEN z0NDNDWIRELEESBDVRULIRVINE 6FFD CA 4992 DTE�BIT_ CARD 0909 90h3 DDS EOT RRt IRVINE y0300 CA DEPTNOF C&223 0 ] 099 FDR DEBIT pp��_ W�LgT g}k E16SOg00O01�AST 91I 8 gCARD �T �47$000528 0911 9B E ITHDRAWAL 32p0 051§2� 000R°DE TTEL TOOFPRDNNAILS COSTA MS CA 091�111 9bb9 EEL CTIC P1%D3 WITHDRAWAL 20700 HO 8VM SI9TRO NEWPORT 8 3331 CA 0911 Q$8 91 ELECTRONIC FUNDS WITHDRAWAL 50,53 I toc�z.tmEuegntt�7 Op 0 000 wnw�oxius 1 F.�r>miti;+nwan i tiravmaatran.. Nov-13-2002 02:62pm From-AMERIOUEP' "IRTGAGE COMPANY +T14-580-060' T-104 P.003/010 F-342 NORDSTROMgIyFEDERAL CREDITU NION SUPBR80X021592MMITTEE SEATTLE, WA 98111-3574 CWA 92663 This is an archived copy of the original statement. Refer to the original for information not included on this copy. All transactions are as they appeared on the original statement. 29501 . E I m"M I CD1l1i . spkm 01SEP02 30SEP02 8�684 STATEMENT PERIOD Dtm akowatm{Ya data Mm Ea -tm daLtad-t dmdG.d m Yaaraacaut DAT p7E a DSBSCMPT10N AMOUNT BALANCLl 0913 9SS �,�, NLLECTR7gONNTIC C RCLE T=-RAWAY,EWPORT88 93. 6CA 2020 FUNDS WITHDRAWAL 1832 09 6 9r2 0 3 ELECTRONIC 2100D1 JORDSTRON #0324 6ANTA ANA CA 09 3 9 ELECTRONIC FUNDS WITHDRAWAL P B BIDDDB C 2000 913 6 D 0916 He` SS02 gg��ODgAgLEss1ONNLINE 703p800gp000035 NEVPfflD684gg00D5MEJA 60 4 1 0916 9{pp, 6D ELECTR7b9N Cgg�7 Is THAgRAWlti+g�+A gA 83300180 E 09 09 6 8 R¢G6 G 3 TTxg0��6pp�000SS928 1 'jyP CRSDITs4'AWR�ID9Tt9H0 524600602 1&gDEeITpC ��AM COSTA MES 913155i CA Z ogle 96 0 3 ECTRONIC F WITHDRAWAL 1140��1ggggggggNOTRqD0 O�#0320 COSTA MES 6250 CA t 09 B 93 RCTRIC�s wzTHDRAWAL 15 2 1. 1140 RDS OM #0320 COSTA M0 FDREB T CARD_ CA 2050 09 7 9¢ ZC F S WITHDRAWAL yLyTCeTeRO 946760554 1851 E FI430684700 055A92B 0920 9 gg O 9 ELECTRONIC FUND0 pr IRAWAT, 41701 VICTDR SECRET 800-8B8-1 115 OOH 8 09 9 FDRCcDEHppINNT CA���ND qq77xx�� P EOOh488C1851.3 BTRSW ANTA ]1NA C 0L000555928 20 0 09 4 gg¢9 9 g2 0 8 9 997777C605554 F t�43068844 D��DTTCS=*08NL INE SERRYICE 09800-848-8 9VAFDR 21 5 09 5 90 3 02102R#NIC SIT FII�2:DS WITHDRAWAL TOP NAILS COSTA MES 12 CA 0 09R6 9aqq p 9 DgEH1 FDE�+TRONTC FUNDS yy►►zzTNDRAWAA��, 22202 HORDEB�_80ON &MS7SISCOSTA MES 15 CA 0 t 09 6 9 o FAR DEBIT cc::+n+.sxwu F,F3F2RONIC FLo ' WITHDRAWAL TIISTSN 1267 CA 1 r 09 5 9 5 CTERTDxY-oAL�OBSBY MMRASANTA ANA RSR026212C2 00 N Ulm 6 2 5p g jT 33272807g0 30 8470000"5928 PiJNDS 4YSTHDRAWAI, 3200 1 09 0 926 O39 ECTRONTC 925 2 F T*24 HOURF ITNESS 760-918-4 CARD 9CA 1 i 09 7 1 7 FDR DEBT ELECTRONIC FUNDS WITHDRAWAL AL ONE ONLINE PMT226939960017565 30 0 1 1 7or,>U7at�aa:rmmsr � DRNA7FlR•fOP17E 1 v�crs�•ma+er � I Nov-13-2002 02;62pm From-AWRIQUBT "FTGAGE COMPANY +714-560-0602 7-104 P.010/010 F-842 NORDTTROOEDERALCRI TU N ON RASRX9� LB26$ATR 813.1-3574 CZT 32663 This is an archived copy of the Original statement, Refer to the original for information not included on this copy. All transactions are as they appeared on the original statement. , 29S01 E EFxiliQXi _ _ _ _ G F7�fR VISSF02 309SP02 8,3685 ST TEMENTnMOD n •ics •Ynw a ne me d•¢t am oaae w arJ aceza or ..M:md m veeuaa efe� DAT ATE f DESCRIPTION AMOUNT BALANCE 09`L7 9 7 ELECTRONIC BDPIDgg oiiTffi)RA�7�, 8 MAcg SLMA Dg8TT521239358101F 83 YIITH�Dg tAAgWTT8A7� 14016 253 1 13�J5 09 7 7 0 ELECpTRONICgFUNDS 0000006598010t01N0DE.1 ��P77pp iE 0930 4333 G, 8'T6837Cg0S000ARS 16 O'7WAL 0P0 a LawSDa 4306897000 928C NoTEDRAWALS= 93 5 e 36 To Ts 1699 4 40000 pp g9 g9 9gy gg 472 IT ( 775 4 ODO 09 3 S� 9'3 RAFT �5j� T 377 $ 8 1I1 890 90 EX DRAFTxErr 780t 15785 09 0 ! 9-0 TOTAL Daa�Ft S PRE6ENTED = 8 NSil BAi,AH _- 117735 _.976�99 I i 1 iI j 1 ! I t i t RWAL77d1104tHIFIiST x+FnotEamuns Nov13-2002 02;52pm From-AMERIQUEF- 'hRTGAGE COMPANY +714-660-060 7-104 P.006/010 F-642 NORDSTROM FSDRRAL CREDiTU NION P OEyB�O$ f15742RUIXTEE SEATTLE, WA 98111-3574 CAT 92663 This is an archived copy of the original statement. Refer to the original for information not included on this copy. All transactions are as they appeared on the original statement. 29501 E Wr N iWI I EWE EMME 01AUG02 31AU002 7j STATFMFNT PFRRTD D nos ebow o w, bo dada am mm V = 4obood or DAT ATE s DESCRIPTION AMOUNT BALANCE gg yy gg PER OX)t OJNAGVG2002- 31AU02002 QQ! 08 1 8 NEWBAT"CE ANCE 5P00 .. - 8 ----- ------- PERZD: Ul LAGRQ031AUG2002__ ------ -- ------ 0851 PREY OCTS or, 9 62 0805 B�t.5 iZCT g g 3a5C�g016p450EPOSIT E430684730005Z8 2EC1TA60O101185ums 8430 08 6 8T8�a+ DEPOSIT C P11O000�25 843L�0 08 0 CCIs E FIRST 170519 G I 9TS�055928 CA TOTAL DEPOSITS = 3 WITH DRAWAALLS:� 3392 9 08 1 O 5 8�22 02 z�rr ANpSa7�HOPSWITNDRAW7f7aCOSTA MSS CA 1405 08i+2 CTRONIC 22 02E8ijOCARDF/ S "TtH82525COSTA 1652. MES CA 0832 7 0 9CTRONIC FUNDS DJITirD y7pL Z9e0B BOUZBTTD2IBDAXERX-CAFE #4C' efE$ 837 CA 1 0805 11 Op8 WIT$A&AWAI+SANTA FDRoPON ANA BIT CA 08p5 0 9 gSEE 7yy31033pR TOP OggFU�NDAgILS= WITHDRAWAL MOIL CA 35�50 0805 3 AL ON C6 16-45SIE 17847H, 2060 84 4A 91AO1 5 28 08L2 g5g 8 2 77� ON ACN EX SSESS24T�HD6 TUSTIN CADR $�3 OBI 2 069 F�GOORTHECBODY Si30P 2211113 0812 ( 809 0�5 #761�9ANTA ANA FDR DEBIT CARD EOTRONIC FUNDS WITHDRAWAL 207 0 CHEVRON CUMON STATITUSTIN CA 20-8 CA 1 08 3 8� FDR DEBIT C CARD LECTRONTFUNDS WITHDRAWAL 20900 OKY0 TVSTIN 14� 0 I OS8 t OBBY FDR DEBTT CA y OB 2 A8 2 ELECTRONIC FINDS WS E MFtE 1c, DSBIT* t**29 4101F 83 50 691 i 3 fi 08 4 B 0� 9 21001RHOR0ERSNBOOKSS &&XURSIC COSTA M S CA 15�D9 vacvmva:.ro�wx�r 000 tcPrxua«das 000 Nov-43-2002 02152pm From-AMERIQUES' •`1RTGAGE COMPANY +714-560-060' T-104 P-008/010 F-842 NORDSTROM FEDERAL CREEDTTU NION SUPERVISORYeRTTE P.O..O. O57p SEATT7aF, WA 98111-3574 qn ACCOM mmffcnl�xn�W+aCsiv��rF Uaw.vwra5rAMea•s.n vg03 VIVIAN CS�g» NEWPORTS EI1f DATE ATE ETD,ECl 0814 8} 0 08 L3 op 8¢3 00! R1E 411 1 08 3 L 3 ELEE 7 Oe 3 8R LECS OB 6 AN 08{�969110' oe 9 jej pge 2 30 81a 80771 08� b 02RO OS 3 0 8 31 90' 08 3 0 BD 7 6 0 8 �pgQ3 08 6 832 E2010 0826 0 8 0826 p FD ONg 0827 8 7 ELEC; 0829 0 9 92601 088as�of gg 8gD9 D^ 08 DRAY, 08 �B 0 8 0 8 7D7�RRAYg'j DRAF' 0828 l7vcrtnmamnmasr 8 8 DRAF'. svo�m�swmnm This is an archived copy of the original statement. Refer to the original for information not included on Nov-13-2002 02:52pm From-AMERIQUES- "IRTGAGE COMPANY +T14-560-060' T-104 P.00T/010 F-842 NgO$DSTROOM FFEDpE�Rpn CPMXW I NiON P OERHO%O21574 "' SEATTLE, AA 98111-3574 APT C CA 92663 This is an archived copy of the original statement. Refer to the original for information not included on this copy. All transactions are as they appeared on the original statement. 29501 E MQSNW ICI= 5 ' SE ,0Yo` O7AIIG42 31AV002 71693 STATEMRNT L FMOD 9wei.Ln-r efe16o4ates am on no v= doLimd or CMCI.d m ynV ACeennL DAT ATE s DESCRIPTION AMOUNT BALANCE AL RAFT& PRESENTED = 7 OBALANCE 989 0 OB�ii 8 1 - I68 ----- i 1 t 1 1 1 i j 4 i t 7➢Gd.luvilE�1«:"� E nTsxtnxostcss ! BYiiDlE4AOtM7C 1ZYa7tilk14:p'd!v INCOME & 3SET CALCULATION WORK' IFFT 1C14EU Wst Nama Flret Name VI I U Relatlonnhlp • HOH sex F Data of Birth 12/B 77 Ago 25 ' Social Socurlty M 522-23-2d144 Frr btudant YESo0j) 2 P41LMF: 5HIIIJ9 Yl7 2 61-5Q-5 Sfr N g s 6 7 B INCOME EMPLOYMENT Family Memb. kk Source Base Rate $ Average Hours Average Annual 52 24 26 12 1 Total WK SEMWO I al•Wx MO YR Arnpayie •1 ftAtngr $ 1822.23 X =$ y7 1 377A9 $ _$ Total Box A: $t 371 Family Memb. lk Source Base Rate $ Average Hours Average Annual 62 24 26 12 1 Total WK SIMt•MO 01•WK MO Ylt $ =a $ — =a $ Tota1 Box e: $ Family Memb. # Source Base Rate $ Average Hours Average Annual 62 24 2e 12 1 Total Semi'Mo uI-WK Me YIt $ $ =$ =a Total Box C: a OTHERINCOME Family Memb.lk Source Base Rate 1 Average Hours Average Annual 52 24 26 12 1 Total WK SEMI - MO al-WK me Ylt $ =$ is — =$ _ Total Box D. TOTAL ANNUAL GROSS INCOME A through D b•nnaannnnann $ 41Z+R77� 9 S- ASSETS Member A Asset Description (savings, chocking, stocks, bonds, Cie.) Imputed/ Current I or C GrosslFalr Mkt. Value Cost to Gel Cash NET Family Assets Value Actual Interest Rate Actual Annual Income from Assets a 1- $ �T 0 _ aT Talais Box E: �$ Box F� Fmnlly lnmme Fmm Avcls..M.,.. IMPUTED INCOME FROM ASSETS Effective ontoNjr�"—ll, " Box E exceeds $5.000—Multiply E by the current passbook interest rate: X Typo of Program%, to unit No. 109 , Unit Sieo 1+2. It Box E dons not exceed$S,000 No.ol Persons 2 enter•0• in box G: BOX G: INPUTED INCOME- WI: r/ Max. Income Limit$ yBr3Gy.ou- FROMASSETS AFb 140%Unit$ 5 d Enter the greater of Box For Box Gin: BOX H: ' • INCOME CONTRIBUTED FROM ASSETS TOTAL ANNUAL INCOME $ 47.377. & TOTAL ASSETS $ g = $ 47 377. cl8 • • New Certificadon /ReeewlleLa Unit Numbe,r - Z, * INCOAM COWUTA.TION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designed to assist you in computing Annual Income in accordance with the method set forth in tl: Department of Housing and Urban Pro ect ("HUD") Reputations (24 CFR 813). You should make certain that this form is at all times up to date wit the HUD Regulations. All caprtaliM terms used herein shall have the meaning set forth in the Regulatory Agreement. Re: (NAME and ADDRESS or Apartment Building) Newport North - CSCDA, (POOL) I/We the undersigned state that I/we have read and answered fully, frankly and personally each of the following•rjuestions far;11 eisotrs who are t occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit: Name of Members Relationship of the ' to Head of Social Security Place of Household Household Age Number Empldyment lgtylir ���— 4=j �q_ ' 464-39- C202 �}I2titi'S tlllEiF rYlirrt� Et`YY Sou 32 t 044 - So - Z27A O-IQC!'s Income Computation 6. The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children under 18 years) listed above for the 12•mor4h per beginning the earlier of the date that I/we plan to move into a unit or sign a lease for a unit hs S qA 1462 .60 Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real of personal property (without deducting expenditures for bush.: expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets except for straight line'depreciation as providec Internal Revenue Service regulations); ' (c) Interest and dividends (including income from assets included below and other net Income from real or personal property'); (d) the full amount of periodic paymerls received from social security, annuides, insurance policies, retirement funds, pensions, disability or death bone and other similar types of periotRic receipts, including any lump sum payment for the delayed star, of a periodic payment; (e) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (f) the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter t utilithes plus the maximum amount that the public assistance agency could in fact allow for sbelter and utilities; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not rest: in the dwelling; ' .(n) all regular pay, special pay aced allowances of a member of the Armed Forces (whether or not living iri the dwelling) who is the head of the household spouse (or other persons whose dependents are residing in the units); and (1) any earned income tax credit to the extent that it exceeds income tax liabilhrr. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts: (o) amounts which are specifically for or In reimbursement of medical expenses; (c) lump sum additions to family assets, such as inheritances, insurance payments (including payments under health and accident insurance aced work: compensation), capital gaits and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational h uthudon, and amounts paid by the government to a veteran for us: meeting the costs of tuition, fees, books and equipment. Any amounts of such scholarships or payments to veterans not used for the above purposes to be included in income; (a) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; , (1) amounts received under training programs funded by HUD; ' (g) foster child care payments; (h) amounts received by a disabled•persor, that are disregarded for a linumd time for pw—,,oses of Supplemental Security Income eligibility and bere5s bet' they are set aside for use under a Plan to Attain Self-SuFrciency; (I) income of a live-in aide; Q) amours received by a participant Ln other pcbiically assisted programs which are specifically for or in reimbursement of out-of-pocket expel -:es in:co and which are made solely to allow paricipation it, a specific program; (k) a resident service sdvsnl (a modest amount (not to exceed S2Co per month) received by a resident for performing a service for r:. owner, on a F=� basis, that enhances the quality of life in the development; ' If this fomh is being completed in accordance with recertification of a Lower Income Tenant's or Very Low income Tersa's occupancy of a Lower Income Unit or a Vert Low Income Unit, respectively, this form must be completed based upon the current income of the occupants. a.hvtcum.:tCcaoaN ,yI'or"+lrfr :S (1) -compensation from state or local employment training programs and training of family member as resident management staff; ' (m) reparation payments paid by a foreign government pursuant to claims filed under the la%s of that government by persons who were persecuted during th Nazi era; _ _.._.. (n) amounts specifically excluded by any other federal statdte from consideration as income for purposes of determining eligibility or benefits undera categor; of assistance programs that includes assistance under the United States Housing Actor 1937; (o) earnings in excess ofS490 for each full -term student 18 years old or older (excluding the head ofhousehold and spouse); (p) adoption assistance payments in excess of 5480 per adopted child; and (q) deferred periodic payments of supplemental security income and social security benefits that are received in a lump sum payment; (r) amounts received by the family in the form of refunds or rebates under state or local Imo for property tares paid on the dwelling unit; (s) amounts paid by a state agency to a family with a developmentally disabled family member living at home to ofi-set the cost of services and equipmcr needed to keep the developmentally disabled family member at home; and (t) amounts specifically excluded by an otherAdemistatutefromconsiderationasincome,forpurposesofdetenniningeligibilityorbenefitsunderacatgor; of assistance programs that includes resistance under the United States Housing Act of 1937. 7. Do the persons whose income or contributions are included in item 6 above: - (a) have savings, stocks; bonds, equity in real property or other forth of capital investment (excluding the values ofnecessary items ofpersbnal propery sue; as fumituri and automobiles and interests in Indian trust land) ' • •Yes' •X� • •No; or •• �'^ •�••"�= (b) have they disposed of any assets (other than at a foreclosure or bankruptcy sale) during the last two years at less than fair market value? Yes ____.2�_No (c) If the answer to (a) or (b) above is yes, does the combined total value of all such assets oivned or disposed of by all such persons tots] inore than Si,C00: Yes � —No (d) If the answer to (c) above is yes, state: (1) the combined total value of all such assets: S '• (2) the amount of income expected to be derived from such assets in the 12-month period beginning on the date of initial occupancy in the unit that y of propose to rent: S �, and r' . (3) the amount of such Inceak, If any, that was included in item 6 above: S • P e S. (a) Are all of the individuals who propose to reside in the'unit full-time students'? Yes- X • No "A full-time student is an individual enrolled as a full-time student during each of 5 calendar months during the calendaryear in which occupancy orthe . unit begins at an educational organization which normally maintains a regular faculty and curriculum and nomtally has a regularly enrolled body ofstudenu In attendance or is an individual pursuing a full-time course of institutional or farm training under the supervision of an accredited agent of such ar educational organization orofastate orpolitical subdivision thereof. (b) If the answer to 8(a) is yes, is at lent 2 of the proposed occupants of the unit a husband and vvlfe entitled to file a joint federal income tax return? Yes �_No 9. Neither myself norany other occupant of the unit Iture propose torentis the owner of the rental housing project in which theunifis located (hereinafter the "Ommer") has any family relationship to the Owner, or owns directly or indirectly any interest in the Owner. For purposes of this paragraph, indirect ownership by or Individual shalt mean ownership by a family member, ownership by a corporation; partnership, estate or trust in proportion to the ownership or beneficial interes In such corporation, partnership, estate or Trustee held by the individual or a family member; and ownership, direct or indirect, by a partner of the individual. 10. This ceniffcate is nade with the knowled,e that h will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit, •'an d l/w'e declare that all information set forth herein is true, eoncct'and complete and based upon information Uwe deem reliable and that the statement of total anticipated incom: contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. 11. IMe will assist the Owner in obtaining arty info, -ration or documents required to verily the statements made herein, including either an income verificatior, f-or mylour present employer(s) or copies of federal tax returns for the immediately preceding calendaryear. 12. Mir acknowledge that Ihve have been advised that the making of any misrepresentation or misstatement in this decinra:ion will constitute a material breach c my/our agreement with the Owner to lease the unit and will entitle the Owner to prevent or terminate my/our occupancy of the unit by institution of en action to ejection or other appropriate proceedings. I/1l'e declare under pennly of perjury that the foregoing is true and correct. Executed this_IS4 day of De, raey)i• , 20ne— in the City of el4'G•i Rear 3•, . Cahfmria Applicant 1 Applican: Rev. 8/9: Applicant Applicant [Signature of all persons (except children tinder the age of IS years) listed in number 2 above required U! 6Nc rvflr Irc-FOW yJdn:�F'•Y: •„ih r;• .•h - .. .:r.=4:1�'k-i;'�ti.1a'i'�:�)��:•'viad: ii5,n=_r'.�ai'v1,;,�,..�, �. ii �••M1 "'#:,,•.�t,'�...- fir.,. .•\'.a r,• •.�•IIM, )..fi.�i�;r.an:. 1 • �?� �� � is .'.' r FOR COMPLIETION BY -APARTMENT OWNER ONLY: 1. Calculation of eligible income: a. Enter amount entered for entire household in 6 above: $ �6 )36Z •60' ,r b: •(1) If the amount entered in 7(c)above is yes, enter the total -amount• entered in 7(d)(2), subtract from that figure the•amount;efitered in ••• 7(d)(3) and enter the remaining balance ($ l0' ); ' (2)' Muftiply the amount entered in 7(d)(1) times the current passbook savings rate as determined by IUD to determine what the'total annual earnings on the amount in 7(d)(1) would be if invested in passbook savings ($ _ _ fi ), subtract from that figure , the amount entered in 7(d)(3) and enter the remaining balance ($ (3) Enter at right the greater of the amount calculated under .61 (1) or (2) above: $ C. TOTAL ELIGIBLE INCOME (line La plus line I.b(3): 2. The amount entered in I.c: -Qualifies the applicant(s) as a Moderate -Income Tenant(s). X Qualifies the applicants) as a Lower -Income Tenarit(s). Qualifies the applicant(s) as a Very -Low Income Tenant(s). 3. Number of apartment unit assigned: I2 S Bedroom size: 2-hZ Rent: $ 1, 254 El This apartment unit w awas not) last occupied for a period of 31 or more consecutive days by persons whose aggregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartment unit qualified them as a Lower -Income Tenant(s). 5. Method used to verify applicant(s) income: Employer income verification. Copies of tax returns. Other ( Manager _ i11�9�02 Date W.ARL.OAyKC-FORM IN00MF A ACCP I f]AI f•1 a A- Il Nl 1A1111111 I' Last Namo First Name Reladonshlp Sox eat* of Birth AGO Social Security li Frr Student 1 NOR fn (, 9 g 6-37-620 r NO YE Fj 2 1 17a 32 0146-4ri.Zg r/ 3 4 5 6 7 n 8 t 11"' V IVIC Family Memb.1A Source Base Rate Average Average Annual $ Hours 62 24 26 12 1 Total WK SCh11•MO DI-WK MO YR 2 X —� =$ 22, s lca,oa _2— =a Cnnlei QRCIIOIry ocAlQlnxrQ crn Total Box A• s 0 [2 6 Family Source Base Rate Average Average Annual Memb. if $ Hours 52 24 20 12 1 Total WK SEMI•MO ul-m Me YR $ =s $ =a $ =a 011MI In AQQIQTAKlnC TOL•tI BOX B: $ Family Source Base Rate Average Average Annual Memb. iP • $ Hours 52 24 20 12 1 Total WK SEMI•M a • M �l Il` a =$ a Total Box C: $ or Family Memb. It Source Base Rate $ Average Hours Average Annual 52 24 2612 1 Total Y4( SEMI•MO I 131-WK I MO I Yn $ =a $ =a $ =a Total Box D: a Ily TOTAL ANNUAL GROSS INCOME A through D >>>>>>>>>>>> a140 ,36z-go - Member 9 Asset Description (savings, chocking, stocks, bonds, cic Imputed/ Current I or C Gross/Fair Mkt. Value . Cost to Gel Cash NET Family Assets Value Actual Interest Rate AcluaPAnnual Income from Assets - T - a Totals Box E: g3 ,gp r Box F: Family lmm�w Ram Avc6 nwn,v IMPUTED INCOME FROM ASSETS III .. Box E exceeds a5,000-multiply _ Typo of Program E by the currant passbook interest rate: X —' °/ Unit No. 124 Unit slm 2 Z It SoxE does notoxeood$5,000 No.ol Persons 2 enter A• In box G: •BOX G: 5 ' INPUTED INCOME Mil: IJ 1A Max. Income Limit$ u I A • FROM ASSETS ASSETS AR: ✓ 140%Limits . C7 727./n �rrr Enter the greeter of Box For Box Gln: BOX H: • • INCOME CONTRIBUTED FROM ASSETS ' TOTAL ANNUAL INCOME $362 .[0 & TOTAL ASSETS $ = S 3[0 6n (1`1EMPL0YMENT VERIFICATIO - -' . '',�;':'�'`+.`:'ft�I:,,TffiS:SF.C:mTOi`7k*�`0�B);•�ei71VIP75E�5�;lB4 r � il Cij , DiB,,-� 1V r t•t , MA'LYEi'•�'t.1`Y�E`+N.7�.`A"L�. TO: (Name & address of employer) i Date: RE: 6:M Il? momt=uy 1444-37-9202 125 Applicant/TenantName• Social Security Number Unit# (if assigned) I hereby authon release of my employment information. r Signature of Applicant/fenant Date The individual named directly above is an applicant/tenant of a housing program that requires verification of income. The information provided will remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial and greatly appreciated. MGLMUS le/'l,20 P Project Owner/Managlimenl Agent Return Form To: Ne"00r•4- t)Po4ftiS4 viomes 2 MICR No ✓ 12, Ki,.-WpOp T B'rrpciA, ct9 g260 . �y '-:'iC..•n 1-:.i%.'�, ":rr` ��6; wi•`'.i%<: % r r '` ''e M"uP�: t�'+ie aC'k��'rti�^�{s,rn' Fy's#7:�'ry'i.i;: ': �.: ,..,-s,;;�,�. .1�7 - .>;��i,:TH)'SSE`CaZtJONTO�E,GO)VI'P•�E'rT1ED1$I�Y/DjIVZ'$Ta0r�,R'��.:lrr„�. ,�,.�, o-.,, .rah; •,:'„...r. Employee Name: �AAn. U v Job Title: Presently Employed: Yes Date First Emplo ed :16&-°L t No Current Wages/Salary: S_ LlrQ (circle one) hourl weekly bi-weekly Last Day of Employment semi-monthly monthly yearly other Average # of regular hours per week: .Y U Year-to-date earnings: S ( U b . u9 throughl�1_10/_O_ Overtime Rate: S jg.. per hour Average # of overtime hours per week: Wk ouw r.:rc .e.,,:.,t n.,m• e ♦J/pr ..er hour Averaoe 9 of shift differential hours ner week: PIA Commissions, bonuses, tips, other: S�J/A (circle one) hourly weekly bi-weekly semi-monthly monthly yearly other r d- i _ , r^ If the employee's work is seasonal or sporadic, please indicate the layoff period(s): P /A Additional remarks' 't 1� ] ► -As C'+(AL4 -tom 1,19, Zt-� z Employer's Printed Name Date C 1( - � -7 4 U - '� Si 6 8 IS 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) macji s west, in 170 O'Farrell Strout San Francisco, CA 94102 IIII I0 III9 IIIIIIIIII IIII Y 11/01/2002.17054 17b548010N 2111348 17038590 0105 ALIEH TABATABAIE ALIEH TABATABAIE .. PO BOX 7662 NEWPORT BEACH, CA 92660 ASSOCIATE NAME ASSOCIATE SOCIAL SECURITY NUMBEER NUMBER ITt-ILDING TAX INFO. PAY BEGIN FEDERAL ST TE DATE PAY ENO DATE DATE CHECK NO ALIEH TABATA13AZE 1703SS90 046-80-2279 M 001 M 001 10/20/02 10/26/02 11/01/02 211134E ARNINGf} DEbuCYIi1NStTAX S p1 CWGT7�pNSt.�AX S;. CRIPTION HOURS CURRENT YEAR-TO-DATE DESCRIPTION CURRENT YEAR-TO-DATE DESCRIPTION CURRENT YEARTO-DA LAR 38.00 285.00 11�101.26 x HTHNTCAHMO 54.66 2�152.32 NCASH 7.00 ■ 401(K) 8.55 322.27 DAYWKD r 84.38 MET PPO B 6.88 224.69R-ST 3.75 AD&D 0.23 10.12 AWARD 54.28 FAM AD8D 0.18 7.92 HRS 156.00 * CLIFF 0.146.16 PAY 318.22 PAY 190.92 FICA-OASDI 13.85 926.84 COMMISSION 4,351.37 FEDERAL 3.30 709.62 INST CRDIT 65.00 FICA-MED 3.24 216.76 CA SUI/SDI 2.01 134.54 CA ST-WHLD 0.06 87.66 GROSS PAY DEDUCTIONS TAXES NET PAY +'PAY'% 285.00 70.64 22.46 191.90 m macy*s .west;. ir�7j cJ '170 O'Farrell Street Ben Franetseo„CA 04102 IIII I0 IIIIIII IIII IIIII II IIII 10/25/2002 17054 17 ALIEH TABATABAIE AS$ACJArE NAME AniUMi _ ALIEH TABATABAIE . 17038 .EARNING$'ION HOURS CURRENT 37.00 277J ION 77.1 ASHWKDRDDIT ffNCASH VAC PAY HOL PAY `V GROSS PAY F 354.58 m•acy s west; 170 O'Farrell Street San Francisco, CA 94102 1 IIIIN IIIII Iilll I III I IN Ill Illl 10/18/2002 17054 '170S480ION 2079822 1703BS90 0105 ALIEH TABATABAIE ALIEH TABATABAIE PO BOX 7662 NEWPORT BEACH, CA 82680 ASSOCIATE NAME ASSOCIATE•: NUMBER SOCIAL SECURITY NUMBER WITHHOLDING FEOERAI. TAX INFO. PAY BEGIN STATE DATE PAY END GATE E K GATE CHECK NI ALIEH TABATABAIE 1,7038590 046-80-2279 1 M 001 M 001 1 10/06/02 10/12/02 10/18/02 207982 RNS/6Ah$S; ;";. r .EAING$ '_' .<'• ',.';' DEbI(GC3(1 .'`"F)EDU(T�t)1iSf,TA9(E�.• < DESCRIf7'ION ' HOURS . CURRENT YEAR-TO-DATE DESCRIPfiON CURRENT YEAR-TO-DATE DESCRIPTION CURRENT• YEAR-TO-D REGULAR 37.00 277.50 10,538.76 ■ HTHNTCAHMO 54.66 2,043.00 COMMISSION 131.72 •4,274.29 401(K) 12.28 303.08 AWRD NCASH 7.00 * MET PPO B 6.88 210.93 HOLIDAYWKD 84.38 ADBD 0.23 9.66 OTHR-ST 3.75 FAM AD&D 0.18 7.56 SEC AWARD 54.28 * CLIFP 0.14 5.88 INST CRDIT 65.00 , NP HRS - 256.00 FICA-OASDI 21.54 894.83 VAC PAY 318.22 FEDERAL 15.35 696.27 HOL PAY 190.92 FICA-MED 5.04 209.28 CA SUI/SDI 3.13 129.90. CA ST-WHLO 1.84 86.82 • GROSS PAY DEDUCTIONS TAXES NET PAY y;, 409.22 74.37 46.90 287.95 i I Bankaf America` ' C - 0162 EO-2 AMIR MOMENY' , ALIEH T MOMENY PO BOX 7662 NEWPORT BEACH CA 92660 Our free Online Banking service allows you to check account balances, transfer funds, pay bills and more, Enroll' at www.bankofamerica.com. Your Bank of America Discount Checking Statement Statement Period: September 11 through October-10, 2002 Account Number: 01626.29132 At Your Service Call: 818.507.6700 Online: www,bankofamerica.com Written Inquiries Bank of America Glendale Main Office PO Box 37176 San Francisco, CA 94137-0001 Customer since 1991 Bank of America appreciates your business and we enjoy serving you. ❑ summary of Your Discount Checking Account — n Beginning Balance on 09/11/02 404.67 Total Deposits +1757.40 Total Checks, Withdrawals, Transfers, Account Fees _ 1372 98 Service Charge - 7.50 Ending Balance $781.59 Number of ATM withdrawals and transfers Number of purchase transactions a Number of 24 Hour Customer Service Calls Self -Service Assisted ❑ Important Information About Your Account A monthly service charge was applied to your account because either your balance was below the minimum balance of $100 or because you made more than two teller deposits or we paid more than ten checks for you during the statement period. O Bank of America News Introducing Total Security Protection only from Bank of America. This represents a new standard in Bank of America Check Card security, giving you greater defense against theft or unauthorized use. even using it online. It's free and automatically available on your Bank of America Check Card. Dreaming about a college education for yourself or your child? We can help you make the dream come true. Get a free student loan guide at www.bankofamerica.com/studentbanWing. Enrolling in our free Online Banking service is a snap. All you need is your Bank of America account number, ATM or Check Card number, ATM PIN and e-mail address. Click the Online Banking 'Enroll' button at www.bankafamerica.com and follow the easy instructions. In no time you'll be able to check account balances, view transactions and more. 0179449.001 T09 California c0 F BankofAmerica �� �-, :• Your Bank of America Discount Checking 0162 Statement EO-2 Statement Period: August 13 through September 10, 2002 Account Number: 01626.29132 AMIR MOMENY At Your Service Ca11:818.5076700 ALIEH T MOMENY PO BOX 7662 Online: www.bankofamerica.com NEHPORT BEACH CA 92660 Written Inquiries Bank of America Glendale Main Office PO Box 37176 San Francisco, CA 94137-0001 Our free Online Banking service allows you to check account balances, Customer since 1991 transfer funds, pay bills and more. Enroll at www.bankofamerica.com. Bank of America appreciates your business and we enjoy serving you. ❑ Summary of Your Discount Checking Account Beginning Balance on 08/13/02 1,134.77 Total Deposits + 602.96 Total Checks, Withdrawals, Transfers, Account Fees - 1,333.06 Ending Balance $404.67 Number of ATM withdrawals and transfers 0 Number of purchase transactions 2 Number of 24 Hour Customer Service Calls Self -Service 0 Assisted 0 ❑ Important Information About Your Account Based on the balance and transaction limits you've maintained in this account, your monthly service charge has been waived. ❑ Bank of America News Bank of America has streamlined the mortgage process by eliminating 80% of the paperwork you have to provide. Visit www.bankofamerica.com/loans today to learn more about getting a mortgage from Bank of America. Not all applicants will qualify for the reduced paperwork benefits. The costs of college add up. If they have you overwhelmed, consider a private loan for students from Bank of America. Eligibility is not based on financial need, and the loan features a low Interest rate, low fees and flexible loan limits and repayment options. Learn more at www.bankafamerica.com/studentbanking. Credit subject to approval. Bank of America is a proud sponsor of the 2002 LA. County Fair, Sept. 13-29 at Fairplex in Pomona. Bank of America presents $5 after 5 p.m. (half-price admission Mon-Thur evenings). The Fair lights up with fireworks and concerts during 'Fair After Dark". We'll see you at North America's largest county fair, Sept.13-29. For Info visit lacountyfair.com. W79262.00I.T09 California �� 1iederated H ''� idServices Your Pre -Tax Payroll Deduction: 3%, Fund A Fixed Income Your Current Future Savings Investment Elections 0% Balance as of JULY 1, 2002 $.00 Contributions ' Pre -Tax .00 After -Tax .00 _ Company Match ...00 Rollover -On Luan Repayments .00 Investment Galn/(loss) .00 Fund Transfers .00 New Loans Taken .00 Distributions .00 Total Balance as of SEPTEMBER 30, 2002 S-00 Vested Balance as of SEPTEMBER 30, 2002;. $.00 Fund B Balanced 100% $119.47 144.38 .00 .00 .01) .00 20.1U- -00 .CO .00 $243.67 $243.67 Federated Retirement Program Statement For, the Quarter: JULY 1, 2002 through SEPTEMBER 30, 2002 Your After -Tax Payroll Deduction: 0% Fund C Fund D Fund E Fund F S&P 500 Small Cap International Federated Index Stock Stock Stock 0% 096 $.00 $.00 $-00 $.00 .UO .UO .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .01) -00 .00 .00 :00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 $.00 $.00 S.00 $.00 $.00 $.00 $.00 $.00 Your: own pre-tax contributions: War to pat,^-: $268.01 From Plan Entry Date: - Your Own after-tax contributions: Year* to Date: $.00 From Plan Entry Date: You are always 1007. vestal in your own savings and their earnings. You are 20% vested 1n the Company Marching Contribution Account. $268.01 S.00 Total Funds tOU4. $119.A! i 1,14.38 .00 .00 .00 .00 20.tU- .00 .00 .Olt $243.U7 $2411.61 - N1 Balanc Adjust Pay Cr Intere Distr) Total SE Vostec SE n Yot 'al mat It Prc To Cal ices Federated Retirement Program Statement For the Ouartrr: JULY 1, 2002 through SEPTEMBFR d0, 2002 13% Your After -Tax Payroll Deduction: 03, Fund 0 Fund D Fund E Fund'F Fund 8' S&P 500 -Small Cap International Federated Total Balanced Index Stock Stock Stock Funds 100% 0% 0$ 0% 0% 100% $119.47 $.00 $.00 $.00 $.00 $119.47 144.38 .00 .00 .00 .00 144.33 .00 .00 -00 - .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 20.18- .00 .00 .00 .00 20.10- .UO .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 .00 $24:3.61 $.UO $.00 $.00 5.00 $243.67 $243.67 $.00 $-Do -,.Do $.00 $243.67 Date_ $268.01 - From Plan Entry Date Date: $.00 From Plan Entry Date .,n your own savings and their earnings. Company Matching Contribution Account. $268.01 $.00 ALIEH TABATABAIE all-th(Irte: 0211at7o Balance as of JULY 1, 2002 S-00 Adjustments .00 Pay Credit .00 Interest Credit .00 Distributions .00 Total Balance as of SEPTEMBER 30, 2002 $.Oo Vested Balance as of SEPTEMBER 30, 2002 $-00 You are 01;, vested in your Cash Account Pension Plan benei,t. 17046802279 You could bp. saving more pre -tar.! Pre-tax savings up to 59s are eligible for Company matching. Call 1.800-337-2363 11 is important that you keep Your Retircaunt Program Benctictary Designatinn uP-to-date. 10 request a Beneficiary Designation form call Federated HR Services at 1.800-337-2363. Care has been taken to produce an accurate statement. if a discrepancy exists between Otis statement and the plan rece:ds, the plan records control. n •`lr w CerFeadon / Reeeriifmdon >( Unit Number 2,1q INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designed to assist you in computing Annual Income in accordance with the method set forth in the Department of Housing and Urban Protect ("HUD") Regulations (24 CFR 813)_ You should make certain that this form is at all times up to date with the HUD Regulations, Ali capitalized terms used herein shall have the meaning set forth in the Regulatory Agreement. Re: (NAME and ADDRESS of Apartment Building) Newport -North - CSCDA (POOL). I/We the undersigned state that I/we have read and answered fully, frankly and personally each of the following questions for all persons who are to occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intbnd to reside in the unit: 1. Name of Members of the Household �� r 2. 3. 4. Relationslid . •. • to Head of Social Security Household Age Number gear) 79 55 2- 1 LI -6397 CenLTN ��_ 572-7o-3347 e- ' ` Income Computation 5. Place of Emalovment HILTettI dl•,_TEU 50C(al SieGUr 6. The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children under 18.yews) listed above for the 12-month period beginning the earlier of the date that I/we plan to move into a unit or sign a lease for a unit is $ 3y 1 q?$ • 24 t Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real of personal property (without deducting expenditures for business expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets except for straight line depreciation as provided in Internal Revenue Service regulations); (c) Interest and dividends (including income from asses included below and other net income from real or personal property); (d) the full amount of periodic payments received from social security, annuities, Insurance policies, retirement funds, pensions, disability or death benefits and other similar types of periodic rpceipts, including any lump sum payment for the delayed start of a periodic payment; (e) payments in lieu of catalogs. such as unemployment and disability compensation, workers' compensation and severance pay; (f) the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter and utilities plus the maximum amount that the public assistance agency could in fact allow for shelter and utilities; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not residing in the dwelling; (h) all regular pay, special pay and allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the household or spouse (or other persons whose dependents are residing in the units); and ' (i) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; (b) amounts which are specifically for or in reimbursement of medical expenses; (e) lump sum additions to family assets, such as inheritances, insurance payments (including payments under health and accident insurance and workers' compensation), capital gains and settlement for personal or property losses; ' (d) amounts of educational scholarships paid directly to the student or the educational institution, and amounts paid by the government to a veteran for use in meeting die costs of tuition, fees, books and equipment. Any amounts of such scholarships or payments to veterans not used for the above purposes are to be included in income; (a) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (f) amounts received under training programs funded by HUD; (g) foster child care payments; (h) amounts received by a disabled person that are disregarded for a limited time for purposes of Supplemental Security Income eligibility and benefits because they are set aside for use under a Plan to Attain Self -Sufficiency; (i) income of a live-in aide; (j) amounts received by a participant in other publically assisted programs which are specifically for or in reimbursement of out-of-pocket expenses incurred and which are made solely to allow participation in a specific program; (k) a resident service stipend (a modest amount (not to exceed $200 per month) received by a resident for performing a service for the owner, on a part-time basis, that enhances the quality of life in the development; If this form is being completed in accordance with recertification of a Lower Income Tenant's or Very Low Income Tenant's occupancy of a Lower Income Unit or a Very Low Income Unit, respectively, this fort must be completed based upon die current income of the occupants. ot,Antc.asoatcc•roaxat (1) compensation front state or local employment training programs and training oft, family member as resident management staff; (m) - reparation payments paid by a foreign government pursuant to claims filed under the laws of that government by persons who were persecuted during the Nazi era; (n) amounts specifically excluded by any other federal statdte from consideration as income for purposes of determining eligibility orbenefits under a categon• of assistance programs that includes assistance under the United States Housing Act of 1937; (o) earnings in excess of $480 for each fult-term student 18 years old or older (excluding the head of household and spouse); (p) adoption assistance payments in excess o£S480 per adopted child; and (q), deferred periodic payments of supplemental security income and social security beneliu that are received in a lump sum payment; (r) amounts received by the family in the form of refunds or rebates under state or local law for property taxes paid on the dwelling unit; (s) amounts paid by a State agency to a family with a developmentally disabled family member living at home to offset the cost of services and equipment needed to keep the developmentally disabled family member at home; and (t) amounts specifically excluded by an other federal statute from consideration as income for purposes of determining eligibility or benefits under a category of assistance programs that includes assistance under the United States Housing Act of 1937. 7. Do the persons whose income or contributions are included in item 6 above: ` (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values oFnecessary items of personal property such X as furniture and automobiles and interests in Indian trust land) • Yes • No; or . • • ny (b) have they disposed of aassets (other than at a foreclosure or bankruptcy sale) during the last two years at less than fair market value? Yes nC No (c) If the answer to (a) or (b) above is yes, does the combined total value of all such assets owned or disposed of by all such persons total more than S5,000? X Yes • No (d) If the answer to (c) above is yes, state: (1) the combined total value of ail such assets: S Tt q AO -$R • (2) the amount of income expected to be derived from such assets in the 12-month period beginning on the date of initial occupancy in the unit that you propose to rent: S. 17FI, 41 and , (3) the amount ofsuch income, if any, that was included In item 6 above: S 179.41 8. (a) Are all of the individuals who propose to reside in the unit full-time students'? Yes yi No !A full-time student is an individual enrolled as a full-time student during each of 5 calendar months during the ealendar.year in which occupancy of the unit begins at an educational organization which normally maintains a regular faculty and curriculum and normally has a regularly enrolled body ofstudents in attendance or is an individual pursuing a full-time course of institutional or farm training under the supervision of an accredited agent of such an educational organization orofastate or political subdivision thereof. (b) If the answer to 8(a) is yes, is at least 2 of the proposed occupants of the unit a husband and wife entitled to file a joint federal income tax return? Yes,�_No 9. Neither myself nor any other occupant of the unit Ihve propose to rent is the owner of the rental housing project in which the unit is located (hereinafter the "Owner"). has any Family relationship to the Owner, or owns directly or indirectly any interest in the Owner. For purposes of this paragraph, indirect ownership by an Individual shall mean ownership by a family member, ownership by a corporation, partnership, estate or trust in proportion to the ownership or beneficial interest In such corporation; partnership, estate or Trustee held by the individual or a family member; and ownership, direct or indirect, by a partner of the individual. 10. This cerificate is made with the knowledge that it will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and I/ssc declare that all information set,fonh herein is true, correct and complete and based upon information Ihve deem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. ]I. I/%Ve will assist the 0•xner in obtaining any information or documents required to verify the statements made herein, including either an income verification from my/our present employer(s) or copies of federal tax returns for the immediately preceding calendar year. 12. IAVe acknowledge that Vwe have been advised that the making of any misrepresentation or misstatement In this declaration will constitute a material breach of my/our agreement with the Owner io lease the unit and will entitle the Owner to prevent or terminate my/our occupancy of the unit by institution of an action for ejection or other appropriate proceedings. I/V/e declare under pennlry of perjury that the foregoing is true and correct. Executed this c;� dayof C mbei- .2062inthe Cky,of NeW11,r •r•�'ti California Applicant Applicant Rev. 8195 Applicnot [Signature of all persons (except children under the age of 18 years) listed in number2 above requiredl lu k%101'197 RC•ro0.11 FOR COMPLETION BY APARTMENT OWNER ONLY: 1, Calculation of eligible income: a. Enter amount entered for entire household in 6 above: (1) If the amount entered in 7(c)above is yes, -enter the total amount entered in 7(d)(2), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ _ 0'_ ); (2) Multiply the amount entered in 7(d)(1) times the current passbook savings rate as determined by HUD to determine what the total annual earnings on the amount in 7(d)(1) would be if invested in passbook savings ($ 9), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ (3) Enter at right the greater of the amount calculated under (1) or (2) above: C. TOTAL ELIGIBLE INCOME (line I.a plus line Lb(3): 2. The amount entered in l.c: ..Qualifies the applicant(s) as a Moderate-Income.Tenant(s). i Qualifies the applicant(s) as a Lower -Income Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenant(s). M $ 3GiV024 3. Number of apartment unit assigned: z 1 y Bedroom size: 212 Rent: $ 1325 4. This apartment unit 041iyas not) last occupied for a period of 31 or more consecutive days by persons whose aggregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartment unit qualified them as a Lower -Income Tenant(s). 5. Method used to verify•applicant(s) income: Employer income verification. . Copies of tax returns. Other ( ccuunk 5i Manage�V l� ` N.AMC PYMMFO.l Date ��L INCOME & ASSET CAI Cl II ATION Wr )PtC.-ZWI -r 1 Laat Namo Flrat Name C •S Relagonshlp HOH Sex Date or Birth g / Ago Social Security% 5J52 - - � Frr Studont YES or� 2 0 T4 TALIVO spise F 2 /1 P 12 3 747 57 — 76-3 C 3 4 5 6 7 B t INwrillC Family Memb, # Source Base Rate $ Average Hours Average Annual 62 24 26 12 1 Total WK I SEMI•MO el.WK MO YR 141 Ira$ 6 - x =$ 1 $ $ v$ ......... ............... .._.._._.._ ___ Total Box A'. $ Family Memb. # Source Base Rate $ Average Hours Average Annual 52 24 26 12 1 Total WK 5EM1-MO el-WK MO YR $ 1247 = $ 15 a $ _$ $ =$ . Total Box B: $ Family Memb. # Source Base Rate $ Average Hours Average Annual 62 24 26 12 1 Total WK I SEMWO li MO YA $ v$ $ v$ $ _$ $ $ Total Box C: $ -8-- Family Memb. # Source Base Rate $ Average Hours Average Annual 52 24 26 12 1 Total WK BEMI• O al-VVK MO YK $ _$ $ _$ $ =$ Total Box D: $ -a— TOTAL ANNUAL GROSS INCOME A through D >>>>>>>>>>>> $ �4r 749 • S-y ASSETS Member # Asset Description (savings, checking, storks, bonds, ate. Imputed/ Current I or C Gross/Fair MkL Value Cost to Get Cash NET FamilyAsels value Actual Interest Rate Actual Annual Income from Assets C 4 •6- = I1C5pg� a 3 a = 3 O o% — e o - o Totals Box E: Box F: IMPUTED INCOME FROM ASSETS Box E exceeds $5,000-mulliply E by the current passbook interest rate: t If Box E does not exceed$5.000 enter-0- In box G: Enter the greater of Box F or Box G in: Immnai ,nrcamv Family income Frmn rommsNecla Effective Dale dOnbO+w 4 Typo of Program %am% Lawj— X Unit No. Z14 Unitsao,--1j,2 BOX G: S 178 • No. of Persons 2 INPUTED INCOME II: hr/14 Max.Income Limit$ NIA FROM ASSETS AR 140%Limit $ 671737.6n s 178.41 BOX H: r INCOME CONTRIBUTED FROM ASSETS TOTAL ANNUAL INCOME $ q,. S & TOTAL ASSETS $ 1 = $ 341 g7s.2 fi1R99]9N-10919969T6T Your New Benefit Amount B NEPICIAMPS NAMi;: SOCIAL SECURITY CLAIM NUMBER CANUTE M OTA ' (only the last 4 digits are shown to help prevent identity theft)::G='' C-6387 A Your Social Security benefits will increase by 2.6.percent for 2002, based on a rise in the cost of living. You can use this letter when you need proof of your benefit amount to receive food stamps, rent subsidies,' energy assistance, bank loans, or for other business. How Much Will I Get And When? • Your new monthly amount (before deductions) is _ $ 2G • The nmount we're deducting for Medicare is $54.00 (If you did not have Medicare as of Nov. 16, 2001, or if someone else pays your premium, we show $0.00.) • After taking any other deductions, we will deposit $1.21s.00 into your baiilr account on Jan..3, 2002. If you disagree with any of these amounts, you should write to us within 60 days from the date you receive this letter. What If I Work? In 2000 the law changed to help people who work and receive benefits. If you are full retirement age (currently age 65) or older, you now may keep all of your benefits no matter how much,yor- ^nrn. If you were under age 65 all year, there is a limit to how much you can emn G�,' . affects your benefits. • If you were under age 65 all year in 2001, the earnings limit was $10,680. We must deduct $1 from your benefits for each $2 you earned over $10,680. - . yuu euraruu age oo usu�g zuui, sae earnings nmrt; was 4izu,uuu. we must deduct ail from your benefits for each $3 you earned over $25,000 until the month you turned 65. If the amount you earned in 2001 is shown correctly on your W-2 or self-employment tax return, we will adjust your benefits based on those earnings. If, however, the amount on your W-2(s) for 2001 includes money you earned in another year, such as deferred compensation, you need to contact us before April 15 to let us ]mow. We'll also ask you to estimate your year 2002 earnings, so we can pay you correctly. What Are The Earnings Limits In 2002? The earnings limit for workers under full retirement age (currently age 65) in 2002 is $11,280. The earnings limit for those workers turning 65 in 2002 is $30,o00. What If I Also Get Supplemental Security Income MIR If you receive SSI, you mpst report all earnings. A Rule About Stepchildren If a stepchild receives benefits on your record and you and the stepchild's parent divorce, you must tell us. Why? Because we must stop the stepchild's benefits the month after the divorce becomes final. Medicare Information The Centers for Medicare and Medicaid Services recently sent the Medicare & You 2002 handbook to all beneficiaries. In 2002, the Part A deductible for the first 60 days of a hospital stay is $812. Your state may help pay for Medicare expenses through the Medicare Savings Programs if- • you have Medicare Part • your monthly income is no more than $1,273 for an individual or $1,714 for a couple (higher in Hawaii and Alaska), and • the things you own (but not your home or one car) are worth no more than $4,000 for an individual or $6,000 for a couple (higher in some states). To find out more, contact your state or local Medicaid, social services or welfare office. If you have questions about Medicare, other than eligibility and enrollment, you can visit www.medicare.gou do the Internet or call 1-800-MEDICARE (1-800-633-4227) or TTY/TDD 1-877-486-2048, if you are deaf or hard of hearing, 24 hours a day. ' Health Insurance For Children If you have children or grandchildren under age 19 who are not covered by health insurance, the Childrer?s Health Insurance Program•may help. To find out more, you can . look on the Internet at wtuminsurelzidsnow,gou or call, toll -free, 1-877-IUDS-NOW (1-877-543-7669). The number connects you to your state's program. � 4126 7 X12= 415-120y)tpo"' Ouer>- M960905-10015969761 Your New* Benefit -Adn.ount . BENEFICIARY'S NAMD: SOCIAL SECURITY CLAIM NLTMBBR 7'OKIKb O'1'A , (only the last 4 digits are shown to help prevent idontitytholt): a'=-%"X-e3s7.13 Your Social Security benefits wiTincrease by 2.6 percent for 2002, based on a rise in -the cost of living. You can use this'letter when you need proof of your benefit amount to ' receive food stamps, rent subsidies; energy assistance, bank loans, or for other business. How Much Will I Get And When? • Your new monthly amount (before deductions) is t 79.00 • The amount we're deducting for Medicare is s54.00 , (If you did not have Medicare as of Nov 16, 2001, or if someone else pays your premium, we show $0.00.) • After taking any other deductions, we will deposit s625.00 into your bank account on Jan. 3, 2002. If you disagree with any of these amounts, you should write to us within 60 days from . the data you receive this letter. 'What If I Work? In 2000 the law changed to help people who work and receive benefits. If you are full retirement age (currently age 65) or older, you now'may keep all of your benefits no matter how much you earn. If you were under age 65 all year, there is a limit to how much you can earn before it affects your bonefits. If you were underage 65 all year in 2001, the earnings limit was $10,680. We must deduct $1 from your benefits for each $2 you earned over $10,680. ..-ycu-vmzieu-ago On aurmg zuu r, the earnings limit was $25,000. We must deduct $1 from your benefits for each $3 you earned over $25,000 until the month you turned 65. If the amount you earned in 2001 is shown correctly on your W-2 or self-employment tax return, we will adjust your benefits based on those earnings. If, however, the amount on your W-2(s) for 2001 includes money you earned in another year, such as deferred compensation, you need to contact us before April 15 to let us know. We'll also ask you to estimate your year 2002 earnings, so we can pay you correctly. What Are The Earnins's Limits In 2002? The earnings limit for workers under full retirement age (currently age 65) in 2002 is $11,280. The earnings limit for those worker's turning 65 in 2002 is $30,000. What If IAlso Get Supplemental Security Income' (SSI)?' If you receive SSI, you must report all earnings. A Ride About Stepchildren If a stepchild receives benefits on your record and you and the stepchild's; parent divorce, you must tell us. Why? Because we must stop the stepchild's benefits the month after the divorce becomes final. Medicare Information The Centers for Medicare and'Medicaid Services recently sent the Medicare & You 2002 handbook to all beneficiaries. la 2002, the Part A deductible for the first 60 days of a hospital stay is $812, Your state may help pay,for Medicare expenses through the Medicare Savings Programs if: • you have Medicare Part • your monthly income is no more than $1,273 for an individual or $1,714 for a couple (higher in Hawaii and Alaska), and • the things you own (but not your home or one car) are worth no more than $4,000 for an individual or $6,000 for a couple (higher in some states). To find out more, contact your state or local Medicaid, social services or welfare office.. If you have questions about Medicare, other than eligibility and enrollment, you can visit www.medicare.goo on the Internet or call 1-800-MEDICARE• (1-800.633.4227) or TTY/TDD 1-877-486-2048, if you are deaf or hard of hearing,'24 hours a day. Health Insurance For Children If you have children or grandchildren under age 19 who are not covered by health insurance, the Children's Health Insurance Program may help. To find out more, you can look on the Internet at www,insurehidsnoiugoa or call, toll -free, 1.877-KIDS-NOW ,(1.877-543-7669). The number connects,you to your state's program. � 61Q.00 X 12; 1 Over >- Pay Periods Year - to - Date divided by pay periods average per pay period Date of Most Recent Pay Ending Date L I Gross per Pay Period (—) it32o.R1 divided by 3 ( x ) how often paid ( x) how often paid = ) Laicuiatea mnnuai income ( = ) Calculated Annual Income it 14Li7.�q i •: .:.Y ..i .+obi!' .. ': ;:•�. ,.�;.�.;:'. - - A. DEfACHCHECKALONGPERFORATION A DETACH CHECKALONG PERFORATION A Canute M Ota SSN: 552.44.6387 Earnings this period year to date Hours rate this period Year to date Regular Wages 434.16 . 2,958.12 Regular Wages 8.1000 53.60 365.20 Overtime 3.04 49.21 Overtime 8.1000 0.25 4.05 ,. }GrpssPaY : 7— Y#.48740 Your federal taxable wages this period are *437.20 Period Beginning: 09 7 002 Check #: 2263083 Period Ending_ 10( //101200 Check Date: 10/17/2002 Taxes Fed Withholdng - 0.00 - 25.40 Fed MED/EE - 6.34 - 43.61 Fed OASDI/EE - 27.10 = 186.45 CA Withholdng - 4.26 - 28.28 CA OASDI/EE - 3.94 - 27.07 �gtPaY... ............ ....,... •'>5.�95•.58.�,. ';$':x:`G�6r5x Department: 01200-Front Office - Location: HILTON COSTA MESA Job Title: Concierge Pay Rate: S 8.1000 Hourly Pay Group: T21-Hilton Costa Mesa ;TaX Data FedefaT:... R.State.'..*.... .•......_........: 'Filing Status: Married Single, or Mar. Allowances: 2 0 Additional Percentage: Additional Amount: Important Notes ♦ DETACH CHECKALONG PERFORATION Canute M Ota Earnings this period year to date Regular Wages 580.77 2,523.96 Overtime t ' 9.72 - 46.17 $SMg "• .�a 2,57q.'A; Your federal taxable wages this period are $590.49 Deductions Taxes Fed Withholdng - 11.16 - 25.40 Fed MED/EE - 8.57 -37.27 Fed OASDI/EE - 36.61 - 159.35 CA Withholdng - 7.32 - 24.02 CA OASDI/EE - 5.31 - 23.13 Nat pay' • ' .r,2 :5x '$ �.3Q91J5. ♦ DETACHCHECKALONGPERFORATION SSN: 552.44•6387 Hours , rate this period year to date Regular Wages 8.1000 71.70 311.60 Overtime 8.1000- 0.80 3.80 #'total'. - .._ .. ., 7�.8(S 315.40• Period Beginning: 09113/2002 Check #: 2224155 Period Ending: 09/26/2002 Check Date: 10/03/2002 Department: 01200-Front Office Location: HILTON COSTA MESA Job Title: Concierge Pay Rate: $ 8.1000 Hourly Pay Group: T21-Hilton Costa Mesa Miix ata: PederaT 0 State' , Filing Status: Married Single, or Mar Allowances: 2 0 Additional Percentage: Additional Amount: Important Notes 3 } ♦ DETACH CHECKALONG PERFORATION A _ ♦ OETACHCHECKALONG PERFORATION AJ Canute M Ota Earnings this period year to date Regular Wages 288.36 1,943.19 Overtime 4.86 36.45 ay ` • • , 1.�. '., - $ h•.S'7$1¢�i< Your federal taxable wages this period are $293.22 Deductions Taxes Fed Withholdng - 0.00 - 14.24 Fed MED/EE - 4.25 - 28.70 Fed OASDI/EE - 18.18 - 122.74 CA Withholdng - 0.00 - 16.70 CA OASDI/EE c - 2.64 - 17.82 :Net 1?aY ........ .. fr MIJ • . 8'1,775•44 SSN: 552.44.6387 Hours - rate this period year to date Regular Wages 81000 35.60 239.90 Overtime 8:1000' 0.40 , 3.00 ;Total: �8�t1p ' . 2 ��80• Period Beginning: 08/30/2002 Check #: 2188466 Period Ending: • . 09/1212002 'Check Date: - '09/1912002 Department: 01200-Front Office Location: HILTON COSTA MESA Job Title: Concierge Pay Rate: 5 8.1000 Hourly' Pay Group: T21-Hilton Costa Mesa -Ta$.Dataf ` .. ,...•Federaf _.. CAState Filing Status: Married Single, or Mar Allowances: 2 0 Additional Percentage: Additional Amount: Important Notes s,saa Account Summary for August 1, 2002 - August 31, 2002 Your Financial Advisor: DUDLEY/HUEY 505 HAMILTON AVENUE 1ST FLOOR PALO ALTO, CA 94301-2014 650-330-38001877-486-5357 Message from Wachovia Securities WITH MORTGAGE RATES AT HISTORIC LOWS, REFINANCING YOUR MORTGAGE NOW MIGHT SAVE YOU THOUSANDS OF DOLLARS OVERTHE LIFE OF YOUR MORTGAGE. TO HAVE A MORTGAGE COUNSELOR DISCUSS YOUR SITUATION AND ANALYZEWHEfHEA REFINANCING MAKES SENSE FOR YOU, CONTACT YOUR FINANCIAL o ADVISOR. _CQ N CID At a Glance cs o If you have more than one account with us, why not get them linked? Your summary below will list them all. -� cm Contact Your Financial Advisor today. — ,.p oo I Accounts Rep Account no. Previous portfolio value Current portfolio value =r.U_. ED Advantage•IRAAccount 9A97 6517.0390 $5,701.45 $5,105.76 rn Total $5,101.45 $5,105.76 � Q _c+')� U — S O ¢M � iris =. Illlllllllllllllll tUi_NZ Wachova Securities, Inc., Member NYSEJSIPC. Brokerage accounts are carried by First Clearing Corporation (FCC), Member NYSEJSIPC., I 1 , i . I. i Advantage-IKA Hccuuut --Statementfor------------------------------- ------ CANUTE M OTA IRA ROLL Page 1 of 2 FCC AS CUSTODIAN Sub Rep A51Statement period: August 1 -August 31, 2002 I 00119A97 �6517-0390 7-0 Your Financial Advisor. OUOLEYMUEY 505 HAMILTON AVENUE 1ST FLOOR PALO ALTO. CA 94301.2014 650.330-3600 y877.486.5357 Current Investment Objective.: Growth & Income + Moderate Summary Other assets These positions reflect purchases made through us or information supplied to us; they are displayed for informational purposes only. It you no longer own any of these investments, please tell us so we can update 1Ms section. These assets are not included in the net portfolio value, and are not Realized Gain/Loss Summary t.on -renu — Total Realized ciamlloss $0.00 - $5,927.76 Assets allocation (portfolio assets) Ej Cash and money market Cash Activity Summary Total cash and money market funds on July 31 • 55,101.45 I n.hft Year to date Total cash and money market funds on Aug 31: $5,105.7E tlemenl counts 29 lin.ing 24 wings 70 STATEMENT OF ACCG 'NTS UNION BANK OF CALIFORNIA HARBOR VIEW OFFICE 071 PO BOX 512360 LOS ANGELES CA CY20 Z 0 C 0000 CANUTE MITSUYUKI TOKIKO OTA 214 MARSALA NEWPORT BEACH CA r• -nigo 1 of 3 Warrant Number, 0711424929 8/30/02.9/27/02 ToloservicasO 90051-0380 For 24-hour Automated Direct Service 800-238.4486 800.826-7345(TDD) Representatives are available from 6 am to i l pm To open additional accounts, or apply for loons, call your banking office al 949-644.3800 Visit us at www.uboc.conn 92660-8301 OTA Thank you for banking whh us since 2002 N The MoslerMoneyATMrm Card isn't a credit card, but it gives you the convenience of one. You can use it at 21 million locations worldwide. So now you can check balances, make transfers, and even get cash at over 600,000 A17vls in 100 countries - virtually anywhere life lakes you. u Beginning balance Endingbalance Ouoklyinq balance an 9/30 Additions Subtractions o 9127 $ $ 1,756.42 $ 3,300.97 $ .3,498.12 $ 1,559.27 t/ ' 766.67 625.00 -757.88 . 633.79 1,805.37 675.00 -1,372.27 1,108.10 $ 4,3213.46 $ 4,600.97 $ 5,62B,27 $ 3,301.16 :KING SUMMARY Account Number: 0711424929 balance on 8/30 $ 1,756.42 Additions 3,300.97 Sublraclions -3,498.12 ' Checks-3,905.70 Payments-600.00 Purchases-943.42 Other withdrawals -49.00 Balance on 9/27 $ 1,559.27 Slalemenl Average Ledger Balance $ 844.80 Wt waived your -service ciurye"iina3lu�rriniit paTiuil`" - - -- -- •--••._„__ Data Duscrtolion Raler Arnaunt 8/30 OFFICE DEPOSIT 45326814 $ 54.26 9/3 US TREASURY312 SOC SEC PPD 56657528 1,213.00 9/ 18 TRANSFER FROM SAYINGS ACCOUNI 08551746 72.27 9/19 NORDSTROM - COSTA MESA CA 72600042 393.29 9/24 TRANSFER FROM ACCOUNT NUMBER 0711427070 65040796 1,300.00 9/24 OFFICE DEPOSIT 46508357 268.1.5 Total $ 3,300.97 nggu 2 of 3 s1umontNumbur:0711424929 8/30/02.9/27/02 u :ks Numbor Data Reforance Amount Number Data Re[ renco Amount 1001 9/12 18424388 $ 40.00 1011 9/10 22130432$ 6.87 1003" 9/3 75039083 1,332.00 1013* 9/20 10315704 20.00 '- 1004 9/4 11121706 22.24 1014 9/20 22417712 50.00 1005 9/5 10226292 5.72 1016` 9/24 10414304 31.66 1006 9/6 80120723 30.00 1017 9/25 IA907012 32.73 1007 9/10 14817852 20.00 1018 9/26 1032AI06 16.35 1008 9/6 80128733 60.00 1019 9/27 83611A88 - 40.00 1009 9/9 18320992 30.00 1020 9/25 22411711 78.13 1010 9/9 23515210 90.00 Total $ 1,905.70 " Checks miuins in sequonce. Oul of sequonce Chocknumbom may Cho be located in Iho Paymools section of your alalemenl. tents Date Descri lion Account mdn. Reference Aniounl e and 9/3 USOC SAVINGS TRANSFER 020903 0711427070 0102 62468879 $ 600.00 onic banking lases Data Descri lion/location Rnferenco Amount card and 9/6 WEB LAUNDR Y CA0110902 NEWPORT BEACH CA t 23033871 72470259 $ 30.00 ar4l.neyT'" aurchases 9/6 9/6 BLOOMINGDA . NEWPORT. BFACH CA BLOOMINGDA 23033871 72.470054 32.3.1. . NEWPORT BEACH CA 23033871 72470054 48.49 9/9 SAV•ON EXP RESS #9561 IRVINE CA 23033871 72491005 12.06 9/9 MITSUWA MR KT CM COSTA MESA CA 23033871 72490943 . 56.46 9/9 MITSUWA MR KT CM COSTA MESA CA 23033871 72490943 73.71 9/12 CHEVRON 110 201093 NEWPORT BEACH CA 23033871 72530312 25.14 9/12 MITSUWA MR KT CM COSTA MESA CA 23033871 72530143 48.93 9/12 YONS S 2660 SAN MIGUEL NEWPORT BEACH CA 23033871 72551110 38.74 9/13 CROWN HARD WARE113 71A6448570 CA 23033871 72550944 11,80 9/16 MITSUWA MR KT CM COSTA MESA CA 23033871 72570951 14.35 9/16 9/18 RALPHS 1100 . IRVINE CA NORDSTROM 23033871 72581707 24.84 • COSTA MESA CA 23033871 72590049 393.29 9/20 RALPHS 1f00 . IRVINE CA 23033871 72621044 36.33 9/20 SAV•ON EXP 17625•A HARVARD IRVINE CA 23033871 72621613 25.00 9/23 MITSUWA MR KT CM COSTA MESA CA 23033971 72600135 9.07 9/23 GELSON S I RUNE R 18 SOS IRVINE CA 23033871 72631006 10.07 9/27 MARUKAI SU 2975 HARBOR SLY COSTA MESA CA 23033871 72691509 52.83 Total $ 943.42 withdrawals Dole Descri lion Rnleranca ng fees and 8/30 WITHDRAWAL It 0000326930 A5325897 $ Amount 40.00 flenls 9/3 TRANSFER FEE 090302 TRSF#5638879 65050344 1.00 9/18 SAVINGS OVERDRAFT TRANSFER CHARGE Total B 00 $ 49.00 1"07'A "-"" - "' ' -' ---- •-- -----CgNUTE'MITSUYUKt account lVuntber: V/I14Z5124 OTA'- Balance on 8/30 $ 766.67 Additions 625.00 Subtractions -757 88 Checks •300.00 Payments •63.40 Purchases •254.4B ATM withdrawals -40.00 Other withdrawals -100.00 Balance on 9/27 $ 633.79 Slalentent Average Ledger Balance $ 864.44 We waived your service charge this statement period. "nge 3 of 3 • • atament Numbor. 0711424929 8/30/02.9/27/02 Additions Dale Descri lion Rulerance Amount 9/3 US TREASURY 312 SOC SEC PPD 56657529 $ 625.00 Cheeps Number Dale Ro(eronco Amount Number Data Re(eranee Amount 1001 9/6 80128689 $ 100.00 1004 9/27 14605623 $ 50.00 1002 9/9 23224083 50.00 Total $ 300.00 1003 9/6 22313687 100.00 P rnenh Account ay Dole Description d R l re cn Amount 'online and 9/10 NEW YORK LIFE INS. PREM. PPD 51852961 $ 63.40 electronic banking Purchases Dole Desai lionAocolton Ro(erence Amount ATM card and' 9/12 SAY -ON EXP RESS V9561 IRVINE CA 23034031 72530149 $ 14.69 MoslerMoneyT^l 9/17 SAY -ON EXP RESS 119561 IRVINE CA 23034031 72580203 27.23 card purchases 9/17 SAKS FIFTH - COSTA MESA CA 23034031 72591058 71.12 9/20 COSTCQ WHO 115 TECHNOLOGY IRVINE CA 23034031 72631328 141.44 _. _. ... Total - $ • 254.40 ATMwithdrawals Dote Descn lion/Locofion Re(arenco Amount 9/20 UBOC WESTPARK LBY IRVINE CA 23034031 72621653 $ 40.00 Other withdrawals Data Doscri lion - .rence Amount including fees and 8/30 WITHDRAWAL R 0000326929 45325896 • $ 100.00 adjustments CANUTE Balance on 8/30 $ 1,805.37 Additions 675.00 Sublraclions -1,372 27 Payments-1,300.00 Other withdrawals' .72.27 Balance.on 9/27 $ 1,108.10 Stalement Average Ledger Balance 2,177.76 Interest Accrued this period $ 1.02 Paid this period $ 0.00 Paid year-lo-dale $ 0.00 Interest Rates 8/30/02-9/27/02 <2 .60 Annual Percenlage Yield Earned 0.59% 9/3 CHECKING TRANSFER 020903 0711424929 0000 62468879 $ 600.00 9/6 OFFICE DEPOSIT 110000724456 47325962 75.00 Total $ 675.00 Payments Data Dsscrlefion Accounf cod R (er nce , Amount online and 9/24 TRANSFER TO ACCOUNT NUMBER 071 1424929 65042561 $ 1,300.00 electronic banking Other withdrawals Data DmE Lion RnI nce Amount including fees and 9/19 TRANSFER TO CHECKING 99241066 $ 72.27 adjustments Iq B,AN K, aF CALIFORNIA STAiEmF•111 OF ACC( JNTS UNION BANK OF CALIFORNIA HARBOR VIEW OFFICE 071 PO BOH 512380 LOS ANGELES CA CY20 Z 0 C 0030 CANUTE MITSUYUKI TOKIKO OTA 214 MARSALA NEWPORT BEACH CA OTA ,, - _Pclgu I of 3 Stulommst Number. 0711424929 8/14/02.8/29/02 Tolosurvims0+ 90051-0380 For 24-hour Aulomalud Direct Service 800-238-AA86 800.826.73451TDD) Representatives are available from 6 am to 1 I put To open additional accounts, or apply for loans, call your banding of tce al 949.644-3800 Visit us at www.uboc.com 92660-8301 Thank you for banking with us since 2002 9 The MasterMoney ATMssI Card isn't a credit card, but it gives you the convenience of one. You call use it at 21 million locations worldwide. So now you can chack balances, make tronsfers, and even get cash at over 600,000 ATMs in 100 countries - virtually anywhere life takes you. 1 SUMMARY OF ACCOUNTS Days in statement period: 16 Deposit Accounts Beginning anco Ouahtyhut L,Iafr obotn VI4 Adddiom Subtractions Fnd(nrq bcdonco on 8/29 Free Checking $ $ 0.00 $ 2,423.47 $ -667.05 $ 1,756.42 071IA24929 Free Checking 0.00 901.25 -134.S8 766.67 .0711425124 55 PLUS Savings 0.00 3,685.37 -1,880.00 1,805.37 0711427070 Total $ $ 0.00 $ 7,010.09 $ -2,681.63 $ 4,328.46 FREE CHECKING SUMMARY Account Number: 0711424929 Balance on 8/ 14 $ 0.00 Additions 2,423.47 Subtractions .667.05 Checks -500.00 Payments -80.00 Purchases -47.05 ATM withdrawals -40.00 Balance on 8/29 $ 1,756.42 Statement Average Ledger Balance $ 621.60 We waived your service charge this statement period. Additions Oulu Desutolion Refareuo Anounl B/14 OFFICE DEPOSIT 45304633 $ 164.33 8/15 WELCOME BONUS 65010129 75.00 8/ I9 OFFICE DEPOSII A742UJ59 384.14 B/27 TRANSFER FROM ACCOUNT NUMBER 0711427070 65040860 1.800.00 Total $ 2,423.47 Checks Nmnbur Ootu Reference Anioual Nmubur Dale Rararonce Anwmd 0093 8/19 47420527 $ 100.00 1002" 8/27 22916196$ 400.Oo Total $ 500.00 ' Chucks missing in sequance. Out of sequence check numheu may also 6 locole.l in Il,o Paymenb sacliou of your slalemanl • Puye 2 of 3 SlatemontNumLa r.0711424929. 8/14/02.9/29/02 f Dom Dasn lion Acmunf coda Rulurantu Amount i d 8/19 TRANSFER TO ACCOUNT NUMBER 0711427070 bankin65044259 $ 80.00 .� g Dole Desai lian/Local"On ReLarwra. Amount I and 8/28 GELSON S N FWPRT 86 SOO NEWPORT BEACH CA 23033871 72380324 $ 47.05 ]neyTAl Rases - drawals Dole Dasai lion/Locnlion ReFerance Amovnf 8/26 UBOC HARBOR VIEW D/U NEWPORT BEACH CA 23033871 72381506 $ 40.00 Ivuntuer vi I I4Za 124 I . CANUTE MITSUYUKI OTA Balance on 8/14 $ 0.00 Additions 901.25 i Subtractions-134.58 Purchases -34.58 ATM withdrawals 100.00' ' Balance on 8/29 $ 766.67 Statement Average Ledger Balance $ 847.95 We waived your service charge this statement period. Dole Desoi lion Rakranco . Amount 8/19 OFFICE DEPOSIT It 0000695210 47420526 $ 100.00 :. 8/19 OFFICE DEPOSIT It 0000/24210 A6422820 726.25 8/20 Total WELCOME BONUS 65010172 5' 75.00 75.0000 $ 907.25 Dole Dalai fion/Localion Re/ararlco Amours Tnd 8/21 Targ-I 033 3750 Barranco P Irvine CA 23034031 72331427 $ 34.58 ,eyTAt Tses awals Dote Dmrn lion/Locnlion Rafe, ants Amount 8/28 UBOC WESTPARK LBY IRVINE CA 23034031 72401410 $ 100.00 TOKIKO OTA Balance on 8/14 $ 0.00 Additions _ 3,685.37 Subiroclions .1, 880.00 Payments-1,800.00 Other withdrawals -80 00 Balance on 8/29 $ 1,805.37 Slalumenl Average Ledger Balance 2,149.J I Interest Accrued this period $ 0.50 ' Paid This period $ 0.00 Paid year -Id -date $ 0.00 Interest Rates 8/14/02-8/29/02 0.60% Annual Percenlage Yield Earned 0.53% Dole D.aoiptlua Rolm unca Awounf 8/14 OFFICE DEPOSIT 110000695196 45304637 $ 10.00 8/19 TRANSFER FROM ACCOUNT NUMBER 0711424929 65041267 80.00 8/19 Total OFFICE DEPOSIT 11 0000724209 46422819 3,595.37 $ 3,685.37 1•� Slawmcm Num6cr: 0711424929 a 8/14/02.8/29/02 Data Dascri lion Avounl coda Ra(manca Amovul cl 8/27 TRANSFER TO ACCOUNT NUMBER 0711424929, 650A2699 $ 1,800.00 - banking _ lldrawals Dole Doscriplion Ref ro lees elnd 8/20 SAFE BOX ACCOUNTING RENTAL FMT ice 90310023 $ Amovol 80.00 lls ' i- x. t I t t i• 't x 239 New Cerdfrcadon /Rgii eeereadon Unit Nrnmber_�� INCO'Y- COI UTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designed to assist you in computing Annual Income in accordance with the method set forth in th Department of Housing and Urban Protect ("HUD") Regulations (24 CFR 813). You should make certain that this form is at all times up to date wit the HUD Regulations. All capitalized terms used herein shall have the meaning set forth in the Regulatory Agreement. Re: (NAME and ADDRESS of Apartment Building) Newport North d CSCDA. (POOL) I(We the undersigned state that I/we have read and answered fully, frankly and personally each of the following'tjuestions for all persons who are t occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit; 1. 2. 3. 4. 5. Name of Members of the Relationship to Head of Social Security Place of Household Household Aee Number Employment TP r1 1�n3�s� f?rnfrtmai-e ; 9 6oQ—46-7994 fort ,ca,-ce �. ry11fCo� 4 t4�.vt,�,rr1 Qccn)make_ .70 ,_ +J'4�_��,-IS'3� �. earh rtUvA Income Computation 6. The total anticipated income, calculated In accordance with this paragraph 6, of all persons (except children under 11 years) listed above for the 12-month per. beginning the earlier of the date that Uwe plan to move into a unit or sign a lease for a unit is S_ j i Sq2, 19 . Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, fees; tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real of personal property (without deducting expenditures for busine expansion or amortization of capital indebtedness or any allowances for depreciation of capital asses except for straight line'deprecladon as provided Internal Revenue Service regulations); (c) interest and dividends (including Income front asses included below and other net income from real or personal property); (d) the full amount of periodic paymetis received from social security, annuides, insurance policies, retirement funds, pensions, disability or death benel aced other similar types of periodic receipts, including any lump sum payment for the delayed start of a periodic payment; (e) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (f) the maximum amount of public assistance available to the above persons other Chan the amount of any assistance specifically designated fo, shelter r ud:ides plus the maximum amount that the public assistance agency could in fact allow for shelter and udlides; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not residi in the dweliing; (h) all regular pay, special pay a:d allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the ho= old spouse (or other persons whose dependents are residing in the units); and (i) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; Co) amounts which are specifically for or in reimbursement of medical expenses; W lump sum. additions to family assets, such as inheritances, insurance payments (including payments under health and accident insura;,c: aced w•o::a compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational insdmdon, and amounts paid by the governmec: to a veteran for use meeting the costs of ruition, fees, books and equipment. Any amounts of such scholarships or payments to veterans not used for the above purposes: to be included in income; (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (0 amounts received under training programs funded by HUD; (a) foster child care payments; (n) amours received by a disabled person tit are disregarded for a li: _d time for purposes of Supplemental Security Income eligib:liy and beneFs bees C;aey are set aside for use under a Plan to Anzin Self -Sufficiency; 0) income of a live-in aide; (j) amounts received by a pa:c:i;aat in Odle, publicatly assisted programs which arc speeirtcally for or in reimbursement of out-of-pocket expenses incur and which are made solely to allow panicipat»n in a speci5c program; (kt a resident service stipend (a modest amount (nor to exceed S2CO per month) received by a resident for performing a serv•i:e for t:,e owner, on a PXI-" basis, that enhanr_s the gc.tl: y of flf: in the developmen:; If this font is being completed is accordance with «cW111 atiOn of a Lower income Tenant's or Very Low Income Terunt's Occupancy of a Lower Ircamc Unit or a Very Low Income Unit, respectively, this form malt be completed based upon the current tnecne of the occupants. V ANC.*kr.ICC•FOAM (1) compensation from state or local employment training programs and training ore family member at resident management staff; (in) reparation payments paid by a foreign government pursuant to claims filed under the laws of that government by persons %who were persecuted during th Nazi era; (n) amounts specifically excluded by my otherrederalstattitefromconsiderationasincomeforpurposesofdeterminingeligibilityorbenefesunderaeategor of assistance programs that includes assistance under the United States Housing Act of 1937; (o) earnings in excess of 5480 for each full -term student 18 years old or older (excluding the head of household and spouse); (p) adoption assistance payments in excess orS480 per adopted child; and (q) defered periodic payments of supplemental security income and social security benefits that are received in a lump sum payment; (r) amounts received by the family in the forth of refunds or rebates under state or local law for property taxes paid on the dwelling unit; (s) amounts paid by a State agency to a family with a developmentally disabled family member living at home to offset the cost of services and equipmer needed to keep the developmentally disabled family member at home; and (t) amounts specifically excluded by an otherfederal statute from consideration as income for purposes of determining eligibility or benefits under a categor of assistance programs that includes assistance under the United States Housing Act or 1937. 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form ofegpital investment (excluding the values ofnecessary items of personal property sue as furniture and automobiles and interests in Indian trust land) X • Yes *No; or I ' (b) have they disposed of an assets (other than at a foreclosure or bankruptcy sale) during the last two years at less than fair market value? Yes n No (c) If the answer to (a) or (bl above is yes, does the combined total value of all such assets owned or disposed of by all such persons total more than S51000 Yes 77CC No (d) If the answer to (c) above is yes, state: (1) the combined total value of all such sets: SS'S" ST$ • 3 h (2) the amount ofincome expect d to be derived from such assets in the 12-month period beginning on the date of initial occupancy in the unit that yo propose to rent: SI, and (3) the amount of such ineprfe, if any, that was included in Item 6 above: S O� , S. (a) Are all of the individuals who propose to reside in the unit full-time students'? Yes V • No •A full-time student is an individual enrolled as a full-time student during each of 5 calendar months during the calendar year In which occupancy orth unit begins at an educational organization which normally maintains a regular faculty and curriculum and normally has a regularly enrolled body ofstudcm In attendance or is an individual pursuing a full-time course of institutional or farm training under the supervision of an accredited agent of such a: educational organization crof estate orpolitical subdivision thereof. (b) if the answer to $(a) is yes, is at least 2 orthe proposed occupants ofthe unit a husband and wife entitled to file a joint federal Income tax return? Yes _�No 9. Neither myself not any other occupant of the unit 1/wwe propose to rent Is the owner ofthe rental housing project in which the unit is located (hereinafter the "Owner"; has any family relationship to the Owner; or owns directly or indirectly any interest in the Owner. For purposes of this paragraph, indirect ownership by a1 Individual shall mean ownership by a family member, ownership by a corporation, partnership, estate or trust in proportion to the ownership or beneficial interes In such corporation, -pa, estate or Trustee held by the individual or a family member; and ownership, direct or indirect, by a parer ofthe individual. 10. This certificate is made wish the knowledge that it will be relied upon by the Owner to determine maximum Income for eligibility to occupy the unit; and 1/we dedar that oil infomation set for th herein is true, correct and complete and based upon information i/we deem reliable and that the statement of total anticipated incom contained in paragraph 6 Is reasonable and based upon such investigation as the undersigned deemed necessary. 11. Me will assist the Owner is obtaining any information or documcats required to verify the statements made herein, Including either an income verification fro, my/ocr present employer(s) or copies of federal tax returns for the immediately preceding calendar year. 12. ]/%%*c acknowledge that Live have been advised that the making of any misrepresentation or misstatement in this declaration will constitute a material breach c my/our agreement with the Owner to lease the unit and will entitle the Owner to prevent or terminate my/our occupancy of the unit by ins'itutlor. oran action to ejection or other appropriate proceedings. ' We declare under penalty of perjury the, Cne foregoing is true and correct. Execu:edthis 15-- day of Tiere01 120C2— intheCityof NeGy 2!:- f-ncn _,Califorrl: Rev. S:'93 Applicant Applicant (Signature ornit persons (except children under the age of is years) listed in number 2 nbove require ul .U:C nay: 11C•FOW FOR COMPLETION BY APARTMENT OWNER ONLY: 1. Calculation of eligible income: a. Enter amount entered for entire household in above: b: (1) If the amount entered in 7(c)above is yes, enter the total amount entered in 7(d)(2), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ P" ); (2) ' Multiply the amount entered in 7(d)(1) times the current passbook savings rate as determined by HUD to determine what the total annual earnings on the amount in 7(d)(1) would be if invested in passbook savings ($ � ), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ (3) Enter at right the greater of the amount calculated under (1) or (2) above: c, TOTAL ELIGIBLE INCOME (line La plus line I.b(3): 2. The amount entered in I.c: Qualifies the applicant(s) as a Moderate Income Tenant(s). )( Qualifies tiie applicant(s) as a Lower -Income Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenant(s). $ 51, 9-q2. IS - 3. Number of apartment unit assigned: 2 3q Bedroom size: 2 'h 2 Pent: $ -.1, 24 is apartment umt vas was no ast occupie or a period0 or more consecutive days y persons w ose aggregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartment un.: qualified them as a Lower -Income Tenant(s). Method used to verify applicant(s) income: Employer income verification. Copies of tax returns. Other ( Manager )2 ) a2 Date G AAIC047.ICC40AV INCnMF R 4RRGT r�nr nr a n-T•,T..T' -- -- —•-- -' ---• Last Namo Flrat Noms —••'-""III Relationship Sax rvry vv vrVBa Dato Olrth \01-1OCI or A Social security it Frrslurinnt HOH —F 4112170 _33_. 6a A-46-227A YES or NO s2 20 3- a3 NO E-32 7 B r Family Memb. It Source Base Rate Average Average Annual $ Hours 62 24 20 12 1 Total YIK SFMI440 eFWK $ jMFOYlt v$ $ _$ $ _$ PUBLIC ASSISTANCr Total Box B: Source Base Rate Average AveragoAnnual $ Hours a2 24 2a 12 1 Total vvY. SLAII�MU 01•WK MU Yi! - ]Family $ _$ $ _$ f1TFIFR INf:f1MC Total fox C: s Family Memb, 1A Source BaseRale $ Average Hours Average Annual 62 24 2e 12 1 Total YVK SEMWO UI•YJK me Tit $ =s ' ToWI Box D: OUg DADA>AAADY•AD $ N•I, ir'A 2.1 Member N Asset Description (savings, checking, stock„ bends, cla Imputed/ Current I or C GrassfFalr W. Value Cost to Get Cash NET FamilyAssats vat lue Actual Interest Role Actual Annual Income from Assets 6 Talals Box L•: � s,35 rs Box F: $-0 -- ie Family wcomo iy Income FrmnNmL• IMPUTED INCOME FROM ASSETS Effective Data December• Box exceeds passbo multiply Typo of Program % 111W the E by the current passbook interest rota; ,X °/< Unit No. 239 Unll Slzo 2i2 II Box E does not exceed SS,000 ('—�� No.or Persons 2 enter-0• In box G: -BOXG: 1== ' INPUTEO INCOME II: Max. Income Llmil$ R' _140°%Llmlt$ r.7r 3266 � �FROMASEfB s Enter the greater of Box F or Box G in: BOX H: ' INCOME CONTRIBUTED FROM ASSETS TOTAL ANNUAL INCOME $ 9I,S42 . Ig & TOTAL ASSETS CO. FILE DEPT. Cl OCK NUIMICR JUM 000312 002011 IRVSA 0000001303 1 OOCUSOURCE,LLC 1751 LANGLEY AVE. IRVINE CA92614 949-862--5270 Taxable Marital Status: Single Exemptions!Allowan ces: Federal: 2 State: 2 Social Security Number 609-46-2279 Earnings rate hours this period year to date Regular - 1150.00 86.67 1,150.00 19,550.00 Auto Allowance 100.00 1,700.00 Drawl 350.00 Commission 3.261.20 -G,russ.pay.'"- - 57;600.0024,381.93 Deductions Statutory Federal Income Tax -185.65 2,608.13 Social Security Tax -98.80 1,504.82 Medicare Tax -23.10 351.93 CA Slate Income Tax -54.49 717.45 CA SUI/SDI Tax -14.34 218.44 Other Dental 125 -6.51 • 110.67 -NeC-Pay': * Excluded from federal taxable wages Your federal taxable wages this period are $1.593.49 Earnings Statement Period Beginning: 09/01/2002 Period Ending: 09/15/2002 Pay Date: 09/16/2002 TERI M. LAING 239_MARSALA NEWPORT BEACH,CA 92660 Other Benefits and Information this period total to date Vac Balance '�LJ 89.7 CO. FILE- DEPT. CLOCK NUMBER JUM 000312 002011 IRVSA 0000001533 1 DOCUSOURCE,LLC 1751 LANGLEY AVE. IRVINE, CA92614 949-862-5270 Taxable Marital Status: Single Faemplions/Allowances: Federal: 2 State: 2 Social Security Number: 609-46-2.279 Earnings rate hours this period year to date Regular 1150.00 86.67 1,150.00 23,000.00 Auto Allowance 100.00 2,000.00 Drawl 350.00 -4c' Commission 5,798.80 ' Gioss'•Pay -. •' " . $'t �600:00' 29,181 .93 Deductions Statutory Federal Income Tax -185.65 3,165.0E Social Security Tax -98.80 1 , B01 .21 Medicare Tax -23.11 421.25 CA State Income Tax -54.49 880.92 CA SUI/SDI Tax -14.35 261.47 Other Dental 125 -6.51* 130.20 Net pay` .;.': •i'$1.�217i09,: * Excluded from federal taxable wages Your federal taxable wages this period are $1.593.49 Earnings Statement Period Beginning: 10116(2002 Period Ending: 10/31/2002 Pay Date: 10/31/2002 TERI M. LAING 239 MARSALA NEWPORT BEACH, CA 92660 Other Benefits and Information this period total t,--4, Vac Balance .06 or W W v Co. HLt ULF1. ULULK NUMfitH JUM 000312 002011 IRVSA 0000001380 1 DOCUSOURCE,LLC 1751 LANGLEY AVE. IRVINE, CA 92614 949-862.5270 Taxable Marital Status: Single Exemptions/Allowances: Federal: 2 State: 2 Social Security Number: 609.46.2279 Earnings rate hours this period year to date Regular 1150.00 86.67 1,150.00 20,700.00 Auto Allowance 100.00 1.800.00 Commission 42.60 3,303.80 Drawl 307.40 Sick 8.00 Gross:.;ply,,. •,� .. :51,5r;,;.00 25,981.93 Deductions Statutory Federal Income Tax e-185.65 2,793.78 Social Security Tax -98.79 1,603.61 Medicare Tax -23.11 375.04 CA Stale Income Tay. -54.49 771.94 CA SUI/SDI Tax -14.34 232.78 Other Dental 125 -6.51 * 117.16 Net,Pay` . 41,2Rmi1; * Excluded from federal taxable wages Your federal taxable wages this period are $1,593.49 Earn inctls.Statement m Period Beginning: 09/16/2002 Period Ending: 09/30/2002 Pay Date: 09/30/2002 TERI M. LAING 239 MARSALA NEWPORT BEACH,CA 92660 Other Benefits and Information this period total io n\ Vac Balance 91.46 1 giro,. P,• •- . Pay Periods Date of Most Recent Pay Ending Date 2�) C°(,-zp 1 Year - to - Date 2..0� O3 divided by pay periods average per pay period q�)a �1A5-gM Gross per Pay Period (, 0 d divided by (x ) how often paid (x) how often paid _ ) uaicuiaiea Hnnuai income ( _ ) Calculated Annual Income 3�� 4g00 Account Statement October 4 through November 5, 2002 Account Number: 071-6236039 Page 1 of 4 125,881 TERI LAING 239 MARSALA NEWPORT BEACH CA 92660-8312 Thar.!:you tar banking with Wells Fargo. For assistance, call: 1.800-70-WELLS (1.800-869.3557), TDD number (tor the hearit • impaired only):1-800.877-4833. Or write: WELLS FARGO SANK, N.A., P.O. BOX 6995, PORTLAND, OR 97228.6995. APPLY FOR A WELLS FARGO VISA CREDIT CARD AND TAKE ADVANTAGE OF LOW INTRODUCTORY RATES THIS HOLIDA SEASON ENJOY VALUE-ADDED FEATURES SUCH AS THE WELLS FARGO REWARDS PROGRAM, LOW -RATE BALANC 'rRSIT WELL ONLINE IAL COO AND ENTERACCESS AND OVERDRAFT OTECTION. APPLY' TODAY. CALL 1-800-350.6401 0 V IF YOU RESIDE OR TRAVEL OUTSIDE OF THE UNITED STATES OR CANADA, BEGINNING NOVEMBER 1, 2002. YOU Wit NEED TO GALL AN MCI OPERATOR TO REACH WELLS FARGO PHONE BANK INTERNATIONALLY FOR ACCOUNT SERVICINi MCI,CO�UNTRY ACCESS NUMBERSOFOR U ER PLEASE rINQUIIRE WITH A WELLSATIONAL N USING AN FARGO ARGO PHONE BANKER. RATOR.'IFYOU NEE CALL FOM AN BANKER Account Summary Daily access accounts Account number Account .............................. . .............................. 071-6236039 Student Checking 671-6347760 WellsI',xira Savings ...................... 'Total ---- Student Checking_-_ _— Teri Laing Account Number: 071-6236039 Activity summary $2,900.53 134dance on 10j03 2,457.37 Deposits - 3 141.26 Withdrawals .......................................................... .............$2,216.64 Balance on 11105 Balance last period $2,900.53 13.93 Balance this Pei ............................. $2,216 13 ................................................. $2,914.46 $2,230 ;::. • . _ , October 4 through November 5, 2002 Ja Account Number: 071-6236039 Page 2 of 4 125,882 Activity detail Deposits Amoun Date. Description $ ................................................................................. ..... ..... .. . 10/16 ATM Deposit,- 10/15 Mach ID 5627E-15030 Second St, Long Beach, Ca-7318 - 1?03.7: Deposit Kl ide En A Branch/Store 30.7: 10/ 1. ATM Deposit ;10/22,Mach ID 0661B,Irvine, Irvine, Ca 7318 ;; ' : ':':::•s. ;:•. 6.0( 11/01 ATM Deposit-.11/Ql Mach" ID 4277F.2540 Mam' St.Ster, Irvine, Ca 7318 ;;=r 1,217.OS ......................................................................................................................... ...2 45 ... Total deposits Withdralvals . „• Checks : ; r,., r. - Number Date $Amount Number Date •$Amount • Number Date $Amour .......................................'.......................................................................................... 26U 10/04 311.00 265* 10125 55.07 262* 10/04 1,500.00 266 10130 650.00 ..............................................................................................:.........................................I...... Total checks $2,516.0 * Cap In Check Sequence ti Other withdrawals Date Description $ Amou ...................... ....................:................................................................................................... ✓... 10109 PUS Purchase - 10/08 Mach ID 000000 4225 Campus Dr Trader Joeirvine Ca 7318 43.8 10/17 Withdrawal Made In A Branch]Store t 10118 1 Foreign Items Deposited rD 1.50 Per Item 10/21 ATM Withdrawal - 10/19 Mach ID 0821D 601 N El Camino Real, San Clemente, Ca 7318 v4O.c .10/23 A'I'M Withdrawal - 10/22 Mach ID 0601B Irvine, Irvine, Ca 7318 10123 'First USA Bank Epay 021022 000000055601825 Laingteri 42 C 10/31 POS Purchase - 10/31 Mach ID 000000 18040 Culver Dnvild Oats Irvine Ca 7318 11/04 First USA Bank Epay 021101 000000056363487 Laingteri ''1'3.1 FFrMM) L jJ]LLL6Y 0G:I"' 1I- 1.( I1(05 POS Usage Fee 'total other withdrawals $625.. .................................................................................................................................................... 53,141 ". Total withdrawals Daily balance summary $ Salan Date $ Balance Date $ Balance Date ......................... •10103•� 10 2,900.53 ....................................:....... 10;18 2,247.79 .......................................... 10131 1,14y 10; 04 1,089.53 10, 21 2,187.79 11/O1 2,366. 101,09 1,045.72 10123 1,911.74 11(04 2.222• 10;16 2,249.29 10;25 1,856.67 11/05 2.216.- 101' 17 2,249.29 10j 30 1,206.67 Account Statement Septeml*r 6 through October 3, 2002 Account Number: 071-6236039 Page I of 4 123,477 TERI LAING 239 MARSALA NEWPORT BEACH CA 92660-8312 Thankyou for banking with Wells Fargo. For assistance, call: 1.800-TO-WELLS (1-800.869.3557), TDD number (tor the hearin Impaired only):1.800.877A833. Or write: WELLS FARGO BANK, N.A., P.O. BOX 6995, PORTLAND, OR 97228.6995. NEED CASH FAST? IN JUST 'HOURS YOU CAN HAVE THE CREDIT YOU NEED TO BUY A CAR, TAKE. A VACATION, CONSOLIDATE BILLS --WHATEVER YOU CHOOSE. APPLY FOR A PERSONAL. LINE OR LOAN ONLINETODAY. JUST GO TC WELLSFARGOSPECIAL.COM AND ENTER KEYWORD: EASY LOAN. EVERY TIME YOU USE YOUR WELLS FARGO CREDIT CARD FOR PURCHASES, EARN REWARDS POINTS FOR TRAVEL AND GIFT CERTIFICATES WHEN YOU'RE ENROLLED IN THE WELLS FARGO REWARDS PROGRAM. IF YOU'RE NOT ENROLLED, SIGN UP TODAY. IF YOU'RE NOT A CARDHOLDER TALK TO YOUR BANKER OR GO TO WELLSFARGOSPECIAL.COM AND ENTER KEYWORD REWARDS, TOAPPLY FOR YOUR CREDIT CARD AND THE WELLS FARGO REWARDS PROGRAM. REWARD YOURSELF NOW. Account Summary Daily access accounts Account Account number Balance last period Balance this perioa', ........................................... r.................................................................................................. ..... Student Checking 071-6236039 $1,971.71 $_,900.5- WellsExira Savings 671-6347760 13.93 13A: ..............................................................................................................._ ..;.......,........................., 'l'otal $1,985.6.4 $2914.4E Student Teri Laing Account Number: 071.62.36039 Activity summary Balance on 0010> I)cposits Withdrawals .......................................................... Valance on H 03 COMBO BONUS. AUTOMATIC RECURRING INVESTMENTS. NO ACCOUNT OR INVESTMENT MINIMUMS. IF YOU ARE OF — LEGAL AGE, WE WILL GIVE YOU A $25REFUND WHEN YOU OPEN AND FUND $1,971.71 YOUR WELLS SHAREBUILDER ACCOUNT. 2,497.S1 ENTER KEYWORD WELLS SHAREBUILDER - 1,56S.99 AT WELLSFARGO.COM, THEN PROMO CODE ............................... WFCOMB025. SEE WEB SITE FOR FULL $2,900.53 DETAILS. OFFERED THROUGH SHAREBUILDER CORPORATION, BROKER'DEALER, NOT AFFILIATED SECURITIES REGISTERED MEMBER NASD/SIPC, IS WITH WELLS FARGO INVESTMENT PRODUCTS: -NOT FDIC INSURED -NO GUARANTEE -MAY LOSE VALUE September 6 through October 3, 2002 Account Number: 071-6236039 Page 2 of 4 123,478 Activity detail Deposits Date Description $ Amour ..................................................................................................................................................... 0 9/1 1 f\TM Deposit - 09/11 Mae It 1D 4277P 2540 Main St.Ster, Irvine, Ca 7318 10.0 09,117 NrM Deposit - 09/16 Mach ID 4277P 2540 Main St.Ster, Irvine, Ca 7318 1,270.7( 09/30 KI'M Deposit - 09/30 Mach r1) 4277F 2540 Main St.Ster, Irvine, Ca 7318 1,217.1 .......................................................................................................................................... ......... Total deposits 52,497.8 Withdrawals Checks Number Date $ Amount ........................................... 257 09/ 1(l 18.12 258 09/16 405.00 Number Date $ Amount Number Date . $ Amour ..................................................................................... 259 09/26 24.31 264 10/03 23.2 263" 10/01 600.00 ................,....... 1 I'oial checks $107U.6 Cup in Check Sequence Other withdrawals Date Description $ Amom ..................................................................................................................................................... 09!12 A'djuti�tment'I'o A'rM Deposit Of 09/ll 50.0 09/16 POS Purchase - 09115 Mach ID 000000 2655 FI Camino Costco Nhotustin Ca 7318 109.3 09/24 POS Purchase - 09/23 Mach ID 000000 5385 Alton Pkwysav-On Druirvine Ca 7318 67.5 09/30 POS Purchase - 09/28 Mach ID 000000 2555 1.iast Bluffralphs Newport Beachca 7318 47.4 10/01 First USA Bank r•;pay 020930 000000053740167 I-aingteri 217.9 10/03 Monthly Service Fee 5.0 10/Q3 POS Usage flee 1.0 Total other withdrawals $498.3 ..................................................................................................................................................... Total withdrawals 51,568.9 Daily balance summary Date $ Balance Date $ Balance ............................................ 09!05 1,971.71 ............................................ 09/16 1,399.24 09/10 1,953.59 U9/17 2,669.94 09/11 1,963.59 09124 2,602.43 09/ 12 1,913.59 09126 2,578.12 Date $ Balanc I 09!30 ........................... 3,747.7 10/01 2,929.7 10/03 2,900.5 Lorij'Bentili Memorial M@d. Ctr. 9,R01 Atlantic Ave , • I'.O, tlov 1428 ,brook irh, CA' 90915 P/..•. ,ono'-. ...r Pay Begin Date: ' 10113 P6YEnd Date:.. Ulf Employee lD: 118321 - "; I" : •'`• Depamnenl: . [.MC-761OOI-Q II., Section ; r" Location:•. :'LOMry >.i - JcbCodefih c6350 ;:'; `.',.-$..';'•: eckly •. Advice/1.-1002937. .. ...; .` .,: r. )" 1•i3. "� .:f:it 5i...i.d-'-R;F ra;:,:. ter: •' .i^ K ..—Curren ':'Famin Descri?lido;'":••.•':`'CuirenC'�-�, •':yfD•- eseri tiori.:Curieni a<::'..YTD.,+ 'Joli'rDe'scri'don .'.,':' Shf Hours s' 2n 08. Fed Withholding 'r4' ' 63501/ ST •:Stmlght Ttne 1 ,21.00 t:n ''16.00 -166J2 "'Fed FIGvlvled Hospital frtf•/EE=s5.78;"';'52559 .•.,` 6350;J ST , Strut iTinte _ ' Fc&0ASDl DMblily-EE' ri'; 2'I,72 r; }'10241 - ,- 7•$+ CA.W111ihbldin 7"r':::•,, .•. 0:45"�'-'Sbl ;, :',v�; ', •'-. -CA 0X$DF%Disabilily ci'EE°'"•l+ 4.3S9„;'.' 1598"- ;i' ; t°• . ,O; •:y'v {;..:':'- :try — - J;^, ''r: ' 4000 39RSf1 Total: r,:,er, .!'- '..' ..5,49 '- •, r2G365, Total: :r...'.e'0.00:n.<A•>O.CO' • .'fowl•.. .. :L1AT'E[ DEDUf.• tHt' : • " L,>[ ; ' •< F,AIPLOYF1LPAt1YB ^; ,. :�' ••Current' LYTD Oeseri don • C1lrtenvi: ;�`.•%•`er[C lion �•.` ::;' ,Descri .ffi r r!r'LV'4: ' ::f'� �: '�C; - '.i",. ' - •.1.f. iY-' i'i •�Jli'°rl' J. .46 , , ire{':�•'.l`ri •'OW •: Total•'. ay O.CO -Tumble •a,,, err.;: .; •5. 1_I—s`•`.'.,.FED'PA)GtntiC.G2tass%'. •e3;<x(rrAt,'eaxrs•,:;paTaunEOYJcvt'ta,�ts•":.:*•:<> %.s•::;s't4rrn' urte 'YaTA ...r:0:� .' '• ^" 1: 04G;11 Corenc .. 398.8U ' S2.G9 . - .. 263.65 .' .' • 0.00' • , .. - :: .. ...;- ':%L501'f0` YCD: 1 7 7 1.764.70 i.<•• 1JP.'f F `Y.DLSt1U1i4T3'ON'`E; do i:, '.` Y TWffis' Pa Ecnson= - "' enuo-. nrnn2ox7 •:346.11 Total PTO Hours: 1024 this Pay Period: 3.85 - • ' - Hours Accrued AccNal'Rateper ,Hour. - 0096154 ,. Total: Nile Shia flours:. 000 - FA nonflouis: O-� r Mein Po• NIA " MESSAGE: WIL ' Iong Beach Memorial Merl. Ctr. :Da 1 rinn?. ' I '2801te Atlantic AV& P.0' Box 1428 Long Beach, CA 908011428 ' DepositAmount: $346:11 To The Account(s) Of IvIERCEDES 6I BERNARD LMC-763001 5437 Fairbrook St Long Beach, CA 90815 NON-NEGOTIABJLIE ' . 'Long Beach Memorin ad. Ctr. 3 +801"Atldntie Ave P.O Bo<1428 '`� ' °`I'Loo � Beach CA 908011429 Sra/9J3 9730 Loch/Re J i N r!D d Pay Group:. ` LB -Long Beach Biweekly Advice p: , 099. Pay Begin Date: '0929/20U2 - _ - uuteo Y4Y14JL-JAW_ Pat,end Date: lu/12/2002' " • •1'• Advice:Dati-tar: • hferccdos M Bernard Employee ID% 113321 TAX DATA: •Fcdemi .• ' : CA Stale �'•.. 5437 Fa1rbrook St Department: ,. LMC-763001-General Section Marital SUNS: t Singlu-�•. ':Single, or A(nrrie ng Long Beach, CA 90RI5 Location:Alaowanct SSN: JohCrxle(s): ,-:: 6350--',' • - Addl. Anil: , .j46.73.1833 '.;, lob Pa Rate s)-.59.67 Houri ,; , '• •, -.i."i:cl,,,',^.e . „ , •%4'>:; :, a,: ,kIOLIRSAN6'$elI2N1NGS•,`; �.l "• `..R i,'Sl'A'^i avgs, . • TAXES ,sr.fD —..---•-•--Current—.---._n don 'Oeuri^tion •"':`•••'•e'!; Shr Hours .Eaminos r - : 'Current t YT cse' iioN"a;'7 Cu rrent" 6350 f S r • Straight Time I 66M (143 W-, Fed Wunlioldmg . 53.60 85.81 . .'• 6350 1011 'Overtime Unsehedulcd I o50 725 Fed FICA &IW Hospital ]its I EE 9.43 19.81 r i, '- "•i;: ' ,. •. red,OASDt/Disability. EE 40.72 &LU9, •. CA Wiihlmiding 5T3 8.36 • _CA OASDI/DL<ahility - EE:, 5.85; ., , I229ti,, • •. I Toiil: 67.00 65031 •.TuUI:. .. 114X I. • 210.96' TaUI: •,. •rr^n'o•.-••10D0 •i..h -. . ' s,.:.r'."AFTfiR T.LF DF,Di1CFfONS':'a: :..` <'.:EMPt,OYER`PA@1HENE67'FS Deurivainn — •.1 Current , IYTr, Description •�+;-CUrtenv..`,1::,+ - I'roUL•, ____U.W -of 1'vTa<abk d,M.: i•n> - :.s•"s > ,,.-',IYO'GtL,tJI2tlSS: „:,FED T,VGtBt,t;.CRO5S;ti�', ;' ;•'TOTiCL:f:t,CES',`t'LO'CAL A1,bi1CFIONS'„`.,';•, s: ,.•';,. Current: ..• 65U.31 :.650.31: • : -114.93 - ,ENE •' 0.00 ,: '�:.: ,;,.; :. ,= i•., .-, :' $ YTDi. JEENFIT CANS•. 1,365,00 -• 1.365:90 - ^Ilblal2>,' 210.96. •, �0.(p ',:.•.:. :"t.: :-A. .' Fly Relson= Nh7pArDIS`MIBGT10N. -1 ohd Total PIU Hours: 631) ., Advice',90999557 • •. I lours Accmed this Pay Period: 639- ,;'•,•_ Accrual Rik per Hour: O.W6153 '.. Nim Shift Hours: • 0 W :•/ Education Hours: •. -000 - r. ' MESSAGE: Ilk' Long Beach Memorial Med. Ctr. Date .Advice''N 041R .2801 Atlantic Ave 10/17/2002 999Q57 P.O. Box 1428 'Long Beach, CA 90801/423 Deposit Amount: $535.38� .1311t&OT D$POSIT3if$T.E161JT10N To The Account(s) Of MERCEDESi�•1BERNARD LIYIC-763001 5437 Fairbnluk St Long Beach, CA 90815 ,� <•, ^••;• ...;; Attount'1'v e . Account Number Deposit Amount Checking. - •1^!2543 - •S53538 'lout: 353538 N01v " .30TIABLE Long Beach Menhoria Ctr. Pay Greup: '-Long Beach Biweekly Check N: 016457 2801 Atlantic Ave 1.0. Box 1423 Pay Begin pate: 09/15/2002 �-� Long Reach CA 90gn1142N 5521931.9730 Local/Rerouted 949/M152.3700 Pav End Date: 091282n02 Check Date: 10/031- Mercedes hl Ilerimrd Unployce ID: 1183_11 1 TAX DATA: Federal CA Sum Marital Status: Single Single, or Married wv 5437 Fairbrook St Department: LbIC•763001-0cmeral Section Long Beach, CA 90815 Location: Allowances: 1 1 • 1obCode(s):' 6350 Add[. Amt.: SSN: 546-73.1833 IobPavRate(s): S9.67 H06'rly' ' HOURS AND YAKNWO3 ; TAXES BEBORPnTAX DEDUOTION --•---Current ----•-- - ' Job Description Shr Hours Earnines Descri iio`n Current YTD Description Current 6350 /ST Stralght Time 1 5230 507.68 Fed Withholding 3221 3221 6350 / UA Unscheduled Hrs/Unpaid 9.00 000 Fed FICA Med Hospital Ins I EE 737 1038 • Fed OASDI/Disability - EE 31AS 4137 CA Withholding 2.63 2.63 CA OASDI/Disability - EE 437 644 Total: 6130 50768 Total: i 7826 r` `'T�AF7F.R=CeLR'3)EE 'Tlflnh-�' 96.07 Total: 0Co _ ` 4iP1.t7YEIt`FhD3 BENEFITS• " Description Current YTD Description Current ' Tout• 0.00 O.W -Taxable ITe-- TOT,tL GROSS ' -m 1iAX�sLGtiR65.5 4 TOVr,Td"Y`,.;,�. '10TAL DEDUCTfO�LS ;'NETT �YTDi 71559•�. 715.59 - 96.03 _0.00619 }lours Accrued this Pay Period: ON An•e,m1 nern ner Hnuc UMCW) •10.11: 41 Pay Periods Year - to - Date divided by pay periods average per pay period Date of Most Recent Pay Ending Date W >b Gross per Pay Period -'�a'-&.--6'0 +' c� 5570 divided by (x) how often paid (x) how often paid = ) Laicuiatea Hnnuai income (= ) Calculated Annual Income 'qD Washington Mutua g ,-� . . STATE-MENT OF ACCOUNT THE FEE FOR EACH OVERDRAWN ITEM, WHETHER PAID OR RETURNED, IS $21.00- 139900000040550 04-E-83 TO REACH CUSTOMER SERVICE, PLEASE CALL TELEPHONE BANKING AT 1-800-788-7000. 52,769 MERCEDES M BERNARD 5437 E FAIRBROOK ST STATEMENT PERIOD: LONG BEACH CA 90815-3020 FROM �08-08-02 THRU. 09-09-02 GIVE THE GIFT THAT MAKES WISHES COME TRUE. AMERICAN EXPRESS(TM) GIFT CHEQUES( AVAILABLE IN FACE VALUES OF 025, 050 OR $100. STOP BY ANY WASHINGTON MUTUAL FINANCIAL CENTER TODAY. FREE CHECKING WASHINGTON MUTUAL BANK, FA FDIC INSURED MERCEDES M BERNARD ACCOUNT NUMBER:- 383-331254-3 13 1 BEGINNING BALANCE TOTAL WITHDRAWA3S TOTAL DEPOSITS LANCE ENDING BA18.00 YTD INTEREST PAID .00 YTD INTEREST WITHHELD: .00 DATE WITHDRAWALS DEPOSITS TRANSACTION DESCRIPTION 08/08 140.00 CUSTOMER DEPOSIT 08/08 9.11 VISA-TOGOS LOS ALTOS LONG BEACH CA 08/08 13.50 VISA -UNITED ARTISTS GAL562-865-6499 CA 08/08 7.03 VISA-CHAR-O-CHICKEN NO 562-498-5600 CA 08/09 100.00 ATM-NCHG SIA07348 1725 XIMENO AVENUE LONG BEACH 57 0609 08/04 241.28 VISA -THE EDGE INSURANCELONG BEACH CA 08/12 EcA.00 Ai?!_ur•;Ir C1A0,>,Cg 4--ca C. SPicxNo ST. LUNG UEACH 80 0812 , O8/12 11.11 VISA -UNION 76 5786CARPINTERIA CA 08/15 20.00 ATM-NCHG SIA07348 1725 XIMENO AVENUE LONG BEACH 20 0814 08/15 280.02 ELEC CHECK# 000472 L6cc Bookstore Long CA 08/16 7.47 POS SY8 DALES DI 4339 EAST CARSON ST LONG BEACH 35 0816 08/16 165.79 ATM-NCHG SlAO7809 6300 E. SPRING ST. LONG BEACH 60 0816 08/16 20.00 ATM-NCHG SlAO7809 6300 E. SPRING ST. LONG BEACH 61 0816 08/19 13.62 POS VONS S 2101 N ROSE AVE OXNARD 15 0817 08/19 11.50 ATM-CHG RBSZAU95 42970 BELLFLOWE LONG BEACH 04 0818 08/20 21.00 POS PAUL'S LIQUO 4172 NORSE WAY LONG BEACH 67 0820 08/21 5.83 VISA -SUBWAY 4113 LONG BEACH CA 08/21 8.06 VISA-BAJA FRESH MEXI GRLONG BEACH CA 08/21 4.83 VISA -ITS A GRIND COFFEESIGNAL HILL CA 08/23 14.89 VISA -CIRCLE MARINA CAR LONG BEACH CA 08/26 171.48 ATM-NCHG SlA07348 1725 XIMENO AVENUE LONG BEACH 93 0824 00/26 15.90 VISA-BAJA FRESH MEXI GRLONG BEACH CA 08/26 12.14 VISA -UNION 76 2763SEAL BEACH CA 08/28 70.00 ATM-NCNC SIA07348 1725 XIMEI•10 AVENUE LONG BEACH 03 0828 08/20 5.56 VISA -SUBWAY .7113 LONG BEACH CA 08/30 100.00 CUSTomFR WITHDRAWAL 08/30 11.47 POS SOU USPS 054 2234 N BELLFLOWER BLVDLONG BEACH 01 0830 03/30 100.00 ATM-NCHG SIA07348 1725 X.IMENO AVENUE LONG BEACH 23 0830 08/30 10.51 POS RITE AID 955 3300 EAST ANAHEIM STRELONG BEACH 09 0830 08/30 35.00 ATM-MCHG SIA07348 1725 XIMENO AVENUE LONG. BEACH 85 0830 09/03 16.04 POS ARCO PAYPOIN 21313 S. AVALON CARSON 85 0831 09/03 87.03 ATM-NCHG SIA07809 6300 E. SPRING ST. LONG BEACH 93 0903 ,,,,• r, nu H?vY nf(rl-1 Washington Mutual STATEME�' OF ACCOUNT THE FEE FOR EACH OVERDRAW ITEM, MHETHER PAID OR RETURNED, IS $21.00. 139900000040550 04-E-83 MERCEDES M BERNARD 5437 E FAIRBROOK ST LONG BEACH CA 90815-3020 FOR CUSTOMER SERVICE CALL 1-800-788-7000 FOR TDO SERVICE CALL 1-800-841-1743 48,907 STATEMENT PERIOD: FROM 09-10-02 THRU 10-07-02 HASHINGTON MUTUAL OFFERS SERVICE FOR HEARING -IMPAIRED CUSTOMERS USING TELECOMMUNICATIONS DEVICE FOR THE DEAF (TOD) EQUIPMENT. CALL (800) 841-1743 USING YOUR TDD ENABLED PHONE. FREE CHECKING MERCEDES M BERNARD BEGINNING BALANCE 18.00 WASHINGTON MUTUAL BANK, FA ACCOUNT NUMBER: TOTAL WITHDRAWALS TOTAL DEPOSITS 163.25 550.14 FDIC INSURED 383-331254-3 ENDING BALANCE 404.89 YTD INTEREST PAID .00 YTD INTEREST NITHHELD: .00 DATE WITHDRAWALS DEPOSITS TRANSACTION DESCRIPTION ATM-CHG 0010 2801 ATLANTIC AVE LONG BEACH 09/10 21.50 40.00 ATM-NCHG SlA07348 1725 XIMENO AVENUE LONG BEACH 09/10 VISA-STARBUCKS D005LONG BEACH CA 09/30 4.90 VISA-FROMEX PHOTO LAB LONG BEACH CA 09/16 09/19 7.52 90.14 CUSTOMER DEPOSIT ARCO PAYPOIN 1785 BELLFLOWER BLVD. LONG BEACH U9T0 15.45 For. ATM-NCHG SIA07348 1725 XIMENO AVENUE LONG BEACH 09/30 09/30 20.00 ATM-CHG 0010 2801 ATLANTIC AVE LONG BEACH 10/04 2.50 420.00 CUSTOMER DEPOSIT 2801 ATLANTIC AVE LONG BEACH 30/07 21.50 ATM-CHG 0010 ATM WITHDRAWAL FEE - DOMESTIC 10/07 6.00 PLUS PACKAGE MEMBERSHIP 10/07 5.00 DETAIL OF CHECKS PAID: CHECK DATE NUMBER PAID AMOUNT 484 09/17 20.00 NOTE: x INDICATES CHECK CUT OF SEQUENCE CHECK DATE NUMBER PAID xp86 10/07 CHECK AMOUNT NUMBER 19.88 2 32 0910 04 0910 On 0928 58 0930 98 1003 72 1005 DATE PAID AMOUNT PAGE 01 (CONTItlUED ON NEXT PAGEI I w Washington Mutual STATEMEt'�OF ACCOUNT 139900000040550 04-E-86 MERCEDES M BERNARD 5437 E FAIRBROOK ST LONG BEACH CA 90815-3020 0 48,90a STATEMENT PERIOD: FROM 09-10-02 THRU 10-07-02 AIRED USING ICATIONS DEVICE FOR TTHEUAL DEAFFFER� SERVICE FOR (TOO) EQUIPMENT. CALL 18001'P841-1743SUSINGSYOUR TOO ENABLEDE�PHONE- STATEMENT SAVINGS WASHINGTON MUTUAL BANK, FA FDIC INSURED ACCOUNT NUMBER: 489-620643-4 MERCEDES M BERNARY7 TOTAL WITHDRAWALS TOTAL DEPOSITS ENDI�EIALANCE61- BEGINNING BALANCE 42.38 43.00 01 INTEREST PAID: .01 NTEREST PAID .02 ANNUAL PERCENTAGE YIELD EARNED 1.62 % YTD INNTEREST HITHHELO: .00 DATE WITHDRAWALS DEPOSITS TRANSACTION DESCRIPTION ATM-NCHG S1B0&392 1725 XIMENO AVENUE LONG BEACH 40 0914 09/16 40.00 INTEREST PAYMENT 10/07 10/07 3.00 .01 SERVICE CHARGE P? PAGE 02 OF 02 "•q�''�v:x ,titWs,Ag,rr• crai;cre)M��,;F,e>;r •y �iir rn , ,n, .. o, e, {�•y.�, Now Cerdfieakon yRecergriication Unit Number 123 It e,'0TN[E COUTUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designed to assist you in computing Annual Income in accordance with the method, set forth,in tt Department of Housing and Urban Project ("HUD') Regulations (24 CFR 813). You should make certain that this form is at all times up to date wit the HUD Regulations. All capitalized terms used herem shall have the meaning set forth in the Regulatory Agyeement, Re: (YAMS and ADDRESS of Apartment Building) Newport North - C S C),,A, �P®OL)t, . LVe the undersigned state that I/we have read and answered fully, frankly and personally each of the following•tjuestions for all p• eFsons who are I intend to in, the unit: occupy the unit being applied for in the above apartment project. • Listed below are the names of all persons who reside Name of Members Relationship of the ' to Head of " Social Security Place of Household Household Age Number Employment 57 367-A Z SAI4 R � $cartdinavlc f 4 Income Computation 6, The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children under 18 years) listed above for the 12-month per beginning the earlier of the date that Uwe plan to move into a unit or sign a lease fora unit is S.ri� L 9.�, �t]_•s Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, cortnoissions, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the renal of real of personal property (without deducting expenditures for bus'm expansion or amortization of capital Indebtedness or any allowances for depreciation of capital assets except for straight line'depreciadon as provider Internal Revenue Service regulations); anm (c) interest and dividends (including Income from assets included below d other net income from real or personal property); (d) the full amount of periodic payments received from social security, annuides, insurance policies, retirement funds, pensions, disability or death bene and other similar types of periodic receipts, including any lump suer payment for the delayed start of a periodic payment; (e) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (f} the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter ; utilities plus the maximum amount that the public assistance agency could in fact allow for shelter and wilitics; . (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and girls received from persons not resin in the dwelling; ' (h) sdl regular pay, special pay and allowances of a member of the Armed Forces (whether of not living in the dwelling) who is the head of the botss:hold spouse (or other persons whose dependents are residing in the units); and (i) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; (b) amounts which are specifically for or In reimbursement of medical expenses; (c) lump sum additions to family assets, such as Inheritances, insurance payments (including payments under health and accident insurance and work-: compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational institudou, and amounts paid by the government to a veteran for us• meeting the costs of tuition, ftes, books and equipment. Any amounts of such scholarships or payments to veterans not used for the above purposes to be included in income; (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (f) amounts received under twining programs funded by HUD; (g) foster child care payments; (h) amounts received by a disabled person that art disregarded for a limited time for purposes of Supplemental Security Income eligibility and benefits beta they are set aside for use under a Plan to Amain Self -Sufficiency; (i) income of a livt-in aide; G) amounts received by a pardcipan: in other pubii _ily assisted programs which are specifically for or in reimbursement of out•of-pocket expenses in_u and which art made solely to allow participation in a specific program; (k) a resident ser4cc stipend (a modest a:rourt (not to exceed s'--Co per mot&) received by a resident for pedomdng a service for the owner, on a par' basis. Cla: emha .Ces the quality of lift in the development; If this fomt is being completed in ateordance with rccenification of a Lower Income Tenant's or Very Low Income Tenant's occuparsy Ora Low:r Income Unit Ora Very Low income Unit, respectively, this ro= mutt be completed based upon the current income of the occupants. cu.AYIC.om, ICC•Foae y$n:V• 4i'�Y' 3'4 9' Hv '1'7 ` �. � :R � ` Y.; x..: L• Z, u'. t.i„ t 1'u...Y -( ., r„ o - : 'compensation from state or local employment training progmins and training ora family member as resident management staff, •' • (m) reparation payments paid by a foreign government pursuant to claims Filed under the laws of thotgovemment by persons who were persecuted during ... Nazi era; . . ..'... •.. . - . .: ..... ... .... ... - it (n) amounts specifically excluded by any other federal statdte from consideration as lncdme for purposes ofdeteimining eligibility or be6cf'[6 undera eatego; of assistance programs that includes assistance under the United States Housing Act of 1937; (o) earnings in excess of$480 for each full -tern student 18 years old or older (excluding the head ofhousehold and spouse); (p) adoption assistance payments in excess of 5480 per adopted child; and - (q) deferred periodic payments of supplemental security income and social security benefits that are received 1n a -limp sum payment;;'• (r) amounts received by the family in the forth of refunds or rebates understate or local law for property tares paid on the dwelling rut, (s) amounts paid by a State agency to d family with a developmentally disabled family member living at home to'offset the cost of services and equipmer needed to keep the developmentally disabled family member at home; and ; , ' (t) amounts specifically excluded by an other federal starule from consideration as income.for purposes of determining eligibility or bcnefits under a catcgo., of assistance programs that includes assistance under the United States Housing Act of 1937. 7. Do the persons whose income or contributions are included in item 6 above: ' (a) . have savings, stacks, bonds, equity in real property'or other form of capital Investment (excluding the values ofnecessary items ofpersonat property suc as furniture and automobiles and interests in Indian trust land) 1r!�'•' Yes "No; or '••%.`''^i'i'•. (b) have they disposed of any assets (other than at a foreclosure or bankruptcy sale) during the last two years at less than fair market value? Yes X No (c) If the answer to (a) or (b) above is yes, does the combined total value of all such assets owned or disposed of by all such persons total inor2 than 55,000 Yes ' X No , (d) Tr the -answer to (e) above is yes, state: (1) the combined total value of all such assets: S 2rG A 6. h �i ' (2) the amount of income expected to be derived from such assets in the 12-month period beginning on the date of inittal occupancy in the unit that y'o propose to rent: S y and' (3) the amount orsueh incank, if my, that was included in Item 6 above: S' L•J 8. (a) Are all ofthe individuals who propose to reside in the unit full-time students'0? Yes• i - No !A full-time student is an individual enrolled as a full-time student during each of calendar months during the calendar year in which occupancy of th unit begins at an educational organization which normally maintains a regular faculty and curriculum and normally has a regularly enrolled body of student in attendance or is an individual pursuing a full-time course or institutional or farts training under the supervision of an accredited agent of such a educational organization or of a state or political subdivision thereof. ' (b) If the answer to 8(a) is yes, is at least 2 of the proposed occupants of the unit a husband and wife entitled to file a joint federal income tax return? Yes_�_No 9. Neither myself nor any other occupant of the unit I/we propose to rent is the owner of theaental'housing project in which the dnif is located (hereinafter the "Owner", has any family relationship to the Owner; or owns directly or indirectly any interest In the Owner. For purposes of this paragraph, indirect ownership by a individual shall mean ownership by a family member, ownership by a corporation, partnership, estate or trust in proportion to the ownership or beneficial interc<- • in such corporation, partnership, estate or Trustee held by the individual or a family member; and ownership, direct or indirect, by a partner of the individual. 10. This cen;ficate is made wlth the knowledge that it will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and IAwe declar that all information set forth herein is true, correct and complete and based upon information Ihwe deem reliable and that the statement of total anticipated Incom contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. 11. I/IS'e will assist the Owner in obtaining any ini'omtation or documents required to verify the statements made herein, including e;theran income verification f cr mylour present employer(s) or copies of federal tax returns for the immediately preceding calendar year. 12. We acknowled=e that Uwe have been advised that the making of any misrepresentation or misstatement in this declaration will constitute a material breach c my/our agreement with the Owner to lease the unit and will entitle the Owner to prevent or terminate my/our occupancy of the unit by institution ofan action fc ejection or other appropriate proceedings. 1/4l'e declare under penalty of perjury that the foregoing is true and correct. Executed this 14* day of Rce,(Wg C .20•Q _ in the city orb G,ch &ar)'1 . Calirom! Applicant Applicant Rcv. 8.(95 Applicant (Signanfrc oral) persons (except children under the age of IS years) listed in number 2 above require` al AMC nn). Ir•C.rokIl FOR COMPLETION BX-APARTMENT OWNER,ONLX':,...._,.-._, 1. Calculation of eligible income: a. Enter amount entered for entire household in 6 above: b: (1) (2) (3) If the amount entered in 7(c)above is yes, enter the total amount, entered in 7(d)(2), subtract from that figure the ainount•enfere"d lin . 7(d)(3) and enter the remaining balance ($ Multiply the amount entered in 7(d)(1) to ies:the bur'rent passbook`.,..'.... savings rate as determined by HUD to determine what'the total annual earnings on the amount in 7(d)(1) would be if invested in passbook savings ($ fef ), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ Enter at right the greater of the amount calculated under (1) or (2) above:" C. TOTAL ELIGIBLE INCOME pine La plus line I.b(3): 2. The amount entered in l.c: Qualifies the applicant(s) as a Moderate -Income Tenant(s). Qualifies tb`e applicant(s) as a Lower -Income Teparit(s). Qualifies the applicant(s) as a Very -Low Income Tenant(s). 3. Number of apartment unit assigned: 123 ( Bedroom size: J -1• l � • : fir. $ 350(21;51.' Rent: $ a i 9 ire oa-- This apartment unit pfasAvas not) iest occupiea tor a perioa or -ii or muic w„�c�uuro uaya vy _ aggregate anticipated . , ual income as" certified in the above manner upon their initial occupancy of the apartment unit qualified them as a Lower -Income Tenant(s). 5. Method used to verify applicant(s) income: Employer income verification. . Copies of tax returns. Other ( P ,. shack Siubs Manager �zl�Jaz. I Date a.A.11=7A:C-FOM INCOME Re ARR FT (:AI rl II ATlnnr 1n Vlnvrn a—.--.- last Namo Flat Neme RelaOanehlp Sez Oalo of Birth Ago SOclal Socurlty g FIT Student 1 HOH V 57 9, _ 2 I YES or NO 2 s a 5 ' 7 B 1 II�uV1Y1C EMPLOYMENT _. Family Memb. yp Source Base Rate Average Average Annual $ Hours 52 xA 25 12 1 Total WK SEMI -MD 01•WK MD YR I $ Q X °$35627, $ -$ $ _$ SOCIAL SECURITY PENSIONS ETC ToWIBoxA: $ y Family Memb.# Source Base Rate Average age Annual $ Hours 522a 1z 1 Total el•WK Mo YR $ t24 _$ $ =s PUBLIC ASSISTANC9 ToWI Box B: S Family Memb. # Source Base Rate Average Average Annual . $ Hours 52 24 20 12 1 Total WK SEMI•Mo al•YM Mo Ya =$ $ =$ mT14F:R 1mr.11 = Total Box C: $ Family Memb. 0$ Source Base Rate Average Hours Average Annual 5x 24 26 12 1 Total WK sEMI•M0 al•WK MO YR $ _$ To rough D >>>>>>>>>>>> $ j627 • �rI " Asset Descrpton mputedl Gross/pal; COstto NET Actual Actual Annual Member (savings, checking, stocks, bonds, Current Mkt. Value Gel Cash Famlly Assets Interest Income from 9 etc) IorC vole Role Assets 07 —5, Lin. 76 0 = o $ o Totals Box E: — yam, Box F: fonYly lnwmo fleet NacL• ,w,na IMPUTED INCOME FROM ASSETS o� Dale Drr.,,a 'eds Box E exceeds $5,000—multiply Typo of Program % t-nm E by the currant passbook Interest rate: X ^/, Unl(No. 193t Unit Sae I*I If Sox E doos not oxcood$5,000 �� No. of Persons I enter•0• In box G: "BOX G: L:.= • INPUTED INCOME Mfl: Max. Income Limit $ FROM SETS AR: ✓ 140%UmilS -"'jt 72 0.40 S Enter the greater of Box For Box GIn: BO%H: , ' INCOME CONTRIBUTED FROM ASSETS ' TOTAL ANNUAL INCOME $- 3E.6 z7. 67 & TOTAL ASSETS $ m = $ c27, sue_ euvmree. rcuvcra rvenre ROYAL SC=INAVIA, INC. 391 LIDIA N. MANE III'. 14C 9RACEORU + WEST BERLIN, N„ 6091 9268 CGAI]plY �'V NC`:i ➢F.?A R'AtE.Y! B:LWCy 3GCITL ]'ECLRIIY\V\16ER 90129 22 ' 337-42-2914 ?'AXES AND DEDIICTIONS' PvR1006-O&Y-I PEPIGV EeCI HECL YVM1I2£R "iCal?Tpa [JfL¢-`II' i YEAR. 9/29/02 10/12/02 10/18/02 DEFOSIT -� TrEI PAYROL 1c'COIJNTP caa"NY IPKI M-02 8329 17h962 HOURS EPI2NING5 :. SOC. sac, {:.DIG17.E 62 1117 ec 198�o9 46426 AVAILABLE TO DATE ➢ESCIiPl01 PJ."RATE 1 HAS.I.Art cuf -NT Y&1R V➢ATE REGULAR 134c4115 2SI66P7 �SW:-I M-02 E71 179q- O✓ERTIME 45247 S.D.I. 1112 291!73 VACA`_'ION VAGITION 1 673�0B 40.00002 EOLIDAY 63980 OTHER 10200 SICK CGlKMISSION � 533800 40.00000 DL'-D125 ALL -2360 -396 8 401R -Sac,E2 -3241�47 PERSONAL i6.00000 GROSS PAY •00 118 i93 2877 C7 - TOTALT6 249 417 L3 NOTICE OF Di RRCi DEFOSIT TO ACCC= NUHRER 0693294134 ul�oreE �wlaER alAe �_�- _..� ROYAL SCA.*�T°"TNAVIA, INC. 391 MD -A N. MAND ..;UAj 140 E.4A>TORU . E WEST PERL-N, NS 00091 9259 CGAIPA.Y'(M1JF'.SER-,I GEf A3T.\ICFT BXA CH S0.-IA., SECLAfi+\IIIHEA 90129 22 L _ 1_ _ I 367 42 6914 XES ANA DEOUCTIONSi P LGOO BEGINN'YG PEPIDD ENGI.YV [I([;[A DATL CX-CK NV�134 DES.:J .OY CLR.CK 1£nR� 9/a1/cz s/14 /02 9l20l02 DEPo=-m — -- THE ,,,P�,A�Y�rZ- lcco Ca2NJ� Fd{ M-02 SCC. SEC. 8329 Gla SSS3C2 ISO z 19 HOURS PVAILA3LE -. : SFAIi*IINGS cEsnu '+ aAr AnTe vav F� <Lwu _ DICARE 1118 4216.5 TO DATE REGULAR OVERTIME 16a27 , ^0 12113e 2247'1�7 4-2.7 _.M Isd. M-02 S.D.I. 1 WI 11 + 162CA 26479 VACATICN VACATION 673102 i. 40.00000 Y.Oi30.AY 16927 B00 13162 6391'90 i OTY.ER 10200 j SICK COlIISSION 503230 40.000aa MED125 ALL -2360 -349 E 401K -134�52 -2942 3 PERSONAL 16. COD00 CROSS PAY I�®» ll8"1i94 2613021 ^CT.A*.c 206�_9 4233iS9 NEi pAY ;i NOTICE OF ➢IRECT DEPOSIT TO ACCOUNT N7JM9ER 0693294134 -'982. 65 1T7,"d.<<•�;: :ir'i. �.K:"S'".:�,iu�i!:.":'i-�S.r;•'.e]��!.q:'�,..,a�j..:i�ri'ie"i:'-.�%3?i''1sr rc�Y�ia^nj:F4a'r',v-s:u:::t•::k;�i c�An"_.='•'I.'.,;�Yi_�:.ii.Yr"�.�,'rs�!it"r" r•'rr:: ti�"..' . �:uM r,La�tr,P.i .11ar •.f, :. �'r.:;. �arf(?].�:'.:'..: .,f`��Sfxrt�r.: .•�+asp r1 ' 6"i ft Statement ` : • October 24 ihrotigh November 25,-2002: _ Account Number: 069-3294134 '- -- - -- Page 1 of 6 LIDIA'N.MANDELBALIM 123.1 •ALICANTE, NEWPORT BEACH CA,92660=3285 .Yti '. .'3r.`t:i.,,.v� :.,..],�. er:r'C•.`..-,.. FA":,]:. :i r"�r c.�:i {.e,, _ - ^:�a i y; it _ :?i• _ `i:., - tii +.xcn rvn t 1 -i-'-i J1'll•�.f••'' Ki'-.�.Yy -' y�tt`.i ,.}: •'1!'.iJ *r .:`'.��' +r1:_V ,'''Ol:•: Ji: ]'..•`. ':Lq. f: ..�. ' i,y$�•1 •Y �?) ..0-- i54STL'H[i..e.Fi,�Y,tIS]••:.��1�-'C'f-a v:'U.]•'n`r4^r:4 ]I,.nr al'1.)l:�hf*!='M1n['•'r-.•6µ. +: J11:},p4rt �".: Thank you for batikitig wtih'1NeIIs:Fargo Fo'ra'ssistance; call:'1 E00-TO-WELLS (1 800:8693557);TDD niiinber(for the hear: :.+ impaired only):1=600=877.4833: .Or-write:,WELLS,FARGO BANK; N.A.; P,.O. BOX 6995, PORTLAND; OA 97228 6995. "APPLY FORA WELLS FAFiGCiyVISA'CFIEDI f C AFiD AND',TAMf ADVANTAGE OF LOW IN7FtODUCT6RY;FiATES THIS HOLIDF SEASON.: ENJOY VALUE-ADDED FEATl1RESSUCH"AS THE WELLS FAFiC,O REW/1RDS PROGRAM,'L`OW-RATE' BALANC -TRANSFERS, FREE ONLINE -4Q0.O•UNT ACCESS,AND;_OVERDRAFT-PROTECTION.{APPLY TODAY, CALL•1-$00;350-6401 C VISITWELLSFARGOSPEOIAL.COM AND ENTER KEYWORD: LOW+INTRO. `• • •1' Account Summary ' ' Daiiy access accoiiants , Account Acwuntnumber Balancelaotpedod _Balance this per Stagecoach Checking 069-3294134 $1,014,74 $734.' WellsExtra Savings 664-3293418 :0.00 0. ........................................ ........................ .............. - .,.. .. Fatal $1M14674 $734. Stagecoach Checising Lldia N Mandelbaum Account Number:, D69-3294134 Activity summary Balance on 10,123 $1,014.74 Deposits 5,637.21 Withdrawals ' - 5,917.19 Balance on 11/25 $734.76 ;�Tyf:, .YJ'a.:y,-_v.i:G: 4` ♦ iUaG v - •' 'iYM ST :'S Ol!�.i. m vi): A October 24 through November 25, 2002 Account Dumber: 069.3294134 ' Page 2 of 6 a 166,398 'Activity detail ' .Deposits Date Description ....................................... 10/25 "ATM Deposit - 10/: 10/30 'ATMDeposit, s10/: 11/01 Royal;Sdandinavi-P. 11/01 ATM Traiisfe'r'Fron • _ i \e1%'tip .i. �:.jya Y'.' •I - :4. f. .. �,'.. '• L••f a 'Y _'•'fi . ic. manta;Ana,:yC�aT2�f2�12 0222,r';t:z,e';` iaiifia'tAnar l ar4 Y.ri 2y.: $ Amo, :...16� : 94: 982, 500.1 l l/04 ' ATM Deposit = 11104, Macli.ID 0643D 5 Coiyorate Plaza;. Newport_Beach',"C a )0222 .'' ;+''3s '•' :• 1,040. 11/(A 'ATM Trari�er Fr6m Checking = 11/04 Mach 'ID 0643I>'S'Corporate I?laza;'+NewPort'I3eaEh;°Ca':'• 500.1 i :'4 :'tea'.`.na'(:v ..S•�:w air'X.'nY__ 1ru2�1..-,• �41 11/12 "Check'Crd'Pur Rta4t 11108,Experiari,Internet'Cred'714-8307191 a'5533472XXXXXX0222 f::'' 14.' 7841117N993KPA8Jg?MCC=7321 121042882DA `--'';;.:'.'' ;r=: : i=' ;; =?' ; ': ;': ,'• 11/12 Tele-Transfer Fr Checking 0376i96633 Reference # TFHX56TW8V ' "' ..,..�L 400.1 11/15 • .. l� `p Dupuis Of Costa Payroll 09282700022434X •Mandelbaum,Lidia'- 962.: 11/15 1t5yal ScandinaVi Payroll 111102 357428914 Mandelbaum,'Lidia N.:`. 516. 11115 Royal Scandinavi Payroll 6111102 357428914 Mandelbaum, Lidia D. 462.: 71/25 Discount For ACH Direiit Deposits 2. .............................. .......r.,.............................................. ....... ........ .............. Total deposits S5,637.: 'Withdrawals Checks ' •s ' Number Date' ..$Amount Number Date $Amount _. Number. :'Date.'.:'. $Amoi 113U 10/25 55.55 1136 11/01" 1,100.00 1141 11%19 ` 5'10. 1131 10/25 •106.00 1137 11/04 ,, ' - 1,266.00 - ' 1142 -. : 11/18,' 20. 1132 10/28 76.00 1138 11/07 500.00 1143 11/22. 48. 1135* 11/04 28.28 1140* 11/12 25.97 ......................................... ...............................................r................................................ ..... Total checks $3,729. • Gap in Check Sequence ' Other withdrawals ' Date Description $ Amo• ................................................................................................... r............................................... 10/25 Check Crd Purchase 10/22 Jules Seltzer & Assoc Los Angeles Ca 533472XXXXXX0222 237. 7848379MTV2LB2Bme '?MCC= 5712 121042982DA 10/25 POS Purchase - 10/25 Mach ID 000000 2555 East Bluffralphs Newport Beachea 0222 120. 10/25 Check Crd Purchase 10/23 Ann Taylor #880 Costa Mesa Ca 533472XXXXXX0222 32. 7054186M•T03I2jzaga ?MCC= 5631 121042882DA 10/25 POS Purchase - 10/25 Mach ID 000000 3 Milano Dr Web I_aundrnewport Beac Ca 0222 20. 10/28 POS Purchase - 10/25 Mach ID 000000 3650 South Brisvons Ssanta Ana Ca 0222 40. 10/28 Check Crd Purchase 10/24 Mandarin King Laguna Beach Ca, 533472XXXXXX0222 33. 70434251MS6120ROX3 ?MCC = 5812 121042882DA 10128 Check Crd Purchase 10j18 Nello Cucina Ristorant Costa Mesa Ca 533472XXXXXX0222 14. 7544298MW232Fkvky?MCC:= 5812 121042882DA 11 Department of the Treasury • Internal Revenue service U.S. Individual Income Tax Return Fortho year4an. I -Dec, 31, 2001, orathertax year beginning 2001, ending 20 1 OMB. No. 1545.0074 uauol L Your first name and Initial Loslname YoursociolsewMynumber I50° InstructionsA LIDIA MANDELBAUM 357-42-8914 6 on page 19.) E Il alolnt return, spouse's first name and initial Lestname Spouse's social secumynumber Uselhe IRS L othermse, H Homo address A Important! plena print E 1231 ALICANTE 1 You must enter ortype. R EI City, town or post office, state, and ZlP code. It you have aforeign address, see page 19. your SSN(S) above. Presidential NEW PORT BEACH CA 92660 Election Campaign , Note. Checking 'Yes" will not change your tax or reduce your refund, You Spouse (See page 19.) Do you, or your spouse if filing a joint return, want $3 to go to this fund? . ►n Yes R No F1 Yes No 1 Filing Status X Single 2 Married filing joint return (even if only one had income) 3 Married filing separate return, Enterspouse's SSN above, full name here. ► Check only 4 Head of household (with qualifying person). (Seepage 19.) If the qualifying person is achild but not your dependant, ' one box. enlerthis child's name hare. ► 5 Qualifying widow(er) with dependent child (year spouse died ► ). (See page 19.) 6 a Exemptions X Yourself. If your parent (or someone else) can claim you as a dependent on his or her No. of boxes . chocked on tax return, do not check box ea ......... ......... so and sb 1 to Spouse .............. I ...................... --(3)Dependent''s No.ayou C Dependents: (2)Dependent's (4)Che6ck ll gforp Ild ch11=6c, 0t (1)Rmt name Last name social Security number rolmicnship to you iaxld credit see 201 lived vdlh you It than six ❑ did not live with more you duedvorco ee ❑ see papa 20. spage ❑ (sse Page 20) ❑ on so rxr<D°auxlents ai ❑ Add numbers d Total number of exemptions claimed . entansd it a ► 1 Income 7 Wages, salaries, tips, etc. Attach Form(s) W-2 7 23,164 8a Attach Be Taxable interest Attach Schedule 8 9 required ......... . ........... Forms W-2 and b Tax-exempt Interest. Do not Include on line 8a .... 8b W-2G here. Also attach 9 Ordinary dividends. Attach Schedule B If required ................... 9 Form(s)1099-R 10 'Taxable refunds, credits, or offsets of state and local income taxes (see page 22) .... 10 If tax was withheld. 11 Alimony received ....................... . .......... 11 12 1 (3,146) 12 Business income or (loss). Attach Schedule C or C-EZ ................. If you did not 13 Capital gain or (loss). Attach Schedule D If required. If not required, check here 10- E] 13 14 get a W-2, 14 Other gains or (losses). Attach Form 4797 ....................... see page 21. 15a Total IRA distributions 15a b Taxable amount (see page 23) 15b Enclose, but do 16a Total pensions and annulges 16a b Taxable amount (see page 23) 16b 17 not attach, any 17 Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E payment. Also, 18 Farm Income or (loss). Attach Schedule F ...................... ' 18 please use 19 Form 1040-V. 19 Unemployment compensation ............................. 20b 20a Social security benefits 120a I b Taxable amount (seepage 25) 21 Other Income. 21 22 Add the amounts In the far right column for lines 7 through 21. This is your total income ► 22 2 0 , 018 Adjusted 23 IRA deduction (see page 27) .............. 23 2,000 Gross 24 Student loan Interest deduction (see page 28) ..... 24 Income 25 Archer MSA deduction. Attach Form 8853 ....... , 25 26 Moving expenses. Attach Form 3903 .......... 26 ' 27 One-half of self-employment tax. Attach Schedule SE 27 28 Self-employed health insurance deduction (see page 30) 28 29 Self-employed SEP, SIMPLE, and qualified plans ... 29 30 Penalty on early withdrawal of savings ........ 30 31a Alimony paid b Recipient's SSN ► 31a 32 Add lines 23 through 31a ..................... . ........ 32 2,000 33 18,018 33 Subtract line 32 from line 22. This is your adjusted gross Income . ► For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, see page 72. EEA Form 1040 (2001) Forrn 1040 (2601) r, `;,f#a j +'" "' Page 2 LIDIA MANDELBAUM 357-42-8914 Tax and 34 Amount from line 33 (adjusted gross income) •............ .... 35a 'Checkif:ElYouwere 65orolder,E] Blind; []spousewas 65orolder,E) Blind. 34 8 018 Credits Standard Add the number of boxes checked above and enter the total here ....... ► 35a - Deduction b If you are married filing separately and your spouse Itemizes deductions, or for— you were a dual -status alien, see page 31 and check here . ...... ► 35b ❑ M a People who 36 Itemized deductions (from Schedule A) or your standard deduction (see left margin) • . checked any 36 4,550 37 box online 37 Subtract line 36 from line 34 .........:............. ........ 13,468 who cor an Geor 38 if line 34 is $99,725 or less, multiply $2,900 by the total number of exemptions claimed on claimed as a line 6d. If line 34 is over $99,725, see the worksheet on page 32 ............. dependent 38 2,900 39 see page 91. 39 Taxable income. Subtract line 38 from line 37. If line 38 Is more than line 37, enter -0- 10 , 5 6 8 • All others: 40 Tax (seepage 33). Check if any tax Is from a ❑ Fonn(s) 8814 b ❑ Form 4972 ... 40 41 Single 41 Alternative minimum tax (see page 34). Attach Form 6251 ................ $4,55d 42 Add Imes 40 and 41 .................... .... .. ► Head of 42 1,586 household, 43 Foreign tax credit. Attach Form 1116It required , .. .43 $6,650 44 Credit for child and dependent care expenses. Attach Pon 2441 . . 44 arriiefiling 45 Credit for the elderly or the disabled. Attach Schedule R .. 45 8u 11ifyingg 46 Education credits. Attach Form 8863 ............. 46 widower , $7,600 47 Rate reduction credit. See the worksheet on page 36 ... 47 Married 48 Child tax credit (see page 37) ................ 48 tiling separately, 49 Adoption credit. Attach Form 8839 ..... ....... 49 $3,800 50 Other credits from: a Form 3800 b ❑ Form 8396 8 - c ❑ Fonn 8801t d Form (specify) 50 61 Add Imes 43 through 50. These are your total credits ................... 51 52 Subtract line 51 from line 42. If line 51 is more than line 42, enter -0. .......... ► 52 Other 53 Self-employment tax. Attach Schedule SE ....................... 53 54 Taxes 54 Social security and Medicare tax on tip income not reported to employer. Ahach Form 4137 . 55 55 Tax on quall0edplans, Including IRAs, and othortax-favored accounts. Attach Farm 53291t required . . . 56 56 Advance earned Income credit payments from Form(s) W-2 ........ ........ 57 57 Household employment taxes. Attach Schedule H .................... 58 Add lines 52 through 57. This Is our total tax ..................... ► 1, 5 8 6 58 Payments 59 Federal Income tax withheld from Forms W-2 and 1099 ... 59 1, 116 If you have a 60 2001 estimated tax payments and amount applied from 2000 return . . . 60 61a qualifying 61a Earned income credit (EIC) ....... ...... child, attach b Nontaxable earned Income ..... 61b Schedule EIC. � 62 9zcass social socially and RRTA lax withheld (see page 51) . .. . . . . 62.. 63 63 Additional child tax credit. Attach Form 8812 ........ 64 64 Amount paid with request for extension to file (seepage 51) .. 65 Olherpayments. Check If from a ❑ Fortn 243e b ❑ Farm 4136 • 65 .. ► 66 66 Add lines 59, 60, 61a, and 62 through 65. These are your total payments 1, 116 Refund 67 If line 66 IS more than line 58, subtract line 5e from line 66. This is the mount you overpaid . . . . . . 67 68a Direct 68a Amount of line 67 you want refunded to you ..................... ► deposit? See ► b Routing number ►c Type: Check(ng 0 Savings page 61and fill In 68b0-d Account number , 68c, and68d. 69 Amount of line 67you want applledlayour2002es5moledtax .► 69 70 470 Amount 70 Amount you owe. Subtract line 66 from line 58. For details on how to pay, see page 52 ► You Owe 71 Estimated tax penalty. Also Include on line 70 ......... 171 •- Third Party Do you want to allow another person to discuss this return with the IRS (see page 53)? Lj Yes. Complete the following. X No Designee Designee's name Phone no. Personal Identification P. ► number(PIN) ► F-E—E-70 Sign Under penalties of perjury, I declare that l have examined this return and accompanying schedules and statements, and to the best of my knowledge and Here belief, they are true, correct, and complete. Declaratlan of preparer(other than taxpayer) Is based on all information of which preparer has any knowledge. Joint return? Ycursignmore Date Your occupation Daytime phone number See page19. 714-549-1959 Keep a Copy Spouse's signature. If ajoinl return, bath mustslgn. for your Date Spouse's occupation records. Preparers Paid Date Checkll Preparers SSN or PTIN 1 signature 04-09-2002 self-employed X 437-17-1820 Preparer's Firm's name (or M M GHAFFARI Use Only itself EIN 95-9547298 yours -employed), 1223 WILSHIRE BLVD. 658 address, and 21P code SANTA MONICA CA 90403 lPhoneno. 310-393-8090 EEA Form 1040 (2001) SCHEDULE C Profit or Loss From. Business rAn No. 154S0074 (Form 1040) (Sole Proprietorship) 2001 Depenmentalthe Treasury ► Partnerships, joint ventures, etc., must file Form 1065 or Form 1065-B. mentInternal Revenue service (99) ► Attach to Form 1040 or Form 1041. ► See Instructions for Schedule C (Form1040). nce No. 09 Name of proprietor Social security number (SSN) LIDIA MANDELBAUM I 3517-42-8914., A Principal business or profession, Including product or service (seepage C-1 of the Instructions) IS Ent"codafmnpocon;W&B ^ ^ ^ C Business name. if no separate business name, leave blank. E Business address (including suite or room no.) Is. or Eirptoyortp tsanber(E M.Ir,any F Accounting method: (1) LXJ Cash (2) Lj Accrual (3) u, Other (specify) ► G Did you "materially participate" in the operation of this business during 20017If "No," seepage C-2 for limit on losses X Yes No H If you started or acquired this business during 2001, check here • ► 1 Gross receipts or sales. Caution: If this Income was reported to you on Form W-2 and the "Statutory employee" box on that form was checked, see page C-2 and check here ............. ► 2 Returns and allowances ........................................ . 3 Subtract line 2 from line 1........................................ . 4 Cost of goods sold (from line 42 on page 2) .............................. . 5 Gross profit, Subtract line 4 from line 3................................ . 6 Other Income, including Federal and state gasoline or fuel tax creditor refund (seepage C-3) ... . 16,347 7 Gross Income Add tines 5 and 6 •► I i _L .0 o, as r an 8 Advertising ........... 9 Bad debts from sales or services (see page C-3) ... 10 Car and truck expenses (see page C-3) ......... 11 Commissions and fees ..... 12 Depletion . . . . . : . . . . . . 13 Depreciation and section 179 expense deduction (not included in Part 111) (see page 0-3) .... 14 Employee benefit programs (other than on line 19) ...... 15 Insurance (other than health) .. 16 Interest: a Mortgage (paid to banks, etc.) .. In Other ............. 17 Legal and professional services ............ 18 Office expense . 8 4,613 19 Pension and profit-sharing plans 20 Rent or tease (see page C-4): a Vehicles, machinery, and equipment b Other business property .... 21 Repairs and maintenance ... 22 Supplies (not Included In Pad III) .. 23 Taxes and licenses ...... 24 Travel, moats, and entertainment: a Travel ............. b Meals and entertainment 2, 592 c Eniernondeduc. able amount in- cluded on line page c) .. d Subtract line 24c from line 24b 25 Utilities ........... 26 Wages poss employmentcredits) .. 27 Other expenses (from line 48 on page2) 19 9 20a 10 5,400 20b 21 11 22 12 23 108 13 24a 1,299 1,296 14 15 16a 24d 16b 25 17 3,805 28 27 2,508 16 464 28 Total expenses before expenses for business use of home. Add lines 8 through 271n columns ..... ► 29 Tentative profit (loss). Subtract line 28 from line 7 ............................. 30 Expenses for business use of your home. Attach Form 8829 ....................... 31 Net profit or (loss). Subtract line 30 from line 29. • If a profit, enter on Form 1040, line 12, and also on Schedule SE, line 2 (statutory employees, see peas C-5). Estates and trusts, enter on Form 1041, line 3. 1 26 1 19 , 4 93 29 (3,146) 30 31 (3,146) If a loss, you must go on to line 32. J 32 if you have a loss, check the box that describes your Investment in this activity (see page C-6). O If you checked 32a, enter the loss on Form 1040, line 12, and also on Schedule BE, line 2 32a All Investment is ati sk. (statutory employees, see page C-5). Estates and trusts, enter on Form 1041, line S. 32b e Some Investment Is not i If you checked 32b, you must attach Form 6198. at dsk. For Paperwork Reduction Act Notice, see Form 1040 instructions. SEA Schedule C (Form 1040) 2001 ,Schi Nar L FPO 33 34 35 36 (Form 1040)2001INTERI DESIGN 541990 SSN 357-42-8 Methods) used to value closing Inventory: a QX Cost b FjLower of cost or market c Other (attach explanation) Was there any change In determining quantities, costs, or valuations between opening and closing inventory? If 1 Yes "Yes; attach explanation ...................................... . Inventory at beginning of year. If different from last year's closing inventory, attach explanation .... 35 Purchases less cost of hems withdrawn for personal use ...................... . 37 Cost of labor. Do not Include any amounts paid to yourself ... • • • • • • • • • • • • • • ' • . 38 Materials and supplies ...................................... . 39 Other costs .... ........................................ . F -QX No 40 Add lines 35 through 39 --- 41 Inventory at end of year ............ ........................... 41 42 Cost of goods sold. Subtract line 41 from line 40. Enter the result here and on page 1, line 4 ' 42 28,853 l Information on Your Vehicle. Complete this part only If you are claiming car or truck expenses on line 10 and are not required to file Forth 4562 for this business. See the instructions for line 13 on page C-3 to find out If you must file. 43 When did you place your vehicle in service for business purposes? (month, day, year) n 44 Of the total number of miles you drove your vehicle during 2001, enter the number of miles you used your vehicle for: a Business b Commuting c Other 45 Do you (or your spouse) have another vehicle available for personal use? .................... Yes No 46 Was your vehicle available for personal use during off -duty hours? ....................... Yes No 47 a Do you have evidence to support your deduction? .. • • • • • • • • • • • • • ' • • ❑ Yes No b If Yes Is the evidenca written? I I Yes No a-r—s v . n�r.e. Gvnnnmc i ice. k, i�...�nangaq not Included on lines 6.26 or line 30. ACCOUNTNIG FEE 180 TELEPHONE EXP 2,174 POSTAGE EXP 154 48 Total other expenses. Enter here and on page 1, line 27 ....................... 48 2,508 Schedule C Form 1040 2001 California Resident Income Tax Return 2001 ® YES ❑ NO DO NOT ATTACH 357-42-8914 MAND 01 PBA LABEL LIDIA . MANDELBAUM Step 1 Name 1231 ALICANTE and NEW PORT BEACH CA 92660 Address 540 ATTACHMENT REOUIR P 541990 AC A R RP FOR COMPUTERIZED.USE ONLY 01 1 37 195 56 0 APE 0• 06 0 38 65 57 0 3800 0 09 0 39 0 58 0 3803 0 11 0 41 0 59 0 SCHG1 0 12 23164 42 0 60 0 5870A 0 14 0 43 0 64 0 5805 5805F '0 16 •0 44 0 65 0 959547298 17 18018 45 0 66 130 18 2960 47 0 68 0 20 274 48 0 23 0 49 0 28 0 50 130 29 0 51 0 30 0 52 0 31 0 53 0 35 0 54 0 36 0 55 0 Step 2 1 Single Filing Status 2 ❑ Married filing joint return (even If only one spouse had Income) 3 ❑ Married filing separate return. Enter spouse's social security number above and full name here Chackonlyme. 4 ❑ Head of household(wilh Qua11fy1n0 person). STOP. See lnstr. 5 ❑ Cualilyin0 widow(er) with dependent child. Enleryou spouse clad Ste.3 6 If someone can claim you (or your spouse, if married) as a dependent on their tax return, check the box here • 6 ❑ p•7 Personal: It you c ec ed x 1, 3, or 4 above, enter 1 n t e box. you c ec a ox 2 or 5, enter.2 7 1 X $79=$ 79 Exemptions to the box. If you checked the box on line 6, see Instructions ... • . .... B X $79 $ 8 Blind: Ifyou (or if married, your spouse) are visually Impaired, enter 1; If both, enter 2 ...... . 9 Senior: If you (or if married, your spouse) are 65 or older, enter 1; If both, enter 2 .......... ® 9 X $79=$ Dependent Exemptions not include yourself or your spouse. credit ... • 11 4 12 State wages from your Form(s) W-2, box 16 . . . . . . . . . . . . . . wiz L 310-1 . Step Taxable 13 Enter adjusted gross income from your 2001 federal return 13 18 018 . Income 14 California adjustments -subtractions. Enter the amount from Schedule CA (540), line 33, column B • 14 15 Subtract line 14 from line 13. If less than zero, enter the result in parentheses, See Instructions ... 15 18 018 . Altach check or money order here. 16 California adjustments - additions. Enter the amount from Schedule CA (540), line 33, column C .016 17 California adjusted gross income. Combine line 15 and line 16 ................... • 17 18018. 18 Enter the larger of your CA standard deduction OR your CA itemized deductions ......... 018 2960 . 19 Subtract line 16 from line 17. This is your taxable income. If less than zero, enter -0- 19 1505,8 . 20 Tax. Check if from ® Tar Table ❑Tax Rate Schedule ❑ FTB 3800 or El FTB 3803...... • 20 274 . Ste p 21 Exemption credits. If line 13 is over $130,831, see Instructions. Otherwise, add line 10 and line 11 21 79. tar Tax 22 Subtract line 21 from line 20. If less than zero, enter .0 . ...................... 22 Anacn cop of 23 Other taxes. Check If from ❑ Schedule G-1 and ❑ form FTB 5870A ........... 023 your Farm s) w-z, ... 24 195. Woe, on other 24 Add line 22 and line 23. Continue to Side 2 Fmms 1099 with Calilomia lax withhold. For Privacy Act Notice, getform FTS 1131. —, 54001106043 F_ Form 54oC12001 Side Your name:, Step 6 Speclal Credits and Non- refundable Renter's Credit 25 Amount from Side 1, line 24..................................... . 28 Enter credit name . code no and amount . • ► 28 . 29 Enter credit name code no and amount .. ► 29 30 To claim more than two credits, see Instructions .............. 030 31 Nonrefundable renter's credit. See instructions for 'Step 6.. ......... 031 33 Add line 28 through line 31. These are your total credits ...................... J 34 Subtract line 33 from line 25,.If less than zero, enter •0. .................... a .. . 25 195 . 33 0. 35 Alternative minimum tax. Attach Schedule P (540) .................. • • �3 Other Taxes 5 Step 7 36 Other taxes and credit recapture. See Instructions 37 Add line 34 through line 36. This is your total tax . • 37 195. Step 8 38 California Income tax withheld. See Instructions ........::::.:::38 65. Payments 39 2001 CA estimated tax and other payments.. , . N 41 41 Excess SDI. See instructions .I . ' • •• • • Child and Dependent Care Expenses Credit. See instructions; attach form FTB 3506. •42 043 M44 ■ 45 46 Add line 38. line 39, line 41, and line 45. These are your total payments 46 65. Step 47 Overpaid tax. If line 461s more than line 37, subtract line 37 from line 46 .....::. .... • • 47 Overpaid Tax 48 Amount of line 47 you want applied to your 20U2 estimated tax . i 48 or Tax Due 49 Overpaid tax available this year. Subtract line 48 from line 47 ............... % .....0 49 50 Tax due. If line 46 is less than line 37, subtract line 46 from line 37 .................. 50 130. Step 10 CA Seniors Special Fund. See instructions . .. . . 051 00 Contributions Alzheimefs Disease/Related Disorders Pond . .. . .. . 052 00 CA Fund for Senior Clgzens .. e53 00 Rare and Endangered Species Preservation Program • • • • 054 00 State Children's Trust Fund fortho Prevention of Child Abuse . . . 4i55 00 CA Breast Cancer Research Fund . . . . . . . . .056 00 CA Firefighters' Memorial Fund . . . . . . . . . . *57 00 Emergency Food Assistance Program Fund . . .. . . . .... . . . . . ill 00 CA Peace Officer Memorial Foundation Fund . . . . .059 00 Lupus Foundation of America, California Chapters Fund . . . .. . . .. . . . 060 00 64 Add line 51 through line 60. These are your total contributions ..................... *64 65 REFUND OR NO AMOUNT DUE. Subtract line 64 from line 49. Mail to: Step 11 Rotund or FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240-0009 . . . . . . . . . . . . . S65 Amount 66 AMOUNT YOU OWE. Add line 50 and line 64. Mail to: You Owe FRANCHISE TAX BOARD, PO BOX 942867, SACRAMENTO CA 94267-0001 . . . . . . . . . . . . . N 66 130. return67 Interest, late d late Step 12 68 Underpayment of estimated tax.Ch Check box: penalties 5805 attached ❑ FTB 5805F attached... N 68 Interest and 69-TotalanmunYduu. Smrinstr.................................. 693-0- �(VT Do not attach a voided check or a deposit slip. Step 13 Direct Deposit Complete this section to have your refund directly deposited. Routing number of Refund Account Type: Acc unt Checking*[] Savfngs�� numI c Checking*[]--► IMPORTAr7n Soo 'Sign YourRetum' In the Form 540 Instructions to find out if you should attach a copy of yourcomplete federal return Underponalties of per)ury, I declare that I have examined this return, Including accompanying schedules and slatemants, and to the best of 6 Sign my knowled Band beget it is true coned and complete. Here Yourslgnature Daytime phone number X (714)549-1959 It is unlawful to Spouse's signature (if aling)olnt, both must sign) forge a spouse's X Date 04-09-2002 signature. Paid preparefe signature(tleclamlion olproposer is based an ell Information of which preparerhas any knowledge) Paid prapareys SSN/PTIN 0 437-17-1820 Joint retum7 See lnslructIons. Finds name (or yours if self-employed) Finn's address FEIN 1223 WILSHIRE BLVD. 658 M M GHAFFARI SANTA MONICA CA 90403 95-9547298 Side 2Form 540C12001 ®7 54001206043 F_ '• }yl,.., ,3- = 1 '�"9 `�4''1 - .'l��`J)t,)1i).:4/'iiJj1�T,. J.. • ((`a ,)nl.. �" I•.5_ ,n }i.::F.S"fi�:Vn•ri:•��. T (f.." •)5L'1• i'• •%L S r. t4�. tin _ •.--.���)) October 24 through November 25, 2002 Aecount Number: 069-3294134 - Page 3 of 6 r • �J66,399 .-�. Other withdrawals -continued A!y�:LM'AFC^ DeaedpOon :k-.di3!cy .• ¢Amour .<- -•..................:.........................................................................................................a:;.......... 10/29 .. ATM Transfer To Checking - 10/28 Mach ID 22560 Bristol Street _Pavillions,,Santa'Ana, Clti ;;s 200.01 D222 �• •r;`l":c"•rk">;':,.'.;r,;:y:::.4'`i':$',h:=5�:krtit!,;�'S`t•.7ei�r�a.7i :• .::-1•'4- ,10/29 ATM Withdrawal - 10128 Mach ID 22560 Bristol Street Pavillions, Santa�Ana;,Ca'0222 "_',..zp_r°j 4U.0 10�29 Check Crd Purchase 10127 Chevron #0201093 Ne�+iport �eacli ;Ca:533472X} XXXXOr222 R 24.8 2346042MXQ7,4Ztjmd 5542 121042882DA, .,'.`>'. •r;,..;>:y; ;`. y r : �a : • , p =k'�• "MCC= :1c 1t... ID 00 '0222..,,., ail:` 31.4 ,10%3l Check Crd Purchase 10 29 Iiinko.'SODInc ¢#31D7 Soanta'"Ana Ca 533472XXXXXX 222!£, ' G�4­ n' ! r.. 48.9 =" ., ...:,, 7048086MZFSLN1Hym?MCC=7338121042882DA'...-:.•'..;_•%:(;-i? Check Crd Purchase 10/31 Advancerx.Com 800-966-5172 Tx 53M72XXXXXX0222;., •. ;;; : i:: 26.6 ;11�01 =' • - ill?f•.r' :!: •�iY'" 7843286N000G4W03F.'?MCC='5969 121[�42882DA' .;.• :;.. ;• " •••.- :: - 11 j04 Y'S',�, Check Crd Purchase 11/02 Trader Joe'S #00001SM2 Irvirie Ca 533472XXXXXX0222.;, ,; , i.r,s«„ 92.1 7141019N3TD4G1kfs..MCC= 5411 121042882DA ,?.';_j;:- Check Purchase 11102 Champagne French Baker. Costa Mesa_Ca 533472XXXXXX0222; c; 29,7 ,l1%04 r :..• 7045078N33DWMM99L ?MCC= 5462 121042882DA ; : ; •' ' }' ; ; °. , ; ';t; *";;': ',',; P.. •.: ">..` '•;ri' " 11/04 Check Crd Purchase 11/01 Celebrity Cleaners NeATort;Beach•Ca 533472XXXXXX0222•;•;; ; : ;. 16.7 7043194N100F9191Z ?MCC= 7216 121042882DA '' "' • - ' ' • ;'?'.. `. 11/04 Check Crd Purchase 11/01 Aaa Upholstry & Supply Santa Ana'Ca 533472XXXXXX0222 •• : 12.01 9242099N100FH9Jfe ?MCC= 5714 121042882DA 11/07 ATM Withdrawal - 11/07 Mach ID 22560 Bristol•Street Pavillions, Santa Ana, Ca•b222 •, 40.0 11/07 Bk Of Am Crd ACH Paybyphone 021105 Mandelbaum 402411600596738300D000 ,` 10D.0 „ 11/07 Check Crd Purchase 11105 Mini U Storage 11506 Newport'Beac Ca 533472XXXXXX0222 •• ,, _",. 98.0 c 7848051N6E7Hrayls'?MCC=4225121042882.DA ... , ;11/O8 Overdraft Fee • '• : ,; ' • . ' • ,, ',::- :. 3G.f 11/OS POS Purchase - 11/09 Mach ID 000000 1785 BelMowerarco Paypolong Beach Ca 0222 .. 23.( ;11/03 Check Crd Purchase 10/25 Nello Cucina Ristorant Costa Mesa Ca 533472XXXXXX0222 13.: 7544298N7232DNV7Q ?MCC = 5812 121042882DA 11/08 Check Crd Purchase 11106 Mello Cucina Ristorant Costa Mesa Ca 533472XXXXXX0222 13.: 7044298N7232DNV1E ?MCC= 5812 121042882DA 11/12 Overdraft Fee 30A 11/12 Overdraft Fee > ' •`;' 30A 11/12 Overdraft Pee 30A _. - - -- - - -- ... �.,.,� _ .__ _._ _." ... <,<r..<, 041 7854186N803R4QJD9 ?MCC= 4814 121042882DA 11/12 Check Crd Purchase 11/07 Experian Internet Cred 714-8307191 Ca 533472XXXXXX0222 14.! 7841117N892MAYOEp ?MCC= 7321 121042882DA 12•: 11/12 Check Crd Purchase 11/06 Nello Cucina Ristorant Costa Mesa Ca 533472XXXXXX0222 7844298NA232Hfkga ?MCC= 5812 121042882DA 11112 Check Crd Purchase 11/07 Champagne French Baker Costa Mesa Ca 533472XXXXXX0222 6• 7045078N83DWMM8Pd ?MCC= 5462 121042882DA 11114 Check Crd Purchase 11/12 Trader Joe'S ##000O1SM2Irvine Ca 533472XXXXXX0222 3b. 7141019NDTD6'LHV7W ?MCC=5411 121042882DA 17. 11/14 Check Crd Purchase 11112 SouthcoasL Brewery Irvine Ca 533472XXXXXX0222 801253ONEGQ5FSYZ0 ?MCC= 5� 12 121042882DA 11115 Check Crd Purchase 11113 Nello Cucina Ristorant Costa Mesa Ca 533472XXXXXX0222 Is. 7044298NE232Q1U9X ?MCC= 5812 121042882DA 31. 11/18 • Check Crd Purchase I1/16 Petco Newport Beach Ca 533472XXXXXX0222 8048307iv1•I6R7AZ61"g?MCC= 5995 121042882DA 21 11/18 Check Crd Purchase 11/15 Las Brisas #0046 Laguna Beach Ca 533472XXXXXX0222 • 7054751 NO3Dfkvvvr ?MCC= 5812 121042882DA J'Y aah(,1' fv.l.?„'•., e � .Yr:.. �i .�`.:u� �..C�9mr4Tr:G.P.Y.:S`I,C.Lre1^� Y-„-1,y �hii.?Y1f:Y.�:Y'J:S 9^��v GUN4r , ,.,+',1 J)'Q'v`tid7'V:EL'^i'vm9.tvf` �. J: N' :'13,-^,,.^'Y.•i�li }y yy�y TCh+f• CM.14-R.^a.�t e, •._ f- =e�,. J `i1�:t.:C-..:....:.L^'3 . ,^'�.N;^��„Y �t l.C�"xiLNJ£YG.n•/(: '- :t: •_,C :L',. :!]Uwtt e Ir:".'• '•l B Octoi ei 24 through November 25, 2002 :Account Number: 069-3294134 '' ''' ' `'' -• Page 4 of 6 ' , 166,400 - Other withdrawals -continued "'Pate DesedpUon ', ,- r • ;t.• ; - t'�"-'"'' $ Amou .:.....................................................................................:.r........................................................... ',11/18 Check Crd Purchase 11115 Las Brisas #0046 Labha Beach:Ca'533472XXXX;{X0222 i.'.l"-" 10.: 7054751NG31)ikvxlr'?MCC=5812121042882DA'• ".' 18 Check Crd Purchase 11/16 Champagne French Baker Costa Mesa Ca 533472XXX}CXXU222' . rY: n-m -: , .: x-�vai.., 7045078NII3DWNII 97X'?MCC=5462121042882T)A ;!:,;:">` "- :.,`a_.-<.°�-:ra'.„.._ •.• .11/18 -Check Crd Purchase 11/17 Champagne French-Baker'Costa'IvIesa C a'533472XXXXXX0222'� s, . 6.S 7045078NI-I3DWMMSRy?1VICC=5462.121042882DA '':`"==n :' :t.: '`. -' y c`:In '=;i1<ri• ii, , -. r• 8 . � Nnr.. t.{-�,,,y. . Check Crd Purchase 11/09 Nello Cucina 12istcrant'Cdki" Mesa" Ca_'�33472XXXXXX0222 "aau;t-;' 6,( 7544298NI-I2320JL9E ?MCC= 5812 121042882DA :11(19 ATM Withdrawal - i l/19 Mach II) 2406A 3333 Bristol, Costa`Mesa;=Ca`0222 ; u;`;:`°:' 40r( 11/191 Check Crd Purchase 11/17 Nello Cucina Ristoriiiti,Costa'Me'sa'Ca'533472XXXXXX0222"`;T•. .: 25.z ' 7044298NJ232Dmxgq'?MCC;=S$12121U42882Di�:': •i ::`: s: :'t,"•:j_' _ ;.'.?w-. ". Check Crd Purchast 11/18 Champagne F rench'Baker'Cost:,,, a Ca 533472XX'XX7iX0222 ^ ; :. 11.: ,11/20 ' 7045078NK3DWMM915 MCC=546212104_882DAs''_ I i%21 A.G.I.S. Investment 021120 000004718898113 lidia N>Mandelbauni ' � •'; •- • ; --,'� �� . • �•' . � s is • .• �. 11121 A.G.I.S. Investment 021120 060004718898113 Lidia N Mandelbatim 33.. ,11/21 A.G.I.S. Investment 021120 000004718898113 Lidia N &Iandelbaum ' =_ :• " - "; i 33.. ;11/21 A.G,I.S. Investment 021120 000004718898113 Lidia N Mandelbautn :::' 3.3.: 11/21 A.G.I.S. Investment 021120 000004718898113 Lidia N Mandelbaum ,: '"•' '' ' ` ;r'' 33.5 .I1/2l Check Crd Purchase 11/19 Quattro C:af£e Costa Mesa'Ca 532472XXXXXX0222 <;,-: ''' '''" ` 19.1 7044298NL232QY5Qq ?MCC= 5812 121042882DA, , ~l 1121 Check Crd Purchase I V19 Aveda Iils#724 Costa Mesa Ca 5334,72XXXXXX0222 e. '' 17.. 7049967NL611-I5Paya ?MCC =7230121042882DA 11/22 Check Crd Purchase-1.1/20 Bandera Corona Del Ma Ca 533472XXXXXX0222' '.• ' 28.. 7U41117NM9L'r2PKF9 ?MCC= 5812 121042882DA '11/22 Check Crd Purchase 11/20 Chevron #0201093 Newport Beach Ca 533472XXXXXX0222 ' 24.: 2346042NMQ74LRXV3 ?MCC = 5542 121042882DA 11/22 Check Crd Purchase 11/20 Champagne French Baker Costa Mesa Ca 533472XXXXXX0222 "' 9.( 7045078\M3DWMM9T2?MCC= 5462 121042882DA 11%25 ATM Withdrawid - 11/23 Mach ID 2406A 3333 Bristol, Costa Mesa, Ca 0222 20.( 11/25 Check Crd Purchase 11/22 Trader Joe'S #00001SM2 Irvine Ca 533472XXXXXX0222 55.1 7141019MUD6W712P ?MCC= 5411 121042882DA 11p3—T -,eek C-r ,3-� avers "�1 "0 ForteAve,�stfBi-beguna—Bd!• ae _ �,,,,��..v�•.I ,V222i 504 70547501N3Jynnl v'?i44CC=5812121042882DA 11/25 Check Crd Purchase 11/23 Dupuis Of Costa Mesa Costa Mesa Ca 533472XXXXXX0222 44.4 7047082NRS6D0Ydvb ?MCC= 5722 121042882DA 11/25 Check Crd Purchase 11/22 Cafe De France Irving Ca 533472XXXXXX0222 11.( 8048307NP6RTE5Mhs ?MCC= 5411 121042882DA 11/25 Check Crd Purchase 11/21 Champagne French Baker Costa Mesa Ca 533472XXXXXX0222 6J 7045078NN31)WMYI8Y7'?MCC= 5462 121042882DA 11/25 Checks Returned With Statement Fee 2•: 11j25 Monthly Service Fee 9.! 11/25 POS Uxtge Fee I J ................... ................................................................................................................................. Total other withdrawals $2.187.: 'i.l oa,,tt•ith. r,..drarr..tr..a.l.s............................................................................................................................... otta55,917.' through blovembei "25 2002 ' cto er• _ Account 000T:`069-3294134 Page 5 of 6 . - . ; 166,401 Daily balance smnmary •, 22 ' ':' Date $ Balance ' Date`'. 10123 1014.74 '::11/04 10/25 :611.85 -11/67: ;. -' :='• ,.r• IO/28 s447.04, :.<M1t^Yll/OS.e i;. >4 a-;,:•'r! . : •. _. ,j ,d;,`18215, ",' tii1�12,; •i 10/30 r' := :il/14. ; %2407..a ^ Balance :Date-,. 10/31 196.27 • 1 , _.:' .,: t. a t>; 11/0l 552.28: 11�18 ,-:•.",' A 832.44 a;fi•: .. •�. .ram 1.: ;',f=.�z .v-: ,:r='; , yi ',e_. :,..... , Direct Deposit Advance.O;ender"- Wells;Far ii;,Bahk-N&hd '•N.A.) %' Outstanding balance. as'of last statexne'nt,;:'S _ x- Outstanding balance as of this'statemenf DO SOMETHING•FAST TO AVOID OVERDRAFTS AND RE•L-ATED FEES! CHOOSE THE DIRECT ADVANCE SERVICE TO ACCESS UP TO $500 PRIOR TO RECEIVING YOUR RECURRING DIRECT DEPOSIT.'' JUST USE THE ATM, ONLINE OR CALL THE PHONE BANK: SEE YOUR CONSUMER ACCOUNT,FEE-i'ar, INCOME. AND INFORMATION SCHEDULE FOR COMPLETE'DETAILS. . E WellsEa'tra Savings wn "' Lidia N Mandelbaum Account Numbai: ; 664-3293418 Activity, summary,., : Balance on 10/23 . $0.00 Deposits and iriterest 0.00 Witlidravvals - 010 :...............................:.:.........::....... 13alance on 11/25 $100 Interest you've earned Interest earned during this period 50 o Average collected balance this period $010 Annual percentage yield earned 010% Interest and bonuses paid to date this year $0.00 $ Balanc 1,257.0 1,245.7 1,042,E 933.( 734.1 $0.00 $0.00 •ca:ix:Ra-:r, 5, r•:n'Ys-Tr`_aacGffi��atT.'d: . •Y.iMTCn`•T .:Ti59.xrt , `ini awls•: •fn" Account Balance• Cak 1. Use the •following worksl • balance: -: 11,1 .• . • 2. Go through your register transaction, payment, deer Be sure that your register and any service charges, withdrawn from your aCCOL 3. Use the chart below,'Iisl outstanding checks,'ATM withdrawals (including any • but your register not shover sted sing a home or refinancing your current one? Call us at l-800-866.0743 a student loan? Callusalt-888-945.5373 •• in9the equityinyour home? Call us att-Boo-777.3000 nrormafina an nap arnducrs and services visit as at Welisfaroo.com • '-ITEMS OUTSTANDING `��...: �.:: �'. �"v�i:-- NUMBER „ira ii'AMOLINT."-`{^r":k`1- rc. • 7. , a; cxe. v; TOTAL $ ' ka ENTER ® The NEW BALANCE shown on yaursteemont...................................................... 0 ADD © Any deposits listed In your s register or transfers into 3 your account which are not s shown on your statement +S TOTAL ................. P' CALCULATE THE SUBTOTAL ................. (Add Pans A and 8) ® SUBTRACT © The total outctarding checks and withdrawals from the than above .................... ros CALCULATE THE ENDING BALANCE (Pan A+Pan B - Pail Of This amount should Le the sane as the current balance shown rn your cheek register ........................................ Line of Credit Information Each principal balance shown on the reverse side reprepsents the unpaid amount of ban advances under your line of credit for that day and each Uay thereafter until a change in the principal balance is shown. The Finance Charge will be determined as follows: • Determine the principal balance for each day during this statement period; then • Multiply the principal batance,lor each day during this statement period by the daily periodic, rate in ellect for such day; and - • Add these results II your account Is subject to Balance Based Pricing, the daily periodic ra!e and corresponding Annual Percentage Rate (APR) tell be detenninea each day based on the outstanding balance of your account. The daily periodic rale�and corresponding APR applicable to each balance range are shown in the Summary of finance charges section on therevarseside. . s'i,. if your accouril Is subject to a. Promotional Discount, You} total finance charge for the statement period is calculated by subtracting from the above•described standard finance charge calculation a prltmolional Interest credit applicable to all Promotional Period net advanaae nn vnur account durma the billino cycle. Your "net advances" are that iVrlion of subtracting an payments or croons mar exceea me punuipat uaiance in yuur, accuum immediately before your Promotional Period began ("Principal balance before promotional advance period began"). This promotional interest credit is calculated by adding your net advance for each day during the Promotional Period in the billing cycle and dividing this number by the number of Promotional Period days In the billing cycle resullin§ in your aJerage.daily promotional balance. Your average daily piomollonal balance, 1s then multiplied by the number of Promotional Period days in the billing cycle and by Ihe'daily periodic rate for the promotional Interest credit rate resulting in, the promotional Interest credit. The promotional interest credit is 'hen subtracted Irom Iha total finance charge al your standard rates) to obtain the total finance charge shown on the front of this. statement. Any transaction charges or processing charges shown on the reverse sde of Ihis statement also must be added to active at the Intel Finance Charge for this period. Loan payments received alter normal business hours Will be credited the following business day. Normal buslnass hours are posted In each allies or branch and will be Iurn"had upon request, or may be obtained by calling. it" customer service phone number listed on the from of this statement. In Case of Errors or Questions About Your Credit Line Transactions II you think your bill is wrong. or it you need more Information about a transaction on your bill, write us at Ilia address shown on the front of this statement as soon as possible. We must hear from you no later than 60 days after the sent you the first bill on which the error or problem bppeared. You can telephone us, but doing so will not preserve your rights. in your letter, give us the following Information: Your name and account number The dollar amount of the suspected error Describe the error and explain, it you can, why you believe there is an error. If you need more information. describe the item you are unsure about. You do not have to pay any amount in question while the are Investigating, but you we still obligated to pay the parts of your bill that are not in question. While we Investigate your question, we cannot report you as delinquent or take any action to collect the antotml you question. Special Rule for Credit Card Purchases. II you have a problem with the quality of goods or services Thal you purchased with acredit card, and you have triad In good lath 'a correct Iha problem with the merchant, you maynot have to pay the remaining amounldus on the goods or services. You have Ihis prateclron only when the purchase price was mare than $ 50 and the purchase was made in your home stale, or within 100 miles of your maililtg address. (II the own Oro r operate the March ail, or it we mailed you the advertisement for the property or services, all purchases are covered regardless ol'amotinl or lmation of purchase.) if You Suspect Errors or Have Questions About Electronic Transactions Including Direct Deposit Advance ° Transactions) on Your Regu!(ar Deposit Account, Please Call Us immediately. Or, it you believe there is an error on your statement or ATM receipt or if you need more Information about a transaction listed on this statement, please contact us immediately. We are available 24 hours a day, seven days a week. Please call the telephone number printed on the front of this statement. Or you may write us at Wells Fargo Bank, P.O. s Box 6995, Portland, OR 97228-6995. t. Tellus your name and account or ATM card number. s 2. As clearly as you can, describe the error or the transfer you are unsure about and explain why you need more Information. 3. Teli us the dollar amount of the suspected error. You must report the suspected error to us no later than 60 days alter the sent you the fast statement on which the problem appeared. We will investigate your question and wall .ju correct any error promptly. II our investigation takes longer than 10 business days (or 20 -s clays in the case of electronic purchases) we will temporarily credit your account fir the amount you believe is in error, so that you have use of the money unl,l our invesfgation is complated. It the error concerns a Direct Deposit Advance transaction, you do not have to pay any amount in question while we are investigating but you are still obligated to pay the parts of your Direct Deposit Advance transaction that are not in ouestion. While we are investigating your question, we cannot report you as delinquent or take any action to Obligor the amount you question. t 1 Members FDIC. 6AeuT '; r�Fi;.1, 4 r•:-.':'i%.�J.ia'�.l•FSi ni:�ia`ii`:.-Tu.A�?� m�a.`.::^�IS'ly'�iS?'Y ��'kc�r�P`:t�;�gbl',l•a1 Y``.^.ii'�:'��.`T5's 1 �'t J'vtla �-;tip, �•, ��L.•¢.I�.tri?e:?•b�'-ti:t•-^t,.•�s.:; •,xvwz•J� q•.n - - .3 a •i ..., v rr.^• -x�t:zs Sepfeaiber 25 through October 23+'2002 Account Number: 069-3294.134' ; Page 1 of 6 174,687 LIDIA N"MANDELBAUM 1231.ALICANTE NEWPORT,BEACH CA 92660-3285 .r n [ i-rC•.`'.•r •, (rr .: •1: `'?R�ItM : FJ!�'. >Lr'V'u ' \' :ii _-•' w•.. Y.l;w� �1.:. • :Coy✓�'r[ - v:_�'r., :•.ti"rx.A. •"- �1.. C'i rS'.K+� \•NOVA•'> ..J. 'Tr'" - ax.• 3i•^ -tlhv?'13Ci •'v'•w•+. :'i•; •.v a: ,',�.;5 •TM: .•�tia',_-y.-..' ✓.='.r:.:.l`-'':i ,. Ttiankyou.tor banking wit 6-11s Fargo: or assistance; oall: 1.800 TO WELLS ,the hoarin „tI0„VM V a.Jr• �. .�,Snn :Are - aJ�-'i�.yiCM1 :1i1-Y ar•i r:r-Y I. r. r4r._ . .f ;✓. „' r-bq•.f;.^SY; '.•:,�;. t.r.,.•dl:Jh'd r'a••.11 NEED:CASH:FAST?-IN:JUSTtiHOURS_YOU-CAN:HAVE THE,;.CREDIT.'YOU, NEED'TO'BUY,-A.CAR,'TAKE A•VACATION CONSOLIDATE, PILLS•-WHAYEVER YOU OHOOSE."APPLY FOR A`P RSONAL LINE_OR LOAN ONLINE TObAY.-JUST GO TC WELLSFARGOSPECIAL,COM A144 ENTER KEYWORD: EASY LOAF { : d'•.'i { ; : ._: .': L":i EVERY TIME YOU USE YOUR .WELLS FARGO CREDIT 'CARD FOR'PURCHASES, EARN;FOINTS FOR TRAVEL AND GIFI -'CERTIFICATES WHEN YOU'RE ENROLLED IN THE WELLS FARGO REWARD PROGRAM.:IF YOU'RE NOT ENROLLED; SIGN OF TODAY. IF YOU'RE NOT A CARDHOLDER TALK TO YOUR BANKER OR.GO TO WELLSFARGOSF'ECIAL.COM AND ENTEF KEYWORD CCREWARDS TO APPLY FOR YOUR CREDIT CARD AND THE OPTIONAL -WELLS FARGO REWARDS PROGRAM. IF YOU RESIDE OR TRAVEL OUTSIDE OF THE'UNITED STATES OR CANADA, BEGINNING'NOVEMBER 1, 2002 YOU WILL NEED TO CALL AN MCI OPERATOR TO REACH WELLS FARGO PHONE BANK INTERNATIONA_LLY;FOk ACCOUNT SERVICING .YOU WILL NO LONGER BE ABLE TO CALL -FROM AN INTERNATIONAL LOCATION USING AN AT&Y.OPERATOR. IF YOU NEE[ MCI COUNTRY ACCESS NUMBERS FOR USE, PLEASE INQUIkE WITH A WELLS FARGO PHONE BANKER'.' Account'Sumiiiary • - Daily access accounts'. Account Account number Balance last period Balaneelhispedo .....................................:................................................. ....................................................... Stagecoach Checking' 069-3294134' $789.99 $1,014.7: Wellsfixtra Savings 664-3293418 0.00 0.0 ...................................................................4...........................•....................................I.........,...... Total $789.99 $1,014.7' Stagecoach Checking Lidia N Mandelbaum Account Number: 069-3294134 Activity summary Balance on 09124 $789.99 Deposits 8,506.50 Withdrawals' 8,281.75 l;alance on 10/23 $1,014.74 1•p�•'n� ,jy.,;-=ti,:.yVyjri,m wnrT�•#Iri'+'.4iZ1.T�!L='41YY�C _ "r `ra�uC.li:l. SRii:3 r,�"i �'+° ••. Fln�Af.4siD3.'V:•:Jgyrs4. lin l." � `qF FS[�SnM September 25 thrbugh dctober 23, 2002 Account Nurhbei: 069-3294134 ' Page 2 of 6 174,688 ,• ,Activity detail - De -:.. ... osits Date . Description ,r.;�•• `. :, •:�'•r" $Amoon b' :i.' �'�•�`"r'�lri; \^ i:• ........ ••4:.Y I-J 6....... ................................'; .09/25: �Iri'-/.• _i'}-:h.9hr"F'P'�• i:[.`:JS,"{.3'ItCS:_'nw•lj'i%u-�^]"Yh•Yt�••••:.\',:J'f•': Deposit;(E x' :x::.=.::•;ti;:;::: + 1137.84 i0930'Dept? L :, .: .r-,• _ - ..'h. 4.'''•n'.J,� !•Y1rL< iA.r .:-Sllh ti)ii}ES' •i.4'.r• t; .d:.:v.__ _ _ :..;":. :.._. ;r.., ' • V '•a1 •''^' '`i'<J:r •i. �i idi11. Ctir;..:::. My.. ..� 355.0; . 10/03'" 1. -a:J •.a.T�•'H3.-i,,• • 4P-BL._ _..-'� R•:S-0`...TSY ,S^ xGCt".OYi: " :^.'F�tU•+"•' Tele'1'ransfer' Ft-Che'ck'ing:0376190633 Reference';# TFfff 3�O : _. ; � - •• 1 500.00 `-10/04 ;r• ,, :.... 4 + i s:a ., : co •:rt `-5• :': A,;:: ' Royal SdEdinkvi'Payrbl1 093002-357428914 Mandel aum; Lidia NY ",.' . - • g=' a • •..4.: 982.6 _ 10/15 ATM'Deposit-.1OJ13 Mach ID,2256N Bnsto)1•,Street-Pavillions,•Santa•"Ana;.:Ca 0222;::•'. ':-:.,.- ' ':'.;y, 401.9, • 10115 Tele=Trdrnsfei Fr.Checkiig 0376190633 keference_" ;; x :';;,'-=•'•. J• 1.•:,F:' 20oAL :10/17 ,TFL7TS647P; T'ele Transfei`Pr Checkirig;0376190633 Refeience:q#,%Th'E71 S711lig'4'">_,','_. "-arty.' rill A 4 3. is,: 2,700.01 • 10/18 Royal Scaiidinavi' payroll :101402,357428914:Mandelbaum, lidia:l�,1';,tws;Y, ;;y ; 982.E 10/18 r _ ;r: •;: Royal Scandinav Pgyroll''101402 35742x914 Maridelbaum l�idia';I� `N. ' ;.' 'ir:„'rl,';'- ' . 244.3_ • 10/23 ,'.'„ Discountl70r ACH Direcf Deposits =;;'` �• s ;: ` t: {" ;' tzc : 2.0( .r r 1 Y. - 'n -v,. _••:'t'•�,!•?)�:.'-0R�IS�-.u.�5�i�'�I rTe".' - • :.1:.• • r • • ,_t'. .•.A. Si' •. �'iu'J ...• �YS ". •'.•Tr' ,�4:� •i ri.:PV•t: r:l r.G �'�: • Total deposits '-' ;;,. '' '• - ............. $8,506.5( Withdrawals t -)Checks ;` ` , :: •' l:" " -'t. '':; y,- : ; i $Number Date $Amount ' `ftdutn6er -' Date' -•$Amount' ,f•-Numb'er'„•Date "-• $Amoun t 1114' 09/25 ', "; 100.00': 1119 - lU 04.,^";- ".-1;269.00 ' ' 1124,•`;:': ;10/07„ 1O.0( :1115 09/25 : 75.46 ":J120 •; .' •19/08 '' _' - ;421`.•9,0 1125_, ; ; '•,10/07; 475.01 111E . 10/04 100:00 1121 10/16",' ' 56.00 1126'•-".- 10/08- 9.7t. 1117 10/03 76.00 1122" 1OJ04' ` 200.00 ' •1127''•.' `' 10/11 106.6: 1118 10/07 400.00 1123 10/08•'• .. : 44.00 1129* 10121 2,700.0( ...................................................................................................................:.................................. Total checks $6,037.7E " Cap in Check Sequence • _ • - Other withdrawals Date Description $ Amour .............................................................. 09/25 .............. ...................................................................... T'ele-Transfer To Checking 0376190633 Reference ## TFH22Pyskp 870.0( 09/25 Check Crd Purchase 09/23 Chevron #0201093 Newport Beach Ca 533472XXXXXX0222 25.2( 2346042LVQ74ZT2NI ?MCC=5542121042882DA 09/25 Check Crd Purchase 09/23 Champagne French Baker Costa Mesa Ca 533472XXXXXX0222 5.11 7045O78LV3DWMM909 ?MCC= 5462 121042882DA 09/26 ATM Withdrawal - 09/26 Mach ID CA333430 3333 Bear Streecrystal C-ocosta Mesa, Ca 0222 101.51 09/26 Non -Wells Fargo ATM Transaction Fee 2.01 09/26 Check Crd Purchase 09/24 Nello Cucina Ristorant Costa Mesa Ca 533472XXXXXX0222 10.01 7044298LNV232QI1028 ?MCC= 5812 121042882DA 09/30 PUS Purchase - 09,'28 Mach ID 000000 4541 Campus Drialbertsoti Irvine Ca 0222 1123. 09/30 Check Crd Purchase 09/28 Trader Joe'S 400001SM2 Irvine Ca 533472XXXXXX0222 72.8 7141019NlO`l'D5M1v1X51? 9MCC=5411 121042892DA 09/30 Check Crd Purchase 09jA Trader Joe'S #00001SM2 Irvine Ca 533472XXXXXX0222 32.9 7141O19MOTD5M31C6C3 ?MCC= 5411 121042882DA 09/30 Check Crd Purchase 09128 Chevron #0091921 Santa Ana Ca 533472XXXXXX0222 25.0 2346042MOQ74Zntds ?)vICC= 5542 121042882DA )f. ....... ., ,• , :.fi••,.F:- • :Y , "E <:,dgny.,r: •� .—•cnax»rxrtax .I ^Y-A}M�Fr��t_V•• CLS :.., ... • .. e . -- .:. •=.F'TI}'rq/y ... ,�f^lX4i:Xj il:y:•, A4u � �eFyx��•-• Sept@tuber 25 through October 23, 2002 s•'-=;:; l Acadu'nt Number: 069-3294134 .'Page 3 of 6 . v:G - .• :.Yll - . O;her withdrmvals -continued :. cam;= •-_f :. Dflte. Descri lion $Arnow ... ..::.. .... ............................................ 09130; Check Crd Purchase 09/28 Aol*online Service•090 800-827:6364 VA 533472XXXXXX0215Y,£ „,.. 23.9 7543286M000SJVB29-?MCC=4816121042882DA,, � ns ,:•t; _• 09/30 Check Crd Purchase 09/27 Nello *Cucina Ristorant;Costa Mesa Ca 533472XXXXXX0222. -t •: n aua�tl:.aV nin°..: 12.9 r,•• t• , •. . •t.. •. _ 7044298M0232Pkwshh'1MCC=58121210428821j 09/30; 'Check Crd Purchase 09/28Kosta• Boda yet 6097685410, Ca;533472XXXXXX0222,; .y-w 11.3 ../.,. .Orrefors F"•y.::3 :,... ...fy: .._._4p: ..f �.n:,.. l..r_y ;-:: t'Srp•::.,...m�- �i 7844641L O3100K1z?MCC=5950 121042882DA ...•;•;.:•.: i_- il. •'=•' : 7 `:^:r J'In`Y91I4C:Y'S 09%30: r Check Crd Purchase 09/28 Aol*premium Service 09,-88'S-'i -02 9, VA 533472XXXXXX0215�7 t,; 4.9 7543286M000Sdzbhh?MCC=491612104288215A .=: 10/Ol Check Crd Purchase 09/30 Celebrity Cleaners Newport Beach Ca 533472XXXXY�X0222, ;7y - 2.2 7043194MI006P4A8A ?MCC =7216 121042882DAs;ti•:=<=:;;, 1OJ01 Check Crd Purchase 0 130 Orrefors, Kosta Boda #,,6097685410'Ca 533472X]CXXXX0222';:'=:x ;:.,.., 11.3 7844641M1030ZS6,F'i¢ ?MCC= 5950.12104A92DA ,2: ' 10%02 Check Cr3,I urchase 09%30 Anthony's Shoe�Repair,-,;,Newport Beach Ca533472XXXXXX,02221F,i�,' "'" 15.0 8014037M2EHP792Rk ?MCC= 7251 121042882D?, ; ° "' ;.'' : ." , = �rw :I•:.-_ "'. sa . 10/07 Check Crd Purchase 10 05 Du uis Of Costa_Mesa'Costa Mesa,,Ca 533472XXXXXX0222 i;,_;:•: ' / P -•t �, 80.8 7047082M7S6QW8Rbr ?MCC= 5722 121042882DA . ' ' _ ;;-„-, :r•+r;i,-• '10/07 Check Crd Purchase 10/04 Chevron #02016§3 Newport Beach Ca'533472XXXXXX0222',''", .11 .- 2346042M6Q74LSV'F9 ?MCC= 5542 121042882DA �•<L:4Arbt : 10/10 POS Purchase - 10/10 Mach ID 000000 27491 La Paz Arco Paypolaguna Niguelca D222 { _ 10/11 Check Crd Purchase -10/09 Aveda Lls#724 Costa Mesa Ca 533472XXXXXX0222 tsT c - 7649967MBUMOOFy?MCC=7230121042882DA 10115,Overdraft Fee :10%15 Overdraft Fee 10115 ATM Statement Fee- 10/13 Mach ID 2256N Bristol Street Pavillions, Santa Ana, Ca 0222 , 10/15 Check Crd Purchase 10/I1 3-In-1 Credit Report 866-226-3736 VA 533472XXXXXX0222 78547501MD3W 1NVA2F ?MCC= 7299 121042882DA'' 10115 Check Crd Purchase 10112 N2P*pennyWk- 973.438-3470 Nj 533472XXXXXX0222 7854186ME03RHMFSP ?MCC=4814 121042882DA ''10.117 Check Crd Purchase 10115 Quattro Caffe Costa Mesa Ca 533472XXXXXX0222' ' 7044298MH232EVRB6?MCC=5812121042882DA 10/17 Check Crd Purchase 10115 Macy*s West #058 Costa Mesa Ca 533472XXXXXX0222 ; 8044473MI-IEl1EJ2Hxt ?MCC= 5311 121042882DA 10/17 Check Crd Purchase 10/15 Macy*s West #058 Costa Mesa Ca 533472XXXXXX0222 8044473MHEPLJ211V6 ?MCC= 5311 121042882DA 10/17 Check Crd Purchase 10/16 Orrefors Kosta Boda # 6097685410 Ca 533472XXXXXX0222 7844641MH030ZXJ0S 2MCC=5950 121042882DA 10/18 Check Crd Purchase 10/16 Chevron #0091921 Santa Ana Ca 533472XXXXXX0222 2346042MJQ74ZNBOI ?MCC= 5542 121042882DA 10/18 Check Crd Purchase 10/17 Vidal Sassoon Academy Santa Monica Ca 533472XXXXXX0222 7054186MK2325KKPO ?MCC=7230 121042882DA i0/18 Check Crd Purchase 10116 Nello Cucina Ristorant Costa Mesa Ca 533472XXXXXX0222 7044298MJ232Dnxgg?MCC= 5812 121042882DA 10/21 Check Crd Purchase 10/19'I-rader Joe'S # 00001SM2 Irvine Ca 533472XXXXXX0222 714l019.MMTD4I-IL7Fw ?MCC= 5411 121042882DA 10121 Check Crd Purchase 10120 Jerry''S Famous Deli Costa Mesa Ca 53347,)%XXXXX0222 7054751 MM791)91'wzd ?MCC= 5812 121042882DA 10/21 Check Crd Purchase 10/18 Nello Cucina Ristorant Costa Mesa Ca 533472XXXXXX0222 7544298.Wv1232FKVK5 f?MCC= 5812 121042882DA ;w;, u•,. ,•;r•,rl;,;�a,.-,.�.,,><,>,,, ,'rt�.. ,1 Aa•, ': ^!'•'•: n:��'� ::\^. '.�l Vt :v�'fA.iJti�i,rvRll(I�: S: ^t,ti�:: ,l Y,l t�!'�I4 LT Al1� � '• '"'4 5j :°:( fSl-_ia..w.., Ntt.C:ti :i'y%:•..:jz= �`t ,','_ '-'`'SS .f. :i.. �hlu:V[.i r' _•Y'• ,v`ial^.I•S:La rant:.-.]'F,\4.:ALl9}�_.�,`sl'n•",:JOT ,i'�;,x�.Ry,:GFkiSi ,' '•A !:�. ;:iris; - .:. -'r.. - .' +u'LOBED '•r•a • ..cam - September 25 through October 23, 2002 Account Number: 069-3294134 Page 4 of 6 174,690 Other withdrawals, -continued ' - - "`'''•' Date DeWplion $Amount ...................... ............. .....::................................................................................. .......:'..' 10/21. Check Crd Purchase 10/19 Borders Books &mttsic##.Costa Mesa Ca:533472XX)ZXXX0222,;! ,'S:, " 19.38 . ..>,..51'_� .. •iv iJ Yr C+J.:1 TYni �:� :•• '••�•'SY �'.. 7043425MNII3ALiVITJ32 ?MCC= 5942'121042882DA'.r'' ;;; "`',;;. i :;,.=-„! •,•..:r•:' Crd Pu'r"chase:10J17.liooters"Of' anta'Monl;S014-"Monica:Ca`5 15.58 10/21 Check ' �'7048077NIKSSrdhrts7MCC-.5812:121042882DA_':i'�`��'���"•�;"�`,;e��,:;:.•. :�•�:>-:-•-,..,-aa'•,:,,�::.<-' lOf 21•' ' (heck Crd Puichase,l0%20 WiiltaPang.i?u'ck #�103 S�C Costa`Me'sa CA',533472XXXXXX0222-,�;• .-:. 12.78 ?-SJ:'�i 7054186MN232gP06A?M(;C='.5812,I21042882DA;`�;_';;' `• '_`°'•••��'-'' "�•' •••''""�" •'' ,�. 1'000004718898113 ,L� idia"N;Si..�^Y.i.�::�513•a•r,.....,.;:iS u•s'': i`4C,';�. 33.20 10�2•.2 10/22 A.G.I;S.'Inve,stment'621b21 000004718898113'1.1did`N4-NSarfdelbaum `{'i,. -•:? "{;'%:` '>' `' '`''''" "'`' 3320 !0/22'A.G.LS.Investmeni021021,000004718898113.Lidiavlandel)?alum:a;....::,.::.:,:"'.;':•.':,..,.:;.'• 3520 -''33.20 621'0100-0'-, 11Lia m]0/22 A:G.LS: Irivesmeiit2 , , 10J22' A.G.I.S. Ii vestment 021021 000004718898113 Li dia;i\,Menilelbaum� ,; :.,.:,, •;;�;.4; '.a_ .,, Y; ;;,r:; . 33.20 ,;Y Check Crd PurchaseM/21 Chevron #0091921 Santa Ana Cz 533 72XXAXXX0222 s 24.95 10/23 2346d42MP074ZMJ7M'?MCC=554212IG42882DA'ar::_,?: `: •::? :.,.'.;.::.':;:';fir'_':>, ,. ` Check Crd_I?uichase 1OJ18 Nello I2istoratit,Costa'Mesa` Ca'S33472XX3CR CX0222. `.: ; 6A0 10123 ,Cucina , • 7844298MI'232RDJD9 ?Mot =`'5812121042882Dt�:' 10/23 Checks Returned With Statement Pee "' _ 2.50 10/23 Monthly Service Tee 9.50 10123 POS Usage Fee 1.00 -. .................... ................. `Total other withdrawals - $2,243.97 :, _. ............................ ................................. ...:....................... •'...... ......... ......................................... ' ' ' S8,281.75 ''Total withdrawals Daily balance summary , Date $ Balance 09/24 ' 789.99 09/25 851.93. 09/26 738.43 09/30 796.93 10/01 753.42 10,102 738.39 10/03 2,162.39 . Date ,' '$ Balance ' Date ; . $ Balance ............................................' 10/04 1,576.02 ' .....:............................ 10/17.". �...0 . _,97J.34 10/07 585.18 , :10/18' ' 4,151.17 109.50 ' _ ' 10/21 •. , 1,222.69 • 10/10 84.10 10/22 1,056.69 '10111 39.77 •;' 10/23 1,014.74 10/ 15 446.25 10/16 396.25 ' Direct Deposit Advance (Lender - Wells Fargo Bank Nevada, N.A.) Outstanding balance as of last statement $0.00 Outstanding balance as of this statement $0.00 DO SOMETHING FAST TO AVOID OVERDRAFTS AND RELATED FEES! CHOOSE THE DIRECT DEPOSIT ADVANCE SERVICE TO ACCESS UP TO $500 PRIOR TO RECEIVING YOUR RECURRING DIRECT DEPOSIT INCOME. JUST USE THE ATM OR CALL THE PHONE BANK. SEE YOUR CONSUMER ACCOUNT FEE AND INFORMATION SCHEDULE FOR COMPLETE DETAILS. 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Js?4r,�iri�t ���:. _ •r• �, :.T�Y-.r: , !r,•U'Itn ,•t � , dY:4:''..MVJ9G h:_.•�b. =YYJYC Y11a':JiSC l'S`1�itp`:�i .•.0 • +. trV r .Deposits and''interestt.•`i Withdraipals:,- :; :' :;1' `.<::I,';id,; ' „. : ,r • , _=..Lp,. :f:•.Y, .. , ,••.::,:•:1:• ,:: ,_:',;^:::. : r . r.h'.:= l�'}•' Mtn'. `eCiG iPi"M1 iY:+.r.v't�}t!`�.:f�n•�--'`!.i-iT�.: ''Jtal:;: `::P'"�,:.'l; _•` ::j.., ..Balance"on ti 10j23.' ,,', .;: c.' ; :: :a. �, 1''f •! �.9(:• �'l l?:'L4i• a �"tU :we CItLitt 'Ip••y i' 'y. a:: �.'R•! Y: :: �„1_ v, L: -VJ'S ">lf{`.:': Jf.,j1w'E.L[c�.91.:r fi^,: ^{:iS� _ ±}9fa•t7: r'A ..J•J.. ~,•)'••'�y;• $il>5r _ T%"i^ir 4{.'if +;S i(.,ji}I%tearv> 4P^$\:'.nGn Y... .yr•<�.:y �, •. •`iV t':'-.•K .if1_ _"':'• :-}r: :C..(�2`--a'Lt.OL.�rlr..l: Sr>`Y?f.::. � i -V{: .r .'KP•.S�v •,A•�: r.T••A9:+. It:Q^Js`. ff.a,^„i �"4+:.tl1..:i. ,•' 'L�..'•� 1_ 'fi Interest•goti;ve earned; "'' i;i:. �••• J:.. •F ,;:.a';....,;.: � :"� "_�:, . . '.:�1. ':w •'f,Y:Y i:,ti' ^?'l �Y. :�:i, d: °:r•. fv Nam!•: ?�:,:: 4;4:' S0.00 Interesfearded ddr,`ing46is'perioil, -r 1, : „a; : ;'_,.: r', .... , Average lcolleeted balance this period:_ Annual percentage yield earned, ,--- r= 0.00% •' • " - interest and bonuses paid to date t}iis,yeaz r "'r^i r; ' ;'$0.00 j. . ..•+ ))ir:' ' .Y••'••�' . .:..fir , '•( _• , 3. ter' "tf1.. • x-Puichasing shame or refinancing your current one? Callus al1.600.866.0743 • �"i GettingIIstudent loan? Call us al l•888.945.5373 i�'Optiiniiing the equity in your home? Call us at 1-800-777-3000 more a Calculation Worksheet ; - --- , worksheel to calculale.,your overall _amount wllhdiewals (Including any from prevlo ft mon your regislerbut not shown on your statement. NUMBER . =".•=:=AMOUNT. n.�+: TOTAL $ �Y ENTER ® The NEW BALANCE shown on your sla:ement.............. _...... _.......... ...... ................ Jt+• ADD , �B Any deposits listed in your $ register or transfers into $ your account which are not It shown on your statement. 4$ TOTAL ................. ® CALCULATE THE SUBTOTAL ................... (Add Parts A and B) SUBTRACT © The total outstanding checks and withdrawals from the chart above .................... CALCULATE. THE ENDING BALANCE (Pan A+ Pan 8 • Pan C) This amount should be the same as the current balance shown in your check register ......................................... rion on our products and services visit as at Wellstatgo.0om Line of Credit Information Each principal balance shown on the reverse side represenls the unpaid amount of loan advances under your line of credit for that day and each day thereafter unlit a change in the principal balance is shown. The Finance Charge will be determined as 10ows: • Determine the principal balance for each day during [his statement period; then • Multiply the principal balance for each day during this statement period by the daily periodic rate in effect for such day; and • Add these results It your amount is subject to Balance, Based Pricing, the daily periodic rate and corresponding Annual Percentage Rate A; III willoe determined each day based on the outstanding balance of your account. The daily periodic rate and corresponding APR applicable to each balance range are shown in the Summary of finance charges section on the reverse side. It your account is'subject to a Promotional Discount, your total finance charge for the statement period is calculated by subtracting from the above -described standard finance charge calculation a promotional Interest credit applicable to ail ProntoOonaI Period net advances on your amount during the billing cycle. Your "net advances" are that portion of the daily balances during the Promotional Pertod after adding new advances and subtracting all payments our credits that exceed the principal balance in your account immediately before your Promotional Period began ("Pdncipai balance helore promotional advance period began"). This promotional interest credit is calculated by adding your net advance for each day durino the Promotional Period in the hilling cycle and dividing this average daily promotional balance. Your average daily promotional balance Is then mulllp]ied by the number of Promotional Period days in the billing cycle and by Ole dat periodic rate for Ota promotional Interest credit rate resulting in the promotional Interest credit. The promotional interest credit is then slrbtracletl front tile lot ai finance charge at your standard rale(s) to obtain the total finance charge shown on the front of [his statement. Any transaction charges or processing charges shown on the reverse side of this statement also must be added to arrive at the total Finance Charge for this period. Loan payments received after normal business hours will be credited the fallowing business day. Normal business hours are posted in each office or branch and will be furnished upon request, or may be obtained by calling the customer service phone number listed on the Iron) of this statement. In Case s e oo a Errors or Questions About Your Credit Line TraII you think your bill is wrong, or 11 you need more information about a transaction on your bill, write us at the address shown on the Iron) of this statement as soon as possible. We must hear from you no later that. 60 days afterwe sent you the first bill oil which the error or problem appeared. You can telephone us, but doing so will not preserve your rights. In your letter, give us the following information: Your name and amount number The dollar amount of the suspected error Describe the error and explain, if you can, why you believe there is an error, If you need more information, describe the item you are unsure about. You do not have to pay, any amount in queslion while we are Investigating, bill you are still obligated to pay the parts of your bill that are not in question. While we investigate your question, we cannot report you as delinquent or take any action to collect the amount you question. Spacial Rule for Credit Card Purchases, 11 you have a problenn with the quality of floods or services that you purchased with acredit card, and you have tried in good faith to correct the problem with the merchant, you may not have to pay the remaining amount due on the goods or services. You have this protection only when the purchase price was more than $50 and the purchase was made in your home state, or willi n toe miles of your mailing address. (11 we own or operate rite merchant, or if we mailed you the advertisement for the property or services, all purchases are covered regardless of amount or location of purchase) If You Suspect Errors or Have Questions About Electronic Transactions /Including Direct Deposit Advance a Transactions) on Your Regular Deposit Account, Please Call Us Immediately. Or, it you believe there Is an error on your statement or ATM receipt or If you need more Information about a transaction listed on this statement. please contact us Immediately. We are available 24 hours a day, seven days a week. Please call the telephone number printed on the front of this statement. Or you may write us at Wells Fargo Bank. P.O. Box 6995, Portland, OR 97228-6995, 1. Tell us your name and account or ATM card number. 2. As clearly as you can, describe the error or the transfer you are unsure about and explain why you need more Information. 3. Tell Lis the dollar amount of the suspected error. You must report the suspected error to us no later than 60 days after we sent you the firs! statement on which the problem appeared. We w,ll investigate your question and will Correct any error prompt!y. It our investigation takes longer than 10 business days (or 20 days in the case of electronic purchases) we will tempora by credit your account lot tre amour you be!ieve is in error, so that you have use of [he moray unit cur mvesii)ai:on Is completed. ,f the error concerns a Direct Deposit Advance transaction, ycu do not have to pay any amount in question while we are investigating, but you are still obligated to pay file Pane of your Direct Deposit Advance transaction that are not in gLmstwn. While vre a•a investigating your question, wo cannot report you as delinquent or take any action to ccl!aCI Ina amount you question. 0 Members FDIC. M-` Page I of 3 325,965 ibei4,18,1,"2002 633 f )IA :N ;`,-,MANbELBAUM 5 1 ':AUI WORT.7BEA g),4_6'CA026 0 3285 --,pan ;j Wbff— — 1A . J ' ' swbm ENjoT�VAU0EFA TB.ANSFERS,- FREE �.ONLINE-iACrd'6UNVAdUbS--AND -OVERDRAFTIPROTE REYWORD:IOWINTRO.-T.� id. Lidia N MandelbaurH- Accouiit Number:I,.037-6i,9.OP33 Activity suminary... Balance on 10/16' $3,891.47 Deposits 3,477.84 Withdrawals 9.39 ........... ! ................................................... ........................ .. Balance on I I 18 $1,349.92 % .hearin. Activity detail Deposits Date De'sodpbon $Amount .............................................................................................................................................. 10/29 ATM Transfer Prom Checking - 10/28 Mach ID 22560 Bristol Street Pavillions, Santa Ana, Ca 200.00 0222 11/04 ATM Deposit - 11/04 Mach ID 0643D 5 Corporate Plaza, Newport Beach, Ca. 0222 3,037.84 11/07 Deposit 240.00 Total deposits S3,477.84 .hearin. Activity detail Deposits Date De'sodpbon $Amount .............................................................................................................................................. 10/29 ATM Transfer Prom Checking - 10/28 Mach ID 22560 Bristol Street Pavillions, Santa Ana, Ca 200.00 0222 11/04 ATM Deposit - 11/04 Mach ID 0643D 5 Corporate Plaza, Newport Beach, Ca. 0222 3,037.84 11/07 Deposit 240.00 Total deposits S3,477.84 ' *: �iC.^a.. �y"•:1:f �Jv:9!`' '0":�nei2A.,v .. 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'!,.rvc+�.., .'.,ac.•.wfa+.u¢•etn v:uw,l ,wwfe,.,,rivr.ri,•...�:.:.,' 0222" v ,:.••t..•. 3tiK IL1F A6 12P.K :ARtS .G'-'yv,;f T_'t M1TY'S41 M..... iiP:M [:T. IYitO T .•. •:f 'a"ttS.Ti`_Y� , 1'..:4 '' f:,_�:..1 aC'n: L:yG.•.:: 'i .:^ -.�� ,.. �. p+: 6,n - 3D;;S;CorpoTat"a,I'laza;Netyport,peac �_, ::*•:'�rl 'Sa=':''" `:£.:: LV,•"'id. t+' ', S00r00 1j%04 ATM _JraiisFer,To.C}iecl=g-11JQ4:Mach'ID,0 ;„Ca,;:'„ ' 0222 -'. �£' ^lL4 ::y.yr����' ` Sua: :.•a�.rn::ttYi'�. p.=.,••,.:•s .. _ ,. :11/12 Te1e-Trig 4fei''To Checlting'0693294134:Reference,#,-•TFHX56TW8Vi; ; "'' r'_ YFry =''' : ;' 400.00 11118 Monthly^Service Fee :?; r_ '"' " : '' ' � - - 9.50 .� . .1 •:L r'.i.._, .'-• ..r •: ;/*._ .S.- :•.• ti11L-J1iLL: :. V.'.• Tofal other . .:; ;,; :;........... ,i.; :',•,; withdrawals . _ . : . ... 's ......... .. ... .. " ..5........ ............... ' `'» Total withdrawals" :.... :�::,:_.'., N . $6 019.39 ." Daily balance summary .• • ' - ' - • Date ', - $ Bda:;ee Date $ Balance , Date • $ Balance :::.r 10J16 3,891.47 1030 1,065.73 "''" 11/12 ;' :•'!'' 1,431.82 10/17 1;191.47 11/Ol' a 565.73 . r 11/18'' _ 1,349.92 10/28 1,084.42 11/04 2,223.57. •' 10/29 1,284.42 -11/07 1,988.56 -. ''',^• :-i nrov a aws,r.,.: �x:�s:g:•.nS r:. Accouht'Balani 1. Use the lollowinl • balance.:-';z: •. 2. Go through your transaction, paym Be sure that your and any service_( Withdrawn from yc S. Use the chat) be .,'-ITEMSiDUTSTANOINGi,. , 'iNDMBEflee ;:',-a;roCa.ridi.•'�miAMOt1NT.ks•:ai�•`•sueo,ceta: ,:,.;:•+• .. '�•1�';%•''„[r`e - �:ii;"rY rarr_�r s;����� �:"�.'S•"^mn.fi�a;,iti%ii,Si4isF� 'Y!� t'•M 9. � _SLGC AN.Y,CA•.::.•'i n._R` •1•`:C .a1:TLfICi:': -`t. - 'fide% n[��:• n C..>. • aid•. -.-t,:: use, , w:i � :•g••gpi •.,{• 4 .m •ecc'.f ^ 4N'uiG a. TOTAL S � ' ENTER ® The NEW BALANCE shown on - yourdiatement...................................... ADD ® Any deposits gated to your $ register or transfers into $ your account which are not S shown on your statement. +$ TOTAL...., 01- CALCULATE THE SUBTOTAL ................... s (Add Pans A and 8) SUBTRACT © The Iola outstanding checks and wnhdruwals hem the chart above ..................... • s ® CALCULATE THE ENDING BALANCE (Pad A+ Pan 8 - Pal C) This amount should be the same as the currant balance shown in yourcheck register ............................................ L-� I a home or refinancing your current one? call us at 1.800-866.0743 • • tudentloan? Cell us all-888-946.5373 the equity in your home? - - .Call us all-Boo-777.3000 •mation on our products and services visit as at wellate rgo.00m - N::C:• f 1 Line of Credit Information Each principal balance shown on the reverse side represergs the unpaid amount of loan Determine the principal balance for each day during this statement period; the Multiply the principal balance for each day during this statement period by periodic rate in effect for such day; and Addlheseresulls It your account Is subject to Balance eEisea� Pdcing. the daily periodic corresponding Annual Pof nlage Hale fAPR I Will be determined each day be outstanding balance of yoJr account. The lly'peirlodic rate and correspor applicable to each balance range are shown in the Summary of finance charges the reverse side. - If your accounj is subject to a Promotional Discount,'your total finance chat statement period is cafc0iated by subtracting frond the above -described standE charge calculation a promotional Interest credit applicable to all Promotional advances on your account during the billing oiycle. Your "net advances" are the the daily balances during thePromotions ,Period .alter addin new advE subtraclmq all oavments or deidlis that exceed the principal baUce in yot advance for as number by the number your sianctara raters) to ootart Any transaction charges or statement also must be adds payments after norn, Normal business o urs are request, or may be obtained arterial Period in the billing cycle and dividirig'tiis Period days in the billing cycle resulling'In.y@0 c' (our average daily promotional balance hstthen, it Period *days in the billing cycle and by 1hE;daily: st credit'rete resulting in the promotional interest s then subtracted tram the total finance chWd6':OL' finance charge -shown an the frontal this staterent.), ig charges shown on the reverse side of :this, at the total Finance Charge for this period. Vain ' s hours will be credited the following business aA. t each office or branch and will be furnished upon, , the customer service phone number listed 0a, the In Case of Errors or Questions About Your Credit Line Transactions II you think your bill is wrong, or if you need more Inlormation.about a transaction oti yodr -• bill, write us at the address shown on the front of this slalegtanlas soon as possible. •We must hear from you net later than 60 days after we sent you the first bill on which the error or problem appeared. You can telephone us, but doing so will not preserve your rights.'"+,r••;,: In your letter, give us the following Information: • Your name and account number - • The dollar amount of the suspected error• fSa C;d•' Describe the error and explain, II you can, why you believe there Is an error. you.: need more information, describe the Item you are unsure about. You do not have to pay any amount In question while we are Investigating, but you are'SVII obligated to pay the parts of your bill that are not in question. While we Investigate your queslion, we cannot report you as delinquent or take any action to collect the amount you quest on. ' Special Rule for Credit Card Purchases. If you have a problem with the quality of goods or services that you purchased with a credit card, and you have tried in good faith to correct the problem wish the merchant, you may not have to pay the remaining amount due on the goods or services. You havo this pprolection only when the purchase price was more than S50 and the purchase was made In your home slate, or within 100 miles of your mailing address. (11 we own or operate the merchant, or It we mailed you the advertisement [or,lhe property or services, all purchases are covered regardless of amount or location 'el purchase.) 'If You Suspect Errors or Have Questions About Electronic Transactions /Including Direct Deposit Advance 0 Transactions) on Your Regular Deposit Account, Please Call Us Immediately..' Or, If you believe there Is an error on your statement or ATM receipt or it you need more Information about a transaction listed on this statement, please contact us immediately. We are available 24 hours a day, seven days a week. Please call the telephone number printed on the front of this statement. Or you may write us at Wells Fargo Bank P.O. Box 6995, Portland, OR 97228.6995. 1. Tell us your name and account or ATM card number. 2. As clearly as you can, describe the error or the transfer you are unsure about and explain why you need more information. 3. Tell us Ilia dollar amount of the suspected error. You must report the suspected error to us no later than 60 days alter we sent you the first statement on which the problem appeared. We will investigate your question and will correct any error promptly. It our investigation lakes longer than 10 business days (or 20 days In Ilse case of electronic purchases) we will temporarily credit your account for' the amount you believe is in error, so that you have use of the money until our investigation Is completed. II the error concerns a Direct Deposit Advance transaction, you do no: have to pay any amount irn question while we at, investigating, but you are still obligated to pay Ilia parts of your Direct Deposit Advance transaction that are not in quesliart. While we are investigating your question, we cannot report you as delinquent or take any action to collect the amount you question. Members FDIC. unvry eiiFruntini�itsin%.i�—ar•M1r:i•`•r,T,-�u^Tzcr`."s.7.n:�is.i��c::8sr,.i:i'dz^r saa•�nr-acr�rnauauxsulr.:e,rJc:,••tr,�u:c-_�:rt+serg:m]yz"a w.,�rtacYctra,'rr,._•.F�txc.::.r.:.'rrcr. g.rec k¢..,: :rnrd �xr.�•ar:v.],'�,—,r,?.>: ny'ts^'a.:a: re.•.-^.-a'i ..,�•r�Jn:t�., r:.zaa+:.r.,x `r';rl�•,•:a.::u�:mi+maas.raa;o;l..x..:; :•s. .,-:.r_._:s.'u ._ �r:cn_.-�nrr.�_rcr;al:•rira yaw:. L.:.e a}�:t:--'rry�..., ;•.c:,•rr:aa.:r; �.l . i^' 1 JS.^TL•tf4 {'. ��2_ y r - - t: i�.:L2i ' ccoin't:,Sfateinext ��' _, iY •' "i :,i' • Septeui6ei7Y8 through',October 16, 2002 � , , ''"<; � �`,:; • .. ., ' `J' Account Number: 037-6190633 Page 1 of 3 ': •. 333,062 •J .r'r .r,0'cq<r LIDIA N :MANDEL'BAUM' r,. ' :1231.--ALICANTE NEWP6RT.-.BEACH..C4'.'49266073285' • '1 - e y '•'Yd ��: �Il'• •••,riR �!ry - ..',i,: � '� � 1,1: � (^. a,'�...14'-':4"5� Y3•:-r6'l' r.. __4.X'.= n'}.. a.; �. ,'S f^ p �. •'?3 'q' n.. ::� .... I::C<••Y5(/s: J": .. _ p _ • �J'.4': (•": �[:'.: •1J::-� dSl i'ia is .l. .9:: f«I�O.LS'LY^c •.r :1'i .a :R.•. :: .+'.. _ •.:.: '-'.. .15a ..... - .:. .L{4f: .••..5 i'.•f :,,�1.. a ;,, •'a. ,:• (a yp i:,l:C:.ih:.1:�'vtf.:Srl�..:::[.1;�:'.�t k•F�:•7 l.' w:;:infw.5'^i.Jw:nVJ1:i �JA•,tpL.S. ..,. .w'=x:,, :,.tt.:+ S:V.tatkYCJ1:c:.t,�4:IL,Is:�i?S:,inf..:IGCL-SF]:,L::r:a3•�'8A•A'.un.=RlG�... „y}'..',•,`,T.JJrk-...yr..,nrh':./':L'.I �Sa A.'�fri[^'.: '�,'"�': v[!:'. 1�-?Yar.Ljft�L�ALYiaeri..-r•::::1.4.T'Ib'^.:!.:^:t•:'N�..E ' F; :Y > v,: Ti,iJ' Y,a ,. ':t%': S .":J(ti•• � .: Si. i'li � tw .-.. GSfCi1Ls,,,•.'wY^�i'•:5+.'LL:aR%^.."isY.f:i:S.:SrS'l,L^r.F'^l.'.'YU:r1 a lY�r i4Je.i G:ea•T:rnl,l°ljrnm,7, ,:; ; '1, ^•?.hS{Y.J. �u.._a:.C4(Jtlh^Y.wLI:SgSCi4:Tf:C:Gli 4'%]Pr.0.'ffi]}5:, :'vTr•(aY.'�]v„+{!rl:.✓ T:I,ST'r2.-.1. ••'oy,• ••�1 i. � ,1' '•: •i u,:^°�2' 3if' Lt f::..p �'•i i i1^.2iNcf' •'i^: ••'r�,.�,�'• ,Y2L.d£JZY,:JC}Yr\4'•va'�MLI"Stlt'(:.(aT:,TFpL^[l.Ma:i�1•'v� Thank' ou,for,banking with,Wells Fargo. Far assistance b51I:'1 800, TO -WELLS (1 800 869;3557j, TDD numbW(fdr the hea you ,... impaired only) VOW— 877— "6 Or mite WELLS FARGO BANKS N A , P O BOX 6995, PORTLAND; OR 97228,6995.• Y - •"Z.l C '7 .L. H V V h �7 :•'1 `1 ✓ i,•i�n "iS�nAih• .1 J Jw.] r Sl .. hl'�.E • J•rA ,. S..0 µti� � � Y2.)'Y.i •lc•L:'4_..:: n.' f•. 1, - �•�:,\'i wlv of"-`:'J.>•.'�'�` 1'.".•Y.iry:.. i4..l:ni'f.n. n 'i'S .,• 'l4;J.n Y. -:'e.,c•,'}::'%.2..lai&r.•(:f.2:GtirC"oG•..L•ri,:- �ilFr.T'CN:.�'1? '. Z,... ....Y. �%-p,• NEED CASH•FAST?<iINJUST;,HOURS�YOl1�CAN,:HAVE�7HE CRE61T^;_YOU ,NEED TO ;:BUY, Q�CAR TAKE A:VACATIc CONSOLIDATEyBILLS_-1AHATEVER ,YOU"CHOOSE .APPLY,FOR A P, E, S- - , .INE ORyLOAI L'1 N- NErTODAY.; JUST GO WELLSFARGOSPECIQL.COM( 1DEN_TERKEYWORD_:-EASY;LOAN ^ ':" •'" "• _ nad.n^•-'n :.liv •_L.:.Gn-uiGJ.•i.�°F lAr ;q•• _v!'S SC^•. _ .�t+ • i A] wT •S.• �,.'4a�2S G.Si } fYw: Yt.,✓ 'f :^,.}l: [.C.,. ir! w:.9L'•i 4acr�• �' A<t.;: ;'::'::";—..a:g.an';,^.L.,..,;,�r..:vp�: EVERY,.,,TIME YOU'USE,;YOUR WELLSTARGO..CREDIT''CARD'FOR`PURCHASES,:EARN;vPOINTS'FOR,:TRAVEL'AND G CERTIFICATES MEN YOU'RE ENROLLED IN WELLS FARGO REWARD PROGRAM.;IF:YOU'RE NOT+ENROLLED, SIGN _ e.•...:.:•x•.... ve.r.. �.. rn•. c._.. r,y.. r...:.. ......, TODAY: ff-.YOIJ'RE, NOT A CARDHOLDER TALK TOjYOUR,BANKER OR:GO,TO:WELLSFARGOSPECIAL.COM AND ENT KEYWORD CCREWARDS TO APPLY FOR YOUR CREDIT CAR D,AND,THE OPTIONAL WELLS FAFtGO REWARDS PROGRAM. IF YOU RESIDE OR TRAVEL OUTSIDE 'OF -THE ,UNITED'STATES'OR CANADA, BEGINNING -NOVEMBER,1 ',2002 YOU W NEED TO CALL AN MCI OPERATOR TO REACH WELLS FARGO PHONE BANK INTERNATIONALLY ,FOR ACCOUNT SERVICIt YOU WILL NO LONGER BE ABLE TO CALL FROM AN INTERNATIONAL LOCATION USING AN AT&T OPERATOR. IF. YOU NE MCI COUNTRY ACCESS NUMBERS FOR USE, PLEASE INQUIRE WITH A WELL$TARGO PHONE BANKER:`%,',';, r - Stagecbach Checking' .. ;. Lidia N Mandelbaum , Account Number: 037-6190633 Activity summary Balance on 09/17 $26.43 Deposits 7,188.75 'Withdrawals - 3,323.71 .r.......... r........... :....... ....................................................;...... Balance on 10/16 " ' $3,891.47 1593-'1.qg/Ig ............ Toidl checl,-s'Y,','- Vitfilln Check -Se$tichoe 'z=" Wl� q 6 �2002 UZI 3' W&I OITA v Y 11 rLsr !. �. - -- , ......................... . . . . . . . . . . . . . . . . . . ... . . . . P'� 6 r t $Amour ............. S48MI 87101 3,710.51 ............ Amouj 72.4 ... ........ $1,514.2 I, A'V - Oih r�Wthdrifi�iifs 4i". 7 '-Deso As "k-4 yQq: is. I $Amou I-_ ,Q,,Q,Q.1 :Date. , , . .................... .. .......... -10/b- To Checking . I...... 1,500.0 .tia�sf�r • 10115, 'f&.Transf&'Td Ch66kiiig 0603295J34. 200.0 ... lom. --ATMWithdrawal -l0/l3Mach 1 '2256N Bribtol.Stfeet-.PavMions,'SaiitA Ana, Ca"0222. 100.0 lOf 6 Monthly Service Fee -,.,.,6 .................. 9.5 ............ ........... !.io"Q'other kbdrawals $1,809.5 ..................... ..................................... ...................... ............. 'Total 323.7 withdrawals', Difly balance suththa ry Date Balance Date $ palanoe Date % $ Balan( ............................................ .............. ............................. ......... 09/11 26A3 0§/30' ::.2,062.87 3,891.z 09/18 13.42 10/03 562.87 09/25 3.42 10115 3,97137 • Account 1. Use the 'balance: ' 2., Go thro) . 3. Use the chart'lieloiv, 11 oulslanding'checks; AT "L:withdrawals(including a :your register but not she F.M'ti y v R'Rf,��'"'!s'Q'A'..14Yim:rN��[i4t�G:Z1: Y_A➢�l.1CK YSaZ>T�ix-- - . . rr; �,.�':Y-":i•�r. ��arr:?:K.wnava rc»• , 1._•e:ie.::.s?�S1v.�ii rLi.i`\o-.•F:YYi.XY'•'♦`. ., i`Puicliusln a Home or refinancingour current one? Call us at 1-800-866.0743 r,GeiOng'a student loan? Call us at 1•886.945.5373 q ryin your home? Cell us at 1-800.777.3000 r' O timliin the a ui ;,,ir::•:.-�,; p !H:,-, ,.•,.. � ,g • . 'FoF mare Information on our products and services visit us at welistargo.com iculalidn Workslieet ;r`nr; ?m Line of Credit Information sheet do calculate your overall eaccount ' Each principal balance shown on the reverse side re resents The unpaid amount of loan 'advances line of credit for that day and da day thereafter unhlachange In the esiz'•.• r end mark each check, withdrawal, y"ATM under your principal balance is shown. The Finance Charge will be determined as follows: posit orothwere dIt listed on your statement. Determine the principal balance for each day during this statement period; then ,r shows any interest paid Info your_accounI Multiply the principal balance for each day during this statemem period by the daily ;,auto matic payments of ATM transact''ions -periodic tale In eileclfor such'day; and.' ;:-' untdrivingSi Add these results "-if litenlperiod.•;; d an 'depesi4s,_translers fo your_accoonl, ..i._ If our account Is subject to Balance: Based Pricing, the daily eilodic rate and Y 1 9• Y P in ''aa"ix `'"''`':"cvv1TEMS OUTSTAND1NGa"o'-'!�;��a-'.a•.'^���<� INUMBER :: =zace. ;tnxAMOUNT • — .;nsrr;^ini'' ±'T:' •'-S:a.>.•..?" fdCT',4'.,•.i::T.71-' ,'•c 5 112 TOTAL $ ' D ENTER. ' ® The NEW BALANCE shown on ' . • your statement....................................................... S ® ADD �B Any deposits listed in your S register or banters Into S your account which are not $ shown on your statement, +S TOTAL_ ................ S ' ® CALCULATE THE SUBTOTAL ................ $ (Add Pass A and B) • ® SUBTRACT © The total outstanding checks and withdrawals from the chart above ...................... •S Eel CALCULATE THE ENDING BALANCE (Port A+Part a - Pan C) This amount should be the same as the current balance shown in your check register .......................... .......... I� t your staleme charge' •advancr the dail subuacl Immedit advancr advancr number average mtllllp;lf ding Annual Percentage Rate (APR) will be determined each day based on the ig balance of your account. The daily periodic rate and corresponding APR to each balance range are shown In the Summary of finance charges section on aside•. .. . • ! count is'subect lo,a Promollonal Discaunt,'your total•Iinance charge for the period Is calculated by subtmeting irom'The above•described standard finance lculation a promotional Interest credit applicable 'a a' Pfomotonal Period net on your account during the 61111ng c cle. Your. our "net advances" are that portion of •balances .during the Promotional Period sitar adding new advances and g all payments or'credils that exceed the principal balance In your account ,ly before your Promotional Period began ("Principal balance before promotional tertod began`). This promotional Interest credit Is calculated by adding your net nr nnnh dev dudno The Promolio..I Period In the blllino cycle and dividina this 'm credit. The promotional Interest credit is then subtracted from the Total finance charge at your standard totals) to obtain the total finance charge shown on the front of this statement. Any transaction charges or processing charges shown on the reverse side of this statement also must be added to arrlve at the total Finance Charge for this period. Loan payments received after normal business hours will be credited the following business day. .Normal business hours are posted In each office 'or branch and will be furnished upon request, or may be obtained by calling the customer service phone number listed on the front of this statement. ' In Case of Errors or Questions About Your Credit Line Transactions II you think your bill is wrong, or If you need more Information about a transaction on your bill, write us at the address shown on the front of this, statement as soon as possible. We must hear from you no later than 60 days afterwe sent you the first bill on which the error or problem appeared. You can telephone us, but doing so will not preserve your rights. In your letter, give us The following information: • or is or and he the error and explain, If you can, why you believe there is an error. If you note information, describe the item you are unsure about. tt have to pay any amount in question while we are Investigating, but you are still to pay the parts of your bill that are not in question. While we Investigate your we cannot report you as delinquent or take any action to collect the amount you lute for Credit Card Purchases. If you have a problem with the quality of goods s that you purchased with a credit card, and you have tried in good faith to correct im with the merchant, you may not have to pay the remaining amount due on the services. You have this protection only when the purchase price was more Than he purchase was made In your home state, or within too miles of your mailing (It we own or operate the merchant, or if we mailed you the advertisement for The or services, all purchases are covered regardless of amount or location of Or, if you believe there is an error on your statement or ATM receipt or it you need more Information about a transaction listed on this statement, please contact us immediately. We are available 24 hours a day, seven days a week. Please call the telephone number printed on the front of this statement. Or you may write us at Wells Fargo Bank, P.O. Box 6995, Portland, OR 97228.6995. 1. Tell us your name and account or ATM card number. - 2. As clearly as you can, describe the error or the transfer you are unsure about and explain why you need more information. 3. Tell us the dollar amount of the suspected error. You must report The suspected error to us no later than 60 days alter we sent you the first statement on which the problem appeared. We will Investigate your question and will correct any error promplly. II our Investigation takes longer than 10 business days (of 20 days in the case of electronic purchases) we will temporarily credit your account for the amount you believe is In error, so That you have use of the money until our investigation Is completed. If the error concerns a Direct Deposit Advance transaction, you do not have to pay any amount in question while vie are investigating. but you are still obligated to pa the parts of your Direct Deposit Advance transaction That are not in question. Nhile we are investigating your question, we cannot report you as delinquent or take any action to co!Eci the amount you question. Members FDIC, A:6coi nt-Nuraller: ,637-61, 'Page l of 3 ' V " 323,628 ' 1-2 L _ .12 N• .1• 9,0633 IDIA EWPORT p„ t. - .; :;>..tr�t.;_•. ib`er 17,2002� . �: - ,. ,r .. ice, J''Y 1•` `(ti... ,.f YLnt•i.. } •I N:'MANDELBAUM.,AL CANTE4- BEACH CA;'92660=3285 vef ,. '. Sb r.� "I• !.1". f: .d. , ia''' �.ti[I•Ibt'•_'IiA, f- ..ti' :�O.j� }1 J: ly: •(.. -v. -•;J-T5 v•r-e --v4*.. '-Sa._r:-:I,' ,.rlY.:'.hf'r `y- fCn---0:,1''_. :til[iflhtY@r,<L 1.•v' .... ..... .v .�. .c.r.v. �_.., a^"IIGc{Y]:_.}. �. .. .. H-yl l•'^? NAir d.-..-. -.- . -Ttiankyou:tar bank1.ing with 5 1.9U0,877.4833. Or wills: WI TO FACILi,rA,rE EFFICIENT E ANY ORIGINATING DEPOSIT •'. I_1n1 ioc'91'A i,LJ 'YIDGG A446I •OR OTHER ITEM WHICH S DEPOSITED IN;ANOTHER FINANCIAL 1NSTITUTION AND THEN. RETURNED UI fiUTHORIZE THAT FINANCIAL INSTITUTION SO,F'RESENT OR REPRESENT THAT CHECK OR OTHER ITEM ..DEBIT...' '..... • . �:. •;t...•..;.::_;;:` v:.°....:: - .. .. ,-:��:;::. _ .. A HOME EQUITY ACCOUNT, CAN HELP,YOU'IMPROVE AND _PROTECT,YOUR;HOME. FIX THE.,ROOF WINDOWS, OR SEAL, ANI) PAINT THE EXTERIOR. HOME EQUITY FINANCING IS'A SMART SOLUTION, V INTEREST THAT CAN BE TAX-DEDUCTIBLE; CONSULT A TAX ADVISOR. TO, APPLY VISIT YOUR LOCAL, E WELLSFARGOSP,ECIAL.COMANDENTER KEYWORD: SMART SOLUTION.' • . Stagecoach • Che&ing Lidia N Mandelbaum Account Number: 637-6190633 Activity summary Balance on 08/15 $155.77 Deposits 1,500.00 1Vithdrawals 1,629.34 ' .................................... ..................................................... Balance on 09/17 $26.43 *NT OR CHECK is, YOU AN ACH LEAKY GO TO Page 2 of 3 . 323,E29_ _ Activity detail Deposits.....":��` • ...... ..<,,:,,�:,.r�.,�:�;-' ��:... __ ��: '01 �OS 'Ti .. f S: •'.:e �tYL-B:J:YL u.iln. 4 r •. :1 $ Amount 1,000.00 500.00 $1,500.00 numogr uate_•, n..: •.s-._ =�gr'lou nt :s F�aNumbefiCfari?.Date 9.zri-sir-t_Tmi?7:$Amount :-�•<;:,,,y.nS^.yyq:xtyt'S.L•uriYIFJ:C4..:4,Xt;Gt'1.•lTi^:lI1L•fcxut.].Gi.!^.nitn'Lt::rtGbOJCJi:'3.'.:.5:1n .';'iiziNUmlier,;4,7`:Date-e,':,;;r, a„ • $Amount ♦ !a'". ^'S_>irw•T-.SL!of»......FXn.........m`K _....... �. iL `.:P:]tl.Mi:f.•. :3•,'ol"J �.'.^, r—.'- f A9-1RL:V•• .i. .Ci a. '.1 �ya$� rll�[Z'-yry::y1<lij .'.'!\ii�i e[S:.i.W.�. AY6l. .. trl 1$84 :O8/16.�.,�r'F:ri:�s.:.. 29.95 " ^15$9 ^' ' ' Og 19 ' t+' ' .�rl lit oviirTa .i 'v4i; .,�i9 n............. L r' : R}' l '- 392.50 �.r,g••-r';:.'<;i�•;/..at::i:vJne�•>tir.�2:!4�. 1586_,U,, :OS%16 = 'a0`1%OQ.' s • .): ' "114.00 rtt,sr3s�1°.:c:„ir'i�.. _/ 3's:.m,}:` = '-w,592 - 09�09 -w:... . 475.01 +'nita%k .:LCl. ,Ti1M�.S: �fiirf'•T.hL'e'brYl_ e::[.:ia� X.G• .C..<'N:.• • 't'� Total checks - .. ;°= $1,113.84 • "; Cap in Check Segaeace �' ' :, :. - ,., ". .',; ,,1,;i O1her•,tvithdra4-als '•'4' i'N. :. 1'i.i. •'c 4�. -F:i ...fi •l JT ]YCt. i�9i.`'n'v.'rl n�.' ����`i nY� Date Description ..,ice+ '�•m•; 7n. aka.. Amount :.:.::.:.. .............................................. ......... :............. :.... :........ ... .. .................................... 09/03 1'ele-Transfer To Checking 0693294134 Refererice # T1j-1T84V5MN : a i^ =' = 506.00 09117 Monthly Service Fee ' 9.50J .': ....................................................:.::................................'.................... Total other withdraN4als $515.50 Totat withdrawals $1,629.34 Daily balance summary :...._,.., .. _ .. ,.. ..:.; ..' . Date $ Balance Date $ Balance Date $ Balance 08/15 155.77 08/22 1,023.44 09 04 10.94 08/ 16 95.84 . _. OS/29.. , 630.94 09/09 35.93 08/19 23.44 '09/03 124.94 09117 26.43 �t^nNfe!-�^rtnrw+wxrFlut®rrra:Ai'rri'a•:n:Ynnuacmwo M ., ,- •• ..4.5Y� �r�,:Qf+]C1"�312YJr^r-19aS3T3tGf.'A..P54DBG4^SaYn`i . C.•,..'^ Yn!yMl" Y i,]�r£.'E:PL'f�W.:.'Pew`":W�htA-Kh-•il4YN.c-'2"�J':'. •�r•`• - ... .' iui :nT25'•h].:' :r•naa•:$rocu-.•.-z'A., cr;.ekw v.:xr ^:."Fr..i WAre;jfOU'� •r:�o:P.ilrolideing ahome or refinancing your current one? Callus atl-500•e66•0743 • -r•= ':;e`-,-Gettitfg a student loan? Call us at i-1788.945.5373 5.5han. `i•`t'....pi '";•': ,:•: •-tar Ophfnkingthe equity inyour home? Calusatt550.777.3000 • - .For hf6re information on our aroducts and services visit as at We11s1atgo.aoM 2. Go thmugl •transaction 'Be sure IN and any sr :withdrawn S. -Use the of ouislandin( withdrawal: -Your reglsh ' •;-,',...,cal=eITEMS OU7STAN01NG.v^.•ucrr.•ta'n•_ •iY'..el'.E.As� 7:i`^•.iti..dA M - '' •i.4+�x6�Yirr ' -AMOUNT :j .ate.:.=.r;,,(•- . y, .••Jl"L, :L�.]f. j��iY A!'�9Ti C.v i 't`� S-4 ' :�5 _'W i�^r n'�i{tilt '+'+� �!•i_ `i.+iY,F 9•X�' S �u' , .,Gi'MI i .'n.. T, •.4''i. nt � TOTAL S ®,ENTER• . ® The NEW BALANCE shown on , ymrsiatement.............. __...................... _................ $ - D ADD © Any deposits hotel in your s register ar transfers into s yourazcoum which are not S ' shown on your statement. "+s TOTAL. ................ s S CALCULATE THE SUBTOTAL .................. $ (Add Pads A and B) SUBTRACT © The total outstanding cheds and e wiedrawaks from the than above ...................... •s ® CALCULATE THE ENDING BALANCE (Pad A + Pan B • Pan C) This amount should be the same as the current balance shown in your checktag''xter................4......................... Line of Credit Information Each principal balance shown on the reverse side represents the unpaid amount of loan advances under your line of credit for that day and eldh day thereafter until a change In the principal balance Is shown. The Finance Charge Will be determined as follows: ., Determine the principal balance for each day during this statement period; then Multiply the principal balance for each day during this statement period by the daily periodic rate in effect for such day; and Add these results ' II your account is subject to •Balance Based Pricing, the daily periodic rate and corresponding Annual Percentage Rate (APR) will be determined each day based on the outstanding balance of your account. •,The daily periodic rate and corresponding APR applicable to each balance range are shown in the Summary of finance charges section on the reverse side. ' If your account is subject to a Promotional Discount, your total Iinance charge for the Iculation a promotional interest creallappncaDie to an riorneuoneu renoo net an your account during'the billing cycle; Your:'neladvsnceis' sire that portion of balances during the Promotional Perlod 'alley addingg new •iidvsnces and 1 all payments or, credits that exceed the principal'balonce in your'account ly before your Promotional Peridd began ("Principal balance beford promotional resod began"). This promotional Interest credit Is calculated by adding your net or each day during the Promotional Period In the billing cycle and dividing this y the number of Promotional Period days In the billing cycle resulting in your iaim Drnmemnnat balance. Your.averacie daily promotional balance is then for the promotional Interest creeu rate resulting in ine promotonal Imar nit romotional Interest credit Is then subtracted from the total finance charge at rate(s) tooblain the total finance charge shown on the fron'of this statement. on charges or processing charges shown on the reverse side of this c must be added to arrive at the total Finance Charge for this period. Loan Narmal business hours are posted in each ollice or brandh and will be furnished upon request, or may be obtained by calling the customer service phone number listed on the front of this statement. .. ' in Case of Errors or Questions About Your Credit Line Transactions II you think your bill is wrong, or if you need more information about a transaction on your bill, write us at the address shown an the Iron' of this statement as soon as possible. We must hear Irom you no laser than 60 days after we sent you the first bill on which the error or problem appeared. You can telephone us, but doing'so will not preserve your rights. In your letter; give us the following Information: Your name and account number , That dollaramount of the suspected error Dis crihe the error and explain, 11 you can, why you be there Is an error. It you , need more information, describe the item you are unsure about. You do not have to pay any amount In question while we are investigating, but you are still obligated to pay the parts of your bill that are not in question. While we Investigate your question, we cannot report you as delinquent or take any stitch to collect the amount you question. Spools Rule for Credit Card Purchases. II you have a problem with the quality of goods or services that you purchased with acredit card, and you have tried in good faith to correct the problem with the merchant, you may not have to pay the remaining amount due on the goods or services. You have this protection only When the PFurchase price was more than $50 and the purchase was made In your home state, or within 100 miles of your mailing address. (If we own or operate the merchant, or It we mailed you the advertisement for the property or services, all purchases are covered regardless of amount or location of if You Suspect Errors or Have Questions About Electronic Transactions ((including Direct Deposit Advance O Transactions) on Your Regular Deposit Account, Please Call Us Immediately. Or, if you believe there Is an error on your statement or ATM receipt or it you need more information about a -transaction listed on this statement, please contact us immediately. We are available 24 hours a day, seven days a week. Please call the telephone number printed on the front of this statement. Or you may write us at Wells Fargo Bank, P.O. Box 6995, Portland, OR 97228-6995. 1. -Tell us your name and amount or ATM card number. 2. As clearly as you can, describe the error or the transfer you dre unsure about and explain why you need more information. 3. Tell us the dollar amount of the suspected error. You must report the suspected error to us no later than 60 days after we sent you the hi st statement on which the problem appeared. We will Investigate your question and will correct any error promptly. 11 our Investigation takes longer than 10 business days (or 20 days in the case of electronic purchases) we will temporarily credit your account for the amount you believe is In error, so that you have use of the money until our investigation is completed. it the error concerns a Direct Deposit Advance transaction, you do not have to pay any amount In question while we are investigating, but you are still obligated to pay the parts of your Direct Deposit Advance transaction that are not in question White we ale Investigating your question, we cannot report you as delinquent or take any action to collect it to amount you question. Member FDIC G',xu ;r�1".r'R�1;t:n•fC•�lf:,{�lijM1;�f�lr7:Y�av'^L'rzV':1•. 'Y_^y'r"%i'1:: ^,'.`IPMfv ..ayi�5 r` J�.i., ..f ':S:i:tt�tw�t�'�J is :'..i'. ..'Y'e•:. Y:' ,'Y"e7S�11 •��4[(y�'�'�<<�; iYi'':i. Pay Periods Date of Most Recent Pay Ending Date , Year - to -"Date divided by pay periods average per pay period Gross per Pay Period divided by - 2 ( x ) how often paid (x) how often paid = ) Lafcuiatea Hnnuaf income (_) Calculated Annual Income n „ • ` NivCerufruuion /Recertification Unit Number IZI�I INCOAM CONOUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This fotmt is designed to assist you in computing Annual Income in accordance with the method set forth in the Department of Housing and Urban Pro ("HAD") Regulations (24 CFR 813). You should make certain that this form is at all times up to date with the HUD Regulations. All cap-ttalized terms used herem shall have the meaning set forth in the Regulatory Agreement, Re: (i.&ME and ADDRESS of Apartment Building) Newport North CSCDA (POOL) I/We the undersigned state that I/we have read and answered fully, frankly and personally each of the following duestions for all persons who are to occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit: 1. Name of Members of the Household 'rae'r•ty Ann 6&V-6 2. 3. 4. Relationship to Head of Social Security Household Age Number HeadZ3554.47-G292 Sl2oucv_ L Income Computation 5. Place of Employment 1-le..;-1..> bak •Ori„r.L�StI'I 6. The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children under 18 years) listed above for the 12-month period beginning the earlier of the date that I/we plan to move into a unit or sign a lease for a unit is S90, 9.3t}. 2 k Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real of personal property (without deducting expenditures for business expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets except for straight line depreciation as provided a• Internal Revenue Service regulations); (c) interest arid dividends (including Income from assets included below and other net income from real or personal property); (d) the full amount of periodic paympdts received from social security, annuities, insurance policies, retirement funds, pensions, disability or death beneru and other similar types of periodio receipts, including any lump sum payment for the delayed star, of a periodic payment; (e) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (f) the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter anc utilities plus the maximum amount that the public assistance agency could in fact allow for shelter and utilities; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not residine in the dwelling; (h) all regular pay, special pay and allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the household or spouse (or other persons whose dependents are residing in the units); and (i) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; (b) amounts which are specifically for or in reimbursement of medical expenses; (c) lump sum additions to fa ;lily assets, such as inheritances, insurance payments (including payments under health and accident insurance and workers compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational institution, and mounts paid by the govern.:at to a veteran for use it meeting the costs of tuidoa, fees, books and equipment. Any amounts of such scholarships or payments to veterans not used for the above purposes at: to be included in Income; (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (f) amounts received under training programs funded by HUD; W foster child care payments; (h) amounts received by a disabled person that are disregarded for a Krnited time for purposes of supplemental Security Income eligibility and benefits becaus they are set aside for use under a Plan to Attain Self -Sufficiency; (i) income of a live -Li aide, Q) amounts received by a paricipai: in other publicapv assisted programs which are specifically for or in reimbursement of out-of-pocket expenses incur,: and which are made solai; to allow participation in a specific program, (k) a resident service stipend (a mc.lest amount (not to exceed S200 per north) received by a resident for performing a service fo: Cie owner, or a par•tim' basis, that enhances the quality of life in the development; If this rams is being eomplctot in accordance with recertification or Lower Incomc Tenam's or Very Low Income Tenant's occupancy or a Lowcr Income Unit or a Very Low Incomc Unit, respectively, this fo= must be completed bared upon the current income of the occupants. e Me en)•tcc•FOFai (m) (n) (o) (q) (r) (s) (t) compensation from state or local employment training programs and training of a family member as resident management staff; reparation payments paid by a foreign.govemment pursuant to claims filed under the laws of that gosemment by persons who were persecuted during the Nazi era; amounts specifically excluded by any other federal statute from consideration as income for purposes of determining eligibility or benefits under a cntegon• of assistance programs that includes assistance under the United States Housing Act of 1937; earnings in excess of $480 for each full -term student 18 years old or older (excluding the head of household and spouse); adoption assistance payments in excess of $480 per adopted child; and deferred periodic payments of supplemental security income and social security benefits that are received in a lump sum pa-vment; amounts received by the family in the form of refunds or rebates under state or local law for property taxes paid on the dwelling unit; amounts paid by a State agency to a family with a developmentally disabled family member living at home to offset the cost of services and equipment needed to keep the developmentally disabled family member at home; and amounts specifically excluded by an other federal statute from consideration as income for purposes ordetermin!ng eligibility, or benefits under a category of assistance programs that includes assistance under the United States Housing Act of 1937. . 7. Do the persons whose income or contributions are included in item 6 above: 8. (a) 9, R (b) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necessary items of personal property such as furniture and automobiles and interests in Indian trust land) Yes V_No; or have they disposed ojgny assets (other than at a foreclosure or bankruptcy sale) during the last two years at less than fair market value? Yes JJ�� No If the answer to (a) or w above is yes, does the combined total value of all such assets owned or disposed of by all such persons total more than S5,000? Yes 7�t� No If the answer to (c) above is yes, state: (1) the combined total value of all such assets: S21,5q S• 32 (2) the amount of income expected to be derived from such assets in the 12-month period beginning on the date of initial occupancy in the unit that you propose to rent: S� 1 571 and (3) the amount of such inconk, if any, that was included in item 6 above: 5 9 r5.1 Are all of the individuals who propose to reside in the unit full-time students*? Yes ___)�_No "A full-time student is an individual enrolled as a full-time student during each of 5 calendar months during the calendaryear in which occupancy of the unit begins at an educational organization which normally m2intakas a regular faculty and curriculum and normally has a regularly enrolled body of students in attendance or is an individual up rsuinn a full-time course of institutional or farm training under the supervision of an accredited agent of such an educational organization or of a state or political subdivision thereof. If the answer to 8(a) is yes, is at least 2 of the proposed occupants of the unit a husband and wife entitled to file a joint federal income tax return? Ye tC No Neither myself nor any other Occupant of the unit Vwc propose to rent is the owner of the rental housing project in which the unit is located (hereinafter the "Owner"). has any family relationship to the Owner; or owns directly or indirectly any interest in the Owner. For purposes of this paragraph, indirect ownership by an Individual shall mean ownership by a family member, ownership by a corporation, partnership, estate or trust in proportion to the ownership or beneficial interest In such corporation, partnership, estate or Trustee held by the individual or a family member; and ownership, direct or indirect, by a partner of the individual. This cenifi =te is made with the know•ledg4at it will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and Uwe declare that all information set forth herein is true, correct and complete and based upon information Ihve deem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. 11. IAVe will assist the Owner in obtaining any information or documents required to verify the statements made herein, including either an income verification front my/our present ernployer(s) or copies of federal tax returns for the immediately preceding calendaryear, 12. IAVc acknowledge that l/we have been advised that the making of any misrepresentation or misstatement in this declaration will constitute a material breach of my/our agreement with the Owner to lease the unit and will entitle the Omer to prevent or terminate my/our occupancy of the unit by institution of an action for ejection or other appropriate proceedings. IM. declare under penalty of perjury that the foregoing is true and correct. Executed this Mh day of McVe-rnhef _.2002intheCityof ).)/r,,/Qvf- geCl.6') .California Applicant Rev. 8195 Applicant Applicamt IS!. -nature of all persons (except children tinder the age of IS years) listed in number 2 above requiredl I In AMc IM9: Irr.eoPM FOR COMPLETION BY APARTMENT OWNER ONLY: 1. Calculation of eligible income: a. Enter amount entered for entire household in 6 above: b: (1) If the amount entered in 7(c)above is yes, enter the total amount entered in 7(d)(2), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ �0' ); (2) Multiply the amount entered in 7(d)(1) times the current passbook savings rate as determined by HUD to determine what the total annual earnings on the amount in 7(d)(1) would be if invested in passbook savings ($ _), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ d ); t (3) Enter at right the greater of the amount calculated under (1) or (2) above: C. TOTAL ELIGIBLE INCOME (line La plus line l.b(3): 2. The amount entered in i.c: Qualifies the applicant(s) as a Moderate -Income Tenant(s). X Qualifies the applicant(s) as a Lower -Income Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenant(s). $ 6atS�4.?3 $ 60, 9-14. 73 3. Number of apartment unit assigned: I u 4 l Bedroom size: 1 + 1 Rent: $ t j 1 I G This apartment unit bras vas not) last occupied for a period of 31 or more consecutive days by persons whose aggregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartment unit qualified them as a Lower -Income Tenant(s). Method used to verify applicant(s) income: X X Employer income verification. Copies of tax returns. Other ( I'P.l 1 I G'2 I Date G.A}IC.Ufl} INCOME \SSET CAI Ct a A rinnl IArn Ot11.U=nr ' I SexDeto ofBldh Ago 3 Soclal SocuntyN 55 T-o202 Frr Student YESorNO 2F 1 9 AI 7 23 570-67-6511 U 3 "MUF:IntE 4 5 6 8 INCOME OME Family Source Base Rate Average Average Annual Memb.1A $ Hours 62 24 26 12 1 Total YVK aFAtl-MO el-N/l M a $1 N Is k =Sg 9e1 } S $ $ 3 =$ 24 g 3 SOCIAI RFCIIRIN PPNCtr1MC crn TotalBaxA. $ 0 g 4. 3 Family Source Base Rate Average Av erage Annual Memb. # $ Hours 52 24 26 12 1 Total YYX SEMI MO BI•N7( MO Yli $ _$ PIIRI If. ASSIATANCR TOlal BOX B: $ Family Source Base Rate Average AvoragoAnnual Memb. # • $ Hours 62 24 26 12 1 Total YaC 6EM1•M0 ti•WK MO YR $ _$ $ _$ $ _$ a =$ Family Memb. # Source Base Rate $ Average Hours Average Annual 52 2a 26 12 1 Total WK SEMI-MOOFurwR—F R0 YR $ _$ $ _$ $ _$ Total Box D: $ TOTAL ANNUAL GROSS INCOME Athrough D AAYD-D0>A?YAYD $ 6o r r24.73 AbbtIS Asset Descnplion Imputed/ Gross/Fair Cost to NET Actual Actual Annual Member (savings, checking, stocks, bonds, Current Mkt. Value Get Cash Family Assets Interest Income from 1{ elo I Or C Value Roto Assets I 5 3W.1 =-3pp,ll I $ e 04 n _ VV J - a Talals Box E- Box F• _ olal N m nwma Fomlly biwmo flummsctNsde IMPUTED INCOME FROMASSETS 1 Effective Oate Box E exceeds $5.000-multiply Typo of Program% LOW '-' E by the covert passbook interest rate: X °/. Unit No. 1441 Unitsize I" BoX E dexceed S6,000 It Box No. of Persons 2 e 04o box box G G: BOX G: S INPUTED INCOME Nut N/A Max. Income Limit$ N/Iq FROMASSErS AR: ,i 140%Limits Enter the greater of Box F or Box G in: BOX INCOME CONTRIBUTED FROM ASSETS TOTAL ANNUAL INCOME $- 4. '13 & TOTAL ASSETS $ 4.5h = $ 6o, G34.24 r• INCOME RESTRICTED FINANCIAL WORKSAEET Project_WELVVMa—1 N00-N Unit No. 1 (i k 1 Applicant's Name: )o wR " 6Er2ay Annual Salary Others Residing in Unit: Co Q211< 6t-roeY Annual Salary Annual Salary Annual Salary, Commiss!ons/Bonuses S 25UOa . oc,-- Savings Accounts: Bank _ Ij S f} iq Balance 300 .11 X.41 %= S Bank Balance Bank Balance x %= S Interest Bearing Checking"Account Bank• U9194 Balance 2L39'.21 x .35%= S Q,Oy" Bank Balance x %= S Stocks/Bonds: Type Amount x °/, = S Trust Fund: Type Amount Other: (Alimony, Child support, retirement pensions, social security, disability payments, parental support, etc.) Show calculation, how Annual is arrived at! Type Annual S Type Annual S Type Annual $ Property Owned . By Resident: Addres's Equity x—%= S TOTAL ANNUAL ELIGIBLE INCOME S ti/;,S2y•?3 Maximum Annual Household Income Limit s 67, 737, 6 0 — Metropolitan Life Insuraw ■ 1 Madison Avenue MetLifd New York, New York 10010 Name JOSEPH GERRY Address 1441 Posada, Newport Beach CA 92660 USA Check Date 10/11/2002 Employee ID 0970877 Pay Period From 09/23/2002 Pay Period To 10/06/2002 PAYMENTS SALARY $1346.15 GROSS EARNINGS - $1346.15 IF ELIGIBLE FOR SIP/401K, ALL PAYMENTS ARE ELIGIBLE EXCEPT THOSE WITH AN ASTERISK (*) FEDERAL PRE-TAX DEDUCTIONS METLIFE OPTIONS PRE TAX TOTAL FEDERAL PRE-TAX DEDUCTIONS FEDERAL EARNINGS OASDUDISABILITY FICA Medicare FEDERAL CA Withholding TOTAL TAXES AFTER TAX EARNINGS NET PAY BANKNAME USAA FEDERAL SAVINGS BANK OASDPDISABILITY FICA Medicare FEDERAL CA Withholding TAXES FM/STAT ADDT TAX 02 S 01 S FEDERAL POST -TAX DEDUCTIONS DIRECT DEPOSIT DISTRIBUTION XXXXIS77 $38.96 $38.96 $1307.19 $81.05 $18.95 $134.83 $40.24 $275.07 $1032.12 $1032.12 $1032.12 EARNING BALANCES (YTD) TAX BALANCES NIP) S33063.64 $2049.95 $33063.64 $479.42 S33063.64 $4339.02 S33063.64 $1183.06 I MetL'M#4 Name JOSEPH GERRY Address 1441 Posada, Newport Beach CA 92660 USA Check Date 09/27/2002 Metropolitan Life Insurar I Madison Avenue New York, New York 10010 Employee 1D 0970877 Pay Period From 09/09/2002 Pay Period To 09/2212002 PAYMENTS SALARY S1346.15 SF SALES INCENTIVE PLAN $824.83 GROSS EARNINGS $2170.98 IF ELIGIBLE FOR SIP/401K, ALL PAYMENTS ARE ELIGIBLE EXCEPT THOSE WITH AN ASTERISK (*) FEDERAL PRE-TAX DEDUCTIONS IIIETLIFE OPTIONS PRE TAX $38.96 TOTAL FEDERAL PRE-TAX DEDUCTIONS $38.96 FEDERAL EARNINGS TAXES MIST AY ADDL TAX OASDI/DISABILITY $132.19 FICA Medicare $30.92 FEDERAL 02 S $355.76 CA Withholding 01 S $90.02 TOTAL TAXES $608.89 AFTER TAX EARNINGS FEDERAL POST -TAX DEDUCTIONS NET PAY DIRECT DEPOSIT DISTRIBUTION BANK NAME ACCOUNT NUMBER USAA FEDERAL SAVINGS XXXX1877 $1523.13 BANK FARMING BALANCES (YTM TAX BALANCES (YTD) OASDI/DISABILITY $31756.45 $1968.90 FICA Medicare $31756.45 $460.47 FEDERAL $31756.45 $4204.19 CA Withholding $31756.45 $1142.82 $2132.02 $1523.13 S1523.13 .% EMPLOYMENT AGREEMENT HERITAGE OAK PRIVATE ELEMENTARY AND PRESCHOOL ("HOPE") 1 1 . HOPE hereby employs 60,-�,1_; �'-2�u•)•�� ( "Employee" ) as an Instructor for the school ye r upon the following terms and conditions. 2. Employee shall receive a salary of $'-:�C�1'G� payable 9J�o�02 _ in i9 equal pay periods in accordance with hope'S normal /// payroll procedures. This said salary is payment for days of &12o%o 3 service. If employment with HOPE is terminated, voluntarily or involuntarily before the completion of the school year, Employee will receive final payment of salary pro -rated on a daily basis according to the number of days Employee worked for salary not yet drawn, the final check being adjusted accordingly. 3. Employee agrees to be present on campus from 7:45 a.m. until 3:15 p.m. or 3:30 p.m. (depending on grade level taught) each school day unless excused by the Director of Operations or Executive Director. Employee's hours will be 746 3 /5 Employee also agrees to: a. Attend Staff Development Days b. Faithfully instruct and impartially govern all pupils who may attend the School C. Exercise due diligence in the preservation of all property belonging to HOPE, including but not limited to the schoolhouse, furniture, apparatus and such other property as may reasonably come within the limits of such supervision d. Attend all Teacher's Meetings, Open Houses, Parent Nights, In -Services, Field Trips and any other such meetings deemed necessary by the Executive Director during the term of this Agreement. e. Perform such other services reasonably related to the operation of HOPE as HOPE may from time -to -time prescribe f. Fully'and enthusiastically participate and/or supervise those special student events both academic and social, including community service, as specified by the Executive Director g. Employee shall be eligible to participate and be covered in HOPE's group health and insurance programs, vacation and other benefits, in effect during the term of this Agreement as set forth in HOPE's Employee Handbook 4. Employment is for no specified term, however, Employee is being employed for a specific school year. Employee understands and agrees that employment with HOPE is terminable at will. This means that either Employee or HOPE may terminate employment at any time, with or without reason or cause during the school year or thereafter. Employee further understands and agrees that HOPE has no obligation to hire Employee for subsequent school years or summer sessions. 5. Employee is hired in a position of trust and confidence. As a material inducement to HOPE, Employee covenants that: a. As used in this Agreement, the term "confidential information" shall mean all information disclosed to Employee or known by Employee as a consequence of or through Employee's employment by HOPE (including, without limitation, lesson plans, curriculum, and information conceived, originated or developed by Employee), whether or- not in Employee's primary field of professional interest, not generally known in the trade or industry in which such information is used, about HOPE's (or third parties') curriculum, processes, services, customers, marketing strategy, employee relationships or business plans including, without limitation, information relative to research, development, manufacture, supplies, purchasing, product design, business studies, plans, projections, practices and finances. b. Except as required in the performance of Employee's duties to HOPE, or as authorized in writing by the Board of Directors, Employee shall not at any time during or after Employee's employment, directly or indirectly, or otherwise, use, disseminate, disclose, or publish any confidential information, or use, for Employee's or another's benefit, or deliver to another, any document, record, notebook, computer program or record or similar repository of or containing confidential information, unless and until such confidential information has become a matter of public knowledge through no fault of Employee or unless otherwise required by Court order to comply with law. C. Upon termination of Employee's employment, all documents, records, notebooks, computer programs and records and similar repositories of or containing confidential information, including all copies thereof, then in Employee's possession or control, whether prepared by Employee or others, will be left with or immediately returned to HOPE. Employee agrees that the client list of HOPE is a trade secret as defined by the Uniform Trade Secret Act. 6. Employee understands that Employee is required to attend and take part in all school related activities outlined in the Teacher's Handbook and noted on the Faculty Calendar, or those that are requested by the administration. In turn, Employee understands that Employee will receive two floating personal days that Employee may request and which will be granted if a substitute is available. If the personal days are not taken, they will be paid. 7. Any dispute or controversy arising under or in connection with this Agreement, including without limitation, claims of harassment or discrimination in violation of any state or federal law, shall be settled exclusively by binding arbitration pursuant to the rules set forth in California Code of Civil Procedure section 1280 et seq. 8. In the event any one or more of the provisions contained in this Agreement shall, for any reason, be held to be illegal or unenforceable in any respect, such illegality or unenforceability shall not affect any other provision in this Agreement. 9. This Agreement contains the entire agreement of the parties. It may be changed or modified only by a writing signed by both HOPE and Employee. "Employee" "HOPE" or "Employer" HERITAGE OAK PRIVATE ELEMENTARY AND PRESCHgO -FEY11NS M. Cygan, esideht USDA FEDERAL FDIC SAVINGS INSURED L)SA BANK DM03648/358782 JOSEPH M GERRY CARRIE A GERRY 1441 POSADA NEWPORT BEACH, N CA 92660-3281 0 E4 180-5517-6 09/30/02 PAGE 1 'P �!_ r, a aid, . DRI. , !my Z.,y0 AkB �';Y��'' ` p' 1ngqp7Ji�}fji Pr d , 4 .}a1 ^^" �f r d.,. tt•.� �j,��• 13 tQ A y1 1 �•/. f. i 100.04 0 0.00 1 2 200.07 1 .00 300.11 visage examine immanumy and report if incorrect. it no report a recnxed wttntn ao day, tds accotnt ww de considered correct. MOVING? USAA'S MOVERS ADVANTAGE TEAM CAN HELP YOU SELL, FIND OR BUY A HOME. CALL (888) 353-1006 OR VISIT USAA.COM. ****BONUS SAVINGS**** DEPOSITS AND OTHER CREDITS DATE........... AMOUNT.TRANSACTION DESCRIPTION 09/20 200.00 ACH CREDIT 092002 USAA FSB - SAV TRANSFER 000021010116979 09/30 0.07.INTEREST PAID ACCOUNT BALANCE SUMMARY DATE......... BALANCE DATE......... BALANCE 08/31 100.04 09/30 300.11 09/20 300.04 >S * * * * * * * INTEREST PAID INFORMATION * * * * * * * * YOUR INTEREST PAID WAS CALCULATED USING YOUR DAILY BALANCE FOR 30 DAYS FOR AN ANNUAL PERCENTAGE YIELD EARNED OF 0.49% THIS BRINGS YOUR YTD INTEREST PAID TO 0.11. ' USAA FEDERAL FDIC I SAVINGS INSURED BANK 16 JOSEPH MICAH GERRY 21 OR CARRIE A GERRY 1441 POSADA NEWPORT BEACH CA 92660-3281 059-1187-7 li��STA,TENENTxb' 09/19/02 PAGE 8 OEHLT3+ � �;sT�TAL2A�hg0U�1�2j��'i? �V�(-'4U:'iR�TU,FAI.iAH011,�r+�-""^�:�'� nS�fjV}.,CE l t'�)�f;.`•9AI:At�CE�TiIi�iNr��:``Fa'�" �,`Y3 LASA7EME e^1L.. P,O�xE+%i1Y PU:1L 1,747.41 116 5,448.03 10 5,196.28 1 .00 1,495.66 r,.... ...mm. I...euu.. ane open a mwron. n ne open .. r.cu..0 nuee.....,q .......................... * * * * * * * * INTEREST PAID INFORMATION * *'* * * * * * YOUR INTEREST PAID WAS CALCULATED USING YOUR DAILY BALANCE FOR 30 DAYS FOR AN ANNUAL PERCENTAGE YIELD EARNED OF 0.28%. THIS BRINGS YOUR YTD INTEREST PAID TO 38 USAA FEDERAL FDIC SAVINGS INSURED USAA BANK JOSEPH MICAH GERRY OR CARRIE A GERRY 1441 POSADA NEWPORT BEACH CA 92660-3281 16 21 g1"ACC04q nBER;;' j 059-2187-7 Y:��STATMEl,'CD�1T,E 4`.j 08/20/02 PAGE 8 ',:� • '; =LiHCE . ' - ,%,; 1. ;,STATEMENr.:'�?ttY;7 OEBITP 't ,•� ,:TUTAL'aPIOUNTi.�• is r 'J1`-�r� DE9,[TS+PgIO; p0':0F .y40EP rt�7w!'iW�fO,TAL�j1HUUNT;`2}•��'; �ERYXCFg"1 BALl1tkE'�•N SI'a�Y{I•i^. :!;•i�",KNOW, 7"; ST♦T�,t�4¢i''�,`T•' r+ .k to AF Yj ,1 E:.f ,ser+ $ 8, a :9 Jj*y pf �E�OCYY 0�r+y; PF, ..,,,Fiv.'.,�m� �i CFUt�iOES.. l�.e',W v, .! 4� �. 5il i+f ,.mi,'�"7.0. r. 3,651.57 1 126 5,391.85 9 3,487.69 1 .00 1',747.43 neaee enamme ......... ty no report it incorrect. it no report is received within w mye, the accomt will be comltlereC Correct, OTHER DEBITS DATE.......... AMOUNT.TRANSACTION DESCRIPTION 08/20 13.48 POS DEBIT 082002 DYER 55 MOBIL SANTA AN ACCOUNT BALANCE SUMMARY DATE......... BALANCE 07/19 3,651.57 07/22 3,448.64 07/23 2,789.83 07/24 2,275.23 07/25 2,036.34 07/26 2,009.64 07/29 1,601.04 07/30 1,255.54 O7/31 1,171.26 08/01 2,151.67 08/02 2,810.97 O8/05 1,327.32 DATE......... BALANCE 08/06 1,205.72 08/07 1,139.54 08/08 941.97 08/09 906.78 08/12 785.58 08/13 782.30 08/14 722.71 08/15 1,614.33 08/16 1,421.28 08/19 1,875.70 08/20 •1,747.41 CA * * * * * * * * INTEREST PAID INFORMATION * * * * * * * * YOUR INTEREST PAID WAS CALCULATED USING YOUR DAILY BALANCE FOR 32 DAYS FOR AN ANNUAL PERCENTAGE YIELD EARNED OF(-0.32% THIS BRINGS YOUR YTD INTEREST PAID TO 3.12. USAA a FEDERAL FDIC SAVINGS SAVINGS INSURED US4A BANK JOSEPH MICAH GERRY OR CARRIE A GERRY 1441 POSADA NEWPORT BEACH CA 92660-3281 21 21 ACCOUNT .NUNBERi 059-1187-7 �KIs AYENENTrDATEj�F,; 07/19/02 PAGE 7 qE@ITS'.'ii,j'�L.�XOUf7T_�„v�'-"•j�': NU: iUf F'o-^ J' 'i5'rrTOTA�. "A190UI�Tir; f,+�;SER'{ICE� 'I U.IIE�US;TS,. au�1BALA,NCE JHIS fy"'alt='a :' AIU� :S� 1 i�E9�,TSfP,�AIb.,� , MALE't4E stjlq�CESi .,f,�yyaff:STA'[E�ik'NT$`�`, ,n6? 1,452.08 101 4,665.60 15 6,865.09 .00 3,651.57 ACCOUNT BALANCE SUMMARY DATE......... BALANCE 06/19 1,452.08 06/20 2,733.68 06/21 2,724.63 06/24 2,196.81 06/25 1,977.74 06/26 1,743.17 06/27 2,284.55 06/28 2,203.03 07/01 1,897.40 07/02 2,559.54 07/03 3,172.31 DATE......... BALANCE 07/05 1,830.92 07/08 2,330.65 07/09 2,242.75 07/10 2,019.50 07/11 1,994.49 07/12 1,857.73 07/15 1,634.05 07/16 1,606.85 07/17 1,583.92 07/18 3,155.15 07/19 3,651.57 ..�...... ...... * * * * * * * * INTEREST PAID INFORMATION * * * * * * * * YOUR INTEREST PAID WAS CALCULATED USING YOUR DAILY BALANCE FOR 30 DAYS FOR AN ANNUAL PERCENTAGE YIELD EARNED 0 0.35--/: THIS BRINGS YOUR YTD INTEREST PAID TO 2.62. Clarification Record Applicant/Resident Name:: Carrie Gerry Initial Certification x Re -certification Date:11-06-02 Date of Expected Move -In: Effective date: 12-01-02 Means of Clarification: Phone Conversation X Person -to -Person Conversation Other: Date of Clarification: 11-06-02 Contact Name: Carrie Gerry Company/Organization: self Summary of Clarification: Employment verification indicates $25,000 annual salary paid during nine month period. Do you receive income paid to you during the remaining three months Explanation or Clarification Given: No resident does not receive income from remaining three months. Employment annual income is $25,000 Employee Name: Marcus Ipcizade Employee Signature W I Clarification Record Applicant/Resident Name:: Joseph Gerry Initial Certification Date: 11-06-02 Date of Expected Move -In: X Re -certification Effective date: 12-01-02 Means of Clarification: Phone Conversation X Person -to -Person Conversation Other: Date of Clarification: 11-06-02 Contact Name: Joseph Gerry Company/Organization: self Summary of Clarification: Pav stub dated 09-27-02 has an incentive plan payment of S 824.83. How often Is the incentive plan bonus paid to you? Explanation or Clarification Given: The incentive plan has been paid only once and do not expect additional bonuses in the next 12 months. Employee Name: Marcus Ipcizade Title: s l r q, YYb*-" Employee Signature: v Date: 11-06-02 r rVgw cergricadon /Recerdfrcadon _ Unit Number z� 6 • t• INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designed to assist you in computing Annual Income in accordance with the method set forth in th. Department of Housing and Urban Project ("HUD") Regulations (24 CFR 813). You should make certain that this form is at all times up to date hvid the HUD Regulations. All capitalized terms used herein shall have the meaning set forth in the Regulatory Agreement. Re: (NAME and ADDRESS of Apartment Building) Newport.North e CSCDA00 L) I/We the undersigned state that I/we have read and answered fully, frankly and personally each of the following questions for all persons who are « occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit: 1. 2. 3'. 4. 5. Name of Members Relationship of the to Head of Social Security Place of Household Household Age Number Employment lar ib Sirloin Uvad �q _ 651-64 ^7653 Numdo In4, Income Computation 6. The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children under 18 years) listed above for the 12-month parit beginning the earlier of the date that Uwe plan to move into a unit or sign a lease for a unit is $ f� 459. 4? - .' Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, fees, lips and bonuses and other compensation for personal services, before payroll deduction;; (b) the net income from the operation of a business or profession or from the rental of real of personal property (without deducting expenditures for busires expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets except for straight line depreciation as provided Internal Revenue.Service regulations); (c) interest and dividends (including income from assets Included below and other net income from real or personal property); (d) the full amount of periodic payments received from social security, annuities, insurance policies, retirement funds, pensions, disability or death benefit and other similar types of periodic receipts, including any lump sum payment for the delayed start of a periodic payment; (e) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (t) the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter at utilities plus the maximum amount that the public assistance agency could in fact allow for shelter and utilities; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not residir in the dwelling; (h) all regular pay, special pay and allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the household t spouse (or other persons whose dependents are residing in the units); and (i) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; (b) amounts which are specifically for or in reimbursement of medical expenses; (c) lump sum additions to family assets, such as inheritances, insurance payments (including payments under health and accident insurance and work!, compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational institution, and amounts paid by the government to a veteran for 'us' meeting the costs of tuition, fees, books and equipment. Any amounts of such scholarships or payments to veterans not used for the above purposes a: to be included in income; (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (0 amounts received under training programs funded by HUD; (g) foster child care payments; ' (h) amounts received by a disabled person that are disregarded for a limited time for purposes of Supplemental Security Income eligibility and benefits beca' they are set aside for use under a Plan to Attain Self -Sufficiency; (i) income of a live-in aide; Q) amounts received by a participant in other publically assisted programs which are specifically for or in reimbursement of out-of-pocket expenses in:=r. and which are made solely to al!ow participation in a specific program; (k) a resident service stipend (a modest amount (not to exceed $200 per month) received by a resident for performing a service for the owner, on a basis, that enhances die quality of life it,, the development; If olis form is being completed in accordance with recertification of a Lower Income Tenant's or Very Low Income Tenant's occupancy of a Lower Income Unit or a Very Low Income Unit, respectively, this form must be completed based upon the current income of the occupants. W ANe.e9971OC.FORM Per (1) compensation from state or local employment training programs and training of family member as resident management staff, (m) reparation payments paid by a foreign government pursuant to claims filed under the laws of that government by persons who were persecuted during the Nazi era; (n) amounts specifically excluded by any other federal statute from consideration as income for purposes of determining eligibility or benefits undera category of assistance programs that includes assistance under the United States Housing Actof 1937; (o) earnings in excess of $480 for each full -tens student 18 years old or older (excluding the head of household and spouse); (p) adoption assistance payments in excess of 5480 per adopted child; and (q) deferred periodic payments of supplemental security income and social security benefits that are received in a lump sum payment; (r) amounts received by the family in the form of refunds or rebates under state or local law for property taxes paid on the dwelling unit; (s) amounts paid by a State agency to a family with a developmentally disabled family member living at home to offset the cost of services and equipment needed to keep the developmentally disabled family member at home; and (t) amounts specifically excluded by an other federal statute from consideration as income for purposes of determining eligibility or benefits under a category of assistance programs that includes assistance under the United States Housing Act of 1937. 7. Do the persons whose income or contributions are included in item 6 above: , (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necessary items of personal property such as furniture and automobiles and interests in Indian trust land) if Yes No; or (b) have they disposed of any asses (other than at a foreclosure or bankruptcy sale) during the last two years at less than fair market value? Yes __�L_No (c) If the answer to (a) or (b) above is yes, does the combined total value of all such asses owned or disposed of by all such persons total more than 55,000? Yes 7C No (d) If the answer to (c) above is yes, state: (1) the combined total value ofa11 such asses: s ra1g4$•17 (2) the amount of income exAccied to be derived from such asses in the 12-month period beginning on the date of initial occupancy in the unit that you propose to rent: S C. I q and (3) the amount of such income, if any, that was Included in item 6 above: $--.C•4S 8. (a) Are all of the individuals who propose to reside in the unit full-time students*? Yes No "A full-time student is an individual enrolled as a full-time student during each of 5 calendar months during the calendar year in which occupancy of the unit begins at an educational organization which normally maintains a regular faculty and curriculum and normally has a regularly enrolled body of students in attendance or is an individual pursuing a full-time course of institutional or farm training under the supers ision of an accredited agent of such an educational organization or ofa state or political subdivision thereof. (b) If the answer to 8(a) is yes, is at least 2 of the proposed occupants of the unit a husband and wife entitled to file a joint federal income tax return? Yes�_No 9. Neither myself nor any other occupant of the unit IAve propose to rent is the owner of the rental housing project in which the unit is located (hereinafter the "Owner"), has any family relationship to the Owner; or owns directly or indirectly any interest in the Owner. For purposes of this paragraph, indirect ownership by an individual shall mean ownership by a family member, ownership by a corporation, partnership, estate or trust in proportion to the ownership or beneficial interest in such corpomtion,'partnership, estate of Trustee held by the individual or a family member; and ownership, direct or indirect, by a partner of the Individual. 10. This certificate Is made with the knowledge that it will be relied upon by the Owner to determine maximum Income for eligibility to occupy the unit; and I/we declare j that all Information set forth herein is true, correct and complete and based upon Information I/wc deem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. I1. I/We will assist the Owner in obtaining any information or documents required to verify the statements made herein, including either an income verification from my/our present employer(s) or copies of federal tax returns for the immediately preceding calendar year. 12. Me acknowledge that Uwe have been advised that the making of any misrepresentation or misstatement in this declaration will constitute a material breach of my/our agreement with the Owner to lease the unit and will entitle the Owner to prevent or terminate my/our occupancy of the unit by institution of an action for ejection or other appropriate proceedings. Me declare under penalty of perjury that the foregoing is true and correct. Executed this 14 day of Gem her .20 c,2 in the City of k3e ugh , California r I ' Appli tt Applicant Rev. 3/95 Applicant Applicant lSkgnnture of all persons (except children under the age of 18 years) listed in number 2 above required! W MIC n"%F ICC•FOPU FOR COMPLETION BY APARTMENT OWNER ONLY: 1. Calculation of eligible income: a. Enter amount entered for entire household in 6 above: $ 2I 1 q iL 9 (1) If the amount entered in 7(c)above is yes, enter the total amount entered in 7(d)(2), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ e ); (2) Multiply the amount entered in 7(d)(1) times the current passbook savings rate as determined by HUD to determine what the total annual earnings on the amou t in 7(d)(1) would be if invested in passbook savings ($ ), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ (3) Enter at right the greater of the amount calculated under (1) or (2) above: $ - 'e C. TOTAL ELIGIBLE INCOME (line La plus line I.b(3): $ • 211,U 8g - 40 2. The amount entered in i.c: Qualifies the applicant(s) as a Moderate -Income Tenant(s). Qualifies the applicant(s) as a Lower -Income Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenant(s). 3. Number of apartment unit assigned: 2229 Bedroom size: ^1 k2 Rent: $ 13 2 6 4. This apartment unit w was not) last occupied for a period of 31 or more consecutive days by persons whose aggregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartment unit qualified them as a Lower -Income Tenant(s). 5. Method used to verify applicant(s) income: X X Manager Employer income verification. Copies of tax returns. Other ( I7 II/Cr Date W ANCA9971CC.F0R%1 INCOME 8 ARSFT rAl rr II ATrnAI tn,rYnvn, HOH 133 R YesrNO M 8 r INC nnnF Family Memb. # Source Base Rale Averaget5224 age Annual a Hours 26 12 1 Total el•WK MO Ylt s $ =a 13, 7L =a a =a a =$ PUBLIC ASSISTANCE Tout Box—e: a I Family Memb.0 • Source Base Rate Average Average Annual $ Hours 52 24 26 12 1 Total YJx OR I•MO 0•WK MO —STjt r1T149R Wn.nM= TOWI Dox C: $ Family SGurce BaseRale Average AveragoAnnual Memb.IP $ Hours 52 24 26 12 1 Total WK SL I•MO al•WK MO YR TOTAL ANNUAL ToWI BOX D: GROSS INCOME Athrough D aa.naannnnnaa $ 2i.0a s2 00__ ASSETS Asset Description Imputed Gross/Fair Cost to NET Actual 'Actual Annual Member (savings,ehec6mg,stocks, bonds, Current Mkl.Vaiuo. Get Cash FamilyAssels Interest Income from a eta IorC value Rate Assets ° 25 "i_— .55 %% 6— G s _r- — --- % W Totals Box E: Dox F: 6, 4 fr IMPUTED INCOME FROMASSETS Box E exceeds $5,000—multiply E by the currant passbook Inlorosl rate; It Box E does not exceed $5,000 enter -0•In box G: Enter the greater of Box F or Box G In: z .X BOX G: INPUTED INCOME FROMASSETS s C,48 BOX H: 1001 LI Total Aduul mama Faudlyinralno FmmAmelz Elredivo Date Dar< Typo ofProgram % Lmr Unll No.2w_ Unit Silo-322dZ9 2 ) No, of Parsons- MA: — Mox.Income Limit $ AR: 140°/ Limit$. 541270 .ea INCOME CONTRIBUTED FROM ASSETS TOTAL ANNUAL INCOME $ 2Lg52.00 & TOTAL ASSETS $ C.FIs =$ 211,y5B,ye .. � . oMa No. 1644 SCHEDULE c Profit or Loss From Businr L-- 2 o Q (Form 1040) (Sete Proprietorship) Department of IbeTreasury )* Partnerships, Joint ventures, etc., must file Form 1065 or Farm 1065.11. Attachment Internal Fi venueservice (sel )* Ahach to Farm 1040 or Form 1041. )*See Instructions for Schedule C (Form 1040). segaoRae No Name of pmpdeter I social security numbortssM A Principal business or profession, including product or service (seepage C-1) 9 We, code from pasta C•7 a8 SERVICE—MER'S SALES REP )* 999999 C Business name. If no separate business name, leave blank. D employer to number PM, 1f any E Business address(including sufte or room no.))* LLLb tSX1Nll171_______--- _______________________ City, town or post office state and ZIP code NEWPORT BEACHr CA 92660 F Accounting method: (1)EXICash (2)0Accrual (3)0 Other(specify) )* __________________________ G Did you 'materially participate' In the operation of this business during 2001? If'No; seepage C-2 for limit on losses • .......;...................... M Yes [] No HIf you started or acaufred this business during 2001, check here ......... ___ .................................. ........................................................... )* 1 Gross receipts or sales. Caution. If this Income was reported to you on Form W-2 and the 'Statutory employes' box on that form was chocked, seepage C-2 and check here.......................................................................................)* 2 Returns and allowances ......................... 3 Subtract line 2 from tine 1 ...................... 4 Cost of goods sold (from line 42 on page 2) 6 Gross profit. Subtract line 4from line 3i1................................................................................................................... 6 Other income, Including Federal and state gasoline or fuel tax creditor refund (seepage C-3) ................................................ Add Enter use of your home only on line 30. 72. 172. 172. 8 Advertising .................................... 6 19 Pension and profit-sharing plans .................. 9 Bad debts from sales or 20 Rent or lease (see page C-4): services (see page C-3) .................. 9 a Vehicles, machinery, and equipment ............. 10 Car and truck expenses b Other business property ........................... (see page C-3) .............................. 10 3,918. 21 Repairs and maintenance .......................... ll Commissions and fees .................. 11 22 Supplies (not Included in Part III) ,,,,,,,,,.,,,., 12 Depletion .................................... 12 23 Taxes and licenses ,,.................................. 13 Depreciation and section 179 24 Travel, meals, and entertainment: expense deduction (not Included in a Travel ................................................... Part III) (see page C-3)..................... 13 b Meals'and 14 Employee benefit programs (other entertainment ................. 2 322 than on line 19) ........................... 14 a Enter nondeductible 15 Insurance (other than health) ............ 15 I amount included on line 24b 16 Interest: ;,,,,,. (sae page C-5).................. a Mortgage (paid to banks, etc.) ......... 168 If Subtract line 24c from line 24b .................. b Other .......................................... 1613 25 Utilities ................................................... 17 Legal and professional 26 Wages (less employment credits) ............... services ....................................... 17 250. 27 Otherexpenses (from line 48 on 18 Office expense ............................. 18 page 2) ................................................ 28 Total expenses before expenses for business use of home. Add lines 8 through 27 in columns ....................................... 0. ............................................................ 29 Tentative profit (loss). Subtract line 28 from line 7.................................... ........, 30 Expenses for business use of your home. Attach Farm 8829.......................................................................................... 31 Net profit or (loss). Subtract line 30 from line 29. e It a profit, enter on Form 1040, line 12, and also on Schedule SE, line 2 (statutory employees, see page C-5). 1 pchlae and trntft ants, nn Fnrm 1n41_ tin a 1. ? 19 20a 206 2,845. —Li- 22 180. 23 770. ........ 249 11 40 0 . 1,161. 24d 25 26 27 28 3 11,21 . 14 19 6. 29 7, 976. 30 31 7 976. u If a loss, you must go to line 32. 32 If you have a loss, check the box that describes your investment in this activity (see page C-6). a If you checked 32a, enter the loss on Form 1040, line 12, and also on Schedule SE, line 2 (statutory emple;ees, sea page C-5). Estates and trusts, enter on Farm 1041, line 3. A.I mrsa. t 322 � is at deL a If you checked 32b, you must attach Form 6198. 32b is me, ea SomeV.vtlurne^t Q LHA For Pap erworkReduction Act Notice, see Form 1040Instructions. Schedule C(Form iD40)2001 120001 10.26.01 SCHEDULE SE Self -Employment Tax OMB No. ta 50074 (Form 1040) 2001 Department ofthaTtmmy► See Instructions for Schedule SE (Form 1040). A-.WcGem f.. Intemal Revenue Service J99) ► Attach to Fort 1040. Sequence No, 17 Name of person with self-employment income (as shown on Form 1040) Social security number of person with sett -employment JACOB SYRQUIN Income j► 1 559 64 €7653__ Who Must File Schedule SE You must file Schedule SE N: • You had net earnings from self-employment from other than church employee income pine 4 of Short Schedule SE or line 4c of Long Schedule SE} of $400 or more or • You had church employee Income of $108.28 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. Note: 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-3. 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 file Schedule SE. Instead, write 'Exempt -Form 4361' on Form 1040, line 53. May I Use Short Schedule SE or Must I Use Long Schedule SE? et No Are you a minister, member of a religious order, or Christian Science practitioner who received IRS approval not to be taxed on earnings from these sources, but you owe self-employment tax on other earnings? No Are you using one of the optional methods to figure your net eamings (sea page SE-3)?, No Did you receive church emolovee Income reoortad on Form W-2 No more Yes and tips subject to social security Is vour net eamings from self - W, Did you receive tips subject to social security or Medicare tax that you did not report to your employer? Section A -Shot t Schedule SE. Caution. Read above to see If you can Use Short Schedule SE. 1 Net farm profit or (loss) from Schedule F, line 36, and farm partnerships, Schedule K•1 (Form 1065), line 15a.......................................................................................................................................... 1 2 Net profit or pass) from Schedule C, line 31; Schedule C-EZ, line 3; Schedule K-1 (Form 1065), line 15a (other than farming); and Schedule K-1 (Form 1065•B), box 9. Ministers and members of religious orders, see page SE-1 for amounts to report on this line. See page SE-2 for other Income to report STNT„ 4.... 3 Combine lines 1 and 2....................................................................................................................................... 2 7,976. 3 7,976. 4 7 , 3 6 6 . 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................................................................................. ► 5 Self-employment tax. If the amount on line 4 is: ' • $80,400 or less, multiply line 4 by 15.3% (.153). Enter the result here and on Form 1040, line 53. 5 1 r 127. ' • More than $80,400, multiply line 4 by 2.9% (.029). Then, add $9,969,60 to the result. Enter the total here and on Form 1040, line 53. ' 6 Deduction for one-half of self-employment tax. Multiply line 5 by 50% (5). Enter the result here and on Form 1040, line 27......................................... 564. 6 • . • ' : • •� � _ •• LHA For Paperwork Reduction Act Notice, see Form 1040 instructions. Schedule SE (Form 1040) 20011 124501 10.23•01 Label (See instructions on page 19.) Use the IRS label. Otherwise, please print or type. Presidential Election Cal DU.S. Individual Income Tax Return � 20011 2001 I(99) r r IRS Use Only -Do not write arstaple In this space. ForNoyearJsn.1-Deo.31,2001,orothertaxywbeglnnrng .2001. ending. gg OMB No. 1545.0074 L Your first name and initial Last name Your social security number A JACOB SYRQUIN 559164€7653 E E If a joint return, spouse's first name and Initial Last name Spouse$ social security number L H Home address (number and street). If you have a P.O. box, see page 19. Apt. no. Important! A E 2226 BRINDISI You must enter E City, town or post ofeee, state, and ZIP coda Ifyeu have foreign address, see page 19. your SSN(s) above. Filing Status 1 2' 3 4 Check only one box. Note. Checking 'Yes' will not change your tax or reduce your refund. • You Spouse Do you, oryourspouse If filing alolnt return, want $3 to go to this fund?......... P • 0 Yes E No 0 Yes 0 No Single Married filing joint return (even if only one had Income) Married filing separate return. Enterspouse's social security no. above and full name here.l. Head of household (with qualifying person). (See page 19.) If the qualifying person is a child but notyour dependent, enter this child's name here. child Near soouse died Exemptions 63 L J Yourself. 'tfyourparent(oraomeano else) can clalmyou as adependentan his orhertaxrolum, do not check boxes ......... 6 0 Spouse ..:................................................. : • c Dependents: (2) Dependent's social P)Dependent's l3,! ere t't security number relationship to ahidbx.1". 0)First name Last name you lost Pace 2( If more than six dependents, see page 20. Income Attach Farms W-2 and W213 here. Also attach Form(s) 1099-R If lax was withheld, If you did not got aW2, see page 21. Enclose, but do notattach,any payment. Also, please use Form10404. 7 Be b 9 10 11 12 13 14 15a 16a 17 18 19 20a 21 Wages,salaries, tips, etc. Attach Form(s) W-2 .............................................................................. Taxable Interest. Attach Schedule 8 H required.............................................................................. Tax-exempt interest. Do not Include on line Be ................................. 1 811 p Ordinary dividends. Attach Schedule 8 fl required........................................................................... Taxable refunds, credits, or offsets of state and local Income taxes ...................................................... 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 ..................... S Other gains or (losses). Attach Form4797...................................:....................................::.......... Total IRA distributions ............... 15a b Taxable amount (see page 23) Total pensions and annuities ,,,.,, 1.62_ b Taxable amount (see page 23) Rental real estate, royalties, partnerships, S corporations, trusts, etc. Attach Schedule E ........................ ''""" """"" Farm income or (loss). Attach Schedule F.................................................................................... Unemployment compensation.................................................................................................. Social security benefits I20a1 13,773.1 b Taxable amount (see page 25) Other Income. List type and amount (see page 27) 7 8a 9 10 11 12 13 14 15b 166 17 18 19 20b 21 22 Add the amounts in the far right column for -lines 7through 21. This isyou rtotal Income .................. 0 22 Adjusted Gross Income 23 24 25 26 27 28 29 30 31a 32 IRA deduction (see page 27)......................................................... Student loan Interest deduction (see page 28) .................................... Archer MSA deduction. Attach Form 8853 Moving expenses.Attach Form 3903 ........... One-half of self-employment tax. Attach Schedule BE ........................ Self-employed health Insurance deduction (see page 30) ..................... Self-employed SEP, SIMPLE, and qualified plans .............................. Penalty, on early withdrawal of savings ............................................ Alimony paid b Recipient'sSSN P Add lines 23 through 31a....................................................................................................... 23 ' .: -' 32 24 25 25 27 5 6 4 . 28 3 6 0 . 29 30 31a checked on 6a and 61, 1 No. olyour children an fie who: with you • did not live with You duo to divorce erseparation (see page 20) Dependents on Go net entered above Adtl numbed t—I entered on l i nesabovov e S ]_ LHA For Disclosure, Privacy Act, and Paperwork Reduction Act Notice, seepage 72. Fomr1040(2M1r Fonn.1040(2001) JACOB SYRQUIN Tax and 34 Amount from line 33 (adjusleu gross income) ................... :.............................................................. Credits 258Checkif: OX You were 65orolder, Blind; E:1 Spouse was 65 or older, EIBIlml. Stands naaman tor- De Add the number of boxes checked above and enter the total here35a .................................... •Proplowho b ff Ifyeuaremnnledfiling separately and yourspeusoltemizesdeductions, oryouwereadual•statusalien ...... i�35b L o^roke my 36 Itemized deductions (from ScheduleA) or your standard deduction (see left margin) """"""""""""" box on llne35a or55b of who 37 Subtract line 36 from line 34 can be claimed seadependent 38 ..................................................................................................... It line 34 is $99,725 or less, multiply $2,900 by the total number of exemptions claimed on line 6d.If line 34 Is over$99,725, see the worksheet on page 32................................................................................ 39 Taxable income, Subtract line 38 from line 37. If Iim38Is more than line 37, enter -0 . .......................... • All others: 40 Tax. Check if tax from aEl Form(s) 8814 bE:J Form 4972........................................................ Single, I41 $4,550 Alternative minimum tax, Attach Form 6251 ................................................................................ Had or 42 Add lines 40 and 41................................................s.................................:.....................:....... household, $8,650 43 Foreign 'tax credit. Attach Form 11169required ....................................... 43 Marled filing 44 Credit for child and dependent care expenses. Attach For 2441.................. 44 loualll ing 45 Credit forthe elderly or the disabled. Attach Schedule R ................ ............. a5 widow(e4, $7,600 46 Education credits. Attach Form8863...................................................... 46 Manted filing 47 Rate reduction credit, Sea the worksheet on page 36................................. 47 a`parat`ly' $3,80o 48 Chfld tax credit see a e 37 ( P 9 )................................................................ 48 49 Adoption credit. Attach For 8839......................................................... 49 50 Other credits from: a EDForm 3800 to [::] Form 8396 , ,50W c 0 Form 8801 d ED Farm (specify) 51 Add lines 43through 50.Tetieseare your total credits ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 52 Suhtrnet Ina ;I from lln942. if line 51 Is: melra than line 49.enter-n-__.... ____--------------- ------- -....... 3 Page 2 .. 34 4,062. 1 ss 5 650. 37 —1 588. ..•.. 38 2 900. .... 39 0 . .... 40 0 . 41 ►" 42 0. Other 53 Self-employment tax. Attach Schedule SE,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, 53 1,127. Taxes 54 Social security and Medicare tax on tip Income not reported tD employer. Attach Form 4137 ........•.................. 54 66 Tax on qualified plans, Including IRAs, and other tax -favored accounts. Attach 5329 if required ........................ 55 56 Advance earned income credit payments from Fors) W-2..................................................................... 66 57 Household employment taxes. Attach Schedule ................................................................................. 67 58 Add lines 52 through 57.This isyour total tax................................................................................ ► 68 1 127 . Payments 69 Federal Income tax withheld from fors W-2 and 1099 .............................. 69 60 2001 estimated tax payments and amount applied from 2000 return ............ 60 380. ., oah'ild. D.�hta-cgh 61 a Earned income credit (EIC) .................. .. ..........................h Nontaxable earned Income,,,,,,,., 161h Ifit Excess social security and RRTA tax withheld (see page 51) 62 63• Additional child tax credit. Attach Form8812............................................. 63 64 Amount paid vrith request for extension to file (see page 51) ........................ 64 65 Other payments. Check if from al]Form 2439b=Form 4136......... 65 E6 Add lines 59. 60, 61a, and 62 through 65. These are your total payments ............................................ P 66 380. Refund 57 If line 66 is more than line 58, subtract line 58 from tine 66. This Is the amount you overpaid ........................... 67 Direct 68a Amount of line 67you want refunded toyou .................................................................................. A Gas Sea Page 51 Rauerg bcoaunt' and all In 68b. • b numt: r d C Ty;c 0 Q.ek'ng 0 $a•,Inys � d numhcr I Amount 70 Amount you awe. Subtract line 66 from line 58. For details on hose to pay, seepage 52 .•............•............ P' 1 70 1 r r You Owe 71 Estimated tax penalty. Also Include on line 70 171 I 26.1 Do you want to allow another person to discuss this return with the IRS (see page 53)7 IXI Yes. Complete the following. 0 No Third Party Designee's Phone Personal identification Designee name ► PREPARER no. A number(PIN) m SignUnder 9 peno"os or ppedury, I declare their have examined this return and accompam Ing schedules and statements, and eb knowleo •. army knowledge and belief, they we uua, core.: end eomplet eelaradon otpreparer(other than taxpaye4 is based on all Infomafnof which preperer has any Here Your _ ura Data Youreccupatian O I Daytime phono number O se I UTSIDE SALESMAN page19. Keep y use's Signature. Ifajoint return, both must sign Date Spausea aaupa0sn .. yeU, for your I Mon I ' Freparaes Date (Check if sell. prsareh SSflorPTIN Paid s'g+a:are ® 04/09/02 "Ploy" (]X P00169213 Preparer's BENJAMIN C. BOHR, CPA e s I 95 €1796183 Use Only Frma name ;or )cusifae!f-en• 8383 WILSHIRE BLVD.r STE 248 IPhone na.323-655-6011 P cy c), add,"., ., �..,".,. ,. ,.T,• ,... .,,, n n n s I 110002 11-27.01 Label (See L Instructions A on page 19.) B E Use the IRS L label. H Otherwise, E please print R ortype. E Presidential Election Campa Department of the Traasu- i,, .d Revenue Service U.S. Individua, .come Tax Ret name a joint return, spouse's first name and Initial I Last name Home address (number and street). If you hays a P.O. box, see page 2226 BRINDISI City, town or post office, state, and ZIP code. Filing Status 1 2 3 4 Check only one box. 5 Exemptions 63 If more than six dependents, see page 20. Income Attach Forms W-2 and W-2B here. Also attach Form(s) 1099-R If tax was withheld. If you did not gat a W-2, see page 21. Enclose, but do not attach, any payment. Also, please use Form 1040.11. ORT BEACH, CA 92660 Note. Checking 'Yes' will not change your tar or reduce your refund. Do notvnite arstsple In this apace OMB No. 1545.0074 Your soda) security number 559i6417653 spouses social security number You must enter your SSN(s)above. Spouse Single Married filing joint return (even If only one had income) Married filing separate return. Enterspouse's sec. sec. do. above and full name here. 1• Head of household (with qualifying person). (See page 19.) If the qualifying person is a child but not your dependent, enter this child's name here. ► died Yourself. If your parent (orsomeone else) can claim you as a dependent on his orhertax return, do not checkbox 6a.......................................................................................................... bF1Sp ''--...................... .................. Dependents: p et (1)First name Lastname ...................................................................... R) Dependents social security number ................ (3)Dependents relationstdp to you ...�v..a.. 141na ehatl for c dnxcredt (sa aee2% 7 Wages, salaries, lips, etc.AhachForm(s)W-2............................................................................... Be Taxable interest. Attach Schedule B If required............................................................................. b Tax-exempt interest. Bo not Include on line Be „ ............................... I Bb 9 Ordinary dividends.AttachSchedule 8Urequired........................................................................... 10 Taxable refunds or credits of state and local Income taxes............................................................... 11 Alimony received..................................................................................................................... 12 Business income or (loss). Attach Schedule C or C-EZ..................................................................... 13 Capital gain or (loss). Ahach Schedule D if required. If not required, check here ..................... 1' 14 Othergains or (losses).Attach Form 4797 .......................................................................:............ 15a Total IRA distributions ..... 15a I b Taxable amount (see page 23) 16a Total pensions and annuities ...... 16a b Taxable amount (see page 23) 17 Rental real estate, royalties, partnerships, 6 corporations, trusts, etc. Attach Schedule E ............. I.......... 18 Farm Income or (loss). Attach Schedule F.................................................................................... 19 Unemployment compensation................................................................................................... 20a Social security benefits ............ I20a 1 13,242.1 Ir Taxable amount (see page 25) 21 Other income. List type and amount (see page 25) 22 Add the amounts in the far right column for lines 7 through 21. This Is your Iota 23 IRA deduction (see page 27)......................................................... 22 Adjusted 24 Student loan Interest deduction (seeepage27).................................... 24 Gross 25 Medical savings account deduction. Attach Form 8853........................ 2: Income 26 Moving expenses. Attach Form3903............................................. 2f 27 One-half of self-employment tax. Attach Schedule BE 2l 28 Self-employed health Insurance deduction (see page 29) ..................... 22 29 Self-employed SEP, SIMPLE, and qualified plans 2` 30 Penalty on early withdrawal of savings ............................................. 3( 31 a Alimony paid b Recipient's SSN D 31 32 Add lines 23 through 31a.................................................................... 33 Subtract line 32from line 22.Thisisyour adjustedgrosslncame .............. No. of boxes chesked an Be 1 and eb _ N o f our o, y children an ea Who; • Ilved vr1 h you • did notlive With you due to divorce orseparallon (see pace 20) — Dependents an Go not entered above Add numbers I� enteral on Imes above 10- 1 072. of "S or LHA For Disclosure, Privacy Act, and Poperwork Reduction Act Notice, seepage 66 Fcrn104012 C: For;n`1040(2000) JACOB SYRQUIN' f --"%64-7653 Paget Taxand 34 Amounttromiine33(ad)u,..dgross Income) .................................................................................... 34 7r128. Credits 35a Check if: OX You were 65 or older, 0 Blind; ED Spouse was 65 or older, F-1 Blind. Add the number of boxes checked above and enter the total here .................................... ;� 35a standard b If you are marded filing separately and yourspouse itemizes deductions, ardmo t n or you were a dual -status alien, seepage 31 and check here P 35b CI people 36 Enter your itemized deductions from Schedule A, line 28,orslandard deduction shown on the left. But see page 31 to find your standard deduction If you "' single: checked any box on line 35a or35b or if someone can clalm you as a dependent .......................................... 36 5,500 . $4,400 37 Subtractline36fromline34 , nos raid: 38 If line 34 is $96,700 or less, multiply $2,800 by the total number of exemptions claimed on $8,450 line Ed. 1f Ifne 341s over $96,700, seethe worksheet on page 32 tar the amount to enter 38 2,800 . 39 Taxable income. Subtract line 38 from line 37. If line 38 is more than line 37, enter-0-................................. 39 0 . Married filing 40 Tax (seepage 32). Check If any tax from a EJ Form(s) 8814 b 0 Form 4972.................:1............. 40 0 . Jointly or 41 Alternative minimum tax. Attach Form 6251.......................................................................................... 41 oualluln9.• ]• a2 0. widowed: 42 Add lines 40 and 41............................................................................ ..................................... $7,050 43 Foreign tax credit. Attach Form 1116 if required 43 Married 44 Credit forchfidand dependent care expenses. Attach Form 2441.................. 44 sling •, separately. 45 Credit forthe elderly orthe disabled. Attach Schedule R •..................:.......... 45 s3,675 46 Education credits. Attach Form 8863...................................................... 45 47 Child tax credit (see page 36)•.......................................................... 47 48 Adoption credit. Attach Form 8839......................................................... afi 49 Other. Check It from a OForm 3800 b 1:1Form 8396 '- c Form 8801 d = Form (speedy) µ - 50 Add lines 43 through 491ase are your total credits......:....................................................................... 50 51 Subtract Iina 50 from line 42. it line 5015 more than line 42, enter -0- .................................................. 61 0 . Other 62 Self-employment tax. Attach Schedule SE............................................................................................. 52 1 488. Taxes 53 Social security and Medicare tax on lip Income not reported to employer. Attach Form 4137 .......................... 53 64 Tax on IRAs, other retirement plans, and MSAs. Attach Form 5329 if required ............................................. 54 55 Advance earned income credit payments from Form(s) N/•2..,,,,,•............................................................. 65 66 Household employment taxes. Attach Schedule ................................................................................. 65 67 Add lines 51through 56. This Isyourtotal tax ............................................ .................................... f> 57 1r488. Payments 68 Federal Income tax withheld from Forms W-2 and 1099 .............................. 68 69 2000 estimated tax payments and amount applied from 1999 return 59 46 0 ., ifyounare 60a Earned Income credit (EIC) 60a,- e qualifying •• - chnd,atlaoh b Nontaxable earned lncome:amount► schedaegc• and type 61 Excess social security and ARTAtaxwithheld(see page 50)........................ 61 62 Additional child tax credit. Attach Form 8812............................................. 62 63 Amount paid with request for extension to file .......................................... 63 64 Otherpayments. Check if from a 0 Form 2439 h O Form 4136 ......... 64 a Refund 65 If line 65 Is more than line 57, subtract line 57 from line 65. This is the amount you overpaid ........................ ... 66 67a aIlesUy 67a Amount of [Ina 66 you want refunded to you.................................................................................... �' deem�ted! D b Routing number I> c Type: Checking 0 Savings end All In 67b, P it Account number 67c, end67d 68 Amount of line E6 you want applied to your 2001 estimated tax ......... Its.fib Amount 69 If line 57 Is more than line 65, subtract line 65 from line 57. This is the amount you owe . ........................e ID' 69 1,069. • • . - You Owe 70 Estimated tax penalty. Also Include on line 69 1 70 - — Sign Underpenatdes !pperJur/, I doctors Ra: l have examined this return and accamp27ing scha.olm and statement W.d to the bet of and GW' to_la ab^^•r ere^ ^•'^t •lha. • paye4 isbmd on all inronnaton of which preparerhasanyknowlr'La ry c _h.edae and brie„they are tn.e,=r A Here Your O.to Youroccupation la Oay cphono number Keep a copy OUTSIDE SALESMAN May the INS d5.149 TdR].nlw+'n C.a }Of yOUf S oa siLnatur_ItaJaini revr., vt n:u sign. Oato Spouse's oecuFatic^ rt artrsicnn Oelewlstt pa;:52J7 feCOrdS. X Yes 0 No P parts Oa.e C...Kk it se:- o:eperees SSN ce PTIN I Paid stgna:ure 04/03/011`Tploye7XjI P00169213 Preparer's BENJAMIN C. BOHR, CPA I' 95 f 1796183 Use Only y urssifsef•er.-ILSHIRE BLVD� 2a8 8383 WILSHIRE Sl T• !--323-655-6011 FI'y4!' address. TTTTTTT[f TTTT ri • 01=2 cl-ea-cl OMS No. 1545.0014 sCHEDULEO .foFit or Loss From Business/� : 2®00 (Form 1040) (Sale Proprietorship) Department of theTreaaury © Partnerships, joint ventures, etc., must file Form 1065 or Form 1065•B. A�enmeel Intemal RevenueseMee (99) ® Attach to Form 1040 or Form 1041. D See Instructions for Schedule C (Form 1040). Sequa:ee No.OcJ Name of pmpdetor Social socurlty number(SSh1 JACOB SYRQUIN 559-64-7653 A Principal business or profession, including product or seivice(see page C-1) BEnter codeb npagc C788 ' SERVICE—MFR'S SALES REP ► 999999� C Business name, if no separate business name, leave blank. D Emptoyer to number(e%It aay E Business address (including suite orroomno.)► ZLGb 13R1ND151 -------=------------------------ City, town or post office. state and ZIP code Nffl'f(:Tff BEACH, CA 92660 F Accounting method: (1)FXX Cash (2)LJAccrual (3)FIOther(specify)01 __----____—._______________ G Did you'materially participate' In the operation of this business during 2000? if'No, see page C-2 for limit on losses .............................. 1XI Yes El No H If you started or acquired this business during 2000, check here,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,•.,,.,,.,...................................... ... ! 0 1 Gross receipts or sales. Caution: If this Income was reported to you on Form 141--2 and the 'Statutoryemplcyee' box on that form was checked, seepage C-2 and check here„•........................................................................... lo. 0 2 Returns and allowances.......................................................................................................................................... 3 Subtract line 2 from line 1....................................................................................................................................... 4 Cost of goads sold (from line 42 on page 2)............................................................................................................... 6 Gross profit. Subtract line 4 from line 3..................................................................................................................... 6 Other income, Including Federal and slag gasoline or fuel tax credit or refund (see page C-3)................................................ Gross Enter ax❑anses for business use of your home only on 4 8 Advertising .................................... 9 Bad debts from sales or services (see page C-3) .................. 10 Car and truck expenses (see page C-3) 11 Commissions and lees ,,,,,,,,,,, 12 Depletion .................................... 13 Depreciation and section 179 expense deduction (not included In Part III) (see page C-3)....................1 14 Employee benefit programs (other than on line 19) ........................... 15 Insurance (other than health) ...,,, 16 Interest: a Mortgage (paid to banks, etc.) ..... ;.,. b Other .......................................... 17 Legal and professional serAces....................................... 18 Office expense .............................. 8 90. 19 Pension and profit-sharing plans.................. 20 Rent or lease (see page C-4): a Vehicles, machinery, and equipment ............ b Other business property .......................:... 21 Repairs and maintenance ........................... 22 Supplies (not included In Part 111) ............... 23 Taxes and licenses ,.,,,............................... 24 Travel, meals, and entertainment: a Travel ................................................... b Meals and entertainment .................. 2 r 217 c Enter nondeductible amount inpludedonline 24b (see page C-5).................. it Subtract line 24c from line 24b .................. 25 Utilities ................................................... 26 Wages (less employment credits) ............... 27 Other expenses (from line 48 on page 2) .................................................. 19 9 20a 10 3,641. 20b 2,975. 21 11 6 0 7 . 22 M . 12 23 219. - 13 24a 1 190. 1 10 8. 14 15 390. .... ; , 15a 24d 16b 333. 25 17 2 5 0 . 26 27 2,328. 18 15 0 . 28 Total expenses before expenses for business use of home.Add lines 8 through 27 In columns ....................................... ® 29 Tentative profit (loss). Subtract line 28 from line 7......................................................................................................... 30 Expenses for business use ofyourhome. Attach Form 8829......................................................................................... 31 Not profit or (loss). Subtract line 30 from line 29. • If a profit, enter on Form 1040, line 12, and also on Schedule SE, line 2 (statutory employees, see page C-6). Estates and trusts. enter on Form 1041. line S. 28 13,443. 29 10,534. 30 131 �� 10 5 3 4 . o if a loss, you must go on to line $2. 32 If you have a lass, check the box that describes your investment in this activity (see page C-6). o If you checked 32a, enter the loss on Form 1040, line 12, and also an Schedule SE, line 2 (statutory employees, see page C-6). Estates and trusts, enter on Form 1041, line 3. o If you checked 32b, you must attach Form 6198. LHA For Paperwork Reduction Act Notice, see Form 1040 Instructions. 32a Aa trvestr. e•.: s a: rs•. 32h <or. eie•r.z, I`s re: a: rsr Schedule C (Farm 1040) 20:0 a2Crat 10.25•CO Bankof America 1124 E 2-5 I I I I I I I I I I I I I I I I I I I I I I I I I I I I I I II I I I I I I I I I I I I I I It I I I III I I I It III JACOB SIRKIN 2226 BRINDISI NEWPORT BEACH CA 92660-3252 - Your Bank Combined Statement of America Account Statement Date: October 18, 2002 At Your Service Call: 760.340.1867 Online: www.bankaramerica.com Written Inquides Bank of America Smoke Tree Branch PO Box37176 San Francisco, CA 94137-0001 Customer since 1988 Bank of America appreciates your Our free Online Banking service allows you to check account balances, business and we enjoy serving you. •transfel' funds, pay bills and more. Enroll at www.bankofamerica.com. ❑ Summary of Your Deposit Accounts ❑ Bank of America News Account Account Number Your Balance Standard Checking 11244-05561 $ 2,913.30 Regular Savings 11247-04605 1.295.70 Total Balances $ 4,209.00 •combined balances In these accounts may be used to eliminate monthly checking account service charges. Introducing Total Security Protection only from Bank of America. This represents a new standard in Bank of . America Check Card security, giving you greater defense against theft or unauthorized use, even using it online. It's free and automatically available on your Bank of America Check Card. Dreaming about a college education for yourself or your child? We can help you make the dream come true. Get a free student loan guide at www.bankofamer'icEi.com/studentbanking. Enrolling in our free Online Banking service is a snap. All you need is your Bank of America account number, ATM or Check Card number, ATM PIN and e-mail address. Click the Online Banking 'Enroll' button at www.bankafamerica.com and follow the easy instructions. In no time you'll be able to check account balances, view transactions and more. ❑ Your Standard Checking Account Account Number: 11244.05561 Statement Period: September 18 through October 18, 2002 Beginning Balance on 09/18/02 $4,045.85 Total Deposits + 2,769.49 Total Checks, Withdrawals, Transfers, Account Fees - 3,902.04 Ending Balance $2,913.30 ❑ important Information About Your Account Interest paid year-to-date $2.61 Number of ATM withdrawals and transfers 0 Number of purchase transactions 41 Number of 24 Hour Customer Service Calls Self -Service Assisted Based on the minimum balance you've maintained in this account, your monthly service charge has been waived. Continued on next page 0011264 001.114 California Page 1 of 0 ' Bankof America JACOB SIRKIN Statement Date: October 18, 2002 ❑ Branch/ATM Deposits Number Date Posted Amount • Number Date Posted Amount 10/04 $ 700.00 10/15 43551 10/07 500.00 Total of 3 deposits $1,635:51 ❑ Checks Paid Date Paid Number Amount Date Paid Vumber Amount 10/07 2299 S 1,332.00 Total of 2 Checks Paid $1,400,00 10/07 2300 68.00 ❑ Account Activity Date Posted Description Reference Number Amount Deposits and Credits "• 10109 SOC SEC US Treakuky 303 Co ID: 3031036030 Jacob Sirkin $1,122.00 ID# Xxxxx7653a SSA Ref000052167727900 10/16 Check Card Purchase Cr Adj on 10/14ECard #'112485693), 10/16 09/18 09118 09/19 09/19 09119 09/19 09/20 09/20 09123 Ref. Che Check Car rota) Deposits and Credits Withdrawals, Transfers an Check Card Purchase on C Barnes & Noble 1: Ref# 02 Check CarPurchase on C Nordstrom 0320-0 Ref # 1000 0019001, Check Card Purchase on C Love La - Termin Ref # 10000001903E Check Card Purchase on C Dfs USA - Lax Tern Ref # 100000019001 Check Card Purchase an C Dfs USA - Lax Tern Ref# 1000000190M APS Pacific Bell 524 9497219783 095 Ref:0000 Check Card Purchase on Bar Rest E( Olvido Ref * 10000 01 03E Check larbella 2 81 encyy Conversion Ad• on 10/14(Card #112�85693), larbella 72 81 6 (CardJ112485693), Mesa A 7 (Card #112485693), Angeles CA 9 7 (Card #112485693), s Angeles CA ,2 7 (Card #112485693), s Angeles CA 9 ID:9638215002 Jacob Syrquin 11456101 8 (Card #112485693), rrero Acao 48 Check Carii Purchase on 09/19 (Card #112485693), 09/23 1 Check Card Purchase on 09119 (Card #112485693), Rest Baikal Acapulco 48 Ref 1000000190233439 09/24 Check Cart Purchase on 09/23 (Card #112485693), Snack Bar Mexico Df 48 Ref # 1000000190460191 Checkcrd Foreign Currency Conversion Ad) Continued on next page 0011264.002.114 California _ 11.75 Bankof America 1124 E 7.4 ILLndILl1I1116d611131111166116nll1ld1111611lid] JACOB SIRKIN 2226 BRINDISI NEWPORT BEACH CA 92660-3252 Our free Online Banking service allows you to check account balances, transfer funds, pay bills and more. Enroll at www.bankofamerica.com. ❑ Summary of Your Deposit Accounts Account "Account Number ' 'Your Balance Standard Checking " 11244.05561 $ 4,045.85 Regular Savings " 11247-04605 1,295.17 Total Balances $ 5,341.02 "Combined balances In these accounts may be used to eliminate monthly checking account service charges. Your Bank of America Combined Account Statement Statement Date: September 17, 2002 At Your Service Call: 760.340.1867 Online: w w.bankbfamerica.com Written inquiries Bank of America Smoke Tree Branch PO Box37176 San Francisco, CA 94137-0001 Customer since 1988 Bank of America appreciates your business and we enjoy serving you. ❑ Bank of America News Bank of America has streamlined the mortgage process by eliminating 80% of the paperwork you have to provide. Visit www,bankofamerica.com/loans today to learn more about getting a mortgage from Bank of America. Not all applicants will qualify for the reduced paperwork benefits. The costs of college add up. If they have you overwhelmed, consider a private loan for students from Bank of America. Eligibility is not based on financial need, and the loan features a low interest rate, low fees and flexible loan limits and repayment options. Learn more at www.bankafamerica.com/studentbanking. Credit subject to approval. ❑ Your Standard Checking Account Account Number: 11244.05561 Statement Period: August 20 through September 17, 2002 Beginning Balance on 08/20/02 $5,845.34 Total Deposits + 3,088.37 Total Checks, Withdrawals, Transfers, Account Fees - 4,887.86 Ending Balance $4,045.85 Interest paid year-to-date $2.61 Number of ATM Withdrawals and transfers 0 Number of purchase transactions 19 Number of 24 Hour Customer Service Calls Self -Service Assisted 0 0 ❑ Important Information About Your Account Based on the minimum balance you've maintained in this account, your monthly service charge has been waived. ❑ Branch/ATM Deposits Number Dale Posted Amount F09103 $ 667.95 09/16 1,267.47 Continued on next page 0011 is 1.00i. i 1; California Numts• Date Posted Amount FTotalof 2 deposits 51,935.42 Page 1 of 4 Bankof America -0�- JACOB SIRKIN Statement Date: September 17, 2002 - ❑ Checks Paid ' Gap in check sequence Date Paid Number Amount Data Paid Number 08/26 2290 $ 192.00 09/16 2296 75641...00100 08/20 " 2292 599.00 09116 2297 08/26 2293 600.00 '09110 2298 09/05 '2295 1332.00 Total of 7 ChecksPaid n Ltnrnunf �rtivifv Date Posted 08/22 08/22 09/11 Description '• - Deposits and Credits Purchase credit on 08/21 Card #112485693), G&m Oil,Lic51 Cityy Of t omme CA Purchase credit on 8/21(Card #1124856931, ',•.: =,: Nevrport Bch Dante Newport Beach CA Check Card Purchase Cr Adj on 09/09(Card #112485693);, ; .r,; ;, t Pacific Union Dent 925 3636000 CA SOC US Treasury 03 Cc ID: 3031036030 Jacob Sirkin �ti"�'`�•^' ID# xxxxx7653a SSA ReE000023816914900 ,;•.•; •„' _ ;`,;,,;; • . .' Reference Number 501777 970199 A.zcunl $1.00 18.00 11 95 1,122.0 0 Tolal Deposits and Credits 11°2.9' 08120 Withdrawals, Transfers and Account Fees Check Card Purchase on 08/18 (Card #112485693), & Ftn Valley CAA �27 13 Moonlight Pizza 08120 Ref # 000000190107846 Direct Pyyt o Cal Edison Cc Cc ID: 9090,260001 Syrquin, Jacob ' #C 45.62 08/20 ID" 090250034320192 Ref:000068170843209 AIDS Pacific Bell 524 Cc ID: 9636215002 Jacob Syrquin • ID# 9497219783 095 Ref:000029186623101 501777 1411.24 1.00 08/21 Purchase on 08/21 Card 0112485693), G&m Oil,Llc 51 Cit Of Comm; CA (Card 112485693). 970199 18.00 08/21 Purchase on 08/21 Newport Bch Denta Mewport Beach CA 10.00 08/22 Check Card Purchase on 08/20 (Card #112485693), Chevron G&m Oil LI Banning CA Ref 1000000190324679 Check Car Purchase on 08/21 (Card #112485693). ti.00 08/23 New ort Beach Dent Newport Beach CA 08/23 Ref 1000000190281865 Check Car Purchase on 08121 (Card #t12485693), - Chevron G&m OII,LI City Of Comme CA Ref 1000000190338329 Carg Purchase 08/22 (Card #112485693), 33781 08/23 Check on Aeramexico 7033411082 TX 08126' Ref# 1000000190436625 Simpleppayy The Gas Company Co ID: 88,81052494 Syrquin Jacob 08126 ID# 059507636978055 P.efP000030747693800 Check Card Purchase on 08122 (Card #112485693), Supercuts Costa Mesa CA 09/03 Ref 1000000190331650 Check Carg Purchase on 09/02 (Card�112485693), 1E C3 Ralphs ;0744 Newpport Beach A 11000001904C6460 Ref Carg Purchase 08/31 (Card #112485693). 2102 09103 Check on An Mobil Inc Yermo CA Ref 1000000190398850 Check Carg Purchase an 08129 (Card #112485693), .277 3; 09/03 Hertz Rent-A-Car Corona Del Ma CA Ref g 1000000190068195 09104 Check Card Purchase on 09/02 (Card #112485693). Denny's 4,7659 Costa Mesa CA Ref # 1060000190388293 Continued on next page peg= 2 c` 4 0011151.002.114 California Co Social Security _,ministration Retirement, Survivors, and Disability Insurance Notice of Change in Benefits WESTERN PROGRAM SERVICE CENTER'. P.O. BOX 2000 RICHMOND, CA 94802-1000 DATE: OCTOBER 31, 2002 . CLAIM NUMBER(S):'559-64-7653 A AIS,MlRI11005,015468 136 - .. .. .. JACOB SIRKIN 2226 BRINDISI NEWPORT BEACH CA 92660-3252 ill1,II111IIIII,IIIIIII!„I,IIIIIIIIII IIu11,1111,1111111still " We checked our records to see .if ­any changes in your benefits are.. We are increasing your benefit amount to,•give•you,.,credit,.for.,your earnings in 2001 which were not included when wp.iigured;y.our . benefit before. e` WHAT WE WILL PAY • We will send you a payment of $1,,133.00 on or about December 11; 2002. This payment includes.your new regular monthly benefit -for November 2002,• plus the difference between•what .we paid you... each month and the $1,123..00 we•should have paid you each month from January,2002 through• October 2602. o After that, .you will .receive $1,123.00 on or about the second Wednesday of each month. The regular monthly payment shown above does not include any upcoming cost of living. adjustment.. We will contact you separately if there is any such increase to your benefits. DO YOU DISAGREE WITH THE DECISION? If you disagree with our decision, you have the right to appeal. We will review your case again and consider any new facts you have. A person who did not make the first decision will decide your case. ■ You have 60 days to ask for an appeal. The 60 days start the day after you receive this letter. We assume you got this letter 5 days after the date on it unless you show us that you did not get it within the 5-day period. c You must have a good reason if you wait more than I,IZ3X12 = 13/476•eo. 559-64-7653A :Page 2 :.of 2 . 60 days to ask for an appeal. You have to ask•for an appeal in writing. We will ask you to sign a Form SSA-561-U2,. called "Request for Reconsideration".' Contact one of our offices if you want help. :•.:;:• IF YOU HAVE ANY QUESTIONS We invite you to visit our website at www.ssa.gov bn the Internet to find general information about Social Security.' If you have any specific questions,'• you may call us' toll -free at r ' 1-800-772-1213, or call your local Social Security office at"'= 1-949-474-1178. We can answer most questions over the phone. , If you *are -deaf • or hard of hearing,. you may 'call' our TT.X humber,•� ' 1-800-325-0778: You can also write or visit any''Sodial Security'::: office.' The office that serves your area is 'located • F i • ( i a Jn SOCIAL SECURITY i r'`'• ..',t 4525 MACARTHUR BLVD. NEWPORT BEACH,'CA' 92660 if you do call or visit an office, please have'this letter with you. It will help us answer your questions: Also, if you'plan to'visit an office, you may call ahead to make an appointment: •This'_Iill help us serve you more quickly •when you arrive at. the off ice-. Jo Anne B. Barnhart Commissioner of'Social Security' Bankof America -*P* 1124 E 2-4 Iltltttr)tlrlitltllitll,titrliltllrlrlrlurlrllrlrlrllrtlrrrll Your Bank of America Combined Account _ Statement _ Statement Date: November 15, 2002 At Your Service Call: 760.340.1867 Online: www.bankofamerica.com JACOB SIRKIN Written'lnquirles 2226 BRINDISI Bank of America NEWPORT BEACH CA 42660-3252 Smoke Tree Branch PO Box 37176 San Francisco, CA 94137.0001 Customer since 1988 Our free Online Banking service allows you to check account balances, Bank of America appreciates your business and we enjoy serving you. transfer funds, pay bills and more. Enroll at www.bankofamerica.com. ❑ Bank of America News -❑ Summary of Your Deposit Accounts Account Account Number Your Balance Your Bank of America Check Card Is now safer than ever with Total Security Protection. It's free and automatic on Standard Checking 11244-05561 $ 3,989.43 your Check Card. For more information, visit www.bankofamerica.com/totalsecurity. Regular Savings ' 11247.04605 1,296.25 ONLINE BANKING GUARANTEE; With our Online Banking Total Balances $ 5,285.68 service, you can be confident that your Bank of America •Combined balances in these accounts may be used to eliminate monthly accounts will be secure and protected. We guarantee $0 checking account service charges. liability for any unauthorized activity originating from Online Banking, including Bill Payment. For terms and conditions, or to learn more about Online Banking, visit www.bankofamer*ica.com. ❑ Your Standard Checking Account Account Number: 11244.05561 Statement Period: October 19 through November 15, 2002 Interest paid year-to-date $2.61 Beginning Balance on 10/19/02 $2,913.30 Total Deposits + 4,122.89 Number of ATM withdrawals and transfers 0 Total Checks, Withdrawals, Number of purchase transactions 28 Transfers, Account Fees 3,046.76 Number of 24 Hour Customer Service Calls Ending Balance $3,989.43 Self -Service 0 Assisted 0 ❑ Important Information About Your Account Based on the minimum balance you've maintained in this account, your monthly service charge has been waived. ❑ Branch/ATM Deposits Number Date Posted Amcunt Number Date Posted Amounl 10121 $ 310.00 11114 1,090.89 10/28 100.00 Total of 4 deposits 53,000.89 11101 1,500.00 Continued on next page Page 1 of 4 0011261.001.114 California c^jr„, Bankof America l%� JACOB SIRKIN ❑ Checks Paid Date Paid Number Amount 11104 2301 $ 1,332.00 11/07 2302 68.00 ❑ Account Activity Statement Date: November 15, 2002 Dale Paid Number Amount [Total of 2 Checks Paid $1,400,00 Date Posted Description Reference Number Amount Deposits and Credits 11/13 SOC SEC US Treasury 303 Cc ID: 3031036030 Jacob Sirkin ID# Xxxxx7653a SSA Ref:000017968451201 $1,122.00 Withdrawals, Transfers and Account Fees 10/21 Check Card Purchase on 10118 (Card #112485693), $9.52 Stratosphere Lucky Las Vegas V Ref # 1000000190068861 15.27 10121 Check Card Purchase on 10/19 Card #112485693), An ggels Mobil Inc Yermo A 10/21 Refz 1000000190189212 Check CarY Purchase on 10117 (Card #112485693), 18.25 An Mobil Inc Yermo CA Ref1000000190189210 10121 Check Cardg Purchase on 10118 (Card #112485693), 47.05 Sun Chlorella 310-371-55 5 CA 10/21 Ref# 1000000190124318 Check Card Purchase an 10119 (Card #112485693), 66.68 Primm Valley Resor Primm NV Ref# 1000000190381653 10/21 APS Pacific Bell 524 Co ID: 9636215002 Jacob Syrquin ID# ' 9497219783 095 Ref:000077620649100 269.07 10.02 10/22 Check Card Purchase on 10120 (Card #112485693), Chevron M&m Petrol Newport Beach CA Ref # 1000000190354533 13.95 10/22 Check Card Purchase on 10120 (Card #112485693), Supercuts Costa Mesa CA Ref# 1000000190414041 10/23 Simple ppay The Gas Comppany Ca ID: 8881052494 Syrquin Jacob Re f:000049584929500 10.58 10/24 ID ph 059507636978065 Phone Pyymt Capital One Co ID: 9541719986 2062628089sirkin Jacob 129.88 ID# 229639860014198 Ref.000004190919601 10/28 Check Card Purchase on 10/24 (Card #112485693), 21.50 Shell Inc 61106775 Orange CA Ref" 1000000190254996 10.00 10/29 Check Carg Purchase on 10126 (Card 1112485693), Web Laundry Ca0110 Newport Beach CA Ref# 1000000190251830 10/29 Check Card Purchase on 10/27 (Card #112485693). 14.25. Angels Mobil Inc Yermo A Ref£ 1000000190270403 10131 Check Card Purchase on 10/29 (Card #112485693), •75 Primm Vallev Resor Primm NV Ref# 1000060190343807 10/31 Check Card Purchase on 10129 (Card #112485693), 48.60 Primm Valley Resor Primm NV Ref# 1000000190343810 11/01 Check Card Purchase on 10/29 (Card #112485693), 15.74 Angels Mobil Inc Yermo CA Rego 1000000190237272 11/04 Check Card Purchase on 10/31(Card 112485693), teach 10.00 Chevron M&m Petrol Newport CA Ref 1000000190310620 19.40 11/04 Check Card Purchase on 11/01 (Card #112485693). 76 / Circle K 7094 Westminster CA P.ef# 1000000190164247 Continued on next page 0011261.002.114 , Bankof America -*;o- JACOB SIRKIN ❑ Acca Date Posted 11/04 11105 11105 11 /05 11/06 11/06 11112 11/13 11/13 11/13 11/14 11114 11/15 unt Activity Continued Description Withdrawals, Transfers and Account Fees Check Card Purchase on 11/01 (Card 112485693). T.G.I. Fridayys ##1 Costa Mesa A Ref 1000000190162961 Check Card Purchase on 11104 (Card #112485693), Agua Bar & Grill A Palm Springs CA Ref' 1000000190423059 Check Carg Purchase on 11103 (Card #112485693). Chevron G&m Oil LI Banning CAA,, Ref # 1000000190388990 Check Caril Purchase on 11/04 (Card #112485693), Enterprise Rentaca Newport Beach CA Ref # 1000000190368110 Check Card Purchase on 11105 (Card #112485693), Dino s Italian Res Westminster CA Ref 1000000190414W Check Carg Pu1chase on 11/04 (Card #112485693), May Garden Restaur Costa Mesa CA Ref f 1000000190120949 Check Card Purchase on 11107 (Card #112485693), Sprintpcs-Custcare 888-211.47 KS Ref' 1000000190160450 Check Carg Purchase on 11/11 (Card #112485693), Union 76 5215 Primm NV Ref"1r 1000000190418800 Check Cara Purchase on 11111 (Card #112485693), Primm Valley Resor Primm NV Refs 1000000190378055 Check Card Purchase on 11/12 (Card #112485693), Enterprise Rentaca Newport Beach CA Ref #E 1000000190284287 Check Card Purchase on 11/13 (Card #112485693), Agua Bar & Grill A Palm Springs CA Ref 1000190325638 100 Check Carg Purchase on.11/12 (Card #112485693), Chevron {{400201093 Newport Beach CA Ref + 1000000190290769 Check Card Purchase on 11/13 (Card112485693), Statement Date: November 15, 2002 Reference Number Amount 30.69 12.43 18.35 250.00 15.75 22.30 i 116.63 22.38. 111.19 250.00 18.28 18.65. 29.60 Total Withdrawals, Transfers and Account Fees $1,646.76 Dale Amount Date Amount Date Amount 10/21 $ 2797.46 10/31 2,637.93 11 /01 4,122.19 11112 2,226.64 11113 2,965.07 10122 2:773.49 10/23 2762.91 11104 2,730.10 2,449.32 11 /14 4,019.03 11 /15 3,989.43 10124 2:633.03 10/28 2711.53 11 /05 11/06 2,411.27 10/29 2:687.28 11107 2,343.27 ❑ Overdraft Protection Plan Overdraft coverage available $1,271.25 Savings Account 11247-04605 Continued on next page 0011261.003.114 California Page 3 of 4 0. Bankof America —�'� JACOB SIRKIN Statement Date: November 15, 2002 ❑ Your Regular Savings Account Account Number: 11247.04605 Statement Period: October 21 through November 17, 2002 Beginning Balance on 10/21/02 $1,295.70 Annual Percentage Yield earned this period 0.50% Interest Paid + .55 Interest paid year-to-date Ending Balance $1,296.25 ' ❑ Important Information About Your Account Your account earned $.50 in interest this statement period. The Interest Paid shown above reflects interest earned since your last payment date. ❑ Account Activity Dale Posted Description Reference Number Amount 10A Interest Paid < Interest Paid from 10/01/02 Through 10/31/02 $.55 0011261.004.114 California Page 4 of 4 ro` Bankof America %W Your Bank of America Combined Account 1124 Statement E 2-5 Statement Date: October 18, 2002 At Your Service Call: 760.340.1867 ILLmIrI.Ilrrdlullrn�r(Iur(r(r(i(nddulrlr(Iu(rnll Online: www.bankafamerica.com JACOB SIRKIN Writteh Inquiries 2226 BRINDISI BankofAmerica NEWPORT BEACH CA 92660-3252 SmokeTree'Branch PO Box 37176 San Francisco, CA 94137-0001 Customer since 1988 Our free Online Banking service allows you to check account balances, Bank of America appreciates your transfer funds, pay bills and more. Enroll at www.bankofamerica.com. business and we enjoy serving you. EI Summary of Your Deposit Accounts 0 Bank of America News Account Account Number Your Balance Standard Checking 11244-05561 $ 2,913.30 Regular Savings 11247-04605 1,295.70 Total Balances $ 4,209.00 'Combined balances In these accounts may be used to eliminate monthly checking account service charges. Introducing Total Security Protection only from Bank of America. This represents a new standard in Bank of America Check Card security, giving you greater defense against theft or unauthorized use, even using it online. It's free and automatically available on your Bank of America Check Card. Dreaming about a college education for yourself or your child? We can help you make the dream come true. Get a free student loan guide at www.bankofamerica.com/studentbanklng. Enrolling in our free Online Banking service is a snap. All you need is your Bank of America account number, ATM or Check Card number, ATM PIN and e-mail address. Click the Online Banking 'Enroll' button at www.bankofamerica.com and follow the easy instructions. In no time you'll be able to check account balances, view transactions and more. ❑ Your Standard Checking Account . Account Number: 11244.05561 Statement Period: September 18 through October 18, 2002 Beginning Balance on 09/18/02 $4,045.85 Total Deposits + 2,769.49 Total Checks, Withdrawals, Transfers, Account Fees - 3,902.04 Ending Balance $2,913.30 ❑ Important Information About Your Account Interest paid year -to -elate $2.61 Number of ATM withdrawals and transfers 0 Number of purchase transactions 41 Number of 24 Hour Customer Service Calls Self -Service Assisted Based on the minimum balance you've maintained in this account, your monthly service charge has been waived. Continued on nextpage on 11264 0e1.114 California Page 1 of 5 Bankof America -*;I- JACOB SIRKIN Statement Date: October 18, 2002 ❑ Branch/ATM Deposits Number Dale Posted Amount Number Date Posted Amount 10/04 $ 700.00 10/15 435.51 10107 600.00 Total of 3 deposits $1,635.51 ❑ Checks Paid Date Paid Number Amount Date Paid Number Amount 10/07 2299 $ 1,332.00 otal of 2 Checks Paid $1,400.00 10107 2300 68.00 ❑ Account Activity Date D ' tl Reference Number Amount Posted escrip on Deposits and Credits 10/09 SOC SEC US Treasury 303 Cc ID: 3031036030 Jacob Sirkin ID# Xxxxx7653a SSA Ref:000052167727900 $1,122.00 10/16 Check Card Purchase Cr Adj on 10/14(Card #112485693). Hotel Puente Roman Marbella 72 Ref. # 1000000190356781 Checkcrd Foreign Currency Conversion Ad' 10116 Check Card Purchase Cr Adj on_10f14ICard #112485693). 11.75 09/18 09/18 09119 09/19 09/19 09/19 09/20 09/20 09/23 09/23 09/24 Ref. # 100000019035 Total Deposits and Credits Withdrawals, Transfers and Check Card Purchase on Ot Barnes & Noble #19 Ref# 100000019 02f Check Card Purchase on Of Nordstrom Ref # 1000i Check Card Purcf I Love La - Ref' 1000 Check Carp Purcf Dfs USA - Ref 1000 Check Cart Purcf Dfs USA - Ref # 1000 9497219783a 95 Check Card Purcf Check Carc Bar. Reft Check Carc Rest Ref 1 Chet Check Carc Rest Rat' Cart Continued on next page 0011204.002 114 a (Card 112485693), Mesa V on 09/17 (Card #112485693), erm Los Angeles CA 30076322 on 09117 (Card #112485693), •erm Los Angeles CA 30077019 i24 Cc ID:9636215002 Jacob Syrquin 00015211456101 on 09/18 (Card #112485693), !do Guerrero Acap 48 30365189 In Currency Conversion Adj on 09/18 (Card #112485693), !do Guerrero Acap 48 30365189 on 09119 (Card #112485693). on 09/19 (Card #112485693), apulco 48 90233439 on 09/23 (Card #112485693). ico Df 48 90460191 gn Currency Conversion Adj California ®r $1,133.98 $11,80 120.03 12.40 40.00 / 60.00 112.02 1.59 80.20 2.15 108.61 .12 Page 2 of 5 1 Q, Rr,P •,; 1. Bankof America -;00- JACOB SIRKIN Statement Date: October 18, 2002 ❑ Account Activity Continued Date Posted Description Reference Number Amount Withdrawals, Transfers and Account Fees 69 09/24 Check Card Purchase on 09/21 (Card #112485693), 09/24 09/24 09124 09/24 09/25 09/25 09/25 09/26 09/28 09/30 09/30 09130 09/30 10/01 10/01 10/02 10107 10/07 10107 10/07 Rest El Cabrito Acapulco 48 P.ef# 1000000190381969 Checkcrd Foreign Currency Conversion Ad' Check Card Purchase on 09/22 (Card #112485693), Rest El Faro Acapulco Gro 48 Ref# 1000000 190460 108 Checkcrd Foreign Currency Conversion Adj Check Card Purchase on 09123 (Card #112485693). Snack Bar Mexico Df 48 , Ref # 1000000190460191 Check Card Purchase on 09121 (Card #112485693). Rest El Cabrito Acapulco 48 Ref # 1000000190381969 Check Card Purchase on 09/22 (Card #112485693). Rest El Faro Acapulco Gro 48 Refµrr 1000000190460108 Check Cara Purchase on 09/23 (Card #112485693), 14ntei Elrnno Recen Acapulco ro 48 Check 1 Check Card P Duty Tt Ref 1 Check Carl P 76 / Ch Ref # 1 Check Card P Promei Refg 1 Check Card P Check Card Put Casino h Ref 10 Check Carl Put T.G.I. Fri Ref 10i Check Carl Put 76 / Circ Ref # 10 Check Card Put Chevron Ref 10 Check Card Pui Primm V Ref # 10 Check Carr Pui Angels k P.er 10 Check Carl Pui Continued on next page C011264.003.114 Syrquin Jacob on on 09/23 (Card #112485693), Aext Mexico 48 30289034 In Currency Conversion Adj on 09/23 (Card #112485693), Aexl Mexico 48 30289034 on 09/26 (Card #112485893), 94 Westminster CA 30000453 on 09128 (Card 9112485693), amar Temecula CA 30409462 on 09/27 (Card #112485693), uran Santa Ana CA 30083000 isional Cr Reversal on 07/23 (Card #112485693), ;E #2326.26J on 09129 (Card #112485693), 3 Res Cabazon CA 30354031 an 09/29 (Card 112485693). i1 Costa Mesa A e on 10/05 (Card #112485693). 01093 Newport Beach CA 1190503398 e on 10/03 (Card #112485693), Resor Primm NV 1190363005 e on 10103 (Card #112485693), Inc Yermo CA 1190047898 e on 10/05 (Card #112485693). B Redlands CA California 1.44 5.87 35.00 72.59 5.52 6,72 i 279.03 1.46 73.66 10.00 19.10 24.43 10.76 38.35 17.51 10.00 17.14 18.20 24.30. Page 3 of 5 0 9 •' Bank ofAmerica JACOB SIRKIN Statement Date: October 18, 2002 . ❑ Account Activity Continued Date Posted Description Reference Number Amount Withdrawals, Transfers and Account Fees 10108 Check Card Purchase on 10/06 (Card #112485693). .26 Hotel Villamagna Madrid 72 Ref# 1000000190411168 Checkcrd Foreign Currency Conversion Ad 13.20 10/08 Check Card Purchase on 10106 (Card #112485693). Hotel Villamagna Madrid 72 Ref 1000000190411168 10110 Check Car Purchase on 10/08 (Card #112485693), 12.55 Orange County Mini Santa Ana CA Ref 1000000190197285 10/10 Check Carl! Purchase on 10/08 (Card #112485693). 24.00 Chevron G&m Oil,Ll Costa Mesa CA Ref#f1000000190338330 10111 Check Card Purchase on 10110 (Card #112485693), 17.27 Union 76 0036 Las Vegas NV Ref# 1000000190381036 10/11 Nwprt_70001bch Automatedpp0020360308301 Paymen Cc ID: 1931113541 Jacob_syrquin Check Card Purchase 110112 (Card #112485693), 6 3..72 10/15 on Fletcher Jones Mot Newport Beach CA 10/15 Ref 1000000190289203 Check Carg Purchase on 10/13 CCard #112465693), Pizza & Fin Va ley CAA 37.10 10/15 Moonlight Ref # 1000000190120682 Check Cari1 Purchase on 10/10 (Card #112485693), Stratosphere Hotel Las Vegas V 78.54 i 10/16 Ref # 1000000190332575 Check Card Purchase an 10/14 (Card 112485693), •23. Hotel Puente Roman Mar ella 2 Ref# 1000000190356800 Checkcrd Foreign Currency Conversion Ad' 11.70 10/18 Check Card Purchase on 10/14 (Card #112495693), i2 Hotel Puente Roman Marbella Ref 1000000190356800 22.91 10/18 Check Carg Purchase on •10/14 (Card #112485693), Chevron G&m Oil,Li Costa Mesa CA Ref# 1000000190367015 10/16 Direct Pyyt So Cal Edison Co Cc ID: 9090250001 Syrquin, Jacob #C ' ID# 090250037358387 Ref:000036438258900 43.66 10117 Check Card Purchase on 10/15 (Card 112485693), 0046 Lagguna Beac CA 60.66 i 10/18 Las Brisas Ref 100012190105956 ATM/ChecUard Provisional Cr Reversal on 07/16 (Card #112485693), 165.00' v . Ref #REFERENCE #6161-22J Total Withdrawals, Transfers and Account Fees S2,502.04 ❑ Daily Balance Dale Amount bate Amount Date Amount 09118 $ 3914.02 09/30 2247.74 10110 2,983.47 09/19 3:689.60 10101 2:198.63 10/11 2922.33 09120 3,607.81 10/02 2181.12 10/15 3:205.49 09/23 3497.05 10104 2:881.12 10/16 3138.96 09124 3:381.34 10107 1911.48 10117 3:078.30 09125 3090.07 10108 1:898.02 10/18 2,913.30 09126 3:014.95 10109 3,020.02 Continued on next page California Page 4 of 5 0011264.004.114 ova P/Yr10 Bankof America —%� JACOB SIRKIN Statement Date: October 18, 2002 ❑ overdraft Protection Plan Savings Account 11247-04605 Overdraft coverage available 51,270.70 ❑ Your Regular Savings Account Account Number: 11247.04605 Statement Period: September 18 through October 20, 2002 Beginning Balance on 09/18/02 $1,295.17 Annual Percentage Yield earned this period 0.50% Interest Paid + .53 Interest. paid year-to-date $4.47 Ending Balance $1,295.70 ❑ Important Information About Your Account Your account earned $.59 in interest this statement period. The Interest Paid shown above reflects Interest earned since your last payment date. ❑ Account Activity Data Posted Description Reference Number Amount Interest Paid 09/30 1 Interest Paid from 09/01/02 Through 09/30/02 $.53 ❑ FACTS • FDIC Insured Account Disclosure Information Go online for a chance to win $5,000. It's all part of the Bank of America $5,000 Giveaway Sweepstakes. Give us your e-mail address and you'll have a chance to win great prizes. Plus, you'll have the opportunity to sign up to receive relevant financial information that is tailored to your needs. Visit www.bankofamerica.com/5kgiveaway by 1117/02 to enter. 0011264.005.114 California Page 5 of 5 Lt'0 Re,'.- Bankof America �� 1124 E 7-4 IlrlrruIIIaIIurllulluurllnrlrlrlrlurjrlulrlrllulnrjl JACOB SIRKIN 2226 BRINDISI NEWPORT BEACH CA 92660-3252 Our free Online Banking service allows you to check account balances, transfer funds, pay bills and more. Enroll at www.bankofamerica.com. Your Bank of America Combined Account Statement Statement Date: September 17, 2002 At Your Service Call: 760.340.1867 Online: www.banKofaroerica.com Written'Inqulries . Bank of America Smoke Tree Branch — PO Box 37176 — San Francisco, CA 94137-0001 — Customer since 1988 Bank of America appreciates your business and we enjoy serving you. ❑ Summary of Your Deposit Accounts ❑ Bank of America Nevis Account Account Number Your Balance Bank of America has streamlined the mortgage process by eliminating 80% of the paperwork you have to provide. Standard Checking 11244.05561 $ 4.045.85 Visit www.bankafamerica.com/loans today to learn more about getting a mortgage from Bank of America. Not all Regular Savings 11247-04605 1,295.17 applicants will qualify for the reduced paperwork benefits, Total Balances $ 5,341.02 The costs of college add up. If they have you overwhelmed, •Combined balances In these accounts may be used to eliminate monthly consider a private loan for students from Bank of America. checking account service charges. . Eligibility is not based on financial need, and the loan features a low interest rate, low fees and flexible loan limits and repayment options. Learn more at www.bankofamerica.com/studentbanking. Credit subject to approval. ❑ Your Standard Checking Account Account Number: 11244.05661 Statement Period: August 20 through September 17, 2002 Beginning Balance on 08/20/02 $5,845.34 Interest paid year-to-date Total Deposits + 3,088.37 Number of ATM withdrawals and transfers 0 Total Checks, Withdrawals, Number of purchase transactions 19 !i Transfers, Account Fees - 4,887.86 Number of 24 Hour Customer Service Calls Ending Balance $4,045.85 Self -Service 0 Assisted 0 ❑ Important information About Your Account Based on the minimum balance you've maintained in this account, your monthly service charge has been waived. ❑ BranchlATM Deposits Number Date Posted Amount Nu-t -- Dale Pos:sc 09/03 $ 667.95 Total of 2 deposits 09116 1,267.47 11 Continued on next page 001115l.cci.11t4 California Amount $1,935.42 Page i of 4 co nnr ♦,IM: P1 Bankof/America —�'� JACOB SIRKIN Statement Date: September 17, 2002 ❑ Checks Paid " Gap in check sequence '— Data Paid Number Amount Date Paid Number Amount 08/26 2290 $ 192.00 09/16 2296 433.91 08/20 " 2292 590.00 09/16 2298 360.00 08126 2293 600.00 09110 2298 60.00 09105 " 2295 1.332.00 Total of 7 Checks Paid $3,541.10 ❑ Account Activity Dae P.l. Description Reference Number Amount Deposits and Credits 08/22 Purchase credit on 08/21 (Card 112485693), G&m OiI,LIC #51 Cttyy Of omme CA 08/22 Purchase credit on 08/21(Card #112485693). Newport Bch Denta Newport Beach CA 09111 Check Card Purchase Cr Adj_on 09/09(Card #112485693). 501771 $1.00 970199 18.00 _ 11.95 0 Ke SOC US Treasury 303 Cc ID: 3031036030 Jacob Sirkin ID# Xxxxx7653a SSA Ref:000023816914900 Total Deposits and Credits 1,122.0 1, 52.05 Withdrawals, Transfers and Account Fees $ 27.13 08120 Check Card Purchase on 08/18 (Card #112485693), CAA Moonlight Pizza & Ftn Valley Ref # 000000190107846 Syrquln, Jacob #C 08/20 Direct Pyyt o Cal Edison Co Co ID: 9090250001 45.62 ID## 090250034320192 Ref.000068170843200 08/20 A Pacific Bell 524 Cc ID: 9636215002 Jacob Syrquin ID# 141.24 9497219783 095 Ref:000029186623101 501777 1.00 08/21 Purchase on 08/21 Card #112485693), 08/21 G&m Oil,Llc 51 City Of Comme CA Purchase on OB/21 Card #112485693), 970199 18.00 Newport Bch Denta Newport Beach CA 10.00 08/22 Check Card Purchase on 08/20 (Card #112485693), Chevron G&m Oil LI Banning CA 08123 Ref �r 1000000190324679 Check Card Purchase on 08/21 (Card #112485693), 18.00 New art Beach Dent Newport Beach CA 08/23 Ref 1000000190281865 Check Car Purchase on 08/21 (Card #112485693), 20.00 Chevron G&m Oii,L( City Of Comme CA 03/23 Ref 1000000190338329 Check Carl Purchase on 08122 (Card #112485693), 397.81 Aeromexico 7033411082 TX Ref# 1000000190436625 03126 Simpleppay The Gas Company Cc ID: 8881052494 Syrquin Jacob ID# 059507636978055 Rel.000030747693800 4.48 95 14.95 08/26 Check Card Purchase on 08/22 (Card #112485693), Supercuts Costa Mesa CA Ref# 1000000190331650 16.03 09/03 Check Carl Purchase'on 09/02 (Card�112485693), P.alphs 0744 Newpport Beach A 09103 Ref, 1900000190406460 Check Carl Purchase on 08/31 (Card #112485693), 2102 Anggels Mobil Inc Yermo CA 09103 Re f# 1000000190398850 Check Card Purchase an 08/29 (Card #112485693), 277.36 Hertz Rent-A-Car Corona Del Ma CA 09/04 Ref # 1000000190068195 Check Carl Purchase on 09/02 (Card #112485693), 29.47 Denny's #7659 Costa Mesa CA P.ef # 1000000190388293 Continued on next page 00tIis1.0081111 California 9 Page 2 of 4 Ci0 F,..t. cp . Bankof America l%� JACOB SIRKIN Statement Date: September 17, 2002 Cl Account Activity Continued Dale Posted Description Reference Number Amount Withdrawals, Transfers and Account Fees 09/06 Check Card Purchase on 09/04 (Card #112485693), 13.95 Moonlight Pizza & Fin Valley 09/09 Ref' 1000000190155215 Check Carg Purchase on 09/07 (Card #112485693). 10.01 Chevron #00201093 Newport Beach CA Ref # 1000000190531192 09109 Check Card Purchase on 09107 (Card #112485693), 14.31 Ague Bar & Grill A Palm Springs CA Ref 1000000190067991 09/09 Check Card Purchase on 09/05 (Card #112485693), 25A4 Chevron #00206037 Los Angeles CA Ref 1000000190325569 60.75 09%10 Check Cal Purchase on 09/08 (Card #112485693). Orange County Mini Santa Ana CA 09116 Ref�rrt 1000000190253227 Check Carg l`UrChaSe on 09/12 (Card #l12485693), 106.45 Sprintpcs-Speedpay 888- 11-4727 KS Ref yrr 1000000190068057 22.40 09117 Check Carf Purchase on 09/15 (Card #112485693), CCA 76 / Circle K 3310 Costa Mesa Ref 1000000190475053 09117 Direct Pyyt o Cal Edison Co CD ID: 9090250001 Syrquln, Jacob #C ID# 090250035772756 Ref:000085445756000 46.34. Total Withdrawals, Transfers and Account Fees $1,246.76 ❑ Daily Balance Date Amount Date Amount Date Amount 08/20 08/21 OS/21 08/23 OS/26 $ 5,032.35 5,013.35 5,013.35 4,586.54 3,770.11 09/03 09/04 09/05 09/06 09109 4,123.65 4,094.18 2,762.18 2,748.23 2,698.47 09/10 09111 09/16 09/17 2,577.72 3,711.67 4,114.59 4,045.85 ❑ Overdraft Protection Plan Savings Account 11247-04605 Overdraft coverage available $1,270.17 ❑ Your Regular Savings Account Account Number: 11247.04605 Statement Period: August 20 through September 17, 2002 Beginning Balance on 08/20/02 $1,294,62 Annual Percentage Yield earned this period Interest Paid + .55 1 Interest paid year-to-date 43.94 Ending Balance $1,295.17 ❑ Important Information About Your Account Your account earned $.51 in interest this statement period. The Interest Paid shown above reflects interest earned since your last payment date. Continued on next page 0011151 003 114 California Page 3 of 4 BankofAmerica -*;I- JACOB SIRKIN r-1 Arr_nunt Activity Statement Date: September 17, 2002 TZ'OWD iplion Reference Number Amounl estPaid est Paid from 08/01/02 Through 08/31/02 $.55 ❑ FACTS - FDIC Insured Account Disclosure Information Go online for a chance to win $5,000. It's all part of the Bank of America $5,000 Giveaway Sweepstakes. Give us your e-mail address and you'll have a chance to win great prizes. Plus, you'll have the opportunity to sign up to receive relevant financial information that is tailored to your needs. Visit www.bankafamerica.com/5kgiveaway by 11/7/02 to enter. t 0011151.004.114 New cerbfrcadon _/HeeerCfreation Unit Number C� INCOME C01M IITATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designed to assist you in computing Annual Income in accordance with the method set forth in t:: Department of Housing and Urban Protect ("HUD") Regulations (24 CFR 813). You should make certain that this form is at all times up to date w•i: the HUD Regulations. All capitalized terms used herein shall have the meaning set forth in the Regulatory Agreement. Re: (\.4ME and ADDRESS of Apartment Building) Newport North a CSCDA. (POOL) I/We the undersigned state that I/we have read and answered fully, frankly and personally each of the following•cjuestions for all persons who are t occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit: 1. 2. 3. 4. S. Name of Members Relationship of the to Head of Social Security Place of Household Household Age Number Employment ln/nnlrn larrno OPAJ /IC- 5��_al� 3025 slxep 1 Income Computation 6, The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children under 18 years) listed above for the 12-month per' beginning the earlier of the date that Uwe plan to noye into a unit or sign a lease for a unit is S ?ac'I I U ) $ . r• 3.1 Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net income from the opeadon of a business or profession or from the rental of real of personal property (without deducting expenditures for bus•:: expansion or amortization of capital indebtedness or any allowances for depreciadoa of capital assets except for straight line'depreciation as provided Internal Revenue Service regulations); (c) Interest and dividends (including intone from assets included below and other net income from real or personal property); (d) the full amount of periodic paymeds received from social security, annuities, insurance policies, retirement funds, pensions, disability or death betel and other similar types of periodic receipts, including any lump sum payment for the delayed star, of a periodic Payment; (c) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (f) the maximum amount of public assistance available to the above penors ocher than the amount of any assistance specifically designated for shelter r utilities plus the maximum amount that the public assistance agency could in fact allow for sbelter and utilities; . (g) periodic and deterrinable allowances, such as alimory and child support payments and regular contributions and gifts received from persons not res,t_ in the dwelling; ' (�) all regular pay, special pay and allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the househo:= spouse (or other persons whose dependents are residing in the units); and (i) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: , (a) casual, sporadic or irregular gifts; Co) amounts which are specifically for or in reimbursement of medical expenses; (c) lump sum additions to family assets, such as inheritances, insurance pk r,.ents (including payments under health and accident insurance and v. o.'� compensation), capital gains and settlement for personal or property losses; or the ational (d) me - rung the Boss of tuitiounts of educational n ifees,pbooks and equipments paid directly to the s Any tamouns of such scholarships ips or payments don, and amounts vetpaid erans not used for the aboveent to a rpur Os!' to be included in incoine; (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (i) amounts received under [mining programs funded by HUD; L) foster child care payments; (h) z'nouns received by a disabled person, that are disregarded for a limited dme for purposes of Supplemental Security Income eligibility and benefl.s beta they are set aside for use under a Plan to Auin Self -Sufficiency; (i) income of a live-in aide; Q) amounts received by a pa:,icip: ^: in ocher publically assisted programs which are speci ically br or in reimbursement of out-of-pocket expenses and which are made solely to allow participation in a speci5c program, (k) a resident serrice stipend (a modest amount (nor to exceed 52CO per moruh) received by a resident for pedomdnS a service for tie owner, on a p•'•r basis. that enhances the gsal•.ry of life in Lie des•eloomenr If this faun is being completed in accordance with recenuiication era Lower Ineor,.e Temnt's or Very Low Income Tenant's occupancy of a Lower Income Unit or a Very Low Income Unit, respectively, this form must be completed based upon the current income of the occupants. G AJIC.M.ICC•Fa0.N 1 (Ij •compensation from state or local employment training programs and training of a family member as resident management staff; (m) reparation payments paid by a foreign government pursuant to claims filed under the Imes of that government by persons who were persecuted during the Nazi era; (n) amounts specifically excluded by any other federal statute from consideration as income for purposes ofdeterniningeligibility orbenefits under acategory of assistance programs that includes assistance under the United States Housing Act of 1937; (o) earnings in excess of$480 for each full -tern student 18 years old or older (excluding the head of household and spouse); (p) adoption assistance payments in excess of S480 per adopted child; and (q) deferred periodic payments of supplemental security income and social security benefits that are received in a lump sum payment; (r) amounts received by the family in the form of refunds or rebates under state or local law for property taxes paid on the dwelling unit; (s) amounts paid by a State agency to a family with a developmentally disabled family member living at home to offset the cost of services and equipment needed to keep the developmentally disabled family member at home; and (t) amounts specifically excluded by an other federal statute from consideration as incomd for purposes of determining eligibility or benefits under a category of assistance programs that includes assistance under the United States Housing Act of 1937. 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necessary items of personal property such as furniture and automobiles and interests in Indian trust land) d Yes L No; or (b) have they disposed of any assets (other than at a foreclosure or bankruptcy sake) during the last two years at less than fair market value? Yes X No (c) Ifthe answer to (a) or (b) above is yes, does the combined total value of all such assets owned or disposed of by all such persons total more than S5,000? Yes XX No (d) if the answer to (c) above Is yes, state: - (I) the combined total value of all such assets: S 31Si 1U (2) the amount of income expected to be derived from such assets in the 12-month period beginning on the date of initial occupancy in the unit that you propose to rent: S 0 414 and (3) the amount of such income, if any, that was included in item 6 above: S O , 64 S. (a) Are all of the individuals who propose to reside in the unit full-time students'? Yes X • No •A full-time student Is an individual enrolled as a full-iime student during each of 5 calendar months during the calendar year in which occupancy of the �— unit begins a an c uca t-E onai organaation w rtl�c�orma y1 malmains a regu�faculry and cumcitT an nallyTias a regularly enrolfedb3y 6t students in attendance or is an Individual pursuing a full-time course of institutional or farm training under the supervision of an accredited agent of such air educational organization orofaState or political subdivision thereof. (b) If the answer to 8(a) is yes, is at least 2 of the proposed occupants of the unit a husband and wife.enthled to file ajoint federal income tax return?Yes is No 9. Neither myself nor any other occupant of the unit I/we propose to rent is the owner of the rental housing project in which the unit is located (hereinafter the "Owner"), has any family relationship to the Owner; or owns directly or indirectly any interest in the Owner. For purposes of this paragraph, indirect ownership by an individual shall mean ownership by afamity, member, ownership by a corporation, partnership, estate or trust in proportion to the ownership orbeneficial interest In such corporation, partnership, estate or Trustee held by the individual or a family member; and ownership, direct or indirect, by a partner of the individual. 10. This certificate is made with the knowledge that it will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and Uwe declare that all information set forth herein is true, correct and complete and based upon information Vwe deem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. II. Mile will assist the Owner in obtaining any information ordocuments required to verify the statements made herein, including either an income verification from my/our present employer(s) or copies of federal tax returns for the immediately preceding calendar year. , 12. Me acknowledge that Uwe have been advised that the making of any misrepresentation or misstatement in this declaration will constitute a material breach of my/our agreement with the Owner to lease the unit and will entitle the Owner to prevent or terminate my/our occupancy of the unit by -institution of an action fe: ejection or other appropriate proceedings. IAVe declare under penalty of perjury that the foregoing is true and correct. Executed this23 rday of Noven be .200�_ in the City of 1owymr± epa6l ,California Applicant Rev.3/95 Applicant Applicant (Signature oral[ persons (except children under tire age of IS years) listed in number above requiredl 01.A.NC 0-J7:ICC•F0P.N FOR COMPLETION BY APARTMENT OWNER ONLY: 1. Calculation of eligible income: a. Enter amount entered for entire household in 6 above: b: (1) If the amount entered in 7(c)above is yes, enter the total amount entered in 7(d)(2), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ P(— ); (2) ' Multiply the amount entered in 7(d)(1) times the current passbook savings rate as detemuned by HUD to determine what the total annual earnings on the amount in 7(d)(1) would be if invested in passbook savings ($ A( ), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ et (3) Enter at right the greater of the amount calculated under (1) or (2) above: TOTAL ELIGIBLE INCOME (line 1.a plus line I.b(3): The amount entered in 1.c: Qualifies the applicant(s) as a Moderate -Income Tenant(s). Qualifies the applicant(s) as a Lower -Income Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenant(s). $ 3q, u IT c .' $ 39,Wc-03 3. Number of apartment unit assigned: �3��I Bedroom size: I i 1 Rent: $ L22I U 4. This apartment unit w /was not) last occupied for a period of 31 or more consecutive days by persons whose aggregate anticipated annual income as certified in the above manner upon_their initial occupancy o: the apartment un t qualified them as a Lower -Income Tenant(s). 5. Method used to verify applicant(s) income: Manager Employer income verification. Copies of tax returns. Other ( Pa i t lwr Ii S> uh� S yin« o C.IY' c t! n<, lacce'vi Sicde,�-�'l i —7 ' 3 U Date G.A.IMMTJCC•FOA4 OCT-23-02 NED 08:43 AN SH,IRP LABS HB tfiLFl,� ,tlzoV3T 8tvi;134:N�1.r _ ;0000atslgi��,;,�. V1iARP LA8C1pl.ATORII?S OF AME111l;A, INC., b 00 NORTI MMsT PACIFIC HIM BL VA OAMA' . Wf1sHINGTOIV M1,07 T1I bio Marital Eldiun. E;na to P rumplwnr./Mawarru;: 1'vclor,l: o OA: 0 8prrdfcpurlyrlumhar �'/9•S?•30?G E:tirrL�p��__ hoots ihi; garicct yoar iTdaTa H,1giII U _--4„_..__t�ta 1'7.1�510 64.00 ,.» 1,1A3. G» ?.G,570.11 ;ilrk 17.OS10 G'Q0 101Eil I X9,77 Venation 17.8510 8.0 14R-al 11S50.91 nonua 1'006.00 Incont Award g00.00 Griid Payer �� w•51?�b,a8 raY,G79.(o p dt�iol Incnmo Tax iRri,titt 3,919.?,.8 F,tici J Ue+rtrihy 'Dix RS.ER 1,P,2ri.8S h/ediciBo TW ?n.0¢ 436.61 CA ruAci li)conte Tex A?.41 9N)123 c:A ,t111`DI Tax •1R.erl 270,92 i�ttiGg C)hl4hci •047'-(8 ' 0-+ni:11 fsq 4r•15' eG9.iS •�011C •!35.GE+R 1,F,$O.EO * Vy.oluded from tr dot al to i h1o'ydnga you,, icgarrd taxr,blo vjo.• •s 4iii; tcriorl arG Si •20C.2S ' FAX NO, 7�49034767 Earininy.=) Statement Pcriod Ending: 10/04P2002 Pay Dale: 10/10/2G02 WANDA HARNEY 11$68 ST. PIERRE WAY CYPRESS, CA 90630 P. 04 6} Other Benefits and IrriOrmation this period total to dato AOtK i,e4o.s� Hclday Hrs Lett rick Hrs Left Vact'n Mm Let: 0.00 8.00 15.00 31,o79.60 2G:s_ j1,5•I6.o7 X w 3gg ,17:.13'2 '............... :;:.<,.,_. — •— — — •'..�.@r..•. SI JAtOI I ABWIATOUXI q OPM14FRJCA, INC. 000 NORTHMST PAOING f1JM OLVD • OAVAs, WASJ•J1N(,'r0N;)84107 Tilxd'al� Alurllr1:11,tlga. 8111S1t� �xwmptwncJAllawanau. fn,ly rl: 0 Ch 0 Earnin -Statement Nriod Ending: oglz0/2o02 Pay' Date: 0 io7002 WANOA HARNEY 11360 ST. PIERRE WAY CYPRESS, CA 90630 Soca11 Socurity Numbor. 673.021,1025 rate irnur: lhim El dotl : ynar to data Other 0enefits and ficpul,u 17,0510 - 64.UQ W 1,1R?.46� - 25,06.71 fnfdrmation thTa period Sick 17.8810 4.00 142.01 1,1PG.90 ' 401K ' ... V,loalion 17.H9f0 8.00 142.61 1,407.40 fioldaY NrS Left Dnhus 1,000,00• Sick firs Left Sic f s ft Intent Award 400.00 eft Pilmorml Hol. ;�� • 260.45 _ ��rngaPa!!' 'L $I.�.I-'92tl,ffti, , r... Reduclion� SWtutorX ' '` , _.•, \ ' Forleril Income TaX 1f v.RO 3,732.78 tilucial Occurlty T[Gr e6.6F 1 ,781.1 Niadirnro Tax ?n.04 416.157 OA Oictle income Tix 42.41 ' 817.H2 CA GUI/SDt Tax •12.44 25S.53 Chklnc P47.76 II^r4111 NO -4m.1b+ 02^7'00 L.T.D. -1,43 4011i t15.6g' 1,765.01 ., Pr.cludod irom frdofal Ga':nilk, Wn s -•_ Ye4r fndarnl tW(A1ble Plata* 11110 p;;ri?d a1'. $1,P'9ti.28 total to date 1,765.0 0.0' 16.0. ?.4.0 DEC-06-02 FRI 02:19 PM SHARP LABS HB kl STATEM-ENT Ia n `11111 C. •�;?5n+ ,H t+P•IlUN ItAt N:<}r CArti Cuftr•nfl • NAPI l:k: Ygtf PO box wos8¢ Las ANCELlS .CA 9n0U1 •(1.360 t,Yl,r,'l uAO260 WANUA 61 IIAMN 1066 ST PURRC WO CYI111GS5 CA 904-30 StC,NATURG BANKINGr' FAX Net 7149034767 P. 05 pcgo I of 3 Stalument Nunt6er: 2481 D07165 10/24/02.11/20/02 Tu6surAcu. fur 24-hour Au:crnulud Nrucl Survicu 600-238-4486 SOO 0267345VDD1 Rapresentalives are avofloblc from 6 ant to I I pre To open odditioRrl accounts, ar' nppfy, lot lanes, cull your brinkfr,3 ollice at S62438-V622 Visit us n1 www.ubac.com Thank you for honking with w since 1999 ' Itld %In nu:,y duutlwr, .i k,jthn„ nu,nbun rA1n ouy'tLintt yvtn berurt dusirus nwnburl Cull 1 v6d,1.113IS AN$ bir a h'won:1. wn, 6r, velbiy loin nr an auto loon today. Prryrd Ilnuoiu j {•tnrl;l $ISM1,AAR't` ov'ACCOUNTS!Joys in Mold orte;ii0il; 28 hugnn�m,/I;4i r:nlrnJ q�n,�c {iarparl A<r;;er,h _ nm,l_lydp,�l..fjn;y.„• �V i+v ,u�: �! .___..... ,j1d,Lli�mt _ Sotvrn•?htn:_�, ,,lul�:o Th.rocl lub;real t;hu l my $ d42.10 $— fi2:i.9fl i 3,23t1 <)4 $ •3,254.54 $ 3 0.317 q U l L7r)7161+ - �C.ZfI.efd{ift Upo..0 Fy:illaryy) lnJun.n A�': tlnun Fnynun,t. r i &Jtop Lulavo On I12o h'cs,li lnu trmir $ 96.10 $ .96,18 it U.UQ ?.4 u 11,07165 — Aalnnca ott 10/24 $ 325.98 Addifions 3,238,94 Suhlrrreli0rl+ -3:254,54 clv.w4 .1,523.47 I'rnymeArils •1,UJ0,90 Purr110-0, -6r14.17 • AIM wi1lide0vv%;I•r 10,IX! L•)llwr willullnv,45... _ ._....__,L��:u`) Dtrlonco on 11 f ; 6 $ 310.38 5lcr6mo'nt AvuruU•; L:dyri I olrlrjl.a Wo wnr9ud your eotvict. t hnry,• 1146 alolcryinto period. 10/7rl St•IARPLAG,AMrh,::I'AY%QI ITI) I0/'1 i IkMP- irrr.I l?C+fyq: AYIr4r',S 0X0UNT 10/:90 TMNSITR FNC';j%A fW, JIA,d. ACCO ONT I0/:ai1 d..A$, I FEtdk9r: I RAN.'':f I'll 10/31 C:A51•IIe'arl'49 rf -i::•ICR 11/1 AfM/I0M--Y111V05A1 492.70 Paid INS period $ 0.04 Paid year-lo•dalu $ 0.37 Inttrost Roles 10/24/02.11 ///02 0,20 `.5 11/8/02.11/20/02 Annual Porcenicigt: Y;eld I:arnud - U. 10 ;u Rdwol« Amount 55000091 $ 947.75 'l'2.3Y 12.01 S9,00 121.00 45217942 350.00 DEO-06-02 FRI 02:20 PM SHARP LABS HB FAX NO, 7149034767 P. 06 ' Pogo 7. of 3 SmNinenl Nunl6ar 2481007165 10/24/02- 11/20/02 I IiPUnro UI1rJ Ulewl JI II Rnfufone eenlfilluee/ I I/7' SHAIWIASAWRICPAY8t311.? ff'D S201514A $ 579,00 I I/7 SHARP IAA MAIPIC FAYU011. PIT) 62015143 94/.%5 11/111 AW/1.011bYIXI:0Ir 46600049 350.00 11/20 IN1umll r•AwrNI 0.04 Wal $ 3,238.94 411rfL�f• 1:1r111!'VI 1!Llfl, •/,•. 11 r,lrlli•n•r.. .,- ,••„Alilalltn lY br& Ret.fVIIL'1 nl,.LllI 2035 10/2p 23'? I (a l l'J $ ?0.96 9.099 -��-•r- 10/30 18917/24 $ 32.33 2086 10/26 OC?;l'i3511 d15,00 2100 10/30 18917723 20.00 20904 10/''2,I 7''0R1168 144.1/ 2101 11/16 26113792 29.19 2091 10/24 A&I10:14 0.1)5 2102 11/12 16701097 63.$3 2092 11/10 101) 0W .55.20 2103 11/13 26327896 10,46 201)3 10/95 10??16()3 I0'05 2106" 11114 14018604 60.00 2094 W/2tf W011690 10Ur00 2107 11/13 22139766 50.00 M;,s 1()/2$ 45125'.:,119 100100 2108 11/19 %5020376 150.00 2076 10/21i 101241187 600.00 2109 11/18 Y5036402 10.00 '409% 10/;iGr 7!I();iwg7 10.00 Total $ 1,523,47 209Ill 1)/6• ?:+/), Y)'1 12.74 t.'llµk, imc:nnl n. r� t�1.+,d,ry lml.may <Igm;Jnw I141P4f0ad 1n Ilm P„ym.cdl1w.61. of Y-uf 1lwnnluN. •, I,ui .l;en _ ....:..-....--............ en_f„ Rulolu,Kt• Alnounf nufinp c1,;rf 10/95 AIS bf RV fIRA N'fhLR 2483003727 65462406 $ )5100 e11�clnnlic,N1pllA;T 11/8 Now ' DI-11ri5 PFr) 52800296 147.00 I1/0 PRif•lfIC8A411:;1ljr;Mff.)EI'YMI 1'FI) 52840077 898.90 Total $ 1,070.90 �UI<Ilfi1lifl On)_ ly1r.J!1 ,lnl faL,ltil•n R, lafdnw� _ � Mnnunf AMA Lul(Irmd 10/24 ARCOPAYN)?;174)II TORQItCI.ICIRO CA 9863237) 72962037�$ 22.20 PAu;n rhl,.nl.:%'-' 10/7.5 MARIC CWLLNI;`LR`L;ill 39 yVG6TPtiNSIFR CA 98632.171 72962321 17.60 rr),d JUM thlu-.; 10/25 VON; 5 1 19151 V,AII @Y VI CSAhDCN GROVE CA 98637371 72980909 2Y.96 10/20 11ARNr5 R N . NRWI'ORI BEACH CA .90632371 72980005 12.26 10/211 V(.)Id5 5 1IBLsI vnu1:Y v1 <,ARf>kN cec)Vr CA 98632371 72902041 25.o4 10/2131 SlAfHt 169 1001 YAI.I!YVICYPIWS5 CA 98637371 73001210 32.15 10/%9 ARCO PAYI'0 600? ilhl SA AVE 11LIMINGTON DE CA 99637371 73011809 20.95 10/29 WALGRI I N C WC Vf VAI MY V CARMN CROVL• CA 98632371 73012025 74.62 10/31 WAI•MAI�rIt13331L11:ACIIBIVVVCSiMINS49 CA 98632371 73032033 20.81 1115 OAPI fNV'S (f Kl:K, Cl)a,1A M gQ'jIA MrSA CA 98632371 %3072309 14,66 11/6 CAILIf 1'17l.AKIIC•lllIli III ORRIT05 CA 986323/1 73080629 28.5/ 11 /6 VON3 S 118 %I YA611"(VI t;Ak1)CPd uttr)VE CA 98637371 73092102 36.29 11/0 VONS SllfMYAIIFYVl<;ARDfN0R0Vr CA 986323?1 73111BOI 40.9A 11/12 VIE Dr. FRA NCI; p15?9 C0,9TA MrrSA CA 9863237I 73142355 14.01 11/12 WALMARI` 0 13.3,11 NW.1.1BLV WES1'MINSTER CA 98632371 73IS2020 19.06 111/12 VONS , S IIA+,I VAI I F.Y Vi (",aWFN GROVE CA ,. 98637371 73141252 - • 20.02 11 /l �) ARL SJ PAYF( 04.10; Kx',A AW I;IUNf INtS)'k7N 8P rA 98632371 73150828 4'%,70 II/13 10KAI IA AVSTANTON CA 966323/1 73162019 17.53 11/14 :iANIAAMA CA 9063237173160634 6.12 II/14 NORO$llli•)M • SAN'iAAIJA CA 98632371 73162229 6.73 I1/15 VONS ,51IUIyp111lYV1GARIn'NGRr)yECA 9063237173181709 14.06 I1/16 RUPY'S5GU1HC,*WI CC)SrAMESA CA 98632371 73200040 19.30 11/18 ALAnt1!tc)rJ57Q5tIKA1111AAVSTANIO}4 CA 9a6323717,9211038 9,65 it/M TRA})CR',I(')E7.Sr)0f IMPLINAI BRrA CA 986323%1 73211843 40.30 11 / 19 7,11 1., O22 483$ lL:uluN4 AV CypnitY CA W637.371 73221931 62.41 11 /20 yr)NS s• I I85I VAUF..'Y VI 0,ARIY.M GROVE CA 96632371 73232002 7.61 ral al s 624.17 A7}A wi1174tenvtfl;:,-. PuW...._..�°i'!flaiu�e/1!�b6aa A.nGuencu F.uuuW - -- 11/15 _ UtIOC HIM iI,NT;IONBI-ACHUNING!ONGC.IICA ___ _ 986323%1 73191236 $ � 70.00 r DEC-06-02 FRI 02:23 PM SHARP LABS HB FAX NO, 7149034767 P. 07 e j I'Qge 3 of 3 Sta%mm1 Nuwl6vr; y481007165 ! rsets • adt 10/24/U2. 11 /20/02 C11l,erwidtdray uIe data _ 0„ri7t lrn Ralornxe Amuunr Ini,lueluttlIf-vs and 10/'79 SgVINt�ac?VLUI)iiArfj�1N!ifL'IiCI!AdaCE $ I1.U0 cdlluJowlim 10/3G 1,gY1PIr�S <1V1111)"Af f I'IU+P; I FR Ctlnhr.,f B 00 Taal S 16.00 LASH FffSl RVi: l INE C16 CREDIT Mf�R SU{v1 •.,.-—.---^—....,.. _._, Galar:eo on 10/?A $ 0.00 Creait Line Ailvun're:, urtrl cLgrU •s 96,10 I.imil $ 1,300,00 Pu(rltenl, nr' c.l cn;ait: .96.1 A Avoiluhle !u lyorww 1,50U,00 11u ancq Lrr 11/20 $ 0,Ot1 Boling cycle Past Goe lirururtr � 000 ANNUAL MCENIAGE PATE 263.64 % Cunonf Dun Anwunl _ Total PFlyU?fnl DNr• $ _0.,00 0,00 Rifling cycle c6in3 anl.• j 1/'t0/02 ' CtBUnf 4Ctlylly, ....... _..__, ,. _...._._._..-. I1r,IJ 15 �. •ryirl�ni '--•-, .., .:.., ..........�.._...... _.. ...— A unemr .., rPmtl C'nuiYer Po nie,d: nt!?lCrvdn 70/30 CAST l f?r:4f VVE MAW,rt R +S9.90 10/30 fflrVvSr''r fit 1h .[ 6 t hlhN�:1' , % . 8.00 IU/31' CASFINISfIdVli l?AN`Jll � 21.00 10/31 ,'IRAN51lkIItvA!v;:t'�I�IAltvl' 11/rl UIiU� SAVihlch • 19ANLSIrR 021'104?48300272y0101 11 /rl CA^I I Ni 51 I?VI I rhdANCI: CI 6 VIE Finggeu C6ruo Calcufulicn Avuro-lo ilnily lailunrc: Ih,ily poriodir. ride Num4u,r of days in po lad Inlareat H114ANCK tadkkt?' Trrutafar hincnice C:horur Tnkd FINA.4cr cll,4i',i3E } 13.53 • Sr .94932 `l.� •� _ O.l 1313 S �tb.18 Con'rspooding Annual PoraonlaJe Rate is 10,00;6 96.18 7ho billing cycle Annual Perconlauu Ruty includes bullt portions of Ilia finance cbar-e; InIerast and Iransfer lee, onnuolivvd. DEC-06-02 FRI 02:14 PM SHARP LABS HB FAX NO, 7149034767 MEJ STATEMENT OF ACCOUN"1'5 UNION II,ANK 01- C AMOI IA kPI.ES 248 PO IIUX 5123811 1 U.S ANGELUS CA CYISZ 00 i(x,0 WAN'DA hi HARNIN 11US V P-TUpl' 41AV CYPRESS CA 906f) SIGNASUR1~ IBANKJNG` Pa0a 1 of 3 Stumneal Number• 2491007166 9/21/02.10/23/02 TolosnrvimU 90a51^ p3typ (r,r 24•hour Automaleal Dlmtl Survice 900,236 4466 000 026.73451TDD1 Raprrasurlraifves ore avoilablu tram 6 anti to I I pn) To open aeldiiional occoutils, or apply for loans, call your !ranking office at 562.438.9622 Visit us al www.uboacorlt Thank you for bunkinsl Willi us .iota 1999 M, 01)11nf, &,,,k;,rg yrp,at pov,r ca';nrr,G:•eer+nt. Mure's o beiier way 10 pqy hills- online Through 8c6 0a 110meu: an tho iVolr with 0111('1ry, hjyurnl Ir:+s f11n01k yynq bills Aid have groolor control over your puymenks & money. I1's simpler and qui,•kpr lhun wrl:kl l cI clicok.'Yeru can pay everyone you now pay Willi chucks. To gel started, ecmtacl un CW1nu 11(viUllp .STa:cialml of 00196.5656, option 1 Then I or gel skirted al www•ubao.eo:n/inslant. SUMiv1ARY OF,ACCOtIMTS,_,_ U,rys in .nrlrrlunl Ixullatl: 33 DrpdifAccugnlp,,,____ CJurLhfyfirll;,Gry:;, "! r" .poannrr h„Guo u .._ npV-1I _ _�'+IJi16,ns v3;1.67.36 S�ktrgclouns r-3,237,34 Fnrlln0 Gntm .-„ on10123 licrutllrlb:ruelChayl:in0 $ bCi9.t)1 p 295:)fi $ $ $ 925.92 O,;iinuirni jr;lnnrn --nnjjdvunuo Poymot rr Fndlnd 1L Credll llh.f (:cisllR<s,.rvaLinec¢Qtedil $ <.n'7/?t 33.02s-••"•� aaf/<fNln<rf 238.74$ rtlltr Cl,rr�}'r -271,76 Er' •�041U/:J 0.00 24B100yI65 TIIrRl:1) ItaTE11@5f,CM6CKING, SU1b1MAJ?V,,,,,•,•,,,, Accouni Number: 2481007165 -.__..Balpncoan4/21 $ __ __._ _�_.___..__ 29596 _ Interest Addllinr,s 3,267.36 Pald Ihls parlod $ 0.09 Sulaharlions 3,23%.3-0 Paid yaryr•ta•dole $ 0.33 chr:ck•t -1.134.IU lntarestRates Pcrytnnnls -1,642 66 9/23/02-10/17/02 0.25 Pulrllfr.Ns 4ri7.:$8 10/18/02.10/23/02 0.20; lilhur wilLaL'u,v_ �s� C.t10,� __ -Annucd Percenlogu Yiuld Earned•• • 0.174 Bnluncc oa 10/23 __ 325.98 61wamonl Av mien Wdour L•n4mas S 559.01 Wu %w4vufl your s;:rVl•:c Oi, ga lki, 00enliml period. -M!to',GR:__..-.... Un)n, ^^ PIrMYi,014ut,-.__.. .-.. _. ....,.�....,... .........-._,.�_ Reralnnte _ Amow!l 9/26 Sl IA1jP V.1`l AMCIaa' f AYfK111 fl'U 56026207 $ 947.75 10/2 (.)I'Fif:E[Jfft;r;•,:f A6115976 350.00 10/y !',AVIN a5 •PAPUSN'R 021007 2.48300272% 0101 62808359 300.00 10/0 TRAI'd'if [It -C�-OLIN1 149.77 10/8 CASH RI Sl R1'I 1)ANN I R 5t,.00 10/9 CAST I Rr•t:LkYI'r 14AlySf I•R 104.00 I Nr:r)hAF A. ACCGT t,A I r I It nTI/1nl .n..-....... • t Sax Dale or Dltth 0 6 Ago $• Social Security ll $ — Z-3d2 Frr Student YESorNO 2a450 WFIMt,4N.w.no 7 8 t 11tl4U1Y1C Family Source Base Rate Average Average Annual Memb. dk $ Hours 52 24 20 12 1 Total ' Yyx scmwa UI•Wx M Tit r $ 1516.a8 =$3gtgIT.03 $ =5 $ _$ ennrnl cunt mlT/ � ToL'tl Box A• $ Family Memb. It Source Base Rate $ Average Hours Average Annual s2 24 20 12 1 Total 1"A( SLMI•MO UI•VM Me Yli $ — =$ $ _$ �nm In n��,,.•,•,..,..� Total Boz B: $ Family Memb. ik • Source Base Rate $ Average Hours Average Annual 62 24 20 12 1 Total YVx SWi4M0 UI•NM MO Ylt $ $ — _$ $ =g $ — _$ Total Box C S Family Merrill. ik Source Base Rate $ Average Hours • Average Annual 52 24 20 12 1 Total YM SG11• O UI•YYK MO Yrt $ _$ $ _$ $ _$ $ _$ Total Box 0• $ or TOTAL ANNUAL GROSS INCOME Athrough D >>>>> .>>> $ 3q r 4 (?.a3 ASSETS Member A Asset Descnpton (savings, checking. stocks, bonds, ota.) Imputeo/ Current I or C GrosslF�Ir Mk4 Value . Cost to Get Cash NET FamilyAssals value Actual Interest Rita Actual Annual Income from Assets 31d.14 o ea moo. CIF— � Totals Box E: b , t 4— Box F• �$ Q. (4 faintly lnwlea FIenl A.acL-uwnm IMPUTED INCOME FROM ASSETS II I Effective Data r)eQd20 ._.r• Box Eoxcoods$5,000—multiply Typo of Program% Ww E by the currant passbook lntorosl mtoi ,X — °b Unll No. 2304 Unit Silo t•FI It Box Edons not exceed $5,000 F—I No. of Persons I anlarA-In box G: BOX G: S —_) ' INPUTED INCOME Min: ✓ Mox.Income Limit$ 42.336 FROM ASSETS AR: 1405 Limit $ 5� Enter the greater of Box For Box GIn: BOX H; ' INCOME CONTRIBUTED FROM ASSETS TOTAL ANNUAL INCOME$ 3g141S vs & TOTAL ASSETSS_ Pay Periods Date of Most Recent Pay Ending Date [')(aI L� of o�,, �6 Year - to - Date 3k�0-7q"(,0C� divided by pay periods average per pay period Gross per Pay Period 1ka-% - 08 divided by ( x ) how often paid (x) how often paid r/ �Y �7 (_) Calculated Annual Income (_) Calculated Annual Income New Cerdfseaticn 1Recerufsealion_X Unit Number 26�_ INC01ME CODTUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designed to assist you in computing Annual Income in accordance with the method set forth in C: Department of Housing and Urban Project ("HUD") Regulations (24 CFR 813). You should make certain that this form is at all tunes up to date wi: the HUD Regulations. All capitalized terms used herein shall have the meaning set forth in the Regulatory Agreement. Re: (NAAM and ADDRESS of Apartment Building) Newport North d CSCD.At-. (]POOL) LrWe the undersigned state that Lwe have read and answered fully, frankly and personally each of the following•tjuestions for all persons who are t occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit: 1 2 3 4. 5. Name of Members Relationship Social Security Place of of the to Head of ry Household Household Age Number Employment /llod- EA +_r MCA ,li3_ IG2-02-o28'I Melanenres. Ce Income Computation 6. The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children under 18 years) listed above for the 12-month per' beginning the earlier of the date that Lwe plan to move into a unit or sign a lease far a unit is S H;. 90 2.66, r Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real of personal property (without deducting expenditures for busirt expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets except for straight lire'depreclation as provided internal Revenue Service regulations); (c) Interest and dividends (including Income from assets included below and other net income from real or personal property); (d) the full amount of periodic payptetilts received from social security, anauldes, insurance policies, retirement funds, pensions, disability or death bent! and other similar types of periodic receipts, including any lump sum payment for the delayed start of a periodic payment; (e) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (t) the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter z utilities plus the maximum amount that the public assistance agency could in fact allow for shelter and utilities; (g) periodic and determinable allowances, such as alimory and child support payments and regular contributions and gifts received from persons not res?di in the dwelling; ' (h) all regularpay, special pay and allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the househo.d spouse (or otherpersdns whose dependents are residing in the units); and (i) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; (b) amounts which are specifically for or in reimbursement of medical expenses; under health and accident insurance and worke (c) lump sum additions to family assets, such as inheritances, insurance payments (including payments compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational institution, and amounts paid by the government to a veteran for meeting the costs of tuition, fees, books and etfuipment. Any amounts of such scholarships or payments to veterans not used for the above purposes to be included in income; (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (f) amounts received under training programs tutted by HUD; (g) foster childcarepayments; (h) amounts received by a disabled person, that are disregarded for a Itrai_d time for purposes of Supplemental Security Income eligibility and benefits bees they are set aside for use under a Plan to Amin Self -Sufficiency; (i) Income of a live-ir. aide; (j) amounts received by a paid-ipaM in of er pubiically assisted programs which are specifically for or in reimbursement of out-of-pocket expenses in."-•*. and which are made solely to allow paricipadon in a specific presrzm; (k) C0 per month.) received by a resident for performing a service for tie owner, on a Pa-:` a trident service stipend (a rtx'est amcua[ (net to exceed S2• basis, that enhances Lie quality of life in the de YcIcTmeRt; If th;s Conn is being completed in accordance with reenircahion or a Lcwer Income Taunt's or Very Low Income Tenant's occupancy of a Lower Income Unit or a Very Low Income Unit, respectively, this form must be completed base' upon the current income of the occupants. O4.Aa1r•rym.ICa.F0A4 "" 5•9G 9493698695 METAGENIC5 TECH PAGE 81 12/18/2002 13; b1 FAb 9dB7201698 NEWPORT NORT(t TA002 (1) •eomparssaian Oamstate orloeal empivyttxattminina proantm avail ttainlns are fatally mombvas resldcnt ass+tsjanantttaR, (m) reperaflerfpayments paid by a foreign povemment pursuant to claim111cdunder the lows Of that government by persons who worst patseepkd during the Nast era: (n) ?mounts speei0edlyeecluded by My otherkderal suhhe 4om Consideration w fame for purposes orde-tarniniaj eligibility debeaetts striders calegat of assistance programs that lndudet assiswee under the United States HOuting Act OF] 537, (a) Mrologs(n excess ofS480(breath lull-temt student l S years old of older(excluding the bead Othousehoid and spousra; (p) adoption assiriance payments in cons+ arsuo per adopted child; and (q) defemdprniodicpoymenual'supplemenbdseeur)t�lneotrtcand saeidtacwItybenetar tsthatsreceivedinalampsumpaymenG (r) amounts received by tiefatally Inthetormofreftnds or rebates under stain or local law IbrpropcMtaxerpaid onlltedaroliingunit; (s) amounts paid by a State agency to a fatally, with a developmentally disabled fandly mcmbirliving at home to offset the cot arservices and equipnmnl needed to keep she developmentally dtsablcd (unity member at homy; and (t) ameant%specitedly excluded bypatharfedenistatute Oomconsideration asIncome Npurposes ardaterminingeligibility orbene0fsunderacategory of assistance prod uns that Includes aulumcc under the United Staten Housing Act of 1937. 7, Do the penoo's whose income or contributions tie Ind uded in Item 6 above: (a) have savings, stocks, bends, aqult In trot property Or other to=ofwpiml(Yu ment(aodudingt a values ofnceassary Items afpersonal pmpertysueh • • , .or prmilere and amomobilcs and imams[ In Indian taws head) dS 'Jt ' ' ' (b) have they disposed oranymets(edierdwtatafrbn oreolosweakmpteyaafe)durinathale1�wYeusatiesetliartfllcrtrarkeevaiue7 Yas >< No (c) If the ansittr to (a) or �) above byes, does rile combined IOW value Oran such assets awned ordisposed of by all such pavans tots[ more than SUM (d) Ifrha enpt'p to (cj e(s yet,swk: , (i) thewmbinedtotalvalueafailsUchsstets: S_�, I43, 38' • (1) the amount oCincome expened kic derived lromsuch assets in the l2-ihonth periol6tgMninB on the dakofinii)sioacpadey in the unit thotivy prepare to tens 5 4. 7% __ -and ' (3) sheamountoflueh Mrgrdc.ICany;Nat waslne)udedln Lem6abeve:S 7..�% , S. (a) Ate all OCthe individuals who propose to teelde In the odic full•tiate audents•7 Yes �• No "A Ibllilma student is N 1ndlVldud enrdled n a NII-time student dutlna ueh of d tdn,tar months during the ederader year in+shlah occupancy of rile unit begin at en edutatlond organ®rion which narmailYmalnmins a tegulanc�alt and nrtledum and nomsallyhtu ■ regularly entailed body pfstudmts in anendnee oT 1s n Individual pur4uing s toil -time eoune of Imtituuonal or farm mining undet the snpervRion arm acomdlkd ascot of such on eduendonaiors . itonorofits tateorpoll0aalsubdivisionthereof. (b) Ifsheanpeerto 8(a)Is es, itat Imt2 of the proposed exupsnts of the unit ahusband utdwlfeentiued to DlnjglntRdcbl Income tax retum7 Yes X 0 9, Neithermysetfnoranyothorbmupnt of the untiiMtproposo to tent is theIn which thetsnifis located(hack'031rthe e0)rw'), has any family relationship to the thvner, or owns all featly or indirectly any Interest In tha Owner, for purposes of this paraSoph, Indirect ownership by an Individual their mean Ownership by a family member, mvnershlp by a corponlior6'pannership, eslato of trust ln•proponion to the oanenh)p or bedeteid leicrest In such eerporffion,•ptutnership, estate orTrw(ce held by the Individual or a family member, and ownership, direct or Indirect, by s parmeroflhe Individual. 10, This aertificito is mo la with the knowledgt that It Hilt be tdled upon by the Owner to determine mahlmurn income far clialbgit to weupy the unit: and Uw'e ddciu< that ail lafenna(ion sea fanh herein Is tme. conetc and complete and based upon information Ihte deem fellable and that the staemcat or total atlltlpatcd income contained in paragraph 6 is reasonable end hased upon such•investigatlon is rite undersigned decried necessary. )I. If%Ve will assist the Owner in obtaining. say Inrersudon of documents required to verify the stetert cots made herein, including either an income ♦erlpcarien ban my/ous present empicyar(s) or copies of federal tax returns for the Immediately preeedins celcedir year. 12. MIN acknowledge that Uwe have been advised Ibatthc making ofany misrepresenaation or milsistement In this dealarsaten will constitute a material breach of mytour agreement with the Owner to lease the unit and Will emlde the O,mcr to prevent or lertninIle mytour occupancy or the unli by Institution of an a -non At ejection or other appropriate proceedings. Me declare under penalty of perjury that the rorogoing is true and correct. FAc:uso6 this Say dayar bec-P.fYlbpz .2o.op in the city or Mi-t Itozi Aenr'k .California r Appliant Appllcnnt ••� Rev, SM.; n.uiea.•srrraui Applicant Applicant 15lgnarure ofxli persons (except children urder the age or IS ycas)Ilsled in number above M111redI FOR COMPLETION BY APARTMENT OWNER ONLY: 1. Calculation of eligible income: a. Enter amount entered for entire household in 6 above: $4:�', � r,2. a b: (1) If the amount entered in 7(c)above is yes, enter the total amount entered in 7(d)(2), subtract from that figure the amount entered in M 7(d)(3) and enter the remaining balance ($ _e— ); (2) ' Multiply the amount entered in 7(d)(1) times the current passbook savings rate as determined by HUD to determine what the total annual earnings on the amount in 7(d)(1) would be if invested in passbook savings ($ _ X ), subtract from that figure _ the amount entered in 7(d)(3) and enter the remaining balance ($ (3) Enter at right the greater of the amount calculated under (1) or (2) above: $ C. TOTAL ELIGIBLE INCOME (line La plus line I.b(3): The amount entered in 1.c: Qualifies the applicant(s) as a Moderate -Income Tenant(s). $ Ll3, 402. ze x Qualifies the applicant(s) as a Lower -Income Tenant(s). . Qualifies the applicant(s) as a Very -Low Income Tenant(s). 3. Number of apartment unit ass!gned: 2,1"2 S' Bedroom size: 3 t2 3 5. Rent: $. 47T 4 .v o This apartment unit (was/was not) last occupied for a period of 31 or more consecutive days by persons whose aggregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartment un t qualified them as a Lower -Income Tenant(s). Method used to verify applicant(s) income: Employer income verification. Copies of tax returns. Other ( Manager 12/1 l62 I Date a natD4;.KC-F w ' METAGENICS INC. 100 AVE. LAPATA SAN CLEMENTE, CA 92673 Taxable Marital Status: Single Exemptions/Allowances: Federal: 9 State: 9 Social Security Number 142.92-0281 - Earnings rate hours this period year to date Regular 20.1923 86.00 1,776.92 35,699.90 Pars 161.54 Eros Pay ,Sd•;7Jfi.9i i 36.204.71 Deductions Statutory ' Federal Income Tax -65.97 942.23 Social Security Tax -102.66 2,086.93 Medicare Tax -24.01 488.07 CA State Income Tax -44.98 691.33 CA SUI/SDI Tax It -14.90 302.94 Other Dentall25 -5. c0* Health Care Med125 Vision * Excluded from federal Your federal taxable wai $1,655.75 105.00 Period BL .ning: 10/20/2002 Period Ending: 11/02/2002 Pay Date: 11/08/2002 ANVAR FAYAZ•FAR 5405 ALTON PKWY #355 IRVINE,CA 92604 Other Benefits and Information .this period . ,total to date Personal 0.00 Sick 19.55 Vacation 9.44 carnings Statement �> > METAGENICS INC. 100 Period Beginning: 08/25/2002 SANNCAVE. Period Ending: 09/07/2002 LEMENTENTE, CA92673 Pay Date: 09/13/2002 Taxable Marital Status: Single Exemptions/Allowances: Federal: 9 State: 9 Social Security Number. 142-92.0281 Earnings rate .. hours ..,, this period Regular 1615.38 • 80,00 ; ;;` ',1,615.38 HOI .'a.00 -" n /• Deductions Statutory Federal Income Tax • .41 ,74 Social Security Tax '-92.64. Medicare Tax '21.67•: CA State Income Tax -30.88 t CA SUI/SDI Tax • -13.45 , Other Dentai125 -5.00* Health Care 104.17* Med125 -9.50* Vision -2.50* ANVAR FAYAZ-FAR 5405 ALTON PKWY #355 IRVINE,CA 92604 year to dare Other Benefits and , 30,692.22 Information 'this period,-' -total•to `date Personal 30;692.22 Sick' ' ? 12.•IS Vacation 14.12 •• 829.42 '•1,175,20 415.17 '607.40 257.69 85.00 1,770.89 161.50 42.50 * Excluded from federal taxable wages Your federal taxable wages this period are $1,494.21 •L^ ' Q Q o ,ew v 9ND UU1tK)2 820900 1 0000001958 1 METAGENICS INC. i oo AVE. LA PATA SAN CLEMENTE, CA9267S Taxable Marital Status: Single Exemptions/Allowances: Federal: 9 State: 9 Social Security Number: 142-92.0281 Earnings rate hours this'period year to date Regular 1615.38 80.00 •,1;615.38 29,076.84 Gross .Pay,• "' .;! �j [",y5:38'; 29,076.84 Deductions Statutory Federal Income Tax -59.92 787.68 Social Security -Tax -• --100.15 -•- --• 1,682.56- Medicare Tax -23.42 393.50 CA Stale Income Tax -41 .22 ' .57C.'k CA SUI/SDI Tax a -14.54 '244:24 other Dental125 80.00 Health Care 1,666.72 Med125 152.00 Vision 40.00 �i'e3 Pay..,= �. .....•.' r '.:.. Si,.3i`6.<j3; Your federal taxable wages this period are $1,615.38 rzarninas .statement Period Beginning: 08/11/2002 Period Ending: 08/24/2002 Pay Date: 08/30/2002 ANVARFAYAZ-FAR 5405 ALTON PKWY #355 IRVINE,CA 92604 Other Benefits and Information this period total to date Personal %_ 8.00 Sick 10.30 Vacation 11.04 "/- Account Statement ()ctober 25 through November 26, 2002 Account Number: 074-3811.9073 Page 1 of 4 4: "AIS 1.1 ANVAR FAYAZFAR 5405 ALTON PKY # 355 IRVINE CA 92604-3717 Thank you for banking with Wells Fargo. For assistance, call: 1.800-TO-WELLS (1.800.869.3557), TDD number (for the hearir Impaired only):1.800.8774833. Or write: WELLS FARGO BANK, N.A., P.O. BOX 6995, PORTLAND, OR 97228.6995. APPLY FORA WELLS FARGO VISA CREDIT CARD AND TAKE ADVANTAGE OF LOW INTRODUCTORY RATES THIS Hn:-IDA` SEASON. ENJOY VALUE-ADDED FEATURES SUCH AS THE WELLS FARGO REWARDS PROGRAM, LOW -RATE BALANCI TRANSFERS, FREE ONLINE ACCOUNT ACCESS AND OVERDRAFT PROTECTION. APPLY TODAY. CALL 1-800-350-6401 Of VISIT WELLSFARGOSPECIAL.COM AND ENTER KEYWORD: LOW INTRO. Account Summary Daily access accounts Aaco,int .................................................... Stagecoach Checking \ ONFxtra Savings Account number Balance last period Balancethisperic ............................................................................................. 074.3808073 $2,092.39 $1,912 .0 660-1320856 1,106.03 1,106.2 $3,198 .................................................................: ;.... Total .42 $3,.0.8 3 Stagecoach Checking Anvar Fayaztar Account Number: 074.3808073 Activity summary Balance on 10/24 Deposits Withdrawals $2,092.39 0.00 - 110.35 ........................................................................ I................. 13abmce on 11/26 $1,982.04 wliLLs FARGO October 25 through November 26, 2002 Account Number: 074-3808073 Page 2 of 4 479,769 Activity detail Withdrawals Other withdrawals Date Description $ Annot I .................. ....... ........... ........ .......... ................. ....:.... .... .... ..... ....................................................... 10/28 ATM Withdrawal - 10/26 Mach ID 0601B Irvine, Irvine, Ca 5006 80.1 11/01 POS Purchase - 10/31 Mach ID 000000 590 S. Pacific Arco Paypolaguna Beach Ca 5006 30.: .................................................................................................................................................... Total other withdrawals $I10.: .Daily balance summary Dale $ Balance ............................................ 10/24 2,092.39 WellsExtra Savings Anvar Fayazfar Account Number: 660.1320856 Date . $ Balance ............................................ 10128 2,012.39 Activity summary Balance on 10124 $1,106.03 Deposits and interest 0.25 NVithdrawals - 0.00 Balance on 11/26 $1,106.28 Interest you've earned Interest earned during this period Average collected balance this period Annual percentage yield earned Interest and bonuses paid to date this year S0.25 $1,106.03 0.25% $13.09 Date $ Balan .......................................... 1 1/0 1 1,982.1 Pay Periods Date of Most Recent Pay Ending Date 26 111GzIO2 Year - to - Date 36,204.71 divided by pay periods average per pay period F23 1,57y.12- Gross per Pay Period 1,-774 ,q2 (*) 1i615.39- (_) 5,60-7.-G9 divided by 3 (x ) how often paid ( x) how often paid 2 6 26 = ) Lalculaiea Hnnuai income L161g2-7,o6 (= ) Calculated Annual Income �3, 3qq . sq Nee , w Cerb'fictrfion /Reeerrffierrtfon n Unit Number — INC014IE COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designed to assist you in computing Annual Income in accordance with the method set forth in the tthhe HUD Regulations. All Urban capitalized terect ms used he herein shall hRegulations ave the meaning set forthld make in the Regulatory ory Agreement.in that this s at all times up to date tviLh Re: gKalB and ADDRESS of Apartment Building) Newport North - CSCDA (P®OL) I/We the undersigned state that I/we have read and answered fully, frankly and personally each of the following tjuestions for all persons who are to occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit: 1. 2. p of the ationshil 3. 4. 5. Name of Members to�Head off Social Security Place of Household Household Aee Number Employment _,Anva Fnt.n��� G:end N3 IU2-t'2-02S1 Mc1nq ntr< Income Computation 6. The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children under 18 years) listed above for the 12-month perioc beginning the earlier of the date that Uwe plan to move into a unit or sign a lease for a unit is S-A y� yZ7. 62 Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, f:es, tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real of personal property (without deducting expenditures for business expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets except for straight line'depreciadon as provided Internal Revenue Service regulations); (e) interest and dividends (including Income from assets included below and other net income from real or personal property); (d) the full amount of periodic paymerits received from social security, annuities, insurance policies, retirement funds, pensions, disability or death benefiu and other similar types of periodic receipts, including any lump sum payment for the delayed star, of a periodic payment; (e) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (f) the maximum amount of public assistance available to the above persons other than the amo sit of any assistance specifically designated for shelter arts utilities plus the rnaxitrum amount that the public assistance agency could Ln fact allow for shelter and u:ilides; (g) periodic and determinable allowances, such as alimony and child suppori payments and regular contributions and gifts received from persons not resifts in the dwelling; (h) all regular pay, special pay and allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the household o spouse (or other persons whose dependents are residing in the units); and (i) any eared income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; (b) amounts which are specifically for or in reimbursement of medical expenses; (c) lump sum additions to family assets, such as inheritances, insurancepayments (including payments under health and accident insurance and workers compensation.), capital gabs and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educadmial institution, and amounts paid by the government to a veteranfoo- use i meeting the costs of tuition, fees, books and equipment. Any amounts of such scholarships o: payments to veterans not used for the above purposes a: to be included in income; (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (r) amounts received tinder training programs funded by HUD; (g) foster child care payments; (h) amounts received by a disabled person that are disregarded for a limited time for pe^oses of Supplemental Security Income eligibility and benefitsecaus they are set aside for use under a Plan to Attain Self-sufficiency; (i) income of a live-in aide; (j) amounts received by a par cipant in oilier publically assisted programs which are specifically for or in reimbursement of out-of-pocket expenses incur: and which are made sole:}• to a'.low participation in a specific program; pa :•sir (k) a rceiden: service stipend (a modest amount (not ro exceed s'_rA per month) receieed by a resident for re dorm:ng a service For the owner, on a basis, that enhances the quality of life in Lie development, If this fort is being compicted in accordance with recerdites:ion of a Lower Income Tenant's or Very Low laeore Tewnt's occupancy or a Lower Income Unit or a Very Low Income Unit, respectively, this form rust be eompictad based upon the current income of the occupants. 04 A.MC.VMJCC•Fex11 (1) compensation from state or local employment training programs and training of family member as resident managementstaif; (in) reparation payments paid by a foreign government pursuant to claims filed under the laws of that government by persons who were persecuted during the Nazi cm; (n) mounts speeifrcallyexcluded byany other federal statute from consideration sincome for purposes ofdeterminingeligibility orbenerrtsunder aeategon of assistance programs that includes assistance under the United States Housing Act of 1937; (o) earnings in excess of$480 for each full -term student 18 years old or older (excluding the head of household and spouse); (p) adoption assistance payments in excess of$480 per adopted child; and (q) deferred periodic payments of supplemental security income and social security benefits that are received in a lump sum payment; (r) amounts received by the family In the form of refunds or rebates under state or local law for property taxes paid on the dwelling unit; (s) amounts paid by a State agency to a family with a developmentally disabled family member living at home to offset the cost of services and equipment needed to keep the developmentally disabled family member al home; and (t) amounts specifically excluded by an other federal statute from consideration as income for purposes of determining eligibility or benefits under a category of assistance programs that includes assistance under the United States Housing Act of 1937. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other forth ofco0al investment (excluding the values of necessary items of personal property such as furniture and automobiles and interests in Indian trust land) Y ` Yes No; or (b) have they disposed of any assets (other than at a foreclosure or bankruptcy sale) during the last two years at less than fair market value? Yes X No (c) If the answer to (a) or (b) above is yes, does the combined total value oral] such asses owned or disposed of by all such persons total more than S5,000? _Yes No (d) If the answer to (c) above is yes, state: (1) the combined total value of all such asses: S�r AI. 2h (2) the amount of income expected to be derived from such asses in the 12-month period beginning on the date of initial occupancy in the unit that you propose to rent: S IWCJ 'LZ •and ' _(3) the amount of such incorlte, if any, that was included in Item 6 above: S (a) Are all of the individuals who propose to reside.in the unit full-time students'? Yes 1,. No 'A full-time student is an individual enrolled as a full-time student during each orS calendar months during the calendar year in which occupancy of the unit begins at an educational organization++hich normally maintains a regular faculty and curriculum and normally has a regularly enrolled body of students in attendance or is an individual pursuing a full-time course of institutional or farm training under the supervision of an accredited agent of such an educational organization or of a state or political subdivision thereof. (b) If the answer to 8(a) is yes, is at lest 2 of the proposed occupants of the unit a husband and wife entitled to file a joint federal income tax return? 5'e; X No 9. Neither myself nor any other occupant of the unit Uwe propose to rent is the ownerofthe rental housing project in which the unit is located (hereinafter the "Owner"). has any family relationship to the Owner; or owns directly or indirectly any Interest In the Owner. For purposes of this paragraph, indirect ownership by an individual shall mean ownership by a family mernber, ownership by a corporation, partnership, estate or trust in proportion to the ownership or benercial interest in such corporation, partnership, estate or Trustee held by the individual or a family member; and ownership, director indirect, by a partner of the individual. 10. This cerificate is made with the knowledge -that h will be relied upon by'the Owner to determine maximum income for eligibility to occupy the unit; and lNe declare that A Information set forth herein is true, correct and complete and based upon information lhve deem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upor. such investigation as the undersigned deemed necessary. II. V%Vc will assist the Owner in obtaining any information or documents required to verify the statements made herein, including either an Income verification, from my'lour present employer(s) or copies off-deral lac returns for the immediately preceding calendar year. 12. IACe acknowledge that V we have been advised that the making of any misrepresentation or misstatement in this declaration will constitute a material breach of my/our agreement with the Owner to lease the unit and will entitle the Owner to prevent or terminate mylour occupancy of the unit by institution of an action for ejection or other appropriate proceedings. Me declare under penalty of perjury that the foregoing is true and correct. Executed this ls+ day of Qncem . 20O2_ in tile City of Uewrtr}'- aect ab , California Applicant V Applicant Rev. SM Applicant Applicant ISig nature of all persons (except children tattler the ate or Is years) listed In number 2 above required) el Me mrq l r-rok%l FOR COMPLETION BY APARTMENT OWNER ONLY: 1. Calculation of eligible income: a. Enter amount entered for entire household in 6 above: (1) If the amount entered in 7(c)above is yes, enter the total amount entered in 7(d)(2), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ (2) 'Multiply the amount entered in 7(d)(1) times the current passbook savings rate as determined by HUD to determine what the total annual earnings on the amount in 7(d)(1) would be if invested in passbook savings ($ ), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ t (3) Enter at right the greater of the amount calculated under (1) or (2) above: TOTAL ELIGIBLE INCOME (line 1.a plus line U(3): 2. The amount entered in 1.c: Qualifies the applicant(s) as a Moderate -Income Tenant(s). )( Qualifies the applicant(s) as a Lower -Income Tenant(s). $ 1-13,6'Ss3.62. $ e $ 43,5$3.6z Qualifies the applicant(s) as a Very -Low Income Tenant(s). 3. Number of apartment unit assigned: 2.6 ,7- S Bedroom size: 3 tZ Rent: $ d t 9 74 . ou 4. This apartment Eru �tivas nod) lash occupied or'a period of 31' or rriore consec>TtiveZlays by persons ose aggregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartment unit qualified them as a Lower -Income Tenant(s). 5. Method used to verify applicant(s) income: Employer income verification. Copies of tax returns. Manager I�%110� I Date a MIC.cn:nrc.vonv INCC)NAF= R CCF'T (`Al f�l li riT,r-�nl rn er�ra. 2 Last Nano Flnt Nolne ' Raiadonahlp HOH Sax r�Y_ Dale or Birth 31,115;q Ago 43 Soelal Security !{ J42-g2-02$1 FR Sludenl YES or NO 3 e 0 y 8 I 11`duuIYIC EMPLOYMENT Family Source Base Rate Average Average Annual Memb. yF $ Hours 52 24 25 12 1 Total ' YYK SEMLMO ul•WK MO Yn $ 66s.F =$ 43,3g1.22 =$ $ =a snrtel sFrnwlr ooMeanelc CT/� Total Box A: $43 3 2 Family Source Base Rale Average Avemge Annual Memb. # $ Hours 52 24 2c 12 1 Total SCMI•MO ul•WK MO Tli $ _$ PHRI III a9S14TAMCP TofaI BOX B: $ Family SOUrc0 Base Rate Average Average Annual Memb. # • $ Hours 52 24 26 12 1 Total WK SEWMWO a •WK MO Yn $ =a IITLIC011.11�I7111C TOLJI BO%r:' $ Family Source Base Rate $ Average Hours 52 2TotalWK SCMI$$ MAnnualMemb.lp _ _ , _TOTAL -ANNUAL GROSMCOME %through D91_ ray SIM11c1 Asset Description - Imputed) —Gross/Fair Cost to NET Actual Actual Annual Member (savings, checking, stocks, bonds, Current Mkt. Value Got Cash Family AssoL- Interest Income from B Cie.) I or C Value Rate Assets — 3 .o O /a 6V- - o �— u Telals Box E: ,nT Box F: IT _114,27 IMPUTED INCOME FROM ASSETS Box E exceeds $5,000 — multiply E by the current passbook interest rate: It Box E does not exceed $5,000 enter •0.In box G: Enter the greater of Box F or Box G in: X z BOX G: I s 1914.62 INPUTED INCOME FROM ASSETS BOX H: S ( .6 Family lnmmo FmmAssl, wn,u Effective Date Dece be - Type of Program % LA LU Unit No. 2629 Unil Sizo_Sip No. or Persons 1 Nlll: Max. Income Limit$_ — AR ri 140%Limit $ .5�119 ;n e!1 INCOME CONTRIBUTED FROM ASSETS TOTAL ANNUAL INCOME $ 4R . �q1 , 22 & TOTAL ASSETS $ IrC4.62 = $ 43, 575.54 . METAGENICS INC. 100 AVE. LA PATA SAN CLEMENTE, CA92673 Taxable Marital Status: Single Exemptions/Allowances: Federal: 9 State: 9 Social Security Number. 142-92-0281 Earnings rate hours this.period year to date Regular 20.1923 88.00 1,776.92 35,699.90 Pars 161.54 Moss_':>42. 36,204.71 Deductions Statuto Federal Income Tax -65.97 942.23 Social Security Tax-102.66 2,086.93 Medicare Tax -24.01 488.07 CA State Income Tax -44.98 691.33 CA SUI/SDI Tax L -14.90 302.94 , Other Dental125 -5.00* 105.00 Health Care -104.17* 2,187.57 Med125 -9.50* 199.50 Vision -2.50* 52.50 et Pay � ' '•.�;1,4t7'3:23 * Excluded from federal taxable wages Your federal taxable wages this period are $1,655.75 �. Period 8L ,nirtg: 10/20/2002 Period Ending: 11/02/2002 Pay Date: 11/08/2002 ANVARFAYAZ-FAR 5405 ALTON PKWY #355 IRVINE,CA 92604 Other Benefits and Information this periad •total to date Personal 0.00 Sick 19.65 Vacation 9.44 9ND 001862 820900 1 0000001958 1 METAGENICS INC. 100 AVE. LAPATA SAN CLEMENTE, CA 92678 Taxable Marital Status: Single Exemptions/Allowances: Federal: 9 State: 9 Social Security Number: 142.92-0281 Earnings rate hours this•period year to date Regular 1615.38 80.00 I-615.318 29,076.84 Gross Palk • :$1p635,t3>. 29,076.84 < Deductions statutory Federal Income Tax -59.92 787.68 Social Security Tax - "-100.15 . "' • • 1 , 652.55 Medicare Tax -23.42 .393.50 CA State Income Tax -41.22 576.52 CA SUI/SDI Tax It -14.54 244.24 Other Dental125 80.00 Health Care 1,666.72 Med125 152.00 Vision 40.00 Your federal taxable wages this period are $1,615.38 r,arrunus o�dtentGtn Period Beginning: 08/11/2002 Period Ending: 08/24/2002 Pay Date: 08/30/2002 ANVARFAYAZ-FAR 5405 ALTON PKWY #355 IRV[NE,CA 92604 Other Benefits and Information this period 'total to date Personal Sick •• •• 10.30 Vacation 11.04 ' •--- ----- =011I III ICIa OUILUlnenE METAGENICS INC. Period Beginning: 08/25/2002 100 AVE. LAPATA Period Ending: 09/07/2002 SAN CLEMENTE, CA 92673 Pay Date: 09/13/2002 Taxable Marital Status: Single Exemption s/Allowances: Federal: 9 State: 9 Social Security Number: 142.92.0281 Earnings rate hours .. this period year to data Regular 1615.38 80.00 30, 692.22 Hal 2 'a.00 - C,ross,.Fay,. ` $1yBjS.38; 30,692.22 Deductions Statutory ANVAR FAYAZ-FAR 5405 ALTON PKWY #355 IRVINE,CA 92604 Other Benefits and Information thi§ period, 'total to data Personal, .. '8.00 Sick' I2.15 Vacation 14.12 Federal Income Tax -41 .74 •• 829.42 Social Security Tax -92.64 1,775.20 Medicare Tax -21.67 415.17 CA State Income Tax -30. e8 ' 607.40 CA SUI/SDI Tax -13.45 257.69 Other Dental125 -5.00* 85.00 Health Care -104.17* 1,770.89 Med125 -9.50* 161.50 Vision -2.50* 42.50 * Excluded from federal taxable wages Your federal taxable wages this period are $1,494.21 Account Statement October 25 through November 26, 2002 Account Number: 074-3808073 Page I of 4 [-t ANVAR FAYAZFAR 5405 ALTON.PKY # 355 IRVINE CA 92604-3717 Thank you for banking with Wells Fargo. For assistance, call: 1.800-TO-WELLS (1.800.869.3557), TDD number (for the hearing Impaired only):1.800.877.4833. Or write: WELLS FARGO BANK, N.A., P.O. BOX 6995, PORTLAND, OR 97228.6995. APPLY FOR A WELLS FARGO VISA CREDIT CARD AND TAKE ADVANTAGE OF LOW INTRODUCTORY RATES THIS HOI.IDAY SEASON. ENJOY VALUE-ADDED FEATURES SUCH AS THE WELLS FARGO REWARDS PROGRAM, LOW -RATE BALANCE TRANSFERS, FREE ONLINE ACCOUNT ACCESS AND OVERDRAFT PROTECTION. APPLY TODAY. CALL 1-800-350-6401 OR VISITWELLSFARGOSPECIAL.COIN AND ENTER KEYWORD: LOW INTRO. Account Summary Daily access accounts Account Account number Balance last period Balance this period ........ 'a'c*h.......................................................................................—$-2*.....................................-2'.*0 Stagecoach Checking U74-38U8073 $2,092.39 $1,9>i2.04 Wclis}'.:xtra Savings 660-1320856 1,106.03 1,106.28 .................................................................................................................... "$3';*088., 3. 8' 'l'otal $3,198.42 2 Stagecoach Checking Anvar Fayazfar Account Number: 074-3808073 it ! Activity summary Balance on 10/24 $2,092.39 1)eposits 0.00 Withdrawals 110.35 Balance on 11/26 $1,982.04 October 25 through November 26, 2002 Account Number: 074-3808073 Page 2 of 4 479,769 Activity detail Withdrawals Other withdrawals Date Description $Amount ....................................................................................................................................................... 10/28 ATM Withdrawal - 10/26 Mach ID 0601E Irvine, Irvine, da 5006 80.00 11/01 POS Purchase - 10/31 Mach ID 000000 590 S. Pacific Arco Paypolaguna Beach Ca 5006 30.35 ...................................................................................................................................................... Total other withdrawals $110.35 Daily balance summary Date $ Balance ............................................ 10/24 2,09K.i3 WellsExtra Savings Anvar Fayazfar Account Number: 660-1320856 Activity summary Balance on 10/24 Deposits and interest Withdrawals Date $ Balance ............................................ 10/28 2,012.39 $1,106.03 0.25 - 0.00 .......................................................................................... Balance on 11/26 $1,106.28 Interest you've earned Interest earned during this period Average collected balance this period Annual percentage yield earned Interest and bonuses paid to date this year $0.25 $1,106.03 0.25% $13:09 Data $ Balance ............................................ 11/01 1,982.04 Account Statement Statement Date: June 25, 2602 Page 1 of 4 074-3908073 493,328 ANVAR FAYAZFAR 5405 ALTON PKY # 355 IRVINE CA 92604-3717 If you have any questions about this statement or your accounts, call: 600.869.3557 (1.800-TO-W ELLS). Or write: W ELLS FARGO BANK, N.A., P.O. BOX 6995, PORTLAND, OR 97228.6995. TRY WELLS FARGO BILL. PAY FOR FREE. ITS YOUR ONLINE CHECKBOOK. YOU. CAN PAY BILLS .TO ANYONE, ANYTIME --WHETHER ITS YOUR MORTGAGE COMPANY OR YOUR DENTIST. SET UP YOUR RECURRING OR ONE TIME PAYMENTS IN ADVANCE AND AVOID PAYING LATE FEES. TRY BILL PAY FOR FREE TODAY. FOR DETAILS, VISIT WELLSFARGOSPECIAL.COM AND ENTER KEYWORD: FREE TRIAL. Account Summary Daily access accounts Account Account number Balance last period Balance this period .............:.:.:...............................................................................................:.: ............................. St...agecoac.. h Checking 074.3808073 $1,791.39 $6,691.39 WellsExtra Savings 660.1320956 8,005.26 8,007.07 ................................................................... t................I............... • .......... ..................................... $9,796.65 $14,698.46 Total Stagecoach Checking Anvar Fayazfar Account Number: 074-3808073 . Activity summary Balance on 05/23 Deposits Withdrawals $1,791.39 4,900.00 - 0.00 .......................................................................................... Balance on 06/25 $6,691.39 Account 'Statement Statement Date: June 25, 2002 Page 2 of 4 074-3808073 493,329 Activity detail Deposits Date Desodption amount, ................................................................................................................... ' 06120 A'I'M Deposit - 06,119 Mach 11) 0983F 4850 Barranca I'kwy, Irvine, Ca 5006 $4,900.00 ........................ :........................ .................................................................. Total deposits 54,900.00 Daily balance summary Date $ Balance Date $ Balance Dale $ Balance U5;23 1,791.39 06/20 6,691.39 WellsExtra Savings Anvar Fayazfar Account Number: 660-1320856 Activity summary Balance on 05123 $8,005.26 Deposits and interest 1.81 Withdrawals - 0.00 Balance on 06/25 $8,007.07 Interest you've earned Interest earned during this period Average collected balance this period Annual percentage yield earned Interest and bonuses paid to date this year 51.81 $8,005.26 0.25e/i $6.88 Pay Periods Date of Most Recent Pay Ending Date L =. Year - to - Date divided by pay periods average per pay period Gross per Pay Period V`l el (+)[V(6. �5�•3'1 23 (+) � � Y•3� divided by _3 __ ( = ) 1166q.22 (x ) how often paid n (x) how often �paid = ) Calculated Annual Income Wni9 V7. 06 ( = ) Calculated Annual Income 1-1313Al-?01 f 1 New Certfseado, /Reeersffeecon Unit Number 6 INCOM C019'UTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designed to assist you in computing Annual Income in accordance with the method set forth in th Department of Housing and Urban Project ("HUD") Reptllations (24 CFR 813). You should make certain that this form is at all tunes up to date vs it the HUD Regulations. All capitalized terms used herein shall have the meaning set forth in the Regulatory Agreement. Re: (NAME and ADDRESS of Apartment Building) Newport Noah C S CDA► (Jr. I/We the undersigned state that I/we have read and answered fully, frankly and personally each of the following•ci-uestions for;11 ersons who are t occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit: 1. Name of Members of the ' Household MI,. e... rl 2. 3. 4. Relationship to Head of Social Security Household Age Number )nra, S o _2� 4trg-4S--6 Chi Id 6 Lrno 04 i1 Id tJ aw Income Computation •5. The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children render 18 years) listed above for the 12-month peril beginning the earlier of the date that Uwe plan to move into a unit or sign a lease for a unit is S 49, 34 3.A : Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, con-issions, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (o) the net income from the operation of a bsiness or profession or from the rental of real of personal property (without deducting expenditures forbusine! expansion or amortization of capital indebtedness or any allowances for depreciation of capital asses except for straight line'depreciation as provided Internal Revenue Service regulations); (c) Interest and dividends (including Income from asses included below and other net income from real or personal property,); (d) the full amount of periodic pay;netis received from social security, annuities, insurance policies, retirement funds, pensions, disability or death bane; and other similar types of periodic receipts, including any lump sum payment for the delayed star, of a periodic payment; (a) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (f) the maximum amount of public assistance available to the above persons other Lhan the amount of any assistance specifically designated for shelter a• uTities plus the maximum amount Lia: lute public assistance agency could in fact allow for sbelter a:.d utilities; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not residi• in the dwelling; (h) ' all regular pay, special pa,, axi allowances of a r.,ember of the Armcd Forces (whether or not living In the dwelling) who is the head of the household t spouse (or other persons whose dependents are residing in the units): and (i) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or Irregular gifts; (b) amounts which are specifically for or In reimbursement of medical expenses; (c) lump sum additions to family asses, such as Inheritances, insurance payments (including payments under healih and accident Insurance and work:; compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational lmdrution, and amounts paid by Lit government to a veteran for use meeting the toss of tuition., fees, books and equipment. Any amounts of such scholarships or payments to veterans not used for the above purposes a to be included in income; (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (f) amounts received under tr-ining programs funded by HUD; (g) foster child care payments; (h) amounts received by a disabled person L4at ate disregarded for a 1utited time for purposes of Supplemental Security Income eligibility and benefs beta" they are set aside for use under a Plan to A=in Self-sufficiency; (i) income of a live-in aide; Q) amours received by a pa =ipatt In other pubiically assisted programs which are. specifically for or is r:imbu;semen cf out-of-pocket expenses incur` and which are made softly to allow participzemn it. a specific program, (S) a resident service stipend (a modes: a -cant (not to ex ed S2CO per month) reeeh'td by a resident fc: perfomdng a ser rice for tuts owner, on a F� : �• basis. Lhat enhances the quality oflift in the development: ' If this feemt is being completed is accordance w;Lh re<nifca:ion or Lower Income Tcmnt's or Very Low Income Tenant's occupancy of a Lower Income Unit or a Ver/ Low Income Unit, respectively, this form must be completed bas:7 upon the current income or the occupants. t,.ANC,ea,:9rGFaaM s (1) (n) (n) (o) (P) W (r) (s) (t) compensation from state or local employment training programs and training of a family member as resident management staff; reparation payments paid by a foreign government pursuant to claims filed under the Imes of that government by persons who were persecuted during th Nazi cra; ' amounts specifically excluded by any other federal statdte from consideration as income for purposes of determining eligibility or benefits under a categor of assistance programs that includes assistance under the United States Housing Act of 1937; earnings in excess ofSM for each full -term student 18 years old or older (excluding the head of household and spouse); adoption assistance payments in excess of5480 per adopted child; and deferred periodic payments of supplemental security income and social security benerrts that are received in a lump sum payment; amounts received by the family in the form of refunds or rebates under state or local law for property tares paid on the dwelling unit; amounts paid by a State agency to a family with a developmentally disabled family member living at home to offset the cost of services and equipmer needed to keep the developmentally disabled family member at home; and , amounts specifically excluded by an otherfedeml statute from consideration as income for purposes of determining eligibility or benefits under a categor of assistance programs that includes assistance under the United States Housing Act of 1937. 7. Do the persons whose income or contributions are included in item 6 above: 8. (a) (b) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necessary items of personal property sue as furniture and automobiles and interests in Indian trust land) or . ' have they disposed crony assets (other than at a foreclosure or bankruptcy sale) during the last two yeas at less than fair market value? Yes X No If the answer to (a) or (b) above is yes, does the combined total value of all such assets owned or disposed of by all such persons total more than S5,C00 Yes X No If the answer to (c) above is yes, state: (1) the combined total value of all such assets: S . ' (2) the amount of income expected to be derived from such assets in the 12-month period beginning on the date of initial occupancy in the unit that yo propose to rent: S 0 . and (3) the amount of such ineprric, if any, that was included in item 6 above: S R% Are all of the individuals who propose to reside in the unit full-time students'? Yes No •A full-time student is an individual enrolled as a full-time student during each of 5 calendarmonths during the calendaryear in which occupancy of th unit begins at an educational organization %which normally maintains a regular faculty and curriculum and normally has a regularly enrolled body ofstudent In attendance or is an individual pursuing a full•time course of institutional or farm training under the supervision of an accredited agent of such a educational organization or ofastate orpolitical subdivision thereof. If the answer to 8(a) is yes, is at least 2 of the proposed occupants of the unit a husband and wile entitled to file a joint federal income tax return? Yes _Z{_No Neither myself nor any other occupant of the unit Vwc propose to rent is the owner of the rental housing project in which the unit is located (hereinafter the "Owner', has any family relationship to the Owner; or owns directly or indirectly any interest in the Owner. For purposes of this paragraph, indirect ownership by a Individual shall mean ownership by a family member, ownership by a corporation, partnership, estate or trust in proportion to the ownership or beneficial intent in such corporation, partnership, estate orTrusice held by the individual or a family member; and ownership, direet'or indirect, by a partner of the individual. Tris certificate is made with the knowledge that it will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and Ilwe declar that all information set forth herein is true, correct and complete and based upon information I/we deem reliable and that the statement of total anticipated incom contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. Inv- will assist the owner In obtaining any information or documents required to verify the statements made herein, including either at income verification ficr my/our present employer(s) or copies of federal tax returns for the immediately preceding calendar year. I/ %*e acknowledge that Uwe have been advised that the making of any misrepresentation or misstatement in this de'clarz:ion will constitute a material breach c my/our agreement with the Owner to lease the unit and will entitle the Owner to prevent or temiaate my/our occupancy of the unit by institution of an action fc ejection or other appropriate proceedings. 11Y. e declare Under penalty o perjury• trot ire loregolng is true and correct. Rev. Sr9: . 2W in the City of L�42± 61=01.1 Ccliforrl �a A raant Applicant (Signature oral) persons (eaeept children under the age of 15 years) listed in number 2 above requires I WAMC."J". ICC•FOW FOR COMPLETION BY APARTMENT OWNER ONLY: 1. Calculation of eligible income: a. Enter amount entered for entire household in 6 above: $ tiq, 313.92 b: (1) If the amount entered in 7(c)above is yes, enter the total amount entered in 7(d)(2), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ IK ); (2) ' Multiply the amount entered in' (a)(1) times the current passbook savings rate as determined by HUD to determine what the total annual earnings on the amount in 7(d)(1) would be if invested in passbook savings (S If ), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ (3) Enter at right the greater of the amount calculated under (1) or (2) above: C. TOTAL ELIGIBLE INCOME (line 1.a plus line I.b(3): 2. The amount entered in 1.c: .Qualifies the applicant(s) as a Moderate -Income Tenant(s). Qualifies the applicant(s) as a Lower -Income Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenant(s). $ tia, 3a3.az 1 Number of apartment unit assigned: 126 Bedroom size: 24 2 Rent: $ 4 ti . oa - This apartment unit (Nvas/was not) last occupied for a period of 31 or more consecutive days by persons whose aggregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartment uni: qualified them as a Lower-Income,Tenant(s). Method used to verify applicant(s) income: Manager Employer income verification. Copies of tax returns. Other( lwrkS4U• 95, Sainy120( cbacLtn� accL*F s6�ehaa4r 12Z11GL Date U.AMC.tAIJCC•FOLM (1) -compensation from state or local employment training programs and training ora family member as resident management staff; (m) reparation payments paid by a foreign government pursuant to claims filed under the laws of that government by persons who teem persecuted during Nazi era; • (n) amounts specifically excluded by any other federal statdte from consideration as income for purposes of determining eligibility or benefits under a carer of assistance programs that includes assistance under the United States Housing Act of 1937; (o) earnings in excess of S4S0 for each full -term student 18 years old or older (excluding the head orhousehold and spouse); (p) adoption assistance payments in excess ofS430 per adopted child; and (q) deferred periodic payments of supplemental security income and social security benefits that are received in a lump sum payment; (r) amounts received by the family in the form of refunds or rebates under state or local law for property takes paid on the dwelling unit; (s) amounts paid by a State agency to a family with a developmentally disabled family member living at home to offset the cost of services and equip, needed to keep the developmentally disabled family member at home; and (t) amounts specifically excluded by an other federal statute from eonsiderotion as income for purposes ofdetermiringe eligibility or benefits under it categ of assistance programs that includes assistance under the United States Housing Act of 1937. 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks; bonds, equity in real property or other form of capital investment (excluding the values of recessary•items ofpelsonal proper.}• s as furnituri and automobiles and interests in Indian trust land) • Yes • • � •N0; or • ' ' • '• • • ' • ' (b) have they disposed of any assets (other than at a foreclosure or bankruptcy sale) during the last two years at less than fair market value? Yes x I'o (e) If the answer to (a) or (b) above is yes, does the eonbined total value of all such assets owned ordisposed of by all such persons total more than SS,C Yes • X No (d) if the answer to (e) above Is yes, state: (1) the combined total valueofalisuch assets: S' (2)• the amount of income expected to be derived from such assets in the 12-month period beginning on the date of initial occupancy in the unit that; propose to rent: 5 ,CT and (3) the amount orsuch lReBnR, if any, that was included in item 6 above: 8. (a) Are all of the individuals who propose to reside in the unit full-time students*7 Yes ): No 'A full-time student is an individual enrolled as a full-tir„e student during each ors calendar months during the calendar yearin which occupancy or .unit begins at an educational organization which normally maintains a regular faculty and curriculum and nomally has a regularly enrolled body orstudc in attendance or is an•Individual pursuing a full-time course of Institutional or farm training under the supervision of an accredited agent of such educational organization or ofastate or political subdivision thereof. (b) If the ausw•er to 8(a) is yes, is at least 2 of the proposed occupants of the unit a husband and wife entitled to file ajoiat federal Income tax return? Yes —NO 9• Neither myself not any other occupantortheunitVtseproposetorentisCteownerortherentalhousingprojectInwhichtheunitislocated(hereinafterthe"Ouse has any family relationship to the Ottner, or owns directly or indirectly any interest in the Owner. For purposes of this paragraph, Indirect ownership by Individual shall mean ownership by a farni:y member, ownership by a corporation, partnership, estate or trust In proportion to the ownership or beneficial late: in such cony oration; partnership, estate or Trustee held by the individual or a family menber; and ownership, direct or indirect, by a partner critic individual 10. This cerifrcate is made with the knowledge chat Itwill be relied upon by the Owner to determine maximum Income for eli=_foility to occupy the unit; and Vwc dwl that all information set forth herein is true, correct and complete and based upon information Vwc deem reliable and that the statement of total anticipated inco contained in paragraph 6 is reasonable and based upon such inses:igation as the undersigned deemed necessary. 11. JAVe will assist the Owner I., oYtaiaing any information or documents required to verify the statements made herein, including either au Income vedfieatior. f.- my/our present employer($) or copies cffideral tax returns for Cie immediately preceding calendar year. 12. IM'e acknowledge that I/w•e have been advised that the rni%ing of any misrepresentation or misstatement in this declaration will constitute d material bread my/our agreement with the Owner to lease the unit and will entitle the Owner to prevent or terminate my/our occupancy of the unit by institution of an a ion• ejection or other appropriate proceedings. I,Ve declare under penalty of perjury that the foregoing is true atd correct. Rev. S19s .2002 inthe Cityor t1-"tn/_QO"'("' ee=ck A Rena: !Signature of all persons (except children under the ale of IS years) listed in number above requi: w xve n9•f KC-FOW Electronic Paycheck Page 1 of 1 - aectronfc Pay Check View Paycheck # 1 Pay Period Ending: 200?J11/15 Co U866 DPT 0200924500 CHECK NO EE 47125 ID . 90245 5465311 COUNTRYWIDE HOME LOANS, INC. 1616 WALNUT GROVE AVENUE ROSEMEAD, CA 91770 Social Security Number: 554.85-0324 Federal Marital Status: Married Federal Exemptions: 07 _ _ Rate/Salary: $1,250.00 Period Beginning,. ' 1114112002. Period Ending: '1111512002 Pay Date: 11/1512002 PAUL WESLEY FRANCIS 2386 CARLTON PLACE COSTA MESA, CA 92627 Summary Taxes . Current Year -to -Date Gross Pay $1,250.'00 -, Federal Income Tax 82.74 4,359.50 Net Check $910.72 Social Security Tax 115.44 2,977.91 Medicare Tax 27.00 696.45 Earnings . Rate Hours Current Department 96 Salary E6.70 $1,250.00 0200924500 Questions on your paycheck? Cali Omar Guerrero at 6261927.4126. CA State Income Tax 14.07 877.54 CA State DIISUI Tax 1.42 416.94 Deductions Current Year -to -Date 83 Medical* 75.00 84 Dental" 18.00 85 Vision" 5.61 Other Information Federal tax ages for this check ar . 31,862.02 Items marked with an asterisk (') are excluded from federal taxable wages. Your year-to-date gross pay Is:, $22,610.06 Vacation Balance: 92.22 Overtime, sick, vacation and adjustment hours on this paycheck are from the prior pay period. https://hrweb. cwinsider.com/servlets/iclientservlet.wls/peoplesoft8/9*ICType=Panel&Ment... 11/1 S/2002 Electronic Paycheck Page 1 of .............................................................................................................................................................................................................................................................. :Electronic Pay Check t ' View Paycheck # 1.................:...............:.:................ i•Pay Period Ending: 2002/11/30 in View Fri^Mendlydly Fdrmat I View Paycheck#2 t ,,,�..�.....,,,�,.�w.Mw..w...,,.,w,.,�,..�.m..M,,,...�..w.,,,...-.,.,�.,.,w,,,,,,,,,,,,,,,,�,.w.,., w�..,,.,.,,..,.. �..�.�....,w„�.,w..,w•M.,,....�....,....,.,�.,,,....,...M.,,,w.,,..,,..�,..,..,� CO U866 OPT 0200924500 CHECK NO EE 47125 ID 90245 6580479 COUNTRYWIDE HOME LOANS, INC. 1516 WALNUT GROVE AVENUE ROSEMEAD, CA 91770 Social Security Number: 554.85-6324 Federal Marital Status: Married Federal Exemptions: 07 Rate/Salary: 1,790.00 Period Beginning:' 1111612002 Period Ending: 1113012002 Pay Date: 1112912002 PAUL WESLEY FRANCIS 2386CARLTON PLACE COSTA MESA, CA 92627 Summary Taxes Current Year -to -Date Gross Pay $1,250.00 Federal Income Tax 94.32 4,688.82 Net Check $910.72 Social Security Tax 120.24 3,129.15 Medicare Tax 28.12 731.82 CA State Income Tax 17.16 924.70 CA State DIISUI Tax 0.00 416.94 Earnings Rate Hours Current Department 96 Salary 86.70 $1,260.00 0200924500 Questions on your paycheck? Call Omar Guerrero at 6261927.4126. Deductions Current Year -to -Date 83 Medical" 75.00 84 Dental* 18.00 85 Vision" 5.61 other Information Federal taxable wages for this check a : 51,939.24 Items marked with an asterisk (") are excluded from federal taxable wages. Your year-to-date gross pay is: $23,760.06 Vacation Ba!ance: 71.52 Overtime, sick, vacation and adjustment hours on this paycheck are from the prior pay period. https://hnveb. cwinsider.com/servlets/iclientservlet.wls/peoplesoftS/?ICType=Panel&Menu=... 12/2/2002 u Electrc:nic Paycheck Page 1 of I .............................................................................................................................. :Electronic Pay Check View Paycheck # 1 i.pay Period Ending: 2002/10/31 ,•�. I ........................................................................................................ CO U866 OPT 0200924500 CHECK NO EE 47125 ID 90245 5404078 COUNTRYWIDE HOME LOANS, INC. 1515 WALNUT GROVE AVENUE ROSEMEAD, CA 91770 Social Security Number: 554-85-0324 Federal Marital Status: Married Federal E:ca.-ptions: 07 Rate/Salary: $1,250.00 Summary Gross Pay Net Check .......................... •........ ......i ........................... ..... I .......... ... ... , Printer Friendly Format Period Beginning: 10/16/2002 Period Ending: 10/3112002 Pay Date: 10/31/2002 PAUL WESLEY FRANCIS 2386 CARLTON PLACE COSTA MESA, CA 92627 Taxes Current Year -to -Date $1,250.00 Federal Income Tax 159.38 3,894.03 $910.72 Social Security Tax 147.12 2,774.58 Medicare Tax 34.40 648.89 CA State Income Tax 41.20 778.42 CA State DIISUI Tax 21.35 402.76 Earnings Rate Hours Current Department 96 Salary 86.70 $1,250.00 0200924500 Questions on your paycheck? Call Omar Guerrero at, 3::31527 -4126. Deductions Current Year -to -Date 83 Medical* 75.00 84 Dental* 18.00 85 Vision* 5.61 Other Information Feder ages for this check are: 52,372.97 Items marked with an asterisk (*) are excluded from federal taxable wages. Your year-to-date gross pay is: $21,260.06 Vacation Balance: 86.92 Overtime, sick, vacation and adjustment hours on this paycheck are frorn the prior pay period. https://hrweb.cwi nsider.com/serviets/icl ientservi et.wls/peopl esoftS/?ICType=Panel&Meni... 11/30/2002 DECLARATION OF NO INCOME APPLICANT SOCIAL SECURITY # a 4 �J I— I EDY— In order to continue processing your application for housing, and occupancy of an affordable apartment, the following "Declaration of No Income" must be signed by the person named below. Thank you! TO BE COMPLETED BY APPLICANT I)- \ 1Ma�Y \ \) � do hereby certify that I do NOT (Applicant Name) receive income from ANY source. I understand sources of income include, but are not limited to the following: Self Employment SSI Retirement Funds Alimony Income from Assets Educational Grants AFDC General Assistance Disability Union Benefits Family Support Work Study Employment by Other Unemployment Compensation Social Security Worker's Compensation Child Support Annuities/Pensions I understand that should I become gainfully employed or begin receiving income from any sources I must report the information to the Resident Manager immediately. I certify that the'foregoing information is true, complete and correct. Inquiries may be made to verify the statements therein. 'I also understand that false statements or omissions are grounds for disqualification and/or pAosecution under the full extent of California law. Date v Your Bank of America Combined Account 1020 Statement EO-5 Statement Date: November 21, 20D2 III l,1tt1,61ittIIIII t$Il„tlldtl,U,till ndlIII III till II DINORAH VIDAL PAUL W FRANCIS 2386 CARLTON PL COSTA MESA . ,CA • 92627-1504 Our free Online Banking service allows you to check account balances, ....transfer.,funds, pay,bills and more, Enroll -at www.bankofamerica.com. ❑ Summary of Your Deposit Accounts .. Account, Account Number Your Balance MyAccess checking 10205.05853 $ 35.70 Regular Savings 09878-60028 73.62 Total Balances $ 109.32 At Your Service Call: 949.837.3482 Online: www.bankofamerica.com Written Inquiries Bank of America Newport Center Branch :.•;. PO Box 37176 San Francisco, CA 94137-0001° .' . Customer since 1995 v v. Bank of America appreciates your business and we enjoy servLng yai ❑ •Bank of America News Your Bank of America Check Card is now safer'than'ever with Total Security Protection. It's free and autdinatic on your Check Card. For more Information, visit ' www.bankafamerica.com/totalsecurity. ' 3 ONLINE BANKING GUARANTEE: With our Online Banking service, you can be confident that your Bank of America accounts will be secure and protected. We guarantee $0 liability for any unauthorized activity originating from Online Banking, Including Bili Payment. For terms and conditions, or to learn more about Online Banking; visit www.bankofamerica.com. ❑ Your MyAccess checking Account Account Number: 10205.05853 "•: Statement Period: October 25 through November 21, 2002 Beginning Balance on 10/25/02 $58.53 Total Deposits + 1,131.39 Total Checks, Withdrawals, Transfers, Account Fees - 1,148.27 Service Charge - 5.95 Ending Balance $35.70 ❑ Important Information About Your Account Number -of ATM withdrawals and transfers 4 Number of purchase transactions 27 Number of 24 Hour Customer Service Calls Self -Service 2 Assisted i MyAccess checking customers who take advantage of Direct Deposit can reduce fees every month! To find out more, contact your employer or visit your local Bank of America banking center. For Social Security or SSI direct deposit, call the Social Security Administration toll -free at 1-800-772-1213. Remember MyAccess checking is free with direct deposit. To avoid the monthly service charge, simply set up a monthly direct deposit, such as a payroll or social security check, to your account. Learn more about direct deposit by calling us at 1.800.900.9000 or stopping by any Bank of America banking center. Continued on next page 0e68222.001.T1a California Page 1 of 0 :-. 1 Banko#America -*;I- Your Bank of America Combined Account 1020 Statement E0-4 Statement Date: October 24, 2002 At Your Service Call: 949.837.3482 IIII$mhll1G1111,1I'll 111,11 ll,,,,L,ILd,d6111,,,1 Online: www.bankofamerica.com DINORAH VIDAL PAUL H FRANCIS Written Inquiries 2386 CARLTON PL Bank of America COSTA MESA CA 92627-1504 Newport Center Branch PO Box 37176 San Francisco, CA 94137-0001 Customer since 1995 Our free Online Banking service allows you to check account balances, Bank of America appreciates your transfer funds, pay bills and more. Enroll,at www.bankofamerica.com. business and we enjoy serving you. ❑ Summary of Your Deposit Accounts ❑ Bank of America News Account Account Number Your Balance Introducing Total Security Protection only from Bank of America. This represents a new standard In Bank of MyAccess checking 10205-05853 $ 58.53 America Check Card security, giving you greater defense against theft or unauthorized use, even using it online. It's Regular Savings 09878-80028 20.00 free and automatically available on your Bank of America Check Card. Total Balances $ 78.53 Dreaming about a college education for yourself or your child? We can help you make the dream come true. Get a free student loan guide at www.bankofamerica.c6m/studentbanking. Enrolling in our free Online Banking service is a snap. All you need is your Bank of America account number, ATM or Check Card number, ATM PIN and e-mail address. Click the Online Banking 'Enroll' button at www.bankofamerica.com and follow the easy instructions. in no time you'll be able to check account balances, view transactions and more. ❑ Your MyAccess checking Account Account Number: 10205.05853 Statement Period: September 24 through October 24, 2002 'Beginning Balance on 09/24/02 $249.97 Total Deposits + 533.81 Total Checks, Withdrawals, Transfers, Account Fees - 719.30 Service Charge - 5.95 Ending Balance $58.53 ❑ Important Information About Your Account I Number of ATM withdrawals and transfers 6 1 Number of purchase transactions 17 Number of 24 Hour Customer Service Calls Self -Service Assisted MyAccess checking customers who take advantage of Direct Deposit can reduce fees every month! To find out more, contact your employer or visit your local Bank of America banking center. For Social Security or SSI direct deposit, call the Social Security Administration toll -free at 1.800.772-1213. Continued on next page 0067731.001 J 16 California Page 1 of 4 1 10 P" 11 __. ____ •:.� 11.1537 73 Bankof America ' 1020 EO-5 DINORAH VIAL PAUL H FRANCIS 2386 CARLTON PL COSTA MESA CA 92627-IS04 GAYLESPINKS our free Online Banking service allows you to check account balances, transfor funds, pay bills and more. Enroll pt www.bankofomerlox Dom. Your Bank Combined Statement PAGE of America Account Statement Otte! September 23, 2002 At Your Sart+lae Call: 948.837.3482 . Online: www.bankofamerica.com Written Inquiries Bank of America Newport Center Branch PQ Box 37178 San Francisco, CA 94137.0001 Customer since 1996 Bank of America appreciates your business and we enjoy serving you. D summary of Your D"asit Accounts O Bank of America News Account Acmuni Number Your Balance MyAccess checking 10205.05853 $ 949.07 Regular'Savinga 019878.80029 33.80 iota/ Balames $ 283.77 Bank of America has streamlined the mortgage process by eliminating 800/6 of the paperwork you have to provide. Visit www.bankofamerica.com/loans today tc learn more about getting a mortgage from Bank of America. Not all ,applicants will qualify for the reduced paperwork benerns. The costa of college add up. If they have you ovarwholmed, consider a private loan for students from Bank of America. Eligibility Is not based on financial need, and the loan features a low interest rate, low fees and flexible loan limits and repayment options. Darn more at www.bankofamerica.com/siudentbanking. Credit subject to approval. 0 Your MyAccess checking Account Account Number: 10209-05953 Statement Period: August 24 through September 23, 2002 Beginning Balance on 08/24/02 $262.62 Total Deposits + 1,525.00 Total Checks, 1Mthdratvals. Transfers, Account Fees • 1,621.70 Service Charge - 5.95 Ending gslence 824B.97 p Irnpott M Information About Your Account Number of ATM withdrawals and transfers 11 Number of purchase transactions 35 Number of 24 Hour Customer Service Calls Self -Service 0 Assisted 1 MyACcess checking customers who take advantage of Direct Deposit can reduce fees every monthl To find out more, contact your employer or visit your local Bank of America banking center. For Social Security or BSI direct deposit, call the Social Security Administration toll -free at 1.900-772.1213. Continued on next page 006767200I.T16 California Page 1 of 5 gnKT.�Fs ._..-__ n-5:14 7/45579273 G.4YLESPT_NKS PAGE 01 Bank ofAmerica � DINORAH VIDAL PAUL W FRANCIS p BranchJATM• ]Deposits F Numear bate Poote7 t g9/o3 5975.025.0 0 , 09/12 200.00 FlIrIR,1AIPRM Y I tf��sel Q Account Aetivky Statement Date; September 23, 2002 11umW DaZrbetsd A\mWtn Teta1 of 5 depoahr �'091,i9 577050:� bare Posted Description ' ' ' • serer nctl'tWmpar A fPPV t 09/03 Deposits and Credits Transfer from checking 008202 $300.00 Bank of America ATM #088703 (Card 004522139) 08109 Transfer from chocking' Bank of America A$TM #243101 1Card #304415581) 001932 1.00.00 09/09 TaleTransfer from Checking ' 100.00 25.00 09112 09/16 Check Deposit Adjustment Telephone Transfer 300'00" Total Deposits and Credits $826.W Whhdrawals, Transfers and Account Fees 516.27 08/26 Check Card'Pumhase an 08122 (Card #304522139), Amecl Pizza And PA Irvine CA Ref# 1000000190116076 Carl! Purchase pn 03/22 (Card #304522138), 22.60 08126 Check Denny's #¢�00037 Long Beach CA Rof#1 1091W0190312521 Purohasa.on 06196 (card #30"15681), 13,47 08/27 Check Cari1 Gap 40287/The Gotta M'ase 27A 08127 Re, 1000000190118803 Check Car Purchase on 08M (Card �304522139), Champagnes Market Newport Beach CA 20.86 09/27 Rof# 10DOW0190312312 Cash withdrawal on 08/26, Bank of America ATM #408965 (Card #304415581) 002439 1 00.00 0.00 0=8 Check Card Purchase on 06/20. (Card #304415581), Newpa t Fam Medic Newport Beach CA 08/29 Ref #t 1000000190230f92 Check Card Purcha6o on 08/27 (cord #30�415581•), 25.69 Barnes & Noble fY25 Irvine CA 09t03 Rer# 10000001 038855 Check Cara Purchase an OW31 (Card #304522139), f4.18 Mothers MVKitchon Costa Mesa CA Roff� 1000000190245021 Check Card Purchase on 09101 (Card #304522139), 17.40 09103 7-Eleven Store 178 Costa Mesa CA 09103 Ref# 10000009902091.OD Purchase on 08/91 (Card #304522139), 910965. 18.36 09103 Circl Costa esa A Cash withdrawal on 08103, Bank of America f4TM #j022945 (Card #304z165Bf) 622945 Card' 304 15581 004834 20.00 09/03 00103 Cash withdrawal on 09103 Bank of America ATM Purchaso on 09/01 (Carde304522139), 340689 20.00 5.98 09/03 Longs Drug Store ewportbeach CA Check Card Purchase an 09101 (Card di304522139), CAA 182 87 Daily#Grill #003 Newport Beach Og/04 Check Card Purchase on 09ro�(Card 304522139), Market Newport #each•CA 18'47 09104 Champagnes Ref �y 1000g00190326901 Check Card Purchase an 08131 (Card #304522139), 25.25 Champaggnes Market Newport Beach CA 09/05 Ref # 1000000190328980 Purchase on 09105 (Card #304522139), 055002 47.98 09/09 Wild pats Market Irvine CA Check 522139), 8.31 ElaMetate Market Co to Mesa CAcard Ref# 1000000190 30600 Continued on next page o007672.002.T16 California page 2 of 5 12/11/2002 05:09 7145579273 GAYLESPINKS PAGE 02 Bankof America �j DINORAH VIDAL PAUL W FRANCIS ❑ Account Activity Continued Statement Date: September 23, 2002 Data Posted• DafcYWicit natareYq Number Pmount Delos WdWrawals Transfers knd Account Fees Check Card1Purcha&a on 09106 (Card #304622139), 12.55 Bloe)daustee Video Newport Beach CA 00/09 Ref# 19*0000191*74999 Check Card Purchase on 00106 (Card #304522139), CA 15,35 EI Toro Meat Shop Santa Ana 09109 Re_f# 1000000190402959 Cosh withdrawal on 09/06, 000026449 21.75 Non -Bank of America ATM #DN000382 Card #304522139) 25,08 00/09 a Cheek Card Purchase n OB/0e (Card #304522 39), Liquor. St Santa Ana CA 09/00 El Toreo Ref 10000001904MB77 Check Card Purchase cn 00108 (Card #304522139), 47.13 EI Meiate Market '## Costa Mesa CA 00/09 Ref U 1000000190530596 Cash withdawal on 09/09, •Bank of America ATM #243101 (Card 004415581) 00034 60.00 09/09 ATM withdrawal fee oh 09106, 000028449 2.00 Non -Bank of America• ATM #DN000382 (Card #304522139) 00110 Check Card Purchase on 09108 (Card #1304522139), CaOf 1Q Nevrpart teach CA 30.00 09/12 Web Laundd��,,� Ref# 10ll2tC rd 3763 Purenase on 09/t2 ttCard•#304522138), ' 862760 6.02 00/12 Carla Jr !p88 Irvine -CA Cash withdrawal on 09N 1, Bank. of America ATM #409965 (Card #304522139) 000704 20.00 09112 Purohase on Deli t fCard 1t304522139), Ralphs 2656 East Newport Beach CA 215714 38.32 •09113 Cash withdrawal -on 09113, 134226786 42.00 Non -Bank of A)nerica ATM #00004502 (Card #304415581) 69/13 ATM withdrawal'fee ch 09/13 NOR -Dank of America ATM #00004S02 (Card #304415581) 184230786 2.00 09/16 Check Card'Purchase on 09115 (Card #304522139), CA 16.39 7-MavanStars, 137.Same Ana Ref # 1000Doo'1900390787 - 000001538 21.75 OBI'le Cash withdrawal on 00f14, Non -Sank of America ATM gTN59923 (Card #304522135) 09116 Check Card Purchase on 09115 (Card g'$M22139), 21.89 7-Eleven Store 437 Santa Ana A 08116 Rat# I000000fSg997.E6 Check CarrdpyPurchase on Dail (Card #304415591), 30.00 Ref #� 1000000 90224132 A '08116 Check Card Purchase on 00113 (Card #304522139), 30,82 (eckbustor• V1deq lldwport Beach CA. Ref 4 10OW001110037015 09116 Ca4h withdrawal on 09/14, COD029706 41.50 Non -Bank of America ATM #TR990400 (Card #304522139) 09/18 Cash withdrawal on WAS, 000242612 41.95 Not -,Bank of America ATM #LYK94647 (Card #304522139) 09116 ATM denial on 09115,. 000231862 1.50 Nan -Bank of America ATM #LYK94647 (Card #304522139) 09/16 ATM denial on 09118, 000231532 1,50 Non -Bank of America ATM #LYK94647 (Card #304522139) 09116 ATM withdrawal toe on Os/15, 000242012 2.00 Non -Bank of America ATM #LYK94647 (Card #304522139) 09/16 ATM withdrawal fee on 09114, 000001536 2.00 Non -Batik of America ATM #TN59923 (Card #304522139) 09118 ATM withdrawal fee on 00/14, 000029706 2.00 Non -Bank of America ATM #TR990400 (Card 030452213s) 09117 Check Card Purchase on 08116 (Card #304522738), 7.84 Tenko Teri ald Hdu Irvine CA 08117 Ref {# 100000019022012 Check Card Purchase on 09113 (Card #304522139), Market Newport CA 17.58 Champaggnes each Ref# 1000000190297347 Continued on next page 0007672.007.TI9 California Page 3 of 5 12/11/2002 05:09 7145579273 GAVIESPINKS PAGE 03 Bankof America �j DINORAH VIDAL PAUL W FRANCIS ❑ Account Activity Continued Statement Date: September 23, 2002 Dale Posted Descdplinn Raferenes Number Amount Withdrawal,, Transfers and Account Fees 09117 Check Card Purchase on 09113 (Card #304415681), 25,10 Champagnes Market Newport Beach CA Ref # 1DOi00D0190297282 09/17 Purchase on 09117 (Card #304415$81), 717534 26.86 Rite AiD #57 6 irviine CA 09/17 Check Card .Purchase on 00/15 (Card #304522139), 191.21 Boomaru-Irvine Irvine CA Ref# 1000000190163130 00/20 Purchase on 09/20 (Card #304522139), 203569 10.83 Wild Date Market Irvine CA pa/23 Check Purchase/18 (Card,#304522139), wr 10.00' N Medic Newport Brach CA Ref # 10000001SQ260866 09/23 Purchase on 00120 (Cardr04522139), 122168 13.24 09/23 Ralpha 255E east. ewport Beach CA Cash withdrpwal on 09/22. 000009385 21.50 Non -Bank of America ATM #TM0038 ((Card #304415581) 09123 Check Card'Purchaso on 09/22 (Card Vy04415581), 41.24 Smg Food Services I.rmg SeaCA efi Re # 09/23 1000000190411"28 ATM with rawal fee an 09122. 00000938E 2,00 Non -Bank of America ATM #TM0038 (Card #304415501) Total Withdrawals, Transfers and Account Fees $1 521.70 Service Charge 08123 Monthly Service Charge 55.9E Q overdraft Protection Plan Savings Account 011711410028 Overdraft covarage available $P.00 ❑ Bank of America: In Balance To assist you in reconciling your account, we have provided the following summary Information. A reconciliation worksheet is printed on the reverse -of this page: e Yaw ending balance from thie statement ... ...............................................................................:...•...........,.,,................•..........$249.97 e Subtract other account fees from your checkbook register ...................................................................................................... 15.00 • Subtract the monthly service charge from your checkbook register ....... .........•....................................................................... 5.95 ❑ Your Regular Savings Account Beginning Balance on 08/26/02 $8.79 Total Deposits + 25.00 Interest Paid + .01 Ending Balance 633.80 Continued on next page 00e7072.0w.T111 California Staietatent:•Period: Aagutt 26 thPough 5epbmber 23,4002 Annual Percentage Yieid sarned.tMs period 0.40% Interest paid year-ttrtiate Si.oti Page 4 of 5 a.ga.arw. 12/11/2002 05:09 7145579273 GAYLESPIN<S IPAGE 04 BankofAmerica- DINORAH VIDAL PAUL W FRANCIS 1-1 Account Activity Statement Dato: September 23, 2002 Data Lasted aacarlpllan Re:erenn Number Amauat Depeelb and Credits 525.00 09/03 Transfer front Checking interest Paid. $.01 08/30 Intergst Paid from 08/01/02 Through 08/31/02 ❑ ATM information This period, you visited the following ATM locations: bank of Atifarlco's AYall Metwork ■1703 Weetcliff Plaza, Newport Beach, CA • lot Ea'sttdurf, Newport Bosch, CA + M55 Irvine Comerotat Ctr, Newport Beach, CA • rn 29AS Eastbluff, Newport Beach, CA Non4lon1c of America ATMs . • DN0oa382 Eleetronic, 27700 Santa Mager, Mission Veljo, CA • .LYK94647 Boo mera•Irvine, 3905 Michelson Dr, Irvine, CA ■ M003B FUst Regional, t00 Aquarium Way, Long Beach, CA • 9923 Financial COhs, 2802 Newport Blvd at Masa, CA • TW991Y100 Village U, .1&M N Puente Ave. 13a`dwin Park, CA • 000" 2 MpeAvail %tone, 401 Newport Centn, Newport Beach, CA p FACTS - FDIC Insured Account Disclosure information Go online for a Chance to win 45,000: lea all part of the Bank of America 45,0o0 Giveaway Sweopstakes, Give us your e-mail address and you'll have a chance to win •grdat prizes, Plus, you'll have the opportunity to sign up to receive relevant financial rm Infoation that is tailored to your needs. Visit www.bankafamerica.com/5kgiveaway by t i17/02 10 enter. 0067972 005.T18 California Page 5 of 5 ORty FM Pay Periods Year - to Date 23,70 ,06 divided by pay periods average per pay period I, 320.uo Date of Most Recent Pay Ending Date I�13c-,,f a2 Gross per Pay Period (=) 6,174. 23 divided by .3 2,05S, 03 (x) how often paid (x) how often paid 2� 24 = ) caicuiatea /-xnnuai income 3), 6?o.a8 (= ) Calculated Annual Income t4q,313.5� , INCOME ck ASSET CAI CI II ATinnf tnlnotecur--1_-r Last Namo Flrat Nerno Ralagonehlp Sex Oeto or Birth Aga Social SecurllyR FRSludant IPa NON in $r L2 113 32 YES or NO Z 2 F 2/17171 2e qs er -Srj-b Nd s r r l,(ID ` Kb 4 _ 3 None k n s g . y MCOMG Family Source Base Rate Average Average Annual Memb, 0 ' $ Hours 52 24 20 12 1 Total WK SEMI.Mo of-M MO Yn t $ k =a s =a $ =a SmCIaI SFr111P1ry oeucrnxm v,• Total Box A: a Family Source Base Rate Average Average Annual Memb.1P $ Hours 52 24 20 12 1 Total YYK SEMI•Mo al•YM MO YR. $ -- =a a =s $ TOtaI QO%B; $ P11R1 IC ACCICTA ett�C Family Source Base Rale Average Average Annual Memb,1A $ Hours 62 24 20 12 1 Total WK SEMI•Mo 01-WK eto Y {(� a =s $ =s Mambef fl Asset Description (savings,checking, Stocks, bands, ale,) Imputed/ Current I or C Gross/Fair Mkt.Value, Cost to Gel Cash NET Famlly Assols value Actual Interest Rnta Actual Annual Incoma from Asools _ 114.73 --`` $ t$�= Totals I $ 167,10Box F: Total NET ToPl AcluallitWme Faintly bmoma Flom Mula IMPUTED INCOME FROM ASSETS ' �� Date n Box E cxcaads$5.000-multiply Typolivo VA/ Typo of Pragmm % 1 Atx/ E by lho,curranl passbook lnlorosl rala: ,X •/. Unll No. 11-6 Unit Sim 21-2 If Box E dons not uxcoad$5,000 No. of Panic" CI enter-0- In box G: -BOX G: INPUTED INCOME Mll: Max. Income Limit$ — FROMASSETS AR ✓ 140%DmiIS 12,01 6,00- s Gnlar lho glcalar of Box or Box Gin: BOX H: 1 3 43.92 Lt 394 a. N2 e AM= IRVINE APARTMENT MANAGEMENT COMPANY October 1, 2002 City of Newport Beach P.O. Box 1786 Newport Beach, CA 92663-3884 Attn: Christy Teague Principal Planner PLANNINGEIVED DEPARTMENT CITY OF NEWPORT SEACH AM DEU, 0 3 2002 PM 7)8)9)101412)1(2)314)8I6 A RE: Affordable Housing Reporting — Newport North Project Agreements to Provide and Maintain Affordable Housing "North Ford Development Agreement" dated 4/22/85 Exp. 324/11 Dear Ms, Teague: Pursuant to the terms of the above referenced agreements, we, as agents for the owners of this property are responsible for qualifying residents as "Affordable Residents." Enclosed you will find the income computations and certifications, as well as other documentation on which we have relied to qualify new residents as "Affordable." This reporting covers new move -ins August 2002. Should you have any questions, please do not hesitate to call me at (949) 450-4290. Sincerely, Yvette M. Machan Bond Compliance Auditor Irvine Apartment Management Company 43 Discovery, Suite 150, P.O. Box 57060, Irvine, California 92619-7060 • (949) 450-4262 • Fax (949) 450-5802 NEWPORT NORTH The undersigned, being an Authorized Borrower Representative of Irvine Apartment Communities, L.P. (the "Borrower' ), has read and is thoroughly familiar with the provisions of the various documents associated with the Borrower's participation in the California Statewide Coimmmities Development Authority's (the "Issuer") Apartment Development Revenue Bond Program, such documents including: The Amended and Restated Regulatory Agreement and Declaration of Restrictive Covenants dated as of May 15, 1998 among the Borrower, the Issuer and U.S. Bank Trust National Association (the "Trustee"). 2. The Loan Agreement dated as of May 15, 1998, between the Issuer and the Borrower. 3. During the preceding month, 4 applications were received from Restricted Tenants (as defined in the Regulatory Agreement): 4. As of the date of this certificate, the following percentages of completed residential units in the Project (i) are occupied by Restricted Tenants, or (ii) are currently vacant and are being held available for such occupancy and have been so held continuously since the date such unit was vacated, as indicated: Occupied by Lower Income Tenants 1u • q % Unit Nos. Occupied by Very Low -Income Tenants �_% Unit Nos.: Held vacant for Occupancy continuously Since last occupied: c, z % Unit Nos.: Total Number of Units: 20 % Unit Nos.: a - Total 35- l3 15- &f 29 The undersigned hereby certifies that the Borrower is not in default under any of the terms and provisions of the above documents, and no event has occurred which, with the passage of time, would constitute a default thereunder, with the exception of the following: THE IRVINE COMPANY Irvine Apartment ManagerAnt Company Contact Person: Yvette Machan Bond Compliance Auditor (949) 450-4290 IRVINE APARTMENT MANAGEMENT• r . • TI AAL :_ AUGUST NEW MOVE IN SEPTEMBER RECERT 2002 NEWPORT NORTH OC85 Move -ins Drior to 5/25/95 Apt. Address Resident Name Size # of Oce. M/I Date M/O Date House Income Rent Recert Due Delkash 2+2 3 1/20/90 $33,559 $1,1361 N/A L ch 2+2 1 6/17/92 $40,047 $1,361 N/A Simich 3+2 4 12/27/93 $39,600 $1,317 N/A K Miller 2+2 3 4/22/95 $32,015 $1,361 N/A Ohanesian 2+2 1 8/1/91 $39,746 $1,326 N/A Cona 3+2 3 6/13/87 $31,481 $1,451 N/A Platt 2+2 1 12/26/87 $24,377 $1,230 N/A S. 2401 Johnson 2+2 1 11/7/89 $27,853 $1,200 N/A 9. 2454 Ode and 3+2 1 3/11/89 $35,250 $1,317 N/A 10. 2534 Cattaneo 3+2 7 12/17/94 $32,650 $1,392 N/A 11. 2600 Joshe ani/Mansoo 3+2 4 1/30/94 $35976 $1,317 N/A 12. 2731 Duli a 2+2 1 4/7195 $42,006 $1,280 1 N/A OC95 Move -ins after 5/25195 Apt. Address Resident . Name Size # of Occ. M/I Date M/O Date House Income Rent Recert Due 1. 102 Gutluie/Fletcher 2+2 2 6/7/02 42007.9 1361 6/03 2. 104 Rhomber 1+1 2 4/24/02 10/02/02 43440 1160 4/03 3. 108 RogrigueztPate 2+2 2 3/8102 45,384 1326 3/03 4, 112 Halstead/Girton 2+2 2 5/5/02 42445.6 1020.75 5/03 5. 124 Szaz 2+2 2 3/1/96 28440 1252 3/03 6. 125 Momeny 2+2 j 2 12/31/98 38600 1252 12102 7. 138 Perez/Malone 2+2 2 10/18/01 40796.7 1326 10/03 8. 146 Almore/Watson TTP=547 2+2 2 6/20/97 22151.6 8 1252 6/03 9. 214 OTA 2+2 2 12/1/99 23234 1326 12/02 10. 218 Rivera 2+2 2 6/28/97 47185.9 1361 6/03 11. 220 CushnieBolt 2+2 2 3/8/02 42285.9 1326 3/03 1-2:-236- Balcazar--.---- -2+2-_ 3---06/30/Ol----- ---•-56308.3- 960--- -06/03---- 13. 237 1 Hoan 2+2 2 1/28/99 1 37876 11.280 1/03 14. 239 1 Carteni/Bemard 1 2+2 2 12/9/98 24568 1326 12/02 15. 244 1 Barr 1+1 1 12/27/01 40000 1 1035 12/02 16. 245 1 Satter 1+1 2 9/28/01 1 9/10/02 19088 1179 09/03 17. 251 1 Ritchie 1+1 2 07/06/01 18347.8 1210 1 07/03 18. 302 Won on 2+2 2 05/09/02 43318.7 1280 05/03 19. 304 Yutan 2+2 1 8/19/00 52964.6 1252 8/03 20. 308 Fakhouri 2+2 2 6115100 31960.6 1326 6/03 21. 311 Elliott/Donr 1+1 1 2 7/3/02 44475.1 1210 7/03 22. 312 Golden 1+1 1 1 08/07/01 1 35840 1160 8/03 23. 313 Walters 1+1 1 10/16/01 10/02/02✓ 39224 884.5 10/02 24. 314 Jones/o'Donoghue 1+1 2 6/l/02 43308 1160 6/03 25. 315 Ochoa 1+1 1 1 05/06/01 1 35800 1 1150 5/03 IRVINE APARTMENT MANAGEMENT COMPANY BOND SUMMARY AUGUST NEW MOVE IN SEPTEMBER RECERT 2002 26. 1100 Fiore 3+2 1 09/01/01 47691.6 1474 09/03 27. 1104 Mcconne 1+1 2 8/13/01 51172.6 1160 8/03 28. 1106 Meyer 1+1 1 7/08/00 35508.7 1160 7/03 29. 1107 Aviles 1+1 4 08/23/01 23416.2 884.25 08/03 30. 1108 Romero/Serrano 2+2 5 11/05/01 37,238 994.5 11/02 31. 1118 Wallach 1+1 1 04/6/02 40298.8 1150 04/03 32. 1122 Hales 2+2 2 7/13/98 33262 1361 7/03 33. 1128 1 DelFante 3+2 1 4 11/06/99 1 58134 1474 11/02 34. 1141 Holder 2+2 1 1/26/96 37600 1252 1103 35. 1144 Se ehrband 1+1 1 11/16/00 37880 1150 11/02 36. 1145 Axelrad 1+1 1 8/30/00 41424.2 1160 8/03 37. 1154 Collins/Collins/Col 2+2 3 7/29/99 26000 1361 7/03 38. 1159 So/Esses 1+1 2 10/7/01 40774 1179 10/02 39. 1183 Pottter 1+1 2 611196 34907.7 1113 06/03 40. 1184 Olson/Ammann 2+2 2 6/7/02 45968.5 1361 06/03 41, 1200 Wood 2+2 3 08/04/01 48871.2 1361 08/03 42. 1203 Gallicano 2+2 1 11/07/01 41,684 1252 11/02 43. 1206 Thomsen/Hawley2+2 2 2/18/01 43285 1361 02/03 44. 1207 Robbs/Fer on 2+2 2 7/14/96 49945 1361 7/03 45. 1231 Lidia Mandelbaum 1+1 1 12/26/99 23060 1210 12/02 46. 1408 Amor 2+2 2 08/15/02 18258.3 1361 08/03 IRVINE APARTMENT MANAGEMENT COMPANY BOND SUMMARY AUGUST NEW MOVE IN SEPTEMBER RECERT 2002 VERY LOW (Phase In - beguming 4/1/98) Apt. Address Resident Name Size # of Occ. M/I Date M/O Date House Income Rent Recert Due 1. 106 Lausen 1+1 1 4/11198 $33886 $ 737 4/03 2. 122 Galla i 2+2 2 01/05/01 $10,523 $ 783 01/03 3. 126 Francis/Vidal 2+2 4 12/28/00 $40000 $ 829 12/03 4. 208 Tarta lini 1+1 2 04/01/01 $27,444 $ 696 04/02 5. 224 Rice/Harris 1+1 2 8/1/99 $30219 $ 737 8/03 6. 228 1 Jones 2+2 2 5/8/99 1 $22,336 1 $ 829 5/03 Batts 1+1 1 5/l/99 $24,154 $ 737 5/03 Francis 2+2 2 2/08/02 $26399 $ 783 02/03 Radford 1+1 1 7/8/99 $23430 $ 737 7103 McGinle 1+1 1 4116199 $8,467 $ 737 4/02 a Sa crowski 1+1 1 2/3/01 $30,000 $ 737 2/02 0 Siroonian 1+1 1 4/7/02 $24,542 $ 737 04103 3 Buoncristian lyh 1+1 3 11/10/01 $27684. $ 737 09/03 4 Hale 2+2 1 4/l/01 $25,819 $ 851 04/03 3 Vacant 1+1 16. 1419 Mino 1+1 1 5106101 $21,600 $ 696 5/03 17. 1530 Siddi i 1+1 3 6/11/00 $46249 $ 737 06/03 18. 2128 Johnston 2+2 2 6/8/00 $24636 $ 829 06103 19. 2140 Vise 2+2 1 02/01/02 $24,000 $ 829 02/03 20. 2210 Rossi 2+2 1 12/07/01 $25,680 $ 829 12/02 21. 2300 Mobler 2+2 3 611199 1 $25,263 $ 829 06/03 22. 2408 Shoeibi/Motta hi 2+2 2 5/12/02 1 25984 $ 851 05/03 23. 2425 1 Uchida 2+2 3 04/11/01 $12,402 $ 783 04/03 24. 2428 Winslett 2+2 1 03/17/00 $23,500 $ 829 3/03 25. 2440 Afshar 2+2 2 05/06/01 $15,424 $ 783 05/03 26. 2450 Warfield 1+1 1 4/11/98 $8,827 $ 737 4/02 27. 2519 Cotter 1+1 1 5/29/01 $25,410 $ 737 5/03 28. 2608 Vidal/Gaxiola 2+2 2 611199 $25426 $ 829 06103 29. 2702 Del ado 2+2 1 4 3/1/02 1 $25,200 1 $ 829 03/03 1998 Phase in - 106-122-224-318-320-2450 1999 Phase in- 228-243-1180-2608-2300-126 2000 Phase in— 2428-1333-2519-1530-2128 2001 Phase in — 333-208-1323-2425,1419,2140,2440,305 2002 Phase in— 2210,2408,2140,2702,1324 Total number of apartments on this property: 570 % of property deemed Income Restricted (Low): 15.26% % of property deemed Income Restricted (Very Low): 4.74% TIP = Total Tenant Payment (Resident is on Certificate or Voucher) Total vacant as of 08/31/02- 25 01/09/2015 03:51 FAX IM 002 New Cerh'ftcation X/Reeerfifteanon Unit Number 14019 INCO1'M COiVII'MATION AND CERTIFICATION Depa�rtriTteDn APARTMENT OWNER: Ho and Ur Pro etc (f oHUD) Ae&ulat costs(24tCPR 8 3). Y ou in a shouulld snake certain that thins fotmual Income in accordance sis at althe it times upset t forth date with the HUD Regulations. All capitalised terms used herein shall have the meaning set forth in the Regulatory Agreement. Re: (NAME and ADDRESS of Apartment Building) Newport North p CSCDA ,(POOL) ItWe the undersigned state that I/we have read and answered fully, frankly and personally each of the follpwing cjuestions for all persons who are to occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit: 1. 2. 3. 4. 5. Name of Members Relationship Social Security' Place of of the to Head Household Householldd Age Number Employment la.r'vvyylr4 Ilrnnr llginrnr - _ 60 415-97- 1a 12 tat?l. tQssis-4c•J Livr'rb --t Qr,a- r�dYvsv^ I A �Le ,4o,,. 61g-27-1a29 _. lfnevlplo� Income Computation 6. The total anticipated Income, calculated in accordance with this paragraph 6, of all persons (except children under IS years) listed above for the 12-month period beginning the earlier of the date that Uwe plan to move into a unit or sign a lease for a unit Is $ leg' 2 g, Included in the total anticipated income listed above are: (a) ail wages and salaries, overtime pay, cpmmisslors, fees, rips and bonuses and other compensation for personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real of personal property (without deducting expendimras for business expansion or amortization of capital indebtedness'or any allowances for deprceladoa of capital assets except for straight line'depreciation as provided in Internal Revenue Service regulations): (c) interest and dividends (including income from assets included below and other net income from real or personal property); (d) the Poll amount of periodic payments received from social security, annuides, irssuzrce policies, retirement funds, pensions, disability or death benefits and otter similar types of periodic"receipts, including any lump sum payment for the delayed start of a periodic payment; (a) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (f) the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter and utaides plus the maximum amount that the public assistance agency could in fact allow for shelter and udlides; (g) periodic and determirmble allowances, such es alimony and child support payments and regular contributions and gifts received from persons not residing in the dwelling; (h) all regular pay, special pay and allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the household or spouse (or other persons whose dependents are residing in the units); and (i) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are; (a) casual, sporadic or irregular gifts; (b) amounts which are specifically for or in reimbursement of medical expenses; meats under hezlah and accident inrarzoee and workers' (c) lump sum additions to family assets, such as inheritances, insurance payments (including payments compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational infinitive, and amounts paid by the goveramea: to a veteran for use in meeting the costs of midon, fees, books and equipment. Any amounts of such scholarships or payments to vet -rant used for the above purposes are to be included in Income; (a) hazardous duty pay to ahousehold member in the Armed Forces who is away from home and exposed to hostile fire; (0 amounts received under training programs funded by HUD; (g) foster child care payments; (h) amounts received by a disabled person that are disregarded for a limited time for purposes of Supplemental Security Income eligibility and benefits beaus: they are set aside for use under a Plan to Attain Self-Suff cieney; (i) income of a live -Li aide; (j) amounts received by a paricipaat in other publically assisted programs which art. specifteaily for or in r_imbursemst of out-0FPecket expenses 1 car:< and which are made solely to allow participation in a specific program; (k) a resident service stipend (a modest amount (not to exceed $200 Per ntamh) received by a resident for perfomtirg a service for L'le owner, on a Part-C:r. basis, that enhances the qualiry of life in the development; Irthis fame is being completed in accordance with recertification afa Lower Income Tenant's or Very Low incomeTeNnes occupancy of a Lower income unit or a Very Low Income Unit, respecttvety, this form must be completed bated Upon the current income of the occupants. G AMC e]'a.ICC.FoaN 07/09/2015 03:51 FAX e003 (1) compensation from state or local employment training programs and training of a family member as resident management staff; (m) reparation payments paid by a foreign government pursuant to claims filed under the laws of that government by persons who were persecuted during the Nazi era; (n) amounts specifically excluded by any other federal statute from consideration as income for purposes ofdetemmining eligibility or benefits underacategory of assistance programs that includes assistance under the United States Housing Act of 1937; (a) earnings in excess of $480 for each full -term student 18 yeam old or older (excluding the head oFhousehold and spouse); (p) adoption assistance payments in excess oFS480 per adopted child; and (q) deferred periodic payments of supplemental security income and social security benefits that are received in a lump sum payment; (r) amounts received by the family in the form of refunds or rebates under state or local law for property taxes paid on the dwelling unit; (s) amounts paid by a State agency to a family with a developmentally disabled family member living at home to offset the cost of services and equipment needed to keep the developmentally disabled family member at home; and (t) amounts specifically excluded by an other federal statute from consideration as income for purposes of delerm(ningeligibility or benefits under a category . of assistance programs that includes assistance under the United States Housing Act of 1937. 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment excluding the values of necessary items of personal property such as furniture and automobiles and interests In Indian trust land) Yes No; or (b) have they disposed of any.Psscts (other than at a foreclosure or bankruptcy sale) during the last two years at less fthan fair market value? Yes- No (c) If the answer to (a) or (b) above is yes, does the combined total value of all such assets owned or disposed of yall such persons total more than S5,0007 Yes X No T (d) If the answer to (c) above is yes, state: �/ (I) the combined total value of all such asses: S ,N (2) the amobnt oFineome expected to be derived from such asses in the 12-month period beginning on the date of initial occupancy in the unit that you propose to rent: S k� and ,! (3) the amount of such income, if my, that was included in item 6 above: Sy_ 8. (a) Are all of the individuals who propose to reside in the unit full-time students*? Yes y Nc *A full-time student is an individual enrol led as a full-time student during each of 5 calendar months during the calendar year in which occupancy of the unit begins at an educational organization which normally maintains aregular faculty and curriculum and normally has a regularly enrolled body ofstudens in attendance or is an individual pursuing a Ihll-time course of institutional or farm training under the supervision of an accredited agent of such an educational organizatton or of a state orpolitical subdivision thereof. (b) Ifthe answer to 8(a) is yes, is at least2 of Ore proposed occupants of the unit a husband and wifNntilled to File a joint federal Income tax return? Yes_�NO 9. Neither myself nor any ether occupant of the unit lAce propose to rent is the owner of the rental housing project in which the uhit is located (hereinafter the"Owner"), has any family relationship to the Owner; or owns directly or indirectly any interest in the Owner. For purposes of this paragraph, indirect ownership by an individual shall mean ownership by afamily member, ownership by a corporation, partnership, estate or trust in proportion to the ownership or beneficial Interest In such corporation, partnership, estate or Trustee held by the individual or a family member; and ownership, direct or Indirect, by a partner of the Individual. 10. This certificate is made with the knowledge that it will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and Uwe declare Vint all information set forth herein is true, correct and complete and based upon information I/we deem reliable and that the statement of total anticipated income contained in paragraph 61s reasonable and based upon such investigation as the undersigned deemed necessary. 11, Me will assist the Owner in obtaining any in formation or do cuments required to verify die statements made herein, including ei ther an income verification from my/our present employer(s) or copies of federal tax returns for the immediately preceding calendar year. 12• I/We acknowledge that Uwe have been advised that the making of any misrepresentatian or misstatement in this declaration will constitute a material breach of my/our agreement with the Owner to lease the unit and will entitle die Owner to prevent or terminate my/our occupancy of the unit by institution of an action for ejection or other appropriate proceedings. ' I/Ne declare under penalty of perjury that the foregoing is true and correct Executed this 151, day of_. l f t)5.+ , 20 Dom_ in the City of �i!� _ten �•-i� n� �n , California A•r Applicant Applicant Applicant Applicant Rev. 8193 (Signature of all persons (except children under the age of 18 years) listed in number 2 above rcquiredi 07/09/2015 03:51 FAX Z 004 FOR COMPLETION BY APARTMENT OWNER ONLY: 1. Calculation of eligible income: a. Enter amount entered for entire household in 6 above: b. (1) If the amount entered in 7(c)above is yes, enter the total amount entered in 7(d)(2), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ 0—_ )> (2) Multiply the amount entered in 7(d)(1) times the current passbook savings rate as determined by HUD to determine what the total annual earnings on the amount in 7(d)(1) would be if invested in passbook savings ($ ), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ (3) Enter at right the greater of the amount calculated under (1) or (2) above: C. TOTAL ELIGIBLE INCOME (line La plus line l.b(3): 2. The amount entered in 1.c: Qualifies the applicant(s) as a Moderate -Income Tenant(s). 1 • X Qualifies the applicant(s) as a Lower -Income Tenant(s). $ 18Iz5�8t 36 $ V $ I5s P-6T.36 Qualifies the applicant(s) as a Very -Low Income Tenant(s). Number of apartment unit assigned: G.9 Bedroom size: 2 4 2- Rent: $ d ,361 4. This apartment unit 'tv vas not) last occupied for a period of 31 or more consecutive days by persons whose aggregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartment unit qualified them as a Lower -Income Tenant(s). Method used to verify applicant(s) income: Employer income verification. . Copies of tax returns. Other ( 5116-102 C Date d,ANQOST:ICUF�0.N ` I I ()-7 --�;-Z- CO. FILL DEP1. CLOCK NUMBER ARC 100720 080108 F 000028264 1 L-L T AR Y ARV ' L(Ang. Fischer Avenue.Suite e Costa Mesa, CA a262G- 714- 757.740G Taxable Marital Status: Married Examp Lions/Allowances; Federal: 5 Ca 5 , Earnings Statement Period Beginning: 05/09/2002 Period Ending: 05/23/2002 Pay Date: - 05/31/2002 ARMOND AMOR 3 ANE #CG IRVINE, CA 92612 Social SecudtyNumber, 61.5-27-1012 Eaynings rate hours this period year to date Other Benefits and nugular 13.8400 01.25 710,25 6,933.31 Information this period total to date Overlime 13.2600 3.00 39.78 603.61 Vdcalion Bal. .1C1.74 Sick Pay 70.72 G-rbVelpayj Important Notes THIS CHECK IS BROUGHT TO YOU BYA SATISFIED Deductions Statutory RESIDENT. Social Security Tax -39.51 441.73 -- Medicare Tax -9.24 103.31 CA SUI/SDI Tax -5.73 64.12 Federal Income Tax - 9.94 Dental-125-16.35* 65.40 Medicai-125-104.39* 417.56 * Excluded from federal taxable wages Your rederal taxable wages this period ore $637.29 r c �776a�.6�T-S- (t� 21.28 a X 12 = 15125-k..3 0 a' se _. e w w z, pr e1•y1MP.uc Y 07/09/2015 03:51 FAX FROM :R@SbS130GMV S FAX NO. :9496540409 ��• ^ItF OVT.�-, LOCK MlM10EH ARCfa0726 Oe0r06 F deeiappg617 1 715 pAsn`��Y • In9 Teug6leMataalSle(uo: Mardod Ekampthna/AYowenecs: P"red. 5 CA: 5 Seelataaeurrty Numb*r et6.27•fof2 LC6..,, r1fit��tll MM fkn" !Ilia jwlQd Fitrgular 8,8400 02,00 7mea Overtime 13.2U* .25 3.32 Sick Pay IM 007 un. 09 2002 10:35RM P1 �11• Earnings 5taternent Period Beginning: d4A4/2Q02 Period Ending: 06109120M Pay Date: CIM S/2002 ARMOND AMOK 3801 PARK VIEW LANE fca IRVINE', CA 99612 '�lv to6,215.06 Irafmmatrdri 1hL 563. e3 vautGnn 8�1. 70.72 3 40 I� 6,849. Wd.. .�tilte S1Alu-- 7HISII pK158ROUgNTTO You DY46nTI8Fl _ RESI�J' 4.NT. .... .-.. _-.,—._,M0dIC8rBTagY-••---Y`.'8'8--'-.. 4G2."1.c _•.__.. .-.. fl.81 94,07 CA' SUIISDI Tau •5•47 $8,39 Federal income Tax 9,94 O1ther aiinl0).125-16.35- 49.05 Malcai-125 .104,39" 313.17 " Exoruded from 1Qdornt 16"blo w419" Your 1e}la ml texabie w4cc this period are 3507.46 %�TT2.�`�/O�l �JGI l�' ,�C'Gl 3 / C l�2 cY c5Y-e:_. • 05 C'x Op✓ 0,10-VO-ZI 0.7/09/2015 03:52 FAX IMOos DECLARATION OF NO INCOME APPLICANT NAME- o R/ S C% SOCIAL SECURITY# In order to continue processing your application for housing, and occupancy of an affordable apartment, the following "Declaration of No Income" must be signed by the person named below. Thank yowl TO BE COMPLETED BY APPLTCANT R/9,do hereby certify that I do NOT (Applicant Name) receive income from ANY source. I understand sources of income include, but are not limited to the following: Self Employment SSI Retirement Funds Alimony Income from Assets Educational Grants AFDC General Assistance Disability Union Benefits Family Support Work Study Employment by Other Unemployment Compensation Social Security Worker's Compensation Child Support Annuities/Pensions I understand that should I become gainfully employed or begin receiving income from any sources I must report the information to the Resident Manager immediately. I certify that the foregoing information is true, complete and correct. Inquiries may be made to verify the statements therein. I also understand that false statements or omissions are grounds for disqualifrcat' and/or prosecution under the full extent of California law. Signature )ate r Witness Signature /`���� Date 9- l/5 /D 2 07/09/2015 03:51 FAX i a w I_ Project NgW ri Unit No. 1 uUS INCOME RESTRICTED FINANCIAL WORKSHEET Applicant's Name: 4ryncrtj l'wtcr- Annual Salary Others Residing in Unit: 005 a.. t' mov- Annual Salary Annual Salary Annual Salary Commiss!o nsffi onuses Savings Accounts: Bank Bank Bank interest Bearing Checking Account Bank Bank Stocks/Bonds: Type Trust Fund: Type $ 4S, 2.�"•36 Balance x' %_ $ Balance x %_ $ Balance x %_ $ Balance Balance x %_ Amount x % _ Amount x % = Other: (Alimony, Child support, retirement pensions, social security, disability payments, parental support, etc.) Show calculation, how Annual is arrived at! Type Annual S Type Annual S Type Annual Property Owned By Resident: Address Equity x_%= $ TOTAL ANNUAL ELIGIBLE INCOME S IT, 2 57?- RA Mnx!mum Annual household Income Limit 5 Lt g1 3gy , OCD -- POOR QUALITY ,R OR11"Gl'NAL (S) 10/30/2002 14:22 FAX 9497201598 NEWPORT NORTH 9 004 New Cerajscaaan IRecerdfic� INCOME COIRUTATION AND CE NOTE TO APARTMENT OWNER: .1T1his form is designed to assist you in computing Am tthhepartment of HUI) Regulations. All capitalizeUrban ed teectr ms us d hereiin shall hegulations ave the meaning set forth Re: (NAME and ADDRESS of Apartment Building) Newport North - CS( Uwe the undersigned state that Uwe have read and answered fully, frankly and personally occupy the unit being applied for in the above apartment project. Listed below arc the t 1. 2. 3. Name of Members Relationship of the to Head of HouseholdHouseholdAge _ ^— Income Computation 6. The total anticipated income, calculated in accordance with tads paragraph 6, of all persons (exe beginning the earlier of the date that Uwe plan to move into a unit or sign a lease for a unit Is 4 included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other cc (b) the net income from the operation of a business or profession or from the rental of real c expansion or amordzadon of capital indebtedness or any allowances for depreciation o Internal Revenue Service regulations); (e) Interest and dividends (including income from assets included below and other net into (d) the full amount of,perlodic payments received from social security, annuities, insurane and other similar types of periodic receipts, including any lump sum payment for the d (e) payments in lieu of earnings, such as uncmploymient and disability compensation, worl (f) the maximum amount of public assistance available to the above persons other than th utilities plus the maximum amount that the public assistance agency could in fact allow (g) periodic and determinable allowances, such as alimony and child support payments and I in the dwelling; (h) all regular pay, special pay and allowances of a member of the Armed Forces (whether spouse (or other persons whose dependents are residing in the units); and (1) any aimed income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income zre; (a) casual, sporadic or irregular gifts; (b) amounts which are specifically for or in reimbursement of medical expenses; (c) lump sum additions to family assets, such as inheritances, insurance payments (inclut compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational institu meeting the costs of tuition, fees, books and equipment. Any amounts of such scholars to be included in income; (e) buardous duty pay to a household member In the Armed Forces who is away from he (0 amounts received trader training programs funded by HUD; (g) foster child care payments; (h) amounts received by a disabled person that are disregarded for a limited time for purpose, they are set aside for use under a Plan to Attain Self -Sufficiency; (i) Income of a live=m aide; (j) amounts received by a pamcipxn in other publically assisted programs which are speca and which are made solely to allow pardeipation in a specific program; (k) a resident service stipend (a modest amount (not to exceed S200 per month) received by basis, that enhances the quality of life in the development; Willits form Is being completed in accordance aith recenifiudan of a Lower Income Taaam's or Very Low Income Income Unit respectively, this form most be completed based upon the current income of the occupants. UnItNumber 1160 accordance with the method set forth in the that this form is at all times up to date with )ry Agreement. A (POOL) of the following questions for all persons who are to of all persons who intend to reside in the unit: 4. S. Place of Employment �rl0-wi� 18 years) listed above for the 12-month period I i pensation for personal services, before payroll deducdons; personal property (without deducting expenditures for business :apital assets except for straight line'depreciation as provided in to from real or personal properly); policies, retirement funds, pensions, disability or death bere6s ayed start of a periodic payment; rs' compensation and severance pay; amount of any assistanoe specifically designated for shelter and or shelter and udiides; aular contributions and gifts received from persons not residi.^,g snot living in the dwelling) who is the head of the household or payments under health and accident insurance and workers' and =cuntspaid by lite government to a veteran for use in or payments to veterans not used for the above purposes a'e and exposed to hostile fire; Security Income eligibility and benefits be=ause Lily for or in reimbursement of out-of-pocket expenses in:uzed resident for performing a service for the owner, on a par-:lme occupancy are Lower Income Unit or a Very Low a Aam.NmACC Mk4 10/30/2002 14:22 FAX 9497201598 NE{SPORT NORTH [a 005 0) compensation from state or local employment training programs and training ofa familylmemberm resident management staff; (m) reparation payments paid by a foreign government pursuant to claims filed under the lmv.ofthat government by persons who, were persecuted during the Nazi era; l: (n) amounts speci0cally excluded by any other federal statute from consideration as income 0t purposes of determining eligibility or benefits under a category of assistance programs that includes assistance under the United States Housing Act of 1 V37; (a) earnings in excess oFS430 for each Poll -term student 18 years old or older (excluding thghead of household and spouse); (p) adoption assistance payments in excess ofS480 per adopted child; and (q) deferred periodic payments of supplemental security income and social security benefits that are received in a lump sum payment; (r) amounts received by the family in the form of refunds or rebates understate or local law lbr property taxes paid on the dwelling unit; (s) amounts paid by a State agency to a family with a developmentally disabled family memPer living at home to offset the cost of services and equipment needed to keep the developmentally disabled family member at home; and (t) amounts specifically excluded by an otherfederal statute from consideration as income fonpurposcs ofdemanining eligibility or benefits under a category of assistance programs that includes assistance under the United States Housing Act of 19r37. 7. Do the persons whose income or contributions are included in item 6 above: I (a) have savings, stocks, bonds, equity in real property or other farm of capital investment (e*loding the values of necessary Items of personal property such as furniture and automobiles and interests in Indian trust land) _ _Yes t Ao, or (b) have they disposed of any assets (other than at a foreclosure or bankruptcy sale) during tMe last two years at less than fair market value? Yes _�L—No (c) If the answer to (a) orb) above is yes, does the combined total value of all such assets otlned or disposed of by all such persons total more than S5,000? Yes 7C No (d) If the answer to (e) above is yes, state: (1) the combined total value of all such assets: (2) the amount of income expected to be derived from such assets in the 12-month peridd beeinning on the date of initial occupancy in the unit that you propose to rent: S .Pi and i (3) the amount of such Income, if any, that was Included In Item 6 above: S. (a) Are all of the Individuals who propose to reside in the unit full-time students*? (;Yes No 'A full-time student Ism individual enrolled as a full-time student during each of 5 ealemlar months during the calendar year in which occupancy of the unit begins at an educational organization which normally maintains a regular faculty and c$lrriculum and normally has aregularly, enrolled body orstudents in attendance or is an individual pursuing a full-time course of institutional or farm tre Ang under the supervision of an accredited agent orsuch an educational organization or of state or political subdivision thereof. (b) if the answer to 8(s) is yes, is at least 2 ofthe proposed occupants of the unit a husband nt d wife entitled to file ajoint federal income tax return? Yes X No I 9. Neither myself nor any other occupant of the unit lAve propose to rent is the owner of the rental housing project in which the unit is located(hereinafter the "Over"), has any family relationship to the Owner; or owns directly or indirectly any Interest in the Ownqer. For purposes of this paragraph, indirect ownership by an Individual shall mean ownership by a family member, ownership by a corporation, partnership, estate or trust in proportion to the ownership or beneficial Interest In such corporation, partnership, estate or Trustee held by the Individual or afamily member; anrfEowacrship, direct or indirect, by a partner of the individual. 10. This ceri0eate is made with the knowledge that it will be relied upon by the Owner to determine ma?imum income for eligibility, to occupy the unit; and Uwe declare that all Information set forth herein is true, correct and complete and based upon information I/w•e deem reliable and that the statement of total anticipated income contained In paragraph 6 is reasonable aid based upon such investigation as the undersigned deefpcd necessary. 11. IAS'e will assist the Owner in obtaining any information or documents required to verity the mytour present employer(s) or copies offederal tax returns far the immediately preceding c 12. We acknowledge that 1/w•e have been advised that the making of any misrepresentation or mytour agreement with the Owner to lease the unit and will entitle the Owner to prevent or o ejection or other appropriate proceedings. VR'e declare under penalty of perjury} that the foregoing Is true and correct. Rev. 8.'95 20�_ in the nts made herein, including either an income verification from )Cm. tement in this declaration will constitute a material breach of e mytour occupancy of the unit by institution oran action for or�ea t h . California (Stgnnturc oral[ persons (except ch/Idren un�er the age of 18 years) listed In number above requiredl 1,0/30/2002 14:23 FAX 9497201598 NEWPORT NORTH ICJ 006 FOR COMPLETION BY APARTMENT OWNER ONLY: 1. Calculation of eligible income: a. Enter amount entered for entire household in 6 above: b: (1) If the amount entered in 7(c)above is yes, enter the total amoount entered in 7(d)(2), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ _0' ); € (2) Multiply the amount entered in 7(d)(1) times the current pass savings rate as determined by HUD to determine what the annual earnings on the amount in 7(d)(1) would be if invest passbook savings ($ Il ), subtract from that f the amount entered in 7(d)(3) and enter the remaining balan (3) Enter at right the greater of the amount calculated under (1) or (2) above: c. TOTAL ELIGIBLE INCOME (line La plus line 1.b(3): 2. The amount entered in 1.c: Qualifies the applicant(s) as a Moderate-Incomb Qualifies the applicant(s) as a Lower -Income Qualifies the applicant(s) as a Very -Low Income 3. Number of apartment unit assigned: 1136 Bedroom size: 4. This apartment unit w was not) last occupied for a period of 31 aggregate anticipated annual income as certified in the above manner ul qualified them as a Lower -Income Tenant(s). S. Method used to verify applicant(s) income: X Employer income verification. Copies of tax returns. Other ( M, r Rent: $ 11474. more consecutive days by persons whose their initial occupancy of the apartment unit M.A4C.COMCW=4 1-0/30/2002 14:23 FAX 9497201598 NEWPORT NORTH Q 007 INCOME F FINANCIAL Project N1P_t.rl t�tar�1t Unit No. 11oc) Applicant's Name: Others Residing in Unit: Sav ings Accounts: Bank Volta 29r5 Bank Bank Interest Bearing Checking Account Bank Bank Stocks/Bonds: Type Balance Annual Annual 5= S /°— $ .= c Trust Fund: Type Amount xT % = a E t Other: (Alimony, Ch!ld support, retirement pensions, social security, disabilitypayments, parental support, etc.) Show calculation, how Annual is ajrived at! Type t Annual S ' s Type Annual S t ' Type ; Annual S Property Owned By Resident: Address Equity % %= S TOTAL ANNUAL ELIGI13LE{NCOi41E s, 4f7 64I1-0 ! E L Maximum Annual household Income' imit S 601,270- 40 _ t r l i 1.0/30/2002 14:23 FAX 9497201598 NEWPORT NORTH - 1@008 Apartment # _I 100 Applicant's Name f r I Your employee has applied for a rental unit located on a City's Multifamily Rental Housing Program. We are ob: statements on all prospective residents for such aoartmer NOTE TO EMPLOYER: Please indicate your emplo, income (numbers only) from wages, overtime, bonuses, of compensation received on a regular basis: START DATE 11913 YTD WAGES YTD OVERTIME YTD BONUSES YTD C011,MSSION TOTAL CURRENT INCOME s g 3 • C�C7 I hereby certify (hathe amounts above are true and i4 ,rty financed under the to stringently verify income Start Date, current annual nissions or any other form to the best of my Title I hereby grant you permission to disclose my income in orde.S that they may determine my in ome eligibility for e rental of an apartment financed under the city's Multifamily Ren Housi a Progra pplicant's Signa re Date IncYar. 25,9633-6.5-- 43i1�4.31x1Z=47j6Q1.6q/r: P/30/2002 14:23 FAX 9497201598 NEWPORT NORTH a [Moog WelisExtra Savings e Account Number: 643-3711280 Activity 'summary Balance on 07/05 $0.00 Deposits and interest 0.00 Withdrawals - 0.00 ------------------ Balance on 08106 Interest you've earned Interest earned during this period 30.00 Average collected balance this period $0.00 Annual percentage yield earned 0.00% Interest and bonuses paid to date this year $0.00 10/14/2002 09:21 FAX 9497201598 NEWPORT NORTH � IM002 New CenjfrcaNan,,_JSecerr1%ie• ' rc Unit Number xl•fh 74 -------- INCOMM COMPUTATION AND CFi T ICATION NOTE Department of HousingNT andand Urban OWNER:This ('1Mform ) Reguladons (24tCPR 813jmpYon short"d mak e mein that rd s form 1s at all method set up tforth i w tha the HUD Regulations. All capitalized terms used herein shall have the meaning set forlh tU the Regulatory Agreement. Re; (NAME and ADDRESS of ApartmentBullding) Newport North. - CS DA (POOL) I1we the undersigned state that 1/we 8 Ua have read and answered fully, frankly and personally �,aeh of the following questions for ail persons vvho are tc occupy the unit being applied for in the above apartment project. Liste&lielow are the n mes of all persons who intend to reside in the unit: Name oMembers • Relauonsh3p 3. s l' S. of the to Head of social Security Place of ' Household Hoouseholdt �jAge [ Number 1 Employment 1� G iaF _ cl _Q5-3(Y'i6 Un co_ Cc�i t�s ciao r �r^irj1PUP (LiPdP.le�e i7A^ _S" IR _� N� I►q gl)yl Income Computation ' 6•. The total anticipated income, calculated in accordance with this paragraph 6, of all persons (excr+pt eiutdrea under IS years) listed above for the Mnionth peria beginning the earlier of the date that Itwe plan to move into a unit or sign a lease for a unit Is $1�%, �_(l4.OU — . Included In the total anticipated income llsied above are; (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other c (b) the net Income from the operation of a business or profession or from the rental of real expansion or amortization of capital indebtedness or any allowances for depreciadon c Internal Revenue Service regulations); (a) Interest and dividends (Including income from assets included below and other not her (d) the full amount of periodic payments received from $octal security, annuities, insutanc and other similar types of periodic receipts, including any lump sumpaymeni for the d (e) payments In lieu of earnings, such as unemployment and disability compensation, wort (t) the maximum amount of public assistance available to the above persons other than atutilities plus the maximum amount that the public assistance agency could to fact allow (g) periodic and determinable allowances, such as alimony and child support payments and i in•ibe, dwelling; (h) all regular pay, special pay and allowances of a member of the Armed Forces (whether spouse (or other persons whose dependents are residing in the uaits)t and (I) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or Irregular gifts; (b) amounts which arc specifically for or In reimbursement of medical expenses; (a) lump sum additions to family assets, such as inheritances, insurance payments (includ compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational insdmt meeting the costs of tuition, fees, books and equipment. Any amounts ofsuch scholarsb to be included in Income; (a) hazardous duty pay to a household member in the Armed Forces who Is away from hon (0 amounts received under training programs funded by HUD; (g) foster child care payments; (h) amounts received by a disabled person that are disregarded for a limited time for purposes t they are set aside for use under a Plan to Attain Seifsufftcieney; (I) Income of a live-in aide; U) amounts received by a participant in other publically assisted programs which are specirm and which are made solely to allow participation in a specific program; (k) a resident service stipend (a modest amount (not to exceed $200 per month) received by a basis, that enhances the quality of life in the development; If tams is being completed In accordance with mcanifiwtion ora Lover Income Tenant's or Very Low Income Income Unit, rrspecdvely, this form must be completed bued upon the current income othee arcupmu, ipeasaton forpersonal services, before Payroll deductions; personal property (without deducting expenditures forbusiueas mp)tal assets except for straight lino depreciation as provided In e from real or personal property); policies, retirement funds, pensions, duabilltypr death benefits tyed smrt of aperiodfc payment; s' corhponssa kin and severance pay; unount of any assistance specifically designated for shelter cod ,r slither and utilities; ular contributions and gifts received from persons not residing not living in the dwelling) who Is the head of the•8ousehold or payments under health and accident insurance and workers', and amounts paid by the government to a veteran for use in or payments to veterans not used for the above purposes are and exposed to hostile fire; Security Income eligibility and benefits because for or in reimbursement of out-of-pocket expenses incurred dent for performing a service for the owner, on a part-time occupancy are Lower Income Unit or a Very Low 10/14/2002 09:21 FAX 9497201598 NEWPORT NORTH U 003 (1) compensation from state or local employment training programs and training bra famil member as resident managementstaW „•,,; (in) reparation payments paid byaforeign govommentpursuant toclaims filed underthelaw.)of that government bypersons who were persecuted during ihc, Nazi era; j} (n) amounts,,specificaltyexcluded byany other kileraistatute from consideration asIncome fo purposes of determining eligibility or benefits under a category of assistance programs that includes assistance underth2 United States Housing Act of 1ttk1937; (a) earnings in excess ofS480 for each full-ternstudent 18 years old or elder (excluding thi head cfhousehold and spouse); (p) adoption assistance payments in excess of S480 per adopted child; and (q) deferred periodic payments of supplemental security income and socialsecurhy,benefits bat are received in a lump sum payment; (r) amounts received by the family in the form of refunds or rebates under state or local law forproperty taxes paid onthe dwelling Unit, (a) amounts paid by a State agency to a family with a developmentally disabladfamily member living at home to offset the cost of services and equipment needed to keep the developmentally disabled family member at home; and (t) amounts specifically excluded by an other fideral statute from consideration as Income fbipurposes of determining eligibility orbenefstsunder acategory of assistance programs that includes assistance under the United States Housing Act of I'?37. 7. Do the personswhoseIncome orcontributions weincluded initem 6above: '. (a) *have savings, stoelm, bonds, equity In real property'orotheir form of caplud investment alluding the values of necessary . Items offiersonal Property such as 9rmiture and automobiles and interests in Indian trust land) Yes No; or (b) have they disposed of any assets (other than aka foreclosure orbanlxuptcysale)duringt elasttwoyears atless than fair marketvalue? Yes„ x No (c) If the answer to (a) or (b) above Ii yes, does the combined total value of all such assets o&ed or disposed of by all such persons total more than S5,0007' • Yes No , • , (d) lrthe answer to (c) above Is yes, state: (1) the combined total value of all such assets: S • •• (2) the mount ofIncome expeete to be derived from such ctsInthe l2-monthperi la beginning on the date offiithdoccupancy inthe unit thatyod� propose to rent: S 0 and (3) the amount ofsuchIncome, Ifmy, that was included in item 6above: S )e 'a= 8. (a) Are all of the Individuals who propose to reside in the unit full-time students*? I Yes x No ••` *A fall -time student Isan individual enrolled asafull-iimestudent during each of5Galen armonthsduringthecalendaryeartnwhichoccupancyofthe unitbegins at an educational organization which normally maintains a regular faculty and curriculum and normally has a regularly enrolled body ofsmdents in attendance or is an individual pursuing a full-time course of Institutional or farm tra ing under the supervision of an accredited agent of such an' educational organization or of astate or political subdivision thereof. (b) Irthe an to Biel Isyes, is otleast2 of the proposed occupants of the unit a husband a`ldw centitledtofileejoint federal Income. retum7 x. Yes No 4Sr �. 9. Neither myself nor any other occupant oftheunit Ywepropose torent isthe owner oftherentalhausingprojeetInwhich the ubiiIslocated fiercind0erthe °Osvner°),': has any family relationship to the Owner; or owns directly or indirectly any Interest in the Owner. For purposes of this paragraph, indirect ownership by an individual shall mean ownership bya. family member, ownership by a corporation, partnership, estkc or trust in proportion to the ownership orbene0clal fitergt.' in such corporation, partnership, estate or Trustee held by the individual orafamily member; an+wnershrp, direct orIndirect, byapartner ofthe Individual, •; 10. This c"ficato Is made with the knowledge that itwill be rclicd uponby the Ownerto determine in rmumIncome for eligibility tooccupy the unit; and Mcdeclare', that all Information set forth herein Is true, correct and complete and based upon InformationT/we eemreliable and that the statement oftotal anticlpatedincome' contalned Inpamgmph 6 is reasonable and based upon such investigation as the undersigned deeq ed necessary. 11. I/We will assist the Ownerin obtaining any information or dacuments required to venly me statemlents made herein, including either an Income verifieslion front ' my/our present employer(s) or copies of federal tax returns for the immediately preceding calendar year. ' 12. IAVa sclatowladge'that Me have been advised that the making of tiny misrepresentation or miss itementInthis declaration will constitute amaterlalbreach ofi my/our agreement with the Owner to lease the unit and will entitle the Owner to prevent or terrain ate my/our occupancy ofthe unit by institution of an action fors, ejection or other appropriate proceedings. Me declare under penalty of perjury that the foregoing is true and correct day of ll aci i . 20C/ P_ in the Qity of tiP.u, ran •{- BG�acJ�t-Califamta•:• Rev. 8195 (Signature of all persons (except children age of 18 years) listed In number 2 above requiredl uaaicavvrncctotisr 10/14/2002 09:22 FAX 9497201598 NEWPORT NORTH r FOR COMPLETION BY APARTMENT OWNER ONLY: 1. ' Calculation of eligible income: a. Enter amount entered for entire household in 6 above: b. (1) If the amount entered in 7(c)above is yes, enter the total at entered in 7(d)(2), subtract from that figure the amount entej 7(d)(3) and enter the remaining balance ($ ); (2) • Multiply the amount entered in 7(d)(1) times the current pa& savings rate a's determined by HUD to determind what the annual earnings on the amount in 7(d)(1) would be if invest passbook savings ($ ef ), subtract from that f the amount entered in 7(d)(3) and enter the remaining balan (3) Enter at right the'greater of the'amount calculated under (1) or (2) above: c. TOTAL ELIGIBLE INCOME (line La plus line 1.b(3): 2. The amount entered in l.c: Qualifies the applicant(s) as a Moderate -Income' x Qualifies the applicant(s) as a Lower -Income Ter Qualifies the applicant(s) as a Very -Low Income 3. Number of apartment unit assigned: 211 R Bedroom size: 4. This apartment unit (&was not) last occupied for a period of 31 c aggregate anticipated annual income as bertified in the above manner upo qualified them as a Lower -Income Tenant(s). 5. Method used to verify applicant(s) income: Employer.income verification. X Copies of tax returns. -Other ( @ 004 $_ _ _3-7 60L) 900 mt in ok dal in re $ 374 60(410u, t(s). ant(s). Rent: $52 . more consecutive days by persons whose their initial occupancy of the apartment unit; r �! /A/0? 61.ANCA997k6F=9 10/14/2002 09:22 FAX 9497201598 All Project_ Neu4x-c± of+h �UnitNo,_ •Z ))f6 NEWPORT NORTH INCOME, REs FINANCIAL Wi Applicant's Name: bris+i42 Riodoi o tornai Others Residing in Unit: i, wrna,1 V�iQr}pI e r.� Li In A^_ Savings Accounts: Bank `N!A •Balanct Bank Balance 'Bank Balance Interest Bearing Chccking'Account Bank_ Bank Stocks/Bonds: 'Type Trust Fund: Type , Other: Balance Balance An (Alimony, Child support, retirement pensions, soc parental support, etc.) Show calculation, how A Type Type Property Owned By Resident: Address Equity_ TOTALANNUAL @ 005 :xF'�rt F.. AnnyialSalary S 44G(j4 ,f Ann al Salary _Annu:`1 Saiaty • . $ — Annu'alSal'i _commt slons/Bonus's'S 117 .%= .S S. Lo ial securlty, disabillry payments, ' •; isagrivedalI Annual S Annual S ; Annual S ' ELiGIBU COh4E s-27 -'pCj 00— !1 MaximumAnnunl Household Income Pmtt • S 7 6120 y,go-- 10/14/2002 09:22 FAX 9497201598 NEWPORT NORTH Form Depedmentifthe Treasury - internal Revenue Service 1040A severe,U-S. Individual Income Tax Return_ Use L the IRS a CHRISTINE M. RIEDEL IMER IathN. E Other- L GEN A RIEDELSHEIMER wise, H please E 2118 RASTIA print R NEWPORT BEACH CA 92660 orty e E e 2001 IRS Use p. presidential Election Campaign , Note. Checking "Yes" will not change your tax or reduce your refund. status 2 M Married filing Joint return (even If only one had Income) 3 Married filing separate return. Enter spouse's social security numbs, above and full name here. Check only 4 Q Head o►household (with qualifying petaon), (see instructions.) If the qi one box, enter this child's name here. lla 5 I -I Qualifying wldow(er) with dependent child (year spouse died ► Exemptions 6a Yourself. If your parent (or someone else) can claim you as a depeil return, do not check box 6a. b spouse W0^ rQj 006 A Important! , You must enter your SSN(s) above. You Spouse Yes iR No n Yes � ying person is a child but not your ). (ziee msuu( on his or her tax C Dependents:If more than seven dependents, see Instructions. (1) First name Lest name (2)Ild s�curity numberend ill's (d) f ependents r kgonahlp to you (4)n It cruai «:eii°(�N inetruclioes) BEAU—MICHELLE RIEDELSHEIMER 615-21-3547 au ihter t 4 Attach = Fonn(s) 8a W-2 hem Also attach b Fotm(s) 8 1099-R if tax —"- was withheld. 10 If you did not 11a get a W-2, no Instructions, 12a Enclose, but do 13 not attach, any payment gross Income Total pensions and annuities. 12a Unemployment compensation, and Alaska Permanent Fund it Social security state tuition program amount lructions amount 9 fi1-' No. of boxes checked on ea end eb 2 No. of your children an sowho: • lived with 1 You I e did not live with you due to divorce oroberatlan (see net.) 0 DogndeMa on 0a not 0 entered Wove 19 Subtract line to from line 16This le your adjusted gross Income ► 19 cy Act, and Paperwork Reduction Act Notice, see instructions. CAA 1 Y04ag12 NTF 2554428 Form 10/14/2002 09:22 FAX 9497201598 NEWPORT NORTH Form 1040A(2001) CHRISTINE M RIEDELSHEIMER Tax, credits, and payments Standard • Enter the amount from line 19 (adjusted gross Income), 21a Check f— rlYou were 65orolder nBlind Enter nu LL Spouse was65orolder nBllnd boxesche b Ifyouaremaniedfiling separately and your spouse ltemizesdeduoUon4p, see Instructions and check here .............................. kE 'berof ked► � tan for.. for • People who checked any box on fine 21a or or who be claimed asa a 22 23 24 28 Enter your standarddeduction (see leftmargin). Subtract line 22 from line 20. If line 22 is more than line 20, enter-0-. Multiply $2.900 by the total number of exemptions claimed on Ilne 6d. Subtract line 24 hom line 23. If line 24 Is more than fine 23, enter-0-. This Is your taxable Income. e dependent, see Instructions. • All others: Single, $4,550 Head of household, $e'lim 26 27 Y8 29 Tax, Including any alternative minimum tax see lnstrucdons . Credit for child and dependent care expenses. Attach Schedule 2. 27 Credit for the ek edy or the disabled. Attach Schedule 3. 28 Education credits. Attach Form 8M. 29 _ _ Ma[ried filing 30 Rate reduction credit. See workshest In the instructions. 30 joint or 31 child tax credit (see Instructions). 31 widow el, $7,e00 32 33 Adoption credit. Attach Form 8839. 32 Add lines 27 through 32 These are yourtotal credits. k Maimed tiling 34 Subtract line 33 from line 26. if line 33 is more than line 28. enter -D-. U Federal Income tax withhold from Forme W-2 and 1099. 38 2001 estimated tax payments and amount Ifyou have applied from 2000 return. of qualifying 39a Earned Income credit mfnt- child' alb b Nontaxable earned in Schedule EIC. 40 Addltfonal child tax or 41 Add Unes37, 38, 39a, Refund 42 If line 41 Is more than " This lsthe amount yo� Direct deposit? 43a Amount of line 42you See Instructions and All In 43b, ► b Routing 43o, and 43d. number ► d Account number C 44 Amount of line 42you 2002 estimated tax. Amount 45 Aunt you owe. Su you owe see Instructions. 46 Estimated tax penalty 37 38 39( rbbract the 36 from line 41. 1. coded to you. ► CType: 0 C lied to your 44 41 from line 36. For details on how to 33 Q Savings Yes. Z 007 zifgn here unaerpenuuas a ury,r acfare that I has 0Xamined this raturn and accompanying scha ulesond statementR and to the beat of my knowledge and belief, they anus rrec and accurately hat allamountsand sowasof Income[ waived uring thetax year. Declaratlonot prepner(otherthanthe based taxpayer nailln mationofwhichthopreperarhasanyknowledge. €p Joint return? Yo r aig o �®i P to Your ocoupatfon Daytime phone number 1 See instructions.' OME14WIZR 949-640-5021 Keep a copy for ep a natu ajoI rtn b9th mustslgn. Date Spcusdsoccuprtltlon ur orecords. e / > ASS7 MGi Preparefs Date Check Ifaelf- PreparerbSSN/PTIN Paid signature ernto ed R 560-84-1419.9 prepareft Firm's neme (or yours ANT Z EDA I EIN use only If eelf-employed), ' 171 DXAMMM VALLEY LANE Phone no. address, and ZIP coca CH O HILLS CA 917 9 909-627-5246 CM 1 1040Al2 NTF2554430 Cupydght2001atas[tend/1 Form 1040A (2001) 10/14/2002 09:23 FAX 9497201598 NEWPORT NORTH moos qt SCHEDULE EIC Earned Income Credit (Form1040Aor10") Qualifying Child Information Complete and attach to Form 1040Aor 1Department of the Treasury only Ifyou have a qualifying c InternalitweeYeServIce rea Nome(s) shown on return 2001 Attachment sequence No. 43 Your social security no. Before you begin' See the Instructions for Farm 1040A, lines 39a and 39b, or Form 040, lines 61a and 61b, to make sure that (a) you can take the EIC and (b) you have a q alirying child, • If you take the EIC even though you are not eligible, you may not be allowed lio take the credit for up to 10 years. See Instructions for details. ppI I • It will take us longer to process your return and Issue your refund iryou do n Y fill in all lines that apply for each qualifying child. catrrloN • Be sure the child's name on tine 1 and social security number (SSN) on Ilne agree with the child's social security card. Otherwise, at the time we process your return, we may resduce or disallow your EIC. If the name or SSN on the child's social security card Is not correct, call (he Social Security Administration at 1-800-772-1213. l Qualifying Child Information Child 1 Child 2 First name Last name First name Last name 1 Child's name If you have more than two qualifying children, you only have to list two to got the maximum credit. EAU—MICH RIEDELSHEAME 2 Child's SSN The child must have an SSN as defined In the Form 1040A instructions or Form 1040 instructions unless the child was born and died in 2001. If your chill was bom and died in 2001 and did not have an SSN, enter "Died" on this line and attach a copy of the child's birth certificate, 615-21-3547 3 Child's year of birth Year 2000 Year If bom after 1982, skip lines 4a If bom after 198Z skip lines 4a and 4b; go to line S. and 4b; go to line 6. 4 if the child was bom before 1983 -- Yes. No. Yes. No. a Was the child under age 24 at the and of 2001 and a student? Go to line 5. Continue Go to line 5. Continue b Was the child permanently and totally disabled Yes. No. i Yes. No. during any part of2001? Continue The child Is nit a Continue The child Is not a qualifying chI4. qua0fying child. ease 8 Child's relationship to you (for example, son, daughter, grandchild, foster child,oto.) Daughter C 8 Number of months child lived with you in the United States during 2001 • if the child lived with you for more than half of 2001 but lees than 7months, enter "7". 12 monthsit months • Irthe child was bom or died in 2001 and your home was the child's home for the entire time he Do not enter more than 12 months . Do not enter more than 12 months. or she was alive during 2001, enter "12'. € You may also be able to take the addldonal child tax credit If your child ta) waspinder age 17 at the and of 2001, (b) Is jlP claimed as your dependent on ins Se of Form 1040A or Form 1040, and c) Is U.S. o' an or resident alien. For more details, see the Instructions for line 40 of Form 1040A or line 63 of Form 1040. For Paperwork Reduction Act Notice, as* Form 1040A or 1040 Instructlone. CM 1 EIC1 NTF2554191 Copyrlght20010reatlano/Neleo LP. Forms Software Only Schedule EIC (Form 1040A or 10/14/2002 09:23 FAX 9497201598 NEWPORT NORTH Q 009 NTF California Resident Income Tax Return 2001 APE DO NOT --- ATTACH 549-85-3006 RIED 615-17-0178 LABEL CHRISTINE M RIEDELSHEIMER JMRGEN A RIEDELSHEIMER Step 1 Name 2118 BASTIA and NEWPORT BEACH CA 92660 91�111111K „244y FOR COMPUTERIZED USE ONLY 01 2 37 67 56 0 APE 0 06 0 38 90 57 0 3800 0 09 0 39 0 58 0 3803 0 11 1 41 0 59 0 SCHG1 0 12 37599 42 0 60 0 5870A 0 14 0 43 0 64 0 5805 5805F 0 16 0 44 0 65 23 17 37234 45 0 66 0 18 5920 47 23 68 0 20 592 48 0 23 0 49 23 28 0 50 0 29 0 51 0 30 0 52 0 31 120 53 0 # 35 0 54 0 36 0 55 0 F18ng Status 2 Married filing Joint return (even if only one spouse had Income) Check only one. Marlednlingsapatetstaturn.. Enter spousa'asocial noudty number above non youa a e ox ,ors ove,enert In a ox. tyouchedkedbox2or5,,pter2m 7 2 X$79 - $ lira box.lt you chocked thabox on Tins e, sea Instructions .................... .... 8 SlInd; if you (orif married, your spouse) are visually Impaired, enter 1; If beg.,enter 2..8 X$79 = $ 8 Senior: If you (or if married, your spouse) are 65 or older, enter 1; If both, an�er 2 .. ,e 9 X $79 • $ Dependent 11 Dependents: Enter name and relationship. Do not Include yourself oryol Exemptions BEAU—MICHELLE RIEDELSHEIMER — Daught step 4 12 State wages from your Fornt(s) W-2, box 16........................ Is' 1A a r , ova, 37,234. 1$ Enter adjusted gross income from your 2D01 federal return ..............k ............... 13 Tearable 14 California adjustments-- subtractions. Enter the amount from Schedule CA154o), line 33, column B * 14 Income 16 Subtract line 14 from line 13. if less than zero, enter the result In parentheses.See Instructions.. 15 37,234. Attach check or 16 CaOWmia adjustments-- additions. Enter the amount from Schedule CA (611). line 33, column C e 16 money order 17 California adjusted gross Income, Combine line 16 and line 16.... . ...................... a 17 37,234. here. 18 Enter the larger of your CA standard deduction OR your CA itemized dedu�ctlens........... • 18 5,920. 18 Subtract line 16 from line 17. This is your taxable Income. If less than zero, slater-0•.. ....... i8 31, 314 . Step 5 20 Tax. Check If from.. L4 Tax Table Tax Rate ScheduleU FTS 3800 or[ f J F S 3803.... U 20 OyZ . Tax 21 Exemption credits. If line 13 Is over $130,631, see Instructions. Otherwise, ac`d One 10 and line 11 21 405. Attach copy or your 22 Subtract line 21 from line 2D. If less than zero, enter -0 ................................ 22 187. Form(s) W-2, W-26, ana alhar 23 Other Taxes. Check If from Q Schedule G 1 and form FTB 5870A ..... ............... 23 Forms toao with Callfarnlalsz 24 Add line 22 and line 23. Continue to Side 2................... . . .....4................ Z< 18 Withhold, 2 For Privacy Act Notice, get form FM 1131. 5400110 6031 1 Form B40 Ct 2001 Side 1 1 CAI NTF 2555737A ttS Copyright 20016raatland Nalm- Formseottwus only I 10/14/2002 09:23 FAX 9497201598 NEWPORT NORTH ) R010 s - L E Paget Your name:RIEDELSHEIMER YourSSN: Step 6 26 Amount from Side 1, line 24................................ . ................ . ........ 26 187. Special 28 Entdit code no Enter credit name and amount.... 28 Credits 29 Enter credit name code no and amount.... 29 and 30 To claim more than two credits, see Instructions ....... I .............. ► 30 Nonrefundable 31 Nonrefundable renter's credit. See Instructions for"Step 6............... ( 31 120. Renter's 33 Add line 28 through Una 31. These are your total credits ................... ........... . I ..... 33 120. Credit 41 Cnh1mn1[Ina 'Y4 born ane 9A if ler_a than>Mll. enter.0..................I'.................... 34_ 67. , Step 7 36 Alternative minimum tax. Attach Schedule P (540)....... ............•...i.................. • 35 Other Taxes 36 Other taxes and credit recapture. See instructions ............. . . . ......FF • 38 37 Add line 34 through Una 36. This Is your total tax .......................4............... ...•37 67. Cfnn R 38 California Income tax withheld. See Instructions ................. 4 ..... 90. Payments 39 2001 CA estimated tax and other payments .......................... tj 39 41 Excess SDI. See instructions ............................... . .. . .. (141 Child and Dependent Care Expenses Credit. See Instructions; attach form FT13 3506. • 42 • 43 . µ 11 46 46 Add line 38 One 39 line 41 and line 45. These are yourtotal payments ......................... 48 90. Step 9 47 Overpaid tax. If line 46 is more than line 37, subtract line 37 from line 46 .. . . ................... 47 23. Overpaid Tax 48 Amount of line 47 you want applied to your 2002 estimated tax .............................. M48 23. or Tax Due 49 Overpaid tax available this year. Subtract line 48 from line 47 ............. .................. M49 60 Tax due. If line 46 Is less than line 37, subtract line 46 from line 37 ........ .................... 6o non8pecs1 Funtl. e61 CAareaelCancer Research Futl Step 10 Seelnst,uctlons ....... •lilt Contributions Alzhalmet's DlseacslRelated CAFlrefighters•Memotlal Fund . • 57 Disorders Fund........ • 52 Emergency Food Assistance CA Fund for senior Citizens. 053 Pm➢ramFund....... ,... •as Rare and Endan eredS soles CAPeacetionF nd ..... g P Foundstlan Funtl ....... • 59 Preservation Program.... • 64 Lupus Foundation of America, State Children'sTruat Fund forthe CalltornisChapters Fund.. . • 60 Praventionof Child Abuse • 66 B4 Add line 51 through line 60. These are your total contributions ............................. • 64 Step 11 65 REFUND OR NO AMOUNT DUE. Subtract line 64 from Una 49. Mall to: 23. Refund or FRANCHISE TAX BOARD, PO BOX 942840, SACRAMENTO CA 94240.000 .................. gas Amount 8a AMOUNT YOU OWE. Add line 50 and Ina 64, Mall to: You Owe FRANCHISE TAX BOARD, PO BOX 942887, SACRAMENTO CA 94261-.0.001 .................. ■ B6 0. Step 12 67 Interest, late return penalties, and late payment penaitles .... . ............................. 67 68 Underpayment of estimated tax. Check box: , . Q FTB 5806 attached Q F�B 6806E attached... 68 Interest and 69 Total amount due. See Instructions .................... 89 Penalties ................................. ( • 70 Step 13 0o not attach a voided check or a deposit slip. Direct Deposit Complete this section to have your refund directly deposited. Routing number • of Refund Account Type: Amount Checking • n Savings • n number 0 • r IMPORTANT: see •sign YourRetum'in the Form5401nstructionsto find out if you should att5ch aeepy of your eompletefedsraf ratuin. Underpsnaltias belief, ale of perjury,IdecfareNatl have examined this return. Including accompanying schedules and statenente, Sign o rises d complete. and to the best of my knowledge and 8 Your Here Your signature Daytime phone number It Is unlawful X �ini� — 949-640-5021 to forge a Spouse's signature (if Offing joint, both mu n spouse's X Dale signature. Paid pf9py'sr'@6lgte ur@ daekr Ippo reparer is based an all Information of which prspar r has any knowledge) Paid preparses SONIPTIN Joint return? L.lyfl • 560-84-1499 See Instructions. FliKleriame(oryours eir--e >loye Flm1'saddress FEIN ANTHONY S 'PED 1715 DIAMOND VALLE vvvVVV CHINO HILLS CA 91709 NTF2565738A Copyri0ht20010reatiandlNelm. FormaSoflwars Only ' Slidell FbmnS40C1 2001 _, 54001206031 10/14/2002 09:23 FAX 9497201598 NEWPORT NORTH Q oil or Name(s) shown on Form 1040 CHRISTINE M and JU'ERGEN A RiEDELSHEiMER Supporting calculation for Form 1040, Line 1. Number of qualifying children: 1 X$600.00. Enterthe 2. Are you filing Form 2555, 2555-EZ, or 4563,or are you excluding incor QX No. Enterthe amount from Form 1040, line 34. 2 ❑Yes. Enter your modified adjusted gross Income. Adjustment for Puerto Rico and American Samoa exclusions 3. Enter the amount shown below for your filing status: • Married filing jointly, enter $110,000 • Single, head of household, or qualifying widow(er), enter $75,000 "' 3• • Married tiling separately, enter $55,000 L• Your social security number 549-85-3006 suit. 1. from Puerto Rico? 37,234. 0. 110,000. r.em 4. is line 2 more than line 3? ® No. Skip lines 4 and 5, enter -0- on line 6, and go to line 7. Yes. Subtract line 3 from line 2 4. 0 S. Divide line 4 by $1,000. If the result is not a whole number, round it up to the next higher whole number (for example, round 0.01 to 1)......................................... 5.. 0 S. Multiply $50 by the number on line 5 .......................... . 6. 0 7. Subtract line 6 from line 1. If zero or less, stop here; you cannot take tils credit ..... 7. 600. 8. Enter the amount from Form 1040, line 42 .................. 8. 3,139. 9. Are you claiming any of the following credits? • Adoption credit, Form 8839 • Mortgage interest credit, Form 8396 • District of Columbia first-time homebuyer credit, Form 8859 ❑7C No. Add the amounts from Form 1040, lines 43 through 47. Enterthe total. 9 0 . ❑Yes. Enter the amount from line 15 of the worksheet 10. Subtract fine 9 above from line 8 .... 10. 3,139. 11. Child tax credit. Enterthe smaller of line 7 or line 10 here and on Form 1040, line 48 ........... 11, 600. TIP /f line 7 above is more than line 11, you maybe able to take Additional Child Tax Credit New Cerhficadon /Reeerafreadon_ JC. - Urit Number. 2yy� INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designed to assist you in computing Annual Income in accordance with the method set forth in Department of Housing and Urban Project ("HUD") Replations (24 CFR 813). You should make certain that this form is at all times up to date vt the HUD Regulations, All capitalized terms used herein shall have the meaning set forth in the Regulatory Agreement, Re: (NAME and ADDRESS of Apartment Building) Newport North e CSCD.A►., (POOL) h I/Ne the undersigned state that Uwe have read and answered fully, frankly and personally each of the following questions for all persons vvlto ate occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit: 1. 2. 3. 4. 5. Name of Members Relationship , of the • to Head of Social Security Place of Household Household Age Number Employment \JfW--,sh Uen It gseel • w4p 31_ 624 -06--Stile _ Wig lkilckritilris Val N1vtAt�16ua.ovn_ R�1-»✓r) `_rW ti15.06-1g'lb T 61?F1P.nintrP Url1 uimAPn6.�99pp Cbt•L.f% Income Computation 6. The total anticipated income, calculated in accordance with Oils paragraph 6, of all persons (except children under 1S years) listed above for the 12-month pe beg -inning the earlier of the date that Uwe plan to move into a unit or sign a lease for a unit is Included in the total anticipated income listed above are: ' (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net Income from the operation of.a business or profession or from the rental of real of personal property (without deducting expenditures for busin expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets except for straight line depreciation as provide, Internal Revenue Service regulations); (e) interest and dividends (including Income from assets included below and other net Income from real or personal properly); (d) the full amount of periodic payrgl nts received from social security, annuities, insurance policies, retirement funds, pensions, disability or death beet and other similar types of periodic receipts, including any lump sum payment for the delayed star, of a periodic payment; (e) payments In lieu of eamings, such as unemployment and disability compensation, workers' compensation and severance pay; (f) the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter utilities plus the maximum amount that the public assistance agency could in fact allow for shelter and utilities; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not resid In the dwelling; (h) all regular pay, special pay and allowances of a interfiber of the Armed Forces (whether or not living In the dwelling) -who Is the head of the household spouse (or other persons whose dependents are residing in the units); and (i) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or Irregular gifts; (b) amounts which are specifically for or In reimbursement of medical expenses; (c) lump sum additions to fam8y assets, such as inheritances, insurance payments (including payments under health and accident insurance and work, compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational institution, and amounts paid by the government to a veteran for use meeting the costs of tuition, fees, books and equipment. Any amounts of such scholarships or payments to veterans not used for the above purposes to be included in income; (a) hazardous duty pay'to a household member in the Armed Forces who is away from home and exposed to hostile fire; (t) amounts received under training programs funded by HUD; (g) foster child care payments; (h) amounts received by a disabled person that are disregarded for a limited time for purposes of Supplemental Security Income eligibility and benefits ttca they are set aside for use under a Plan to Attain Self -Sufficiency; (i) income of a live-in aide; Q) amounts received by a participant in other publicall-v assisted programs which are specifically for or in reimbursement of out -or -pocket expenses irrur and which are made solely to allow participation in a specific program; (k) a resident service stipend (a modest amount (not to exceed S2CO per;.month) received by a rtsidtnt for performing a service for the owner, on a basis, that enhances the quality of life in the development; lrthis form is being completed in accordance with recertification of a Lower Income Tenant's or Very Low Income Tenant's occupancy of a Lower Income Unit or a Very Low r Income Unit, respectively, this tam must be eomplacii basil upon the current Income of the occupants. 11 V. 0, ANC,C0n:ItC•P:9N 1, I L`1^ (I) -compensation from state or local employment training programs and training of family member as resident management staff; (m) reparation payments paid by a foreign government pursuant to claims filed under the laws of that government by persons w•ho were persecuted during tF Nazi era;,. (n) amounts specifically excluded by any other federal statdtefrom consideration asincome for purposes ofdetermining eligibility orbenefits under acategor of assistance programs that Includes assistance under the United States Housing Act of 1937; (o) earnings in excess ofS480 for each full -term student 18 years old or older (excluding the head of household and spouse); (p) adoption assistance payments in excess ofS480 per adopted child; and (q) deferred periodic payments of supplemental security income and social security benefits that are received in a lump sum payment; (r) amounts received by the family in the form of refunds or rebates under state or local law ferproperty tares paid on the dwelling unit; (s) amounts paid by a State agency to a family with a developmentally disabled family member living at home to offset the cost ofsen•ices and equipmer needed to keep the developmentally disabled family member at home; and , (t) amounts specifically excluded by an other federal statute from consideration as income for purposes of determining eligibility or benefits under a ca:egor orassistance programs that includes assistance under the United States Housing Act of 1937. 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other fom of cap! tat investment (excluding the values of necessary items of personal property sucl as furniture and automobiles and interests in Indian trust land) •_,Yes No; or (b) have they disposed ofany asses (other than at a foreclosure or bankruptcy sale) during the last two years -at less than fair market value? Yes �_No (c) If the answer to (a) or b) above is yes, does the combined total value of all such asses owned or disposed of by all such persons total more than 55,000: Yes %( No (d) If the answer to (c) above Is yes, state: / (1) the combined total value of all such asses: S �;j qb , jJ� (2) the amount of income exEected to be derived from such asses in the 12-month period beginning on the date orinitial occupancy In the unit that you • propose to rent: S. F, 7 , Q 2 , and (3) the amount of such income, if any, that was included in item 6 above: S 8. (a) Are all of the individuals who propose to reside in the unit full-time students*? Yes _Y_No *A full-time student is anindividual enrolled as a full-time student during each of calendarmonths during the calendar year in which occupancy of the unit begins at an educational organization which normally maintains a regular faculty and curriculum and normally has a regularly enrolled body orstudens in attendance or is an individual pursuing a full-time course of institutional or farm training under the supervision of an accredited agent of such as educational organization or of a state or political subdivision thereof, (b) 1f the answer to 8(a) is yes, Is at lent 2 of the proposed occupants of the unit a husband and wife entitled to file ajolnt federal income tar return? Yes_Na ,• . 9. Neither myself nor any otheroecupant of the unit Vwe propose to rent is the owner of the rental housing project in which the unit is located (hereinafter the "Owner"), has any family relationship to the Owner; or owns directly or indirectly any interest in the Owner. For purposes of this paragraph, indirect ownership by an individual shall mean ownership by a family member, ownership by a corporation, partnership, estate or trust in proportion to the ownership or beneficial interest In such corporation, partnership, estate or Trustee held by the individual or a family member, and ownership, direct or indirect, by a partner of the individual. 10. This certificate is made with the knowledge that it will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and Uwe declare that all Information set forth herein is true, correct aid complete and based upon information i/wc deem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. 11. JAVC will assist the Owner in obtaining any information or documents required to verify the statements made herein, Including either an income verification from my/our present employer(s) or copies of federal tax returns for the immediately preceding calendar year. 12. IA%*e acknowledge that i/we have been advised that the making of any misrepresentation or misstatement in this declaration will constitute a material breach or my/ouragreement with the Owner to lease the unit and will entitle the Owner to present or terminate my/our occupancy of the unit by institution of an action for ejection or other appropriate proceedings. , r Me declare under penalty of perjury that the foregoing Is true and correct. Executed this zfJ day of Kin r•t , 200E in the City orQpt tp(A &_'aC', 1 , California Applicant � Y U � &A�I�AA c Applicant\ Applicant Applicant Rev. S!96 JSignaturc of all persons (except children under the age of IS years) listed in number 2 above required; W F CM7, IMFOPM FOR COMPLETION BY APARTMENT OWNER ONLY: 1. Calculation of eligible income: a. Enter amount entered for entire household in 6 above: b: (1) If the amount entered in 7(c)above is yes, enter the total amount entered in 7(d)(2), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance (2) Multiply the amount entered in 7(d)(i) times the current passbook savings rate as determined by HUD to determine what the total annual earnings on the amount) 7(d)(1) would be if invested in passbook savings ($ _ ), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ (3) Enter at right the greater of the amount calculated under (1) or (2) above: C. TOTAL ELIGIBLE INCOME (line I.a plus line 1.b(3): 2. The amount entered in 1.c: $ '0 Qualifies the applicant(s) as a Moderate -Income Tenant(s). i Qualifies the applicant(s) as a Lower -Income Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenant(s). 3. Number of apartment unit assigned: 2 4'4 6 Bedroom size: 2+2 Rent: 4. This apartment unit (5a2s'was not) last occupied for a period of 31 or more consecutive days by persons whose aggregate anticipated annual income as certified in the above manner upon.their initial occupancy of the apartment unit qualified them as a Lower -Income Tenant(s). 5. Method used to verify applicant(s) income: Employer income verification. , Copies of tax returns. Other( Nrliarl/ .5 ubs , Snving'; r+rzcount 1;'a - of 5 /20 102 Date � _ •-� —. UNIVERS. Y OF CALIFORNIA - IRVINE ACCOUNTING OFFICE 92697 IMPORTANT: PLEASE VERIFY ALL INFORMATION CONTAINED IN THIS STATEMENT AND NOTIFY YOUR DEPARTMENT OF ANY ERRORS. RETAIN THIS STATEMENT AS A RECORD OF EARNINGS AND DEDUCTIONS FROM THE UNIVERSITY. EMPLOYEE ID NO: 090977620 HOME DEPT NO:. 173900 SOCIAL "SECURITY NO: 615-06-1810 EARNINGS STATEMENT ADDRESS: NICOLA VAN NIEUWENHUYSEN COM-MC PSYCHIATRY FED•WTHHLDG: SINGLE 001 ALLOW STATE WTHHLDG: MARRIED 002 ALLOW STATE ITEMIZED: 000 ALLOW PERMANENT ADDRESS: 2446 NAPLES NEWPORT BEACH CA 92660 CUR $3,666.67 1_16E -F7 $660.07 $3,006.60 EAR TO DATE S 4.666.68 S14.666.6 PAY TYPE PEG -POST MD * TOTAL EARNINGS EARNINGS DETAIL PAY RATE TIME 3666.67 1.0000 % * GROSS 3,666.67 3 666.67 PERIOD END DATE 03' 31 DEDUCTION CONTRIBUTION DETAIL DEDUCTIONS COVERAGE AMOUNT AMT TAX-DEF Y-T-D AMT FEDERAL TAX 568.23 2,405.32 CA STATE TAX 58.74 234.96 NRA FED TAX 33.10• * TOTALS * $660.07 $.00 CONTRIBUTIONS * TOTALS * .00 LEAVE HOURS BALANCES AS OF 03 31 BEGIN ACCRUED TAKEN FINAL VACATION .00 .00 .00 .00 SICK LEAVE .00 .00 .0.0 .00 COMP TIME .00 .00 .00 .00 ' PAID TIME OFF .00 .00 .00 .00 0.4-01-02 �3, 666,6 7 X12, 4 yq IODO'oy l _ UNIVERSI OF CALIFORNIA - IRVINE - Hv�COUNTING OFFICE 92697 IMPORTANT: PLEASE VERIFY.ALL INFORMATION CONTAINED IN THIS STATEMENT AND NOTIFY, YOUR DEPARTMENT OF ANY ERRORS. RETAIN THIS STATEMENT AS A RECORD OF EARNINGS AND DEDUCTIONS FROM THE UNIVERSITY. EMPLOYEE ID NO: 090977620 FED WTHHLDG: SINGLE 001 ALLOW HOME DEPT NO: 173900 STATE WTHHLDG: MARRIED 002 ALLOW SOCIAL SECURITY NO: 615-06-1810 STATE ITEMIZED: 000 ALLOW EARNINGS STATEMENT ADDRESS: PERMANENT ADDRESS: NICOLA VAN NIEUWENHUYSEN 2446 NAPLES COM-MC PSYCHIATRY NEWPORT BEACH CA 92660 ORANGE 00941 NET EARNINGS OF $3,006.60 HAS BEEN SENT TO ACCOUNT 24313-03712 AT BANK OF AMERICA FOR THE 03/01/02 PAY DAY. GROSS EARNINGS TAXABLE EARNINGS DEDUCTIONS NET EARNINGS CURRENT $3,666.67 $3,666.67 $660.07 $3,,006.60 YEAR TO DATE $11 000 01 $11 000 01 EARNINGS DETAIL PAY TYPE _ PAY RATE TIME GROSS PERIOD END DATE REG-POST MD 3666.67 1.0000 a 3,666.67 02/28/02 * TOTAL EARNINGS $3,666.67 DEDUCTION CONTRIBUTION DETAIL DEDUCTIONS COVERAGE AMOUNT AMT TAX-DEF' Y-T-D AMT FEDERAL TAX 568.23 1,803.99 CA STATE TAX 53.74 176.22 NRA FED TAX 33.10 * TOTALS * $660.07 $.00 . VACATION .00 .uu .vu .vv SICK LEAVE .00 .00 .00 .00 COMP TIME .00 .00 .00 .00 'PAID TIME OFF .00 .00 .00 .00 03-01-02 0 APPLICANT NAME: _ VRNess F'i VR1y tvicu! u �Huys� SOCIAL SECURITY i# 61 S — O� — «k O In order to continue processing your application for housing, and occupancy of an affordable apartment, the following "Declaration of No Income" must be signed by the person named below. ' Thank you! TO BE COMPLETED BY APPLICANT I, VRtJCSSP% uRPJ N)kQ LOCQ) h U `i C N do hereby certify that I do NOT (Applicant Name) receive income from ANY source. I understand sources of income include, but are not limited to the following: Self Employment SSI Retirement Funds Alimony Income from Assets Educational Graiiis AFDC General Assistance Disability Union Benefits Family Support Work Study J Employment by Other Unemployment Compensation Social Security Worker's Compensation Child Support Annuities/Pensions I understand that should I become gainfully employed or begin receiving income from any sources I must report the information to the r 'dent Manager immediately. 1 certify that the foregoing information is true, complete and correct. Inquiries n.�y be'made to verify the statements therein. I also understand that false statements or omissions are grounds for disqualification and/or prosecution under the full extent of California law. Witness Signature t Date Date f13c11gWWt(71'Y etiiYlYtErd'�4:iu 'v�=�.. P.O. Box 3530 Rancho Cordova, CA 95741.3530 2431 EO-3 IIIIrIn6611JIdII dn111111all III AN VAN NIEUWENHUYSEN DR E 2446 NAPLES NEWPORT BEACH CA 92660-3262 Your Bank Combined Statement of America Account' Statement Date: April 12, 2002 At Your Service 'Call: 714.973.8495, 24 hours, 7 days a week Written Inquiries Bank of American Eastbluff Branch PO Box 37176 San•FraAcisco, CA 94137-0001 Customer since 1998 Bank of America appreciates your business and we enjoy serving you. ❑ Summary of Your Deposit Accounts ❑ Bank of America News Account - Account Number Your Balance VERSATEL Checking 24315-03759 $ 403.92 Regular Savings 24311-00685 3,396.15 Total Balances $ 3,800.07 Online Banking at www.bankofamerica.com lets you bank anytime, anywhere you have Internet access. View updated account information, transfer money, re -order checks and more - all in one secure place. You can even receive and pay your bills online from one easy screen - in just minutes. Get started today at www.bankofamerica,com/bankonline. Renovating? Remodeling? Refurnishing? With a Bank 0f America Equity Maximizer we can help yeu Invest h3.your home and enjoy it more. Log on to ' www.bankofamerica.com/loans to learn more.' ❑ Your VERSATEL Checking Account Account Number: 24315.03759 Statement Period: March 14 through April 12, 2002 Beginning Balance on 03/14/02 $336.71 Total Deposits + 405.95 Total Checks, Withdrawals, _ Transfers, Account Fees - 333.24 Service Charge - 5.50 Ending Balance $403,92 ❑ Important Information About Your Account ' Number of ATM withdrawals and transfers 0 Number of purchase transactions 10 Number of 24 Hour Customer Service Calls Self -Service Assisted VERSATEL Checking customers who take advantage of Direct Deposit can reduce fees every monthl To find out more, contact your employer or visit your local Bank of America banking center. For Social Security or SSI direct deposit, call the Social Security Administration toll -free at 1-800-772-1213. Now you can create a password that protects you when you buy online. Introducing Verified by Visa, the new service that helps'prevent unauthorized purchases before they happen. So what's your password? Visit us at www.bankofamerica.com/verified for more details. Continued on next page 0074309.001.T 1 i California Page 1 of 3 w fty" I INCOME RLSTPLICTED FINANCIAL WORKSHEET Project 41taUpo±%JO4 Unit No. 244 6- Applicant's Name: Van Wkmpntitr45en Annual Salary Others Residing in Unit: 'Van slid,ArPn�OAnnual Salary Annual Salary Annual Salary Commissionst8onuses $ Af Savings Accounts: Bank Anx-r•i rg,_ Balance(, 1,F -x- 7_%= S 67. q 2 Bank Balance x %° = S Bank Balance x %= S interest Bearing Checking Account Bank Balance x Bank Balance x %_ $ Stocks/Bonds: Type Trust Fund: Type Amoun Amount x % = Other: (Alimony, Child support, retirement pensions, social security, disability payments, .parental support, etc.) Show calculation, how Annual is arrived at? Type _' Annual S Type --- _ — Annual S `�--_--.--_--• Type Annual • $ Property Owned By Resident: Equity X—%= S TOTAL ANNUAL ELIGIBLE INCOME s 44f n 67, R 6 Maximuin Annual Household Income Limit S 761204 •-G — 07/25/2015 01:00 FAX C{1.j o 08 New cerdleadon �II_ /Reeerdleadm INC0N7E CO1NVUTATION AND CERTIFICATION Unit Number, Z�.53 NOTE TO APARTMENT OWNER: This form is designed to assist you in computing Annual Income in accordance with the method set forth in the Deparinent of Housing and Urban Project ("HUD') Regulations (24 CFR 813). You should make certain that this form is at all times up to date with the HUD Regulations. All capitalized terms used herein shall have the meaning set forth in the Regulatory Agreement. Re: (NAME and ADDRESS of Apartment Building) Newport Forth' - CSCDA, .(POO L) I/We the undersigned state that Ilwe have read and answered fully, frankly and personally each of the Irclilowing 4uestions for all persons who are to occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit: 1. Name of Members of the Household 2. 3. 4. 5. Relationship to Head of Social Security place of Household Age Number Employment QCMM AnjP 7? - 57 AL9-S4CR--Tourr_n7. . Poo mry } L �2_ y6s-s7-g6a�s tin � � d Income Computation 6. The total anticipated ineoms, calculated in accordance with this paragraph 6, of all, persons (except children tinder 18 years) listed above for the 12-month peic beginning the earlier of the date that I/wo plan to move into a unit or sign a lease for a unit is Se s 6 . 16 .r Included in the total anticipated income listed above are: (a) • all wages and salaries, overtime pay, commissions, fees, tips acid bonuses aid other compensation for personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real of personal property (without deducting expenditures for busies expansion or amordxzdon of capital indebtedness or any allowances for depreciation of Capin assets except for straight 1'me'depreciation as provided Internal Revenue Service regulations): (c) Interest and dividends (including Income from assets included below and other net Income from real or personal property); (d) the full amount of periodic payments received from social security, annuities, 'insurance policies, retirement funds, pensions, disability or death berefi and other sim1hr apes of periodic receipts, including any lump sum payment for the delayed start of a periodic payment; (e) payments in lieu or earnings, such as unemployment and disability compensadon, workers' compensation and severance pay; (1) the maximum amount of public assistance available to the above persons md:er than the amount of any assistance specifically designated for shelter ar utilities plus the maximum amount that the public assistance agency could in fact allow for shelter and u:ilides; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not resids In the dwelling; (h) all regular pay, snxcial pay and allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the head or the household < spouse (or other persons whose dependents arc residing in the units); and (i) any earned income tax credit to the extent that it exceeds income tax liabilirv. Bxeluded from such anticipated income are: (a) casual, sporadic or irregular gifts; (b) amounts which arc sp.eifncaliy for or in reimbursement of medical expenses; (c) lump sum additions to family assets, such as inheritances, insurance payments (including payments under health and accident insurance and worker compensation), capital gauze and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational insdation, and amounts paid by the govemmen: to a veteran for use meeting the costs of tuition, fees, boos and equipment. Any amounts of scch scholarships or payments to veterans not used for the above purposes a. to be included in income; (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (0 amounts received under training programs funded by HUD; (g) foster child care payments; (la) amounts received by a disabled person that are disregarded for a lir. _d dme for purposes of Supplemental Security Income eligibility and benefits beer_ they are set aside for use under a Plan to Arvin Self -Sufficiency; (I) Income of a live-in aide; 0) amounts received by a participant in other publically assisted pros ra-s which are specifically for or in reimbursemenc of out-of-poe::at expenses ime—, and which are made solely to allow participation in a specific program; (k) a resident service stipend (a modest &.mount (not to exceed S200 per month) received by a resident for performing a service for the owner, oma par.-i basis, that enhances the quality of life in the development; ' If this form Is being completed In accordance with recertification of a Lower Income Tensm's or Very Low Income Tenant's occupancy of Lower Income Unit of a very Low Income Unit, respecnvcly, this form nua be eomplcad ba;cd upon ale current income of the eccepoaen. a Mc.oamccsoae 07/25/2015 01:01 FAX IM004 (1) compensation from state or local employment training programs and training of a family member as resident management staff; (m) reparation payments paid by a foreign gavemment pursuant to claims filed under the laws afthat gos•emmcnt by persons who were persecuted during the Nazi era; (n) amounts specifically excluded by any other federal statute from consideration at income farpurposes ofdetemrining eligibility or benefits under a catego, of assistance programs that includes assistance under the United States Housing Act of l937; (a) earnings in excess ofS4S0 for each full -ten student IS years old or older (excluding the head of household and spouse); (p) adoption assistance payments in excess orS430 per adopted child; and (q) deferred periodic payments of supplemental security income end social security benefits that are received in a Jump sum payment; (r) amounts received by the family in the form of refunds orrbates understate or local Jaw for property taxes paid on the duelling unit; (s) amounts paid by aState agency to a family with a developmentally disabled family member living at home to offset the cost of services and equipment needed to ):cep the developmentally disabled family member at home; and (t) amounts specifically excluded by an other fedemistatutefrom consideration asincome forpurposesofdelenining eligibility orbenefits under acategory of assistance programs that includes assistance under the United States Housing Act of 1937. , 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in rcil property or other farm of capital investment(excluding the values ofnecessary• items of personal property such as furniture and automobiles and interests in Indian trust land) . X. Yes No; or (b) have they disposed oran assets (other than at a foreclosure or bankruptcy sale) during the last two years at less than fair market value? Yes 6 No (c) If the answer to (a) or (b) above is yes, does the combined total value of all such assets owned or disposed of by all such persons total more than S5,000? Yes J: No (d) if the answer to (c) above is yes, state: (1) the combined total value of all such assets: S (2) the amount of income expect to be derived from such assets in the 12-month period beginning on the date of initial occupancy in the unit that you propose to rent: SI, and ��// (3) the amount ofsuch income, If any, that was included In item 6 above: S A S. (a) Are all of the individuals who propose to reside in the unit full-time students'? Yes •� No •A full-time student is an Individual enrolled as a full-time student during each ors calendar months during the calendar year in which occupancy of the unit begins at an educational organization which normally maintains a regular faculty and curriculum and nonally has a regulatly enrolled body of students in attendance or is an individual pursuing a full-time course of Institutional or farm training under the supervision of an accredited agent of such an educational organization or of a state or political subdivision thereof, (b) If the answer to S(a) is yes is at least 2 ofthe proposed occupants of the unit a husband and wire entitled to file ajoint federal Income tax return? Yes__�I;o 9. Neithermyselfnor any other occupant of the trait Uwe propose to rent is the owner of the rental housing project in which the unit Is located (hereinafter the "Owner'). has any family relationship to the Owner; or owns directly or Indireedy any Interest in the Owner. For purposes of this paragraph, Indirect ownership by on individual shall mean osnership by a family nember, ownership by a corporation, partnership, estate or trust in proportion to the ownership or beneficial Interest in such corporation, partnership, estate or Trustee held by the Individual or a family member; and ownership, direct or indirect, by a partner -of the individual. yJ 10• This certivicate is made with the knowledge that It will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and Uwe declare that all information set forth herein is true, correct and complete and based upon information I/we deem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. II. Inve will assist the Owner in obtaining any information or documents required to verify the statements made herein, including either an income veriOeation from my/our present enployer(s) or copies of federal tar returns far the immediately preceding calendar year. 12. I/1S'e acknowledge that Ills: have been advised that the marling of any misrepresentation or misstatement In this declaration will constitute a material breach of my/our agreement with the Owner to )ease the unit and will cridde the Owner to prevent or terminate my/our occupancy of the unitby institution ofari action for ejection or other appropriate proceedings. INie declare under penalty of perjury• the! the foregoing is true and correct. Executed this 10 day of AULW 200.2, in the City of 1 1 r oz!. L` j?eot.Yt •. California Applicant Applicant Applicant Applicant es'• 8195 lSignature o(all persons (except children under the age of 7g Years) listed in number: nbova required! n, µ1CAJVr Icc•ok%[ 07/25/2015 01:01 FAX 1a005 FOR COI2LETION BY APARTMENT OWNER ONLY: Calculation of eligible income: a. Enter amount entered for entire household in 6 above: (1) If the amount entered in 7(c)above is yes, enter the total amount entered in 7(d)(2), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ ); (2) Multiply the amount entered in 7(d)(1) times the current passbook savings rate as determined by HUD to determine what the total annual earnings on the amount in 7(d)(1) would be if invested in passbook savings ($ rG ), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ (3) Enter at right the greater of the amount calculated under (1) or (2) above: C. TOTAL ELIGIBLE INCOME (line La plus line U(3): 2. The -amount entered in l.c: Qualifies the applicant(s) as a Moderate -Income Tenant(s). X Qualifies the applicant(s) as a Lower -Income Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenant(s). $ 4Gf 636.36 $ l+ $146, 636.36 3. Number of apartment unit assigned: .26 $ 3 Bedroom size: 2 +2 Rent: $ (i 2 $G 4. This apartment unit (tvas/was not) last occupied for a period of 31 or more consecutive days by persons whose aggregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartmen: unit qualified them as a Lower -Income Tenant(s). S. Method used to verify applicant(s) income: is Employer income verification. Copies of tax returns. I/ Other( Pcvwn }al SU�oov i i �l e' ) S /ZO /r 2 Manager \ {J Date u.Avc rm ice.eanv 07/25/2015 01:01 FAx Qj007 FROM :PAK FAX NO, :714-201-0475 "-Sep. 03 2002 06:SSPM P1 ' a 1 J.I Apartment ,Applicant'srfgize4 \ Your employeehas applied for a rental unit'located on a property finan.wd under the City' a Multifamily Rental MttsingPsogram. We'afeobligedtostringentiyverlfy,income statements on all prospective residents for such apartments, xg,.rE TO RMP>AY cT Please Indicate your employee's Start Date, current annual income Oumbars anlyl from wages, overtime, bonuses, commissions or any other form Of compensation received owa regular basis: r 2ST,412T DMA YT) WAG•rS gymmm Pik— . = amuses , . a /A ' carussrox, s_ ±f P �:oTALenRaxilT1XC 7gP s- 1 .5 i hereby certify that the amounts above are true and complete to the best ofmy knowledge. rf�a/dam. `,d•��' l±m o r s re 7�a----- to •— • Title 1 hereby grant you permission to disclose my income in order thattltey may determine Rental T-lincome eligibility for the rental of an Reapartment financed under the clty's Multifamily ousing Program. S'�zO%ax. Applicant's Signature ---Tate mh.v,,. Ii.750-2.75n+636,36x12 =•�-1,636.36 08/01/2015 01:39 FAX 2002 PARENTAL / FAMILY SUPPORT Resident: a �r-6 ^ d Address: 2 6 Y3 3 aAA VKarrro Community: VAv`tt \ I/We'will contribute $ 33 d o o per ,year to the above referenced resident. ' . I/We declare under penalty of perjury that the foregoing is true and correct. This information is made with the knowledge that it will be relied upon by the Owner to determine maximum income for eligibility to occupy the above mentioned apartment. And I/We declare that all information set forth herein is true, correct and complete. Executed this so day of "e v sl , 20 o z-------------- . Signature Supp.Lelter 07/25/2015 01:01 FAX Im 00s DECLARATION OF NO INCOME APPLICANT NAME: SOCIAL SECURITY # 5rZ6— S-7 -- q 6 q B' In order to continue processing your application for housing, and occupancy of an affordable apartment, the following "Declaration of No Income" must be signed by the person named below. ' Thank you! TO BE COMPLETED BY APPLICANT I, T7@JU NK N No, do hereby certify that I do NOT (Applicant Name) receive income from ANY source. I understand sources of income include, but are not limited to the following: Self Employment SSI Retirement Funds Alimony Income from Assets Educational Grants AFDC General Assistance Disability Union Benefits Family Support Work Siudy Employment by Other Unemployment Compensation Social Security Worker's Compensation Child Support Annuities/Pensions I understand that should I become gainfully employed or begin receiving income from any sources I must report the information to the Resident Manager immediately. 1 certify that the foregoing information is true, complete and correct. Inquiries maybe made to verify the statements therein. I also understand that false statements or omissions are grounds for disqualification and/or prosecution under the full extent of California law, Signature Date elMtla2 Witness Sig ature Date 07/25/2015 01:02 FAX Account Statement Statement Date: July 19, 2002 Page 4 of 5 049-6085887 298,203 WelisExtra Savings Richard Ro Account Number: 644-9914654 Activity stunmary Balance on 06/20 $0.00 Deposits and interest 0.00 Witlidrawals - 0.00 B;ilance on U7/19 .. $0.00 Interest you've earned Interest earned during this period $0.00 Average collected balance this period $0.00 Annual percentage yield earned 0.00% Interest and bonuses paid to date this year $0.00 IM 009 07/25/2015 01:01 FAX Lim 1 . INCOME RESTRICTED FINANCIAL'WORKSHEET Applicant's Name: Reri1AYY`) i3O Annual Salary Others Residing in Unit: '© rihm;n Cam._ Annual Salary JJ Annual Salary Annual Salary $_ 71 636.36 r Commissionsmonuses S. Savings Accounts: Bank Wpjjjq Fy. Balance_x_Z%= $ •Bank Balance x %_ S Bank Balance x %_ $ Interest Bearing Checking Account Bank Balance Bank Balance x %= $ Stocks/Bonds: Type _ S Amount x % = S Trust Fund: Type Amount x % = S Other: (Alirribny, Child support, retirement pensions, social security, disability payments, .parental support, etc.) Show calculation, how Annual is arrived at! Z Type Phyy n4al e u,)*W srl Annual $ 33 F OOO . OCr— Type Annual S Type _ Annual $__ Property Owned By Resident: Address a Equity x_%= S TOTAL ANNUALELIGIBLEINCOME $ 40. MaximumAnnunllfouscholdIncome Limit S. 9?j 3?H,00_" " 10/30/2002 14:27 FAX 9497201598 NEWPORT NORTH IM 002 New Certifrearfon /Recertification _ INCOME COiVII'UTATION AND C NOTE TO APARTMENT OWNER: This form is designed to assist you in computing A Department of Housing and Urban Prq ect ("HUD") Regulations (24 CFR 813). You sh( the HUD Regulations. All capitalized terms used herein shall have the meaning set fort Re: (SAME, and ADDRESS of Apartment Building) Newport North - CS+ UWe the undersigned state that Uwe have read and answered fully, frankly and personall occupy the unit being applied for in the above apartment project. Listed below are the 1. 2. 3. Name of Members Relationship of the to Head of Household Household Age (_ i\lill I6rslrinc-6rI 1iU)1 nA Cp i i s abi AIn thine! _ kart, _133 Income Computation 6. The total anticipated Income, calculated in accordance with this paragraph 6, of all persons ( beginning the earlier of the date that Uwe plan to move into a unit or sign a lease for a unit Included in the total anticipated income listed above are: (a) all wages and salaries, overdme pay, commissions, fees, rips and bonuses and other col (b) the net income from the operation of a business or profession or from the rental of real o expansion or amortization of capital indebtedness or any allowances for depreciation of Internal Revenue Service regulations); (e) interest and dividends (including Income from assets included below and other net incor (d) the full amount of.periodic payments received from social security, annuities, insurance and other similar types of periodic receipts, including any lump sum payment for the de (e) payments in lieu of earnings, such as unemployment and disability compensation, work! (0 the maximum amount of public assistance available to the above persons other than the utilides plus the maximum amount that the public assistance agency could In fact allow 1 (g) periodic and deterrninable allowances, such as alimony and child support payments and re in the dwelling; (h) all regular pay, special pay and allowances of a member of the Armed Forces (whether to spouse (or other persons whose dependents are residing in the units); and (i) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; (b) amounts which are specifically for or in reimbursement of medical expenses; (c) lump sum additions to family assets, such as inheritances, insurance payments (•mcluda compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational Instimd, meeting the costs of tuition, fees, books and equipment. Any amounts of such scholarshi to be included In income; (c) hazardous duty pay to a household member in the Armed Forces who is away from horn (0 amounts received under training programs funded by HUD; (g) foster child care payments: (h) amounts received by a disabled person that are disregarded for a 1-united time for purposes e they arc set aside for use under a Plan to Amain Self -Sufficiency; (i) income of a live-in aide; 0) amounts received by a participant in other publically assisted programs which are specifics and which are made solely to allow participation in a specific program; ' (k) a resident service stipend (a modest amount (not to exceed $200 per month) received by a basis, that enhances the quality of life in the development; tf dris form is being completed in accordance with recertification of a Lower Income Teunt's or Very Low Income Income Unit, respec(ively, this form meat be completed based upon the current income of the occupants. U Unit Number 3 1;7TIFICATION fml Income in accordance with the method set forth in the 11 make certain that this form is at all times up to date with in the Regulatory Agreement. DA (POOL) of the following questions for all persons who are to of all persons who Intend to reside in the unit: 4. ' 5. I Security Place of smber Employment q 36 Osa� 18 years) listed above for the 12•month period ion for personal services, before payroll deductions; rat property (without deducting expenditures for business assets except for straight line'depreciadon as provided in from real or personal property); )Iicles, retirement funds, pensions, disability or death benefits rod start of a periodic payment; ' compensation and severance pay; mount of any assistance specifically designated for shelter and shelter and utilities; lar contributions and gifts received from persons not res!.dicg living in the dwelling) who is the head of the household or payments under health and accident insurance and worker; and amounts paid by"the government to a veteran for use in or payments to veterans not used for the above purposes a-e and exposed to hostile fire; Security Income eligibility and benefits becaese for or in reimbursement of out-af-pocket expenses incurred dent for performing a service for the owner, on a par;•:ia:e occupancy of lower Income Unit or a Very Low oa nstc.vm.rcc.rosss 10/30/2002 14:27 FAX 9497201598 NEWPORT NORTH [a 003 (i) compensation from state or local employment training programs and training of faro (in) reparation payments paid by a foreign government pursuant to claims filed under the In Nazi era; (n) amounts specifically excluded by anyother federal statute from consideration as Income ofassistance programs that includes assistance under the United States Housing Act of (o) earnings in excess ofS480 for each full -term student 18 years old or older (excluding t (p) adoption assistance payments in excess of5430 per adopted child; and (q) defamed periodic payments of supplemental security income and social security bench (r) amounts received by the family, In the form of refunds or rebates understate or local In (s) amounts paid by a State agency to a family with a developmentally disabled family rat needed to keep the developmentally disabled family member at home; and (t) amounts specifically excluded by an other federal statute from consideration as income I of assistance programs that includes assistance under the United States Housing Act of 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment w furniture and automobiles and interests in Indian trust land) Yes (b) have they disposed ofany assets (other than at a foreclosure or bankruptcy sale) during Yes 1( No (c) If the answer to (a) or (b) above is yes, does the combined total value of all such assets Yes ---,X_No (d) If the answer to (c) above is yes, state: (1) the combined total value of all such assets: S 11 (2) the amount of income expected to be derived from such assets In the 12-month pe propose to rent: S V , and (3) the amount of such income, if any, that was Included in item 6 above: S Are all of the individuals who propose to reside In the unit full-time students*? 'A full-time student is an individual enrolled as a full-time student during each of cah unit begins at an educational organization %hich normally maintains a regular fatuity and in attendance or is an individual pursuing a full-time course of institutional or farm b educational organization or of a state or political subdivision thereof. (b) If the answer to 8(a) is yes, is at least 2 of the proposed occupants of the unit a husband Yes X No member as resident management staff; of that government by persons who were persecuted during the r purposes of determining eligibility or benefits under a cat,"on• t37; head of household and spouse); that we received in a lump sum payment; for property taxes paid on the duelling unit; fiber living at home to offset the cost of services and equipment purposes of determining eligibility or benefits under a category the values of necessary items of personal property such at less than fair market value? ofby all such persons total more than $5,000? beginning on Ore date of initial occupancy In the unit that you Yes --.,Y No r months during the calendarycar in which occupancy of the Iculum and normally has a regularly enrolled body of students ig under the supervision of an accredited agent of such an wife entitled to file ¢joint federal income tax return? 9. Neither myselfnor any other occupant of the unit Uwe propose to rent is the owner of the rental houeng project in which the unit is located (hereinafter the "Owner"). has any family relationship to the Owner; or owns directly or indirectly any interest in the Owner. For purposes of this paragraph, indirect ownership by an individual shah mean ownership by a family member, ownership by a corporation, partnership, esKK a�te or trust in proportion to the ownership or beneficial interest in such corporation, partnership, estate orTrustee held by the Individual or a family member; andpw•nership, direct or indirect, by a partner ofthe individual. c 10. Ibis certificate is made with the knowledge that it will be relied upon by the Owner to determine maximum Income foreligibilin• to occupy the unit; and Uwe declue, that all information set forth herein is true, correct and complete and based upon information Mve teem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deerped necessary. ] I. I/we will assist the Owner in obtaining any information or documents required to verify the statemznts made herein, including either an income verifiea0on front my/our present ernployer(s) or copies or federal tax returns for the immediately preceding calendaly year. 12. I/N%'e acknowledge that I/we have been advised that the making of any misrepresentation or misst Itemenl in this decivation will constitute a material breach of my/our agreement with the Owner to lease the unit and will entitle the Owner to prevent or lermina a my/our occupancy ofthe unit by institution of an action for ejection or other appropriate proceedings. ; Me declare under penalty of perjury that the foregoing is true and correct. Executed this 10111 day of a I S—�' , 200in the 4Aporlc, Applicant Rev. 8/95 ISignature ofan persons (except children niOU/ 1�SY"}"' l�nc.Lr , CnliTm'ra the age of 18 years) listed in number above rcquiredl Ul MICo. 'V ICC.M&" 10/30/2002 14:28 FAX 9497201598 NEWPORT NORTH ID 004 FOR COMPLETION BY APARTMENT OWNER ONLY: Calculation of eligible income: a. Enter amount entered for entire household in 6 above: b. (1) If the amount entered in 7(c)above is yes, enter the total anl.ount entered in 7(d)(2), subtract from that figure the amount enterl9d in 7(d)(3) and enter the remaining balance (2) Multiply the amount entered in 7(d)(1) times the current pass savings rate as determined by HUD to determine what the annual earnings on the amount in 7(d)(1) would be if invest passbook savings ($ _ ?i ), subtract from that f the amount entered in 7(d)(3) and enter the remaining balan AL._), (3) Enter at right the greater of the amount calculated under (1) or (2) above: C. TOTAL ELIGIBLE INCOME (line La plus line I.b(3): 2. The amount entered in I.c: Qualifies the applicant(s) as a Moderate -Income Qualifies the applicant(s) as a Tower -Income X Qualifies the applicant(s) as a Very -Low Income 3. Number of apartment unit assigned: 3 2 3 Bedroom size: 4. This apartment unit (5hyas not) last occupied for a period of 31 aggregate anticipated annual income as certified in the above manner ul qualified them as a Lower -Income Tenant(s). 5. Method used to verify applicant(s) income: x Employer income verification. Copies of tax returns. Other ( �— Manager Date ($ $_ 271&5q.72 $ 27, MS 9. 72 Rent: $ 737 more consecutive days by persons whose their initial occupancy of the apartment unit /a2 a net MVIMFOM • 10/30/2002 14:28 FAX 9497201598 Project. New0w+ KloA Unit No. 1223 Applicant's Name: Others Residing in Unit: NEWPORT NORTH INCOME RES' FINANCIAL WC Savings Accounts: Bank — Balance Bank Balance Bank —Balance— Interest Bearing Checking Account Bank Bank Stocks/Bonds: Type Balance Trust Fund: Type Amount x_ Other: (Alimony, Child support, retirement pensions, social securit parental support, etc.) Show calculation, how Annual is ar Type Type Type Property Owned By Resident: Address Equity TOTAL ANNUAL ELIGIBLE Q 005 ISalary S I Salary $ Salary $ Salary S disability payments, ived at! Annual S Annual S Maximum Annual Household Income Limit % = S niE $ 27 AS� - 72 s 47�G2$.•tro. 10/30/2002 14:28 FAX 9497201598 NEWPORT NORTH CO. FILE DEPT. CLO' NUMBER UNV 009906 0000103303 1 OSWALD 8, YAP A PROFESSIONAL CORPORATION 16148 SAND CANYON IRVINE, CA926f8 949 788.8900 Taxable Marital Status: Single Exemptions/Allowances: Federal: 7 State: 7 Social Security Number. 560-88.6895 Earnings rate hours this period year to date Regular 1153.53 1,153.53 1f53,>pay,',: .1,„ "• , 11353;5KI` 16,149.42 Deductions Statuto Federal income Tax -14.32 200.48 Social Security Tax -71.51 1,001.26 Medicare Tax -16.73 234.17 CA State_Income Tax -5.60 78.40 CA SU116DI Tax -10.38 145.34 Other Dentine -17.81 249.34 401K -25.00* 350.00 * Excluded from federal taxable wages Your federal taxable wages this period are $1,128.53 IF, EarStatement �> > t 0 Period 1Beginning: 07/1612002 Period Ending: 07/31/2002 Pay Dgte: 08/01/2002 NINA}}M BUONCRISTIANI 1323 ARTEGENA #T-4 NEWPOSIT BEACH CA 92660 I 0 461 lyq,t�2 ; 7 _ �2/3a7,o6 X 12 27149 .7P 10/30/2002 14:28 FAX 9497201598 NEWPORT NORTH CO. FILE DEPT. CLCC^" NUMBER UNV 009906 0000103287 1 OSWALD & YAP A PROFESSIONAL CORPORATION 16146 SAND CANYON IRVINE, CA92618 949 788-8900 Taxable Marital Status: Single Exemption s/Allowances: Federal: 7 State; 7 Social Security Number. 56&88.6895 Earnings rate hours this period year to data Regular 1153.53 1,153.53 14,995.89 Deductions Statutory Federal Income Tax -14.32 186.16 Social Security Tax -71.52 929-75 Medicare Tax -16.73 217.44 CA State.Income Tax -5.60 72.80 CA SUI/SDI Tax -10.38 134.96 Other A-400.00 Denins -17.81 231.53 401K-25.00* 325.00 * Excluded from fei Your federal taxabl $1,128.53 Period Period Pay D NINP 1323 #T•4 NEW IM007 s Statement Sinning: 07/01/2002 ling: 07/15/2002 07/16/2002 BUONCRISTIANI RTEGENA IT BEACH CA 92660 t-; Fug , . 10/30/2002 14:28 FAX 9497201598 NEWPORT NORTH IM 008 `.: APPLICANT NAME: SOCIAL SECURITY # In order to continue processing your application for housing, and oa following "Declaration of No Income" must be signed by the person Thank you! TO BE COMPLETED BY APPLICANT I, - ` fAw11j! do hereby (Applicant Name) receive income from ANY source. I understand sources of income ins of an affordable apartment, the below. that I do NOT but are not limited to the following: Self Employment AFDC Employrent by Other SSI General Assistance Unemployment Compensation Retirement Funds Disability Social Security Alimony Union Benefits Worker'sCompensation Income from Assets Family Support Child Support Educational Grants Work Study Annwdesi+Pensions I understand that should I become gainfully employed or begin receivinglincome from any sources I must report the information to the Resident Manager immediately. I certify that the Ifibregoing information is true, complete and correct. Inquiries may be made to verify the statements therein. I lilso understand that false statements or omissions are grounds for disqualification and/or prosecution under the fufil extent of California law. 6tgnaturrgnat/ure � Date Witness Date Z IRVINE APARTMENT MANAGEMENT COMPANY March 13, 2003 City of Newport Beach P.O. Box 1786 Newport Beach, CA 92663-3884 Attn: Daniel Trimble Program Administrator PLANNINGEIVED DEPABy RTMENT CITY pF nIF1n10nR-r gEACFI AM MAR 21 2003 PM 7181911011211�(� I�I�I`�16(6 RE: Affordable Housing Reporting — Newaort North Project Agreements to Provide and Maintain Affordable Housing "North Ford Development Agreement" dated 4/22/85 Exp. 324/11 Dear Ms. Teague: Pursuant to the terms of the above referenced agreements, we, as agents for the owners of this property are responsible for qualifying residents as "Affordable Residents." Enclosed you will find the income computations and certifications, as well as other documentation on which we have relied to qualify new residents as "Affordable." This reporting covers new move -in during January 2003. Should you have any questions, please do not hesitate to call me at (949) 450-4290. Sincerely, Yvette M. Machan Bond Compliance Auditor Irvine Apartment Management Company 43 Discovery, Suite 150, R.O. Box 57060, Irvine, California 92619-7060 • (949) 450.4262 • Fax (949) 450-5802 EXHIBIT C Pro er Name: New ort North ♦aT nnNrvT.TAN AS OF January 2003 The undersigned, being an Authorized Borrower Representative of Irvine Apartment Communities, L.P. (the `Borrower"), has read and is thoroughly familiar with the provisions of the various documents associated with the Borrower's participation in the California Statewide Communities Development Authority's (the "Issuer") Apartment Development Revenue Bond program, such documents including: vc Cove 1 The dated as ofdMay 5ed and R1998 among the Borrower, the Issuer and U.S. Bank Trusestated Regulatory Agreement and De Is a on Of Res ctNational is Association (the 17rustee'�. 2. The Loan Agreement dated as of May 15, 1998, between the Issuer and the Borrower. 3. During the preceding month .7- applications were received from Restricted Tenants (as defined in the Regulatory Agreement): 4. As of the date of this certificate, the following percentages of completed residential units in the Project (i) are occupied by Restricted Tenants, or (ii) are currently vacant and are being held available for such occupancy and have been so held continuously since the date such unit was vacated, as indicated: 1 2 3 Studio Bdrm. Bdrm. Bdrm. Total Occupied by Original' 12 Low Income Tenants N/A U 7 5 2.11% Unit Nos.: Occupied by Lower 3 73 Income Tenants N/A 28 42 12.81 % Unit Nos.: Occupied by Very 29 Low -Income Tenants N/A 14 15 5.08% Unit Nos.: Held vacant for O Occupancy continuously N/A 0 0 Since last occupied: 0.00% Unit Nos.: Total Number of Units: 114 20_00% Unit Nos.: N/A 42 64 8 Since last occupied: • *1141 dId not comp6y with re-certi, fuation andwilr6e removedfivm the (Bondpmpam The undersigned hereby certifies that the Borrower is not in default under any of the terms and provisions of the above documents, and no event has occurred which, with the passage of time, would constitute a default thereunder, with the exception of the following: THE IRVINE COMPANY Irvine Apartment Management Company By: Brian R Schaefgen Controller Contact Person: Yvette Machan Bond Compliance Auditor (949) 450-5841 IRVINE APARTMENT MANAGEMENT COMPANY BOND SUMMARY JANUARY 2003 MOVE IN IRVINE APARTMENT MANAGEMENT COMPANY BOND SUMMARY JANUARY 2003 MOVE IN 27. 1104 Mcconne 1+1 2 8/13101 51172.6 1160 8/03 28. 1106 Meyer 1+1 1 7/08/00 35508.7 1160 7/03 29. 1107 Aviles 1+1 4 08/23/01 23416.2 884.25 08/03 30. 1108 Romero/Serrano 2+2 5 11/05/01 56534.9 1026.75 11/03 31. 1118 Hardison 1+1 2 01/18/03 37171.60 1160 01/04 32. 1122 Hales 2+2 2 7/13/98 33262 1361 7/03 33. 1128 DelFante 3+2 4 11/06/99 83456.1 1512 11103 34. 1141 Holder 2+2 1 01/26/96 1 37600.00 1361 01103 35. 1144 Sepeluband 1+1 1 11/16/00 14022 1160 11/03 36. 1145 Axelrad 1+1 1 8/30/00 41424.2 1160 8/03 37. 1154 Pilon 2+2 1 01/15/03 42037.55 1361 01/04 38. 1159 Tochluck 1+1 2 12/15/02 38411.79 1210 12/03 39. 1183 Patter 1+1 2 611196 34907.7 1113 06/03 40. 1184 Olson/Ammann 2+2 2 6/7/02 45968.5 1361 06103 41. 1200 Wood 2+2 3 08/04/01 48871.2 1361 1 08/03 42. 1203 Gallicano 2+2 1 11/07/01 37729.53 1280 1 11/03 43. 1206 Bottiaux 2+2 2 10/19/02 34927.08 1361 10/03 44. 1207 Robbs/Fer on 2+2 2 7/14/96 49945 1361 7/03 45. 1231 andelbaum 1+1 1 12/2 99 35627.51 1210 12/03 46. 1408 Amor 2+2 2 08/15 02 18258.3 1361 08/03 47. 1411 Loranger 2+2 1 02/22/02 40,491 1326 02/03 48. 1412 Fu'ioka 2+2 1 7/10/98 44371 1361 7/03 49. 1418 Lee 1+1 2 7/12/02 1 34902 1160 07/03 50. 1441 Gerry 1+1 2 12/08/01 1 60834.24 1210 1 12/03 51. 1444 Dou las 2+2 1 2112199 50147 1326 2/03 52. 1502 Smith 2+2 4 3/31/96 64615.4 1306 03/03 53. 1557 Graves 1+1 1 2/12/02 212103 39500 1.179 02/03 54. 2116 Zitharson 2+2 1 03/29/02 19280 1326 03/03 55. 2123 Ross 1+1 3 11/16/01 49894.73 1210 11/03 56. 2134 Huish 2+2 3 9111199 22574.2 1361 9/03 57. 2212 Riedelsheimer 2+2 1 3 08/20/02 37,604 1326 8/03 58. 2224 An'ozian 1+1 1 5/27/98 1 35210 1160 5/03 59. 2225 Ziese 1+1 2 01/10/03 37713.74 1210 01/04 60. 2226 Syrquin 2+2 1 12/17/96 21458.48 1361 12/03 61. 2301 Aithen/Mchu 2+2 2 05/10/01 39661.38 1361 01/04 62. 2309 Harney 1+1 1 11/23/02 39418.03 1210 11/03 63. 2312 Nam 2+2 1 01/11/00 52800 1326 01104 64. 2322 Marino 1+1 1 8/8/96 15840 1115 8/03 65. 2402 Westbrook 2+2 1 2 12/21/02 28289.27 1361 12/03 66. 2423 Malkin 2+2 1 2 8/23/96 1 24000 1280 8/03 67. 2426 McKee 2+2 12 614/02 21108 1020.75 6/03 68. 2507 Bora 2+2 3 01/31/03 49572.00 1280 01/04 69. 2612 Van Nieuwenhu a 2+2 3 08/08/02 44067.9 1361 08103 70. 2628 Fa azfar 3+2 1 12/10/01 43583.62 1512 12/03 71. 2633 ChunWRo 2+2 2 08/20/02 40636.3 1280 08/03 72. 2719 Fuller 1+1 1 6/10102 35000 1160 6103 73. 2720 Larson 1+1 1 1 10/10/99 156922.3 1160 1 10/03 VERY LOW (Phase In -beg IRVINE APARTMENT MANAGEMENT COMPANY BOND SUNQAARY JANUARY 2003 MOVE IN NEWPORT NORTH Apt. Address Resident Name Size # of I Occ. M/I Date M/O Date House Income Rent Recert Due 1. 106 Lausen 1+1 1 4/11/98 $33886 $ 737 4/03 2. 122 Galla i 2+2 2 01/05/01 $12205.00 $ 851 01/04 3. 126 Francis/Vidal 2+2 4 12/28/00 $49393.92 $ 845 12/03 4. 208 Tarta lini 1+1 2 -04/01/01 $27444 $ 696 04/03 5. 224 Rice/Harris 1+1 2 8/l/99 $30219 $ 737 8/03 6. 228 Jones 2+2 2 518199 1 $22 336 S 829 5/03 7. 243 Batts 1+1 1 511199 $24154 S 737 5103 8. 301 Francis 2+2 1 2 2/08/02 $26399 $ 783 02/03 9. 318 Radford 1+1 1 7/8199 $23430 $ 737 7/03 10. 320 McGinley 1+1 1 4116199 $8 467 $ 737 4103 11. 333 Saporowski 1+1 1 2/3/01 $30 000 $ 737 2/03 12. 1180 Siroonian 1+1 1 4/7/02 $24 542 $ 737 04/03 13. 1323 Buoncristian 1+1 3 11/10/01 $27684.77 $ 737 09103 14. 1324 Hale 2+2 1 4/1/01 $25819 $ 851 04/03 15. 1333 Stork 1+1 1 9/7/02 $23068 $ 756 09/03 16. 1419 Mino 1+1 1 5106101 $21600 $ 696 5103 17. 1530 Siddi i 1+1 3 61111,,00 $46249 . S 737 06103 18. 2128 Johnston 2+2 2 618100 $24636 $ 829 06/03 19. 2140 Vise 2+2 1 02/01/02 $24000 S 829 OV03 20. 2210 Ferro 2+2 2 01/12/03 $26030.00 $ 851 01/04 21. 2300 Mohler 2+2 3 6/.1199 $25263 $ 829 06/03 22. 2408 Shoerbi/Motta 2+2 2 5/12102 25984 $ 851 05/03 23. 2425 Uchida 2+2 1 3 04/11/01 $12402 $ 783 04/03 24. 2428 Winslett 2+2 1 03/17/00 $23500 $ 829 3/03 25. 2440 Afshar 2+2 2 05/06/01 $15424 $ 783 05103 26. 2450 Warfleld 1+1 1 4111198 $8827 S 737 4/02 27. 2519 Cotter 1+1 1 5/29/Ol $25410 $ 737 5103 28. 2608 Vidal/Gaxioht 2+2 2 611199 $25426 $ 829 06/03 29. 2702 1 Delgado 2+2 4 1 3/1/02 S25200 S 829 03/03 1998 Phase in-106-122-224-318-320-2450 1999 Phase in- 228-243-1180-2608-2300-126 2000 Phase in - 2428-1333-2519-1530-2128 2001 Phase in - 333-208-1323-2425,1419,2140,2440,305 2002 Phase in- 2210,2408,2140,2702,1324 Total number of apartments on this property: 570 % of property deemed Income Restricted (Low): 15.26% % of property deemed Income Restricted (Very Low): 4.74% TTP = Total Tenant Payment (Resident is on Certificate or Voucher) Total vacant as of 0 1/31/31 - 29 New cerdfrcadon —X_/Recerfirieadon INCOME COMPUTATION AND CERTIFICATION Unit Number• 2 I O NOTE TO APARTMENT OWNER: and Urban iTihis form is designed to assist you In computing Annual Income In accordance with the method set forth I. Department HUD Regulations. All capitalized erms us d he herein shall hRegulations ave the meaning set forthiin ttheRegulatory Agreemin that this ents at ail Canes up to date Re: (NAME and ADDRESS of Apartment Building) Newport North - CSCDA, (P®OL) IrWe the undersigned state that I/we have read and answered fully, frankly and personally each of the following•4irestions for all persons who at occupy the unit being applied for in the above apartment project. Listed below are,the names of all persons who intend to reside in the unit: 1. Name of Members of the Household s< a 2. Relationship to Head of Household gp � 3. Age _5 iy. 4. Social Security Number SA4 -3e- OOu? NrylP Income Computation ;I Place of Employment raoc P*1R kia= Nbele 6. The total anticipated Income, calculated In accordance with this pazagrapli 4, of all persons (except children under IS years) listed above for the 12-month p beginning the earlier of the date that Uwe plan to move Into a unit or signs lease for a unit is $ ZE Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, eomalss!ons, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net Income from the operation of a business or profession or from the rental of real of personal property (without deducting expenditures for bus! expansion or amoriaadon of capital Indebtedness or any allowances for depreciation of capital assets except for straight llne'depreclation as provid- Internal Revenue Service regulations); (a) Interest and dividends (including Income from assets included below and other net income from real or personal properly); (d) the full amount of periodic payments received from social security, annuldes, Insurance policies, retirement funds, penslom, disability or death ben and other similar types of periodic receipts, Including any lump sum payment for the delayed star of a periodic payment; (a) payments In lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (f) the maximum amount of public assistance available to the above persons other than the amount of any assistance spectfrcal!y designated for shelter ud!!des plus the maximum amount that the public assistance agency could in fact allow for shelter and udiides; (g) periodic oral determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not resi• In the dwelling; (h) all fegular pay, special pay, and alowances of a member of the Armed Forces (whether or not living in the dwelling) who Is the head of the househol spouse (or other persons whose dependents are residing in the units); and (I) any, earned income tax credit to the extent that it exceeds Income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; (b) amounts which are specifically for or In reimbursement of medical expenses; (c) lump sum additions to family assets, such as Inheritances, insurance payments (including payments under health and accident insurance and wort: compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational institution, and amounts paid by the gover,_neat to a veteran for us meeting the costs of midon, fees, books and equipment. Any amounts or such scholarships or payments to veterans not uses for the above purposes to be included in income; (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (Q amounts received under training programs funded by HUD; (g) foster child care payments; (h) amounts received by a disabled person tha: are disregarded for a lirdaed time for purposes of Supplemental Security Income eligibility and benefits beer they are set aside for use under a Plan to Attain Self -Sufficiency; (1) income of a live-in aide; G) aounts received by a participant in other peblically assisted programs which are specifically for or in rimbursemen; of out•ot-pocl et expenses !ozu: m and which are made solely to allow parieipadon in a specific program; (k) a resident service stipend (a modest a,.cunt (not to exceed SICK) per month) received by a resident for performing a service for tse owner, on a ra t basis, that enhances Lit quality of lit- in the development; If thh form is beins completed in accordarce with reecnifica:ion of a Lower Income Tenant's or Very Low Income Tenant's occupercy life Lower Income Unit or a Very Low Income Unit, respectively, this form must be completed band upon the current income of the eceupanu. FrM -compensation from state or local employment training programs and training of family member as resident management staff; reparation payments paid by a foreign government pursuant to claims filed under the laws of that government by persons uho were persecuted during Nazi era; ' amounts specifically excluded by any other federal statdte from consideration as income for purposes of determining eligibility or benefits under a cruel of assistance programs that includes assistance under the United States Housing Act of 1937, earnings in excess ofS4S0 for each full-tcrm student IS years old or older (excluding the head orhousehold and spouse); adoption assistance payments in excess orS430 per adopted child; and deferred periodic payments of supplemental security income and social security benefits that are received in a lump sum payment; amounts received by the family in the form of refunds orrebates understate or local law for property tares pardon the dwelling unit; amounts paid by a State agency to a family with a developmentally disabled family member living at home to offset the cost of services and equipm li needed to keep the developmentally disabled family member at home; and . amounts specifically excluded by an otherfedeml statute from consideration as income for purposes of determining eligibility or benefits under a eateg of assistance programs that Includes assistance under the United States Housing Act of 1937. Do the persons whose income or contributions are Included in item 6 above: (a) (b) (c) (d) (a) (b) have savings, stocks, bonds, equity In real property or other form of capital investmeh excluding the values ofneeessary Items of personal property st as furniture and automobiles and interests in Indian trust land) Ves _'No; or • have they disposed otany asses (other than at a foreclosure or bankruptcy sale) during the last two years at less than fair market value? Yes if the answer to (a) or (b) above is yes, does the combined total value of all such assets owned or disposed of by all such persons total more than 55,00 Yes,_X No If the answer to (c) above is yes, state: (1) the combined total value of all such assets: S .4!1( (2) the amount of Income expected to be derived from such assets In the 12-month period beginning on the date of initial occupancy in the unit dial y propose to rent: S .ems and (3) the amount ofsuch lncprde, If any, that vves included in item 6 above: S Are all of the individuals who propose to reside in the unit full-time students*? Yes '1 No •A full-time student is an Individual enrolled as a full-time student during each of calendar months during the calendar year in which occupancy oft; unit begins at an educational organization which normally maintains a regular faculty and curriculum and normal lyhas aregularly enrolled body ofstuder in attendance or is an Individual pursuing a full-time course of his thutional or farm training under the supervision of an accredited agent of such 1 educational organization or of aslate orpoiltical subdivision thereat. If the answer to s(a) is yes, is at least 2 or the proposed occupants ofthe unit a husband and wife entitled to fit- ajoin: federal income tax return? Yes _-2L_No Neither myself nor any other occupant of the unit (/sve propose to rent is the owner of the rental housing project in which the unit is located (hereinafter the "Omer" has any family relationship to the Owner; or owns directly or indirectly any interest in the Owner. For purposes of this paragraph, Indirect ownership by a Individual shall mean ownership by a family member, ownership by a corporation, partnership, estate or trust in proportion to the ownership or beneficial Intere. in such corporation, -partnership, estate or Trustee held by the individual or a family member; and ownership, director indirect, by a partner of the individual. This certificate is made with the knowledge iliat it will be relied upon by the Owner to determine maximum Income for eligibility to occupy the unit; and Ussc declet that a:l information set forth herein is true, correct and complete and based upon information Uwa deem reliable and that the statement of total anticipated incom contained In paragraph 6 Is reasonable and based upon such Investigation as the undersigned deemed necessary. Y%Vc will assist the Owner in obtaining any information or documents required to verify the statements made herein, including either zn income verification R.-r my/our present employer(s) or copies of federal tax returns for the Immediately preceding calendar year. I.AVe acknowledge that Uwe have been advised that the making of any misrepresentation er misstatement in this decta:vion will constitute a material breach c my/our agreement with the Owner to lease the unit and will entitle the Owner to prevent or terminate my/our occupancy of the unit by institution of en action fa ejection or other appropriate proceedings. IN'e declare under penalty of perjury that the foregoing is true and correct. Executed this f Zilt day of _Ta✓1! O-in . 206_ in the City of kiBwl�ri- 13ECLC�'t . Califorr.Ea Applicant App:;can: Rev. V95 Applicant Applicant (Signature of ail persons (except children under.the age of IS years) lis:ed in number 2 above rcquir07; W AHe mur I1e•ra611 n � e FOR COMPLETION BY APARTMENT OWNER ONLY: 1, Calculation of eligible income: a. Enter amount entered for entire household in 6 above: b: (1) If the amount entered in 7(c)above is yes, enter the total amount entered in 7(d)(2), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ .0'— ); (2)' Multiply the amount entered in 7(d)(1) times the current passbook savings rate as determined by HUD to determine what the total annual earnings on the amount in 7(d)(1) would be if invested in passbook savings ($ 0' ' ), subtract from that figure the amount entered in 7(d)(3) and enter the remaining balance ($ (3) Enter at right the greater of the amount calculated under (1) or (2) above: C. TOTAL ELIGIBLE INCOME (line i.a plus line ib(3): 2. The amount entered in 1.c: Qualifies the applicant(s) as a Moderate -Income Tenant(s). Qualifies ttie applicant(s) as a Lower -Income Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenant(s). $ 26, 030.00— .71 3. Number of apartment unit assigned: 2210 Bedroom size: ,12 Rent: 4. This apartment unit w was not) last occupied for a period of 31 or more consecutive days by persons whose aggregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartment unit qualified them as a Lower -Income Tenant(s). 5. Method used to verify applicant(s) income: Employer income verification. Copies of tax returns. U 12 iG3 Date Pay Periods Date of Most Recent Pay Ending Date -L+I Ilz 115-lo4 Year - to - Date 2,515.2� : divided by pay periods average per pay period 23 122, 40 Gross per Pay Period �25'•�0 (�) 762.. 25 (^) 21271. 25 divided by 3 (-)F 757.0E ( x ) how often paid (x') how often paid 2y z� = ) uaicuiaieo Hnnuai incume 21 q 37. 45 I,alQuIaiea HnnUdl 1 161 i70.oL--�- ENT BY: 7 CCC ANH i; ^peps N ER RISES, IN PO Be Ivalte M. Ferrao 8.0047 7147780165; DEC-18-02 10:53AM; PAGE 2/2 606, Yorba Linda, t;x yseoa U b; .i U l ll Date 12/15/02 pay Period 1211l02 thru 12l15/02 PayroCheck No 62308 Net Pay '"733.46 ESlDEDUCTIONS 584.3 EARN INdS/CREDITS Desc. %sts Hours Curront 76000 9.50 80.0 . 1425 40 50.00 OReTpPayay Vac. Pay 0 : 0,00 Hot pay 0.00,0 8.00 Bonus 826.00 Totals EMPLOYER PAID TAXESANS Social Security 11.15 1.90 Medicare Federal Unemployment 6.60 18.50 Slate Unemployment 0.88 Employment Training 0.00 Grp Medical Insurance 87.04 Employer Paid Items VTO Gross 2,726.50 69.76 0.00 0.00 19.00 2,815.2S 174.55 40.82 22.62 58.31 2.81 0.00 297.01 TAX Description Current Federal Tax Social Security 51.15 Medicare 11.96 CA State Tax 00 CA Statb Disability 70.00 43 Ins Grp Medical. 00 Wage Advance 0.00 Drawer Shortage 00 0.00 Miscellanous 0 Emp Sav1n95 o 00 Totals 91.64 Y-T-0 43.00 174.55 40.82 0.00 25.35 0.00 0.00 0.00 0.00 0.00 283.72 ENT 9Y: 7 CCC ANH i; AS ENTERPRISES, INC, Ivette M. Farrao 584.38-0047 7147780iBS; DEC -I' 02 i:SiPM; PACE 214 p0 Box Verbs Linda, CA e2885 P 714.777.2577 • 062261 payroll Date 11/30/02 Pay Period 11/16/02 thru 11/30/02 Check No 62251 Net Pay "'•618.51 YAXES/peDUCTIONS EAR NINQS/CREDITS Desc, Rate Hours Current Reg Pay 9,So 710 874,50 OT Pay 0.00 . vac. Pay 0.00 01•0 0.00 Hal Pay 0.00 0.0 0 9.60 Bonus 684.00 Totals EMPLOYER PAID TAXESl1NS Social Security 42.41 9.92 Medicare Federal Unemployment fi:47 State Unemployment 13:88 0.68 Employment Training 0.00 Grp Medical Insurance 72.16 Employer Paid Items YTD Gross 1,958.50 12.76 0.00 0.00 11.00 1, 990, 26 123.40 28.88 15.92 39.81 1.98 0,00 209.97 Description Current Federal Tax Social Security 42.4 Medicare 992 CA State Tax .0 -CA State Disability 6116 Grp Medical Ins Wage Advance 0.00 00 Drawer Shortage 0,00 Mlecellanous 0.00 Emp Savings 0.00 Totals 66.49 Y-T•D 22.00 123.40 28.88 0.00 17.92 0.00 0.00 0.00 0.00 0,00 192.18 I FAASENTERPRISES, INC. PO Box'606, Yorba Linda; CA 92885 Ph: .714.777.9577 062216 Ferr Ivette M. Ferrao , ivette M. Pay Period 11/1102 thru 11/15/02 Payroll'Date 11/18/02 '. Net Pay * * * * 6 8 2.0 8 Check No 62216 EARNINGS/CREDITS Rate Hours Current Gross TAXES/DEDUCTIONS DescriptionReg Current Y-T-D Dose. 8.50 88.0 748.00 .YTD 1,292.00 Federal Tax 15.00 ' 15.00 OTPay 12.75 1.0 12.75 12.75, Social Security 47•.26 80.99 Vac. Pay 0.00 0.0 0.00 0.00 Medicare 11.05 `•18.94 Hol Pay 0.00 0.0 . 0.00 0.50 00 CA State Tax 0.00 0.00 Bonus 1.50 . 1. CA State Disability' •6.86 11.76 Totals 762.25 1,306.25 Grp Medical Ines 0.00 _ 0.00 EMPLOYER PAID TAXES/INS Wage Advance 0.00 0.00 Social Security .25 .9 16 18.94 Drawer Shortage 0.00 0.00 Medicare ;- Federal Unemployment• 11.05 11 6.10 10.45. Miscellanous 0.00 0.00 State Unemployment . 15.25 26.13 Emp Savings 0.00 0.00 Employment Training 0.76 1.30 Totals 80.17 126.69 Grp Medical Insurance. ( 0.00 Employe; Paid Items 80.42 130.00 FAAS ENTERPRISES, INC. PO Box 606, Yorba Linda, CA, 92885 '- Ph: 714.777.9577 062166 Ivette M. Ferrao Pay Period 10/16/.02 thru 10/31/02 Payroll Date 10/31/02 f 584-38-0047 Net Pay ****497.48 Check No 62166__ EARNINGS/CREDITS TAXES/DE)DRUCTIONS Dose. Rate Hours Current •YTD Gross Description Current Y-T-D Fieg Pay 8.50 64.0 544.00 544.00 Federal Tax 0.00 0.00 OT Pay 0.00 0.0 0.00 0.00 Social Security 33.73 33.73 , Vac. -Pay 0.00 0.0 0.00 0.00 Medicare 7.89• 7.89 Hol Pay 0.00 • 0.0 0.00 0.00 '0.00 CA State dx T 0.00 0.00 Bonus Totals 0.00 544.00 544.00 CA State Disability 4.90 4.90 N EMPLOYER PAID TAXES/INS _ Grp Medical Ins Wage Advance 0.00 0.00 0.00 0.00 Social Security ' 33.73 33.73 7.89 Drawer, Shortage. 0.00 0.00 Medicare Federal Unemployment < 7.89 4.35 4.35 Miscellanous 0.00 0.00 State Unemployment 10.88 10.88 Emp Savings _. 0.00 0.00 Employmeht Training 0.54 0.54 Totals 46.52 46.52 Grp Medical Insurance 0.00 0.00 Employer Paid Items 57.39 57.39 mt to weir. a mat'. t.oee�fa 1w1a.I enu , w,o.<p TELEPHONE NO.: -"DISTRICT ATTORNEY State Bar#51374 (714)541-7600 PAX: (714)541.7401 P.O. Box 2209E ;UPERIOR COURT OF CALIFORNIA, COUNTY OF ORANGE STREET ADDRESs: 341 The City Drive MAILINGADDRESS: Poet Office Box 14170 CITY AND ZIP CODE: Orange 92863-1570 RESPONDENT/DEFENDANT: VIJAY P MANGHIRMALANI OTHER PARENT: ORDER AFTER HEARING (Governmental) DA r: 22-74.17 FD SUPERIO��ER CALIFORNIA COUNTY OF ORANGE LAMOREAUX JUSTICE CENTER JAN 112001 ALAN SLATER, Clerk of the Court BY. K�,DEPUTY NUMBER: 1. This matter proceeded as follows: Q Uncontested Q By stipulation . ® Contested a. Date: 01/11/01 Dept.: L51 Judicial Officer: RICHARD VOGL b. M Petitioner/Plaintiff present '®X Attorney present JULIE BUTLER, DDA c. Respondent/Defendant present Attorney present (name): d. 4N Other parent present Attorney present (name): e. District attorney (Wolf. & Inst. Code, §§ 11475.1, JULIE BUTLER, DDA D294074 f. © Other KATHY LEWIS. court clerk; S90ther'Parent ELLIS, reporter g. The Obligor (the parent ordered to pay support) isPetitioner/Plaintiff ® Respond'ent/Defendant 2. Q Attachad is a computer printout showing the parents' income and percentage of time each parent spends with the child(ren). The printout, which shows the calculation of child support payable, shall become the court's findings. 3. Q This order is based on the attached documents 4. THE COURT ORDERS a. All orders previously made in this action shall remain in full force and effect except as specifically modified below. b. Obligor is the parent of and shall pay current child support for the following Name Date of birth Monthly support amount JACQUELINE MANGHIRMALANI 11/03/86 9 655.00 (1 0 Other (specify): Child Care Expenses: (2 OX For a total of: $655.00 payable on the: Jet day of each month beginning DECEMBER, 2000 (3 Q The support order was reduced, pursuant to the low income adjustment, because the Obligor's net monthly income is less than $1,000. (4 Any support ordered shall continue until further order of court, unless terminated by operation of law. NOTICE: Any party required to pay child support must pay interest on overdue amounts at the "legal" rate, which is currently 10 percent. (Continued on reverse) Form Adopted by Rule 1298.07 welfare & institutions Cade, Judicial Council of Cellfomia ORDER AFTER HEARING If 11350, 113Eo.1, 11475.1 1298.07 (Rev. July 1, 19991 (Governmental) D.A. # 22-74-17 IVETTE M MANGHIRMALANI RESPONDENT/DEFENDANT: VIJAY P MANGHIRMALANI Obligor owes support -arrears as follows, as of (1 = Child support: Q Spousal support: (2 = Interest is not included and is not waived. CASE NUMBER: D294074 Q Family support: (3 Q Payable: on the: day of each month beginning (4 = Interest shall accrue on the entire principal balance owing and not on each installment as it becomes due. d. No provision of this judgment shall operate to limit any right to collect the principal (total amount of unpaid support) or to charge and collect interest and penalties as allowed by law. All payments ordered are subject to modification. e. All payments shall be made to (name and address of agencyJ: District Attorney Family Support Division P.O. Box 448 Santa Ana, CA 92702-0448 f. A Wage and Earnings Assignment Order shall issue. g.=Obligor= Obligee shall (1) provide and maintain health insurance coverage for the children If it is available through employment, a group plan, or otherwise at no or reasonable cost, and shall keep the district attorney's office informed of the availability of the coverage; (2) if health l4urance is not available, provide coverage when it becomes available; (3) within 20 days of the district attorney's rdquest, complete and return a health insurance form; (4) provide to the district attorney all information and forms necessary to obtain health care services for the children; (5) present any claim to secure payment or reimbursement to the other parent or caretaker who incurs costs for health care services to the children; (6) assign any rights to reimbursement to the other parent or caretaker who Incurs costs for health care services for the children. If the "Obligor " box is checked, a Health Insurance Coverage h. Both parents shall complete a Child Support Case Registry Form (form 1285.92) and send (deliver or mail) it to the district attorney within 10 days of the date of this order. The parents shall notify the district attorney of any change in the information submitted within 10 days of the change by submitting an updated form. I. The forms Notice of Rights and Responsibilities (form 1285.78) and Information Sheet on Changing a Child Support Order (form 1285.79) are attached. j. Q The following person (the "Other Parent") is added as a party to this action under Welfare and Institutions• Code section 11350.1 Enamel: k.Q The court further orders (specify): Date: UN 11 2001 5, Number of pages attached: Approved as conforming to court Date: Is/glrHARn VOGL - JUDICIAL OFFICER SIGNATURE FOLLOWS LAST ATTACHMENT FOR January 1, 19991 ORDER AFTER HEARING Pape INCOMES STET CALCULATION WORK 4EET 1 'last Name Fimt Name Rehuonshfp HON Sax Dstaoferth 10 Ago Social Securltys OO Frr Student YES or NO 2 17 None lJ a 4 . s T INCOME Family Source Base Rate Average Average Annual Memb. # $ Hours 62 24 2e 12 1 Total • WK SEMI• 0 01•YAK MO YR $ ° g $ °$ s °$ $ °$ QnClel QoenolTv oeuQlnMQ ern Total Dox A:, $ Family Source Base Rate Average Average Annual Memb. # $ Hours 62 24 2e 12 7 Total SEM1•MO 01-WK I MO YR v$ $ v 1111121 IC AOQIQTAAIna TOtaI DOX B: $ Family Source Base Rate Average Average Annual Memb. # $ Hours 62 24 20 12 1 Total 1 B• MO Yt $ $ °$ $ a$ $ °$ Family Memb. # Source Base Rate $ Average Hours Average Annual 62 24 26 12 1 Total 0 •WK $ 155 °$ $ 191.1 °$ $ °$ Total Box 0• $ TOTAL ANNUAL GROSS INCOME A through D amaa;t.>>> an $ -4)_Q•,- ASSETS Member # Asset Description (savings, chactting, storks, bonds, oic) Imputed! Current I or C Grass/Fair Mkl. Value Cost 10 Get Cash NET Family Asset Value Actual Interest Rate Actual Annual Income from Assets _ aT"$ - a - a �— ° 6a — o uo o Totals I Be) E: Box F: IMPUTED INCOME FROM ASSETS Box E "wads $6,0g0—multiply E by the currant passbook Interest rate: IT Box E does not exceed $6,000 enter •0• In box G: Enter the greater at Box F or Box G in: BOX G: L� IINPU�TE7D INCOME FROM —1 GETS $ BOX H: olo1NT0111AEluallnoome Faulty lnocmo Fwn,Msch, Effective Dale T�ou, o Typo of Program °�lro'Id•yQla� Unll No. 2210 Unll o:o t No. of Persons 9 Mil: V Max. Income Llmlt $ 30r 9 gO.aa - ARe 140%Umit$ INCOME CONTRIBUTED FROM ASSETS TOTALANNUALINCOME$ 11,030.0o & TOTALASSETSS ex eS or ea FAX TRANSMITTAL MDG Associates, Inc. 10722 Arrow Route, Suite 822 Rancho Cucamonga, CA 91730 Phone 9091476-9696 Fax 9091 476-6086 M D G ASSOCIATES • INC. DATE: ATTENTION: FIRM: FAX NUMBER: FROM: 1 — 1Q_ C�kTN�14 Ljl4) 2-W. 03go NO. OF PAGES: (Including Cover Sheet) COMMENTS: LYNT tfiP` ?tits `5 lltE I, -MCAT C.eJA94f-'-- This transmission is intended only for the use of the addressee and may contain information that is privileged, confidential and exempt from disclosure under applicable law. If you are not the intended recipient or the employee or agent responsible for delivering the message to the intended recipient, you are hereby notified that any dissemination, distribution or copying of this communication is strictly prohibited. If you received this e-mail communication in error, please immediately notify the sender by replying to this communication or by contacting the sender by telephone at the above number. Thank you EXHIBIT C `,'�'nily �� r--- AS OF June 2003 The undersigned, being an Authorized Borrower Representative of Irvine Aparttneut f the Communities, L.P. (the "Borrower"), has read and is tha•oughly familiar with the provisions o various documents associated with the Borrower's participation in the California Statewide Conumnlities Development Authority's (the "Issuer") Apartment Development Revenue Bond Program, such documents including: e"t and Declaration of I The Amended dated as f May d Restated1998 at o g the BoAower,�tile Issuerand U.S. Bank TrusttNa onal ve ants Association (the "Trustee"). 2. The Loan Agreement dated as of May 15, 1995, between the Issuer and the Borrower. applications were received from Restricted Tenants (as defined 3. During the preceding month 6 in the Regulatory Agreement): 4. As of the date of thus certificate, the following percentages of completed residential units in the Project (i) are occupied by Restricted Tenants, or (i i) are currently vacant and are being held available for such occupancy and have been so held continuously since the date such unit was vacated, as indicated: 1 2 3 Studio Bdrm. Bdrm. Bdrm. Total Occupied by Original in' 11 Low Income Tenants N/A Q Unit Nos.: 1.93OA Occupied by Lower 27 42 3 72 Income Tenants N/A Unit Nos.: 12.81% Occupied by Very Low -Income Tenants N/A 14 15 Q 29 Unit Nos.: 5.09% Held vacant for Q 2 Occupancy continuously N/A 1 1 Since last occupied: Unit Nos.: 0.17% Total Number of Units: 64 I 8 ] 14 Unit Nos.: 20.00% N/A 42 Since last occupied: The undersigned hereby certifies that the Borrower is not in default under any of the terms and provisions of the above documents, and no event has occurred which, with the passage of time, would constitute a default thereunder, with the exception of the following: MMr 1 r . Wllli�. /. Vice President, Controller Contact Person: Jason Di Antonio Bond Compliance Auditor (949) 450-4290 LRVINE APARTME BONT ND SUMMARY COMPANI ,I UNE 2003 NE'VV PORT NORTH TRVINE APART BOND SUMMAR' I UN E 2003 IRVINE APARTMENT MANAGEMENT COMPANY BOND SUMMARY .I UNE 2003 NEWPORT NORTH VERY LOW (Phase In - beginnin;_ 4!1/9S) 1999 Pltasein- 225-243-1180-2608-23uu-1/0 2000 Pllase in— 2425- 1333-2519-1 i30-2125 2001 Phase in — 333-208-1323-2425.1419 2140 2440,305 2002 Phase in — 2210,240S,2 [40.27011324 Total number of apartments on this prnperty: 570 "/" of property deemed Income Restricted (Low): 15.26% "/" of property deemed Income Restricted (Very Low): 4.74% TTP =Total Tenant Payment (Resident is on Certificate or Voucher) Total vacant as of 053103 - 13 y , . IRVINE APARTMENT MANAGEMENT COMP:\N)' BOND SUMMARY DUNE 2003 NEWPORT NORTH Ne:v Ce::;:ic::as, ,Rece::�tica�•ar''.tt`` Unit Number_ INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT 01VNER• This form is designated to assist you in computing Annual Income m accordance with the method set forth in the Department of Housing and Urban Project ("HUD-) Regulations (24 CFR 80). You should make certain that this form is at all times up to date :with the HUD Regulations. All capitalized terms used herein shall have the meaning set forth in the Regulatory Agreement. CSCDA (Pool) - Newport North I/We the undersigned state that I we have read and answered ftdly, frankly and personally each of the following questions for all persons who are to occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit. 1 2. 3. 4. 5 Name of Members Relationship Of the to Head of Social Security Place of Household Household Age Number Employment Income Computation 6. The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children under 18 years) listed above for the 12-month period beginning the earlier of the date that IAve plan to move into a unit or sign a lease for a unit is 23r1407.00 Included in the total anticipated income listed above are: (a) all wages and salaries. overtime pay, commissions, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real or personal property (without deducting expenditures for business expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets); (c) interest and dividends (including income from assets included below and other net income from real or personal property); (d) the full amount of periodic paymdnts received from social security, annuities, insurance policies, retirement fonds, pensions, disability or death benefits and other similar types of periodic receipts, including any lump sum payment for the delayed start of a periodic payment; (e) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (f) the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter and utilities; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not residing in the dwellings; (h) all regular pay, special pay and allowances of a member of the Armed Forces (whether or not lit ing in the dwelling) who is the head of the household or spouse; and (i) any earned income tax credit to the extent that it exceeds income tax liability. Excluded fronrsuch anticipated income are: (a) . casual, sporadic or Irregular gifts; (b) amounts which are specifically for or in reimbursement of medical expenses; (c) lump sum additions to family assets, such as inheritances, insurance payments (including payments under health and accident msuiance and workers' compensation), capital gams and settlement lot personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational institution, and amounts paid by the government to a veteran for use in meeting the costs of tuition, fees, books and equipment Any amounts of such scholarships or payments to veterans not used for the above purposes are to be included in income; (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; M relocation payments under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970: (g) foster child care payments, (h) the value of coupon allotments under the Food Stamp Act of 1977: (i) payments to volunteers under the Domestic Volunteer Services Act of 1973; (j)• payments received under the Alaska Native Clairns Settlement Act: (k) income derived from certain submarginal land of the United States that is held in trust for certain Indian tribes; (1) payments on allowances made under the Department of Health and Human Services' Low -Income Home Energy Assistance Program; (m) payments received from the Job Partnership Training Act; (n) income derived from the disposition of funds of the Grand River Band of Ottawa Indians; and (o) the first 52000 of per capita shares received from judgement funds awarded by the Indian Claims Commission of the Court of Claims or front held in trust for an Indian tribe by the Secretary of Interior. 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of neck- ary items of personal property such as furniture and automobiles and interests in Indian trust land) VV Yes No; or (b) have they disposed of any assets (other thar�at a foreclosure or bankruptcy sale) during the last,mo years at less than fair market value? Yes No / (c) If the answer to (a) cr (b) above is Yes, does the combiryEd total value of all such assets owned or disposed of byall such persons total more than S6,000? Yes No (d) If the answer to ( c) above is Yes, state: (1) the combined total value of all such assets: S (2) the amount of income expected to be derived from such assets in the 12-month period beginning on the date of initial occupancy in the unit that you propose to rent: S ,and (3) the amount of such income, if any, that was included in item 6 above: S S. (a) Will all the persons listed in column I above be or have been full-time student during five (5).calendarmonths of this calendar year at an educational institution (other than a correspondence school) with regular faculty and students? Yes No (b) Complete only if the answer to Ouestlon 8(a) is "Yes"). Is any such person (othej than nonresident aliens) married and eligible to file a joint federal income tax returns? Yes / No 9. This certificate is made with the knowledge that it will be relied Tupon by the Owner to determine maximum income for eligibility to occupy the unit; and I/we declare that all information set forth herein is true, correct and complete and based upon information 1. we deem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. 10. I'"We will assist the Owner in obtaining any information or documents required to verify the statements made herein, including either an income verification from mv.'our present employers) or copies of federal tax returns for the immediately preceding calendar year. 11. Me acknowledge that all of the foregoing information is relevant to the status under federal income tax law of the interest on bonds issued to finance the of the apartment building for which application is being made. We consent to the disclosure of such information to the issuer of such bonds, the holders of such bonds, any trustee acting on their behalf and any authorized agent of the Treasury Department or Internal Revenue Service. 1 We declare under penaky of perjury that the foregoing is true and correct. Executed this day of JUrle , 20 GS (year) in the City of %_}may �-13Qie�n California Applicant Applicant Al p icant Applicant — (Signature of all persons (except children under the age of I S years) listed in number 2 above required) FOB COMPLETMON By 4a, RTINMN-T' OWNER ONLX: I. Calculation of t:ligiblc income: a. Fmier amount entered for entire household in 6 above: b. (1) If the amount encored in 7(o)above is yes, enter the total amount entered in 7(d)(2), subtract fi-orr '•vt figure the amount entered in 7(dx3) and enter the rema° tint -e (5 ) (2) Multiply the amain. !t un the current passbook savings rate ti 1 u to determine what the total annual earnin, would be if invested in passbook savor, subtract from that figure The amount enm, a 7(a)(3) and enter the remaining balance ($ (3) Enter at right the greater of the amount calculated under (1) or (2) above: C. TOTAL ELIGIBLE INCOME (line I.a plus line 1.b(3): 2. Tne amount entered in I.c: Qualifies the anplicant(s) as a Moderate -Income Tenanr(s). x Qualifies the apolicant(s) as a Lower -Income Tenant(s). Qualifies the applicants) as a Very -Low Income Tenant(s). 29.407.�� ; 3. Number of ipartment unit assigned: 144 Bedroomsize: 2 + Z Rent: $ i3k 4. This anartrnent unit&IYwot) last occupied for a period of 31 or more consecutive days by persons whose aggregate ahticipated annual income riot) as certified in the above manner upon their initial cccupancy of the apartment unir qualified them as a Lower -Income Teaant(s). S, NJ--thed used to verify applicant(s) income: Employer income verification. Con°es of tax retums. v trinar(__Socia� age " o1�� &/i / 03 Date mx.vIVIL' -' ASSET CA! CUI �TIr1n) lArr,c„-,-,-_._------_..._--- nss0l uuScuf:Uun (Lavings. ehothing, sWLYs, builds. :• IPU I EU INCOME FROM AbSC1 S I: E CxLCerls$5.000—❑Udllf I:I-11110 Lull alit passbook Imams rota: H Dun Lr Juua )rut oncuuJ SS,Uou -aRur•U-In box G: l ulm lhu ill ualuf ul Uon For Uux G m; MkL Vnluu I Gut Cush M d X _ UOX G:— INPUTED INCOME FROM SETS uox D: d Interest I Incanm from RlmnAvels Effective Dalo .l U 1: TYPO or Program Unit No. 9+ 7 Unit Sica 141, No. of Pcran: 9 M)I• Max. Income Lmlit- AN: t/ 14001. Limits e Income Restricted Certification Ouestionnaire I Name: Y�zo.A/1(F. RL/"fC Riitial Certification Re -certification Other Yes No Ouestion Unit /4 1— mnrnfhly Tnnnmo I'we receive Family Support, Spousal Support, and/or any other cash contributions of gifts, including rent or utility payments from persons not livine with me. Ilwe receive Veteran's Administration, Pension, Unemployment benefit. Disability benefit, AFDC, Lottery winnings, Inheritance, t, orAnauities. I'we receive income from Rental Property. �i I I 1%vz- '::e b^. 1�.. ..:cfiM/Lt:OII'i: :70::: Scc:al Secii:lt; t0 ::tzladt' � SSA, SSI and/or periodic social security payments. The household receives unearned income for family members age 17 or tinder. I we are entitled to receive child support payments. I'we am currently receiving child support payments. I we am'are currently making efforts to collect child support owed to me. I'tve have other assets (example: 40IK, IRA, Revocable Trusts, ✓ Stocks, Bonds, Treasury Bills, Money Market accounts, Certificate of Deposits, Whole Life insurance, Real Estate) Ihve have cash on hand. Student Status: LRP— ^/,`t`L EKE Does the household consist of persons Nvho are all full-time V/ students (example: Colle e/Universit , trade school, etc.)? Does your household anticipate bdcoming a full-time student household in the next 12 months? If you answered ves to either of the previous two questions are you: t/ i Married and filing ajoint tax return. Lander penalties of perjury, I certify that the information presented on this form is true and accurate to the best of nay knoitledge. The undersigned further understands that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information will result in the denial of application or termination of the income restricted lease agreement. to R ident Siena« ire Date ��L U 6/lI03 Signature of Owner Agent Date SOCIAL SECURITY ADMINISTRATION SUPPLEMENTAL SECURITY INCOME PLAN TO ACHIEVE SELF-SUPPORT (PASS) PASS Cadre 300 S. Harbor Blvd, Suite 310 Anaheim. CA 92805 Phone: (800) 551-1507 EXT. 206 FAX: (714) 502-0623 TDD: (714) 502-9684 Office Hours: 9 AM to 4 PM Date: January 24, 2003 To Whom It May Concern: Yvonne Ahnore-Watson has an approved PASS plan (Plan for Achieving Self -Support). Yvonne currently receives the following income through the Social Security Administration. January 2003 - Supplemental Security Income 53007.00. This is the initial funding For her PASS plan and must be spent on items approved as part of PASS plan. - Social Security Disability $943.70. February 2003 and continuing - - Supplemental Security Income $757.00. This money is to be used For her living expenses. - Social Security Disability $943.70. $923.70 of this money each Month must be set aside and used for items approved as part of Her PASS plan. It is our understanding that according to the following section in your regulations, that any income or resources that she is receiving or setting aside under the terms of the PASS plan are not counted under HUD regulations. The relavant HUD regulation is 24 CFR 5.609.(c) (8) (ii). Thank You for your consideration of this :natter. Sincerely, / '_ )d4lci- Janet Cochrane Pass Specialist Asset Calculation Worksheet Name - Yvrj" AO lglm^� Account Type 25.3( (+) 53.2y divided by 2 (average account balance) ( x) Interest rate: % C/ (_) Income from asset: $ F. rs %�m wkjuI ire U.S. Service Canter 013 PO Box 769013 San Antonio, Tx 73£45.9013 YVONNE ALMORE WATSON 146 LAURENT NEWPORT BEACH CA 92660-8303 v II,I I I II II1.II„JId11.1IMI,.III I..L.ItILM111I 11'<?�fLR1i F•?;Z 005 CITIBANK (WEST). FSB Account 7434011768 Statement Period Apr. 23 -play 22. 2003 F'•uge 1 of 6 CIT113ANO EZ CHECKING AS OF MAY 22. 2003 1 CITIBANK© EZ CHECKING SUMMARY: Checking S25.31 Savings ..... Investments ..... (not FDIC insured) Loans ..... nrArli+ r:arrlc ..... Banking Online- It's easy and FREE'! You have everything you need to bank online. It's as easy as 1-2.3. 1 Go to www.citibankonline.com 2. Enter your Citibank.:. Banking Card number 3. Use your PIN and you're readyto go! 'Reoularaccount charges apply. Planning to Move? We understand that moving to a new location is a lot to deal with, but as a Citibank customer, you won't have to think twice about your banking. Let us make Your move easier, by taking care of your banking. Stop by your local Citibank financial center or call 1-800-274.6660. SUGGESTIONS AND RECOMMENDATIONS }•`;.;ff 4 a ' 1" Let Women & Co.©, from CitigroLlp, keep you informed about key issues affecting worneli s financial lives. Join at www.womenandco.com and receive access to emails and conference calls that explore financial subjects you confront each day including retirement planning, education funding, and more. CITIBANK® EZ CHECKING RATES AND CHARGES ! Citibank,gives you the benefit of lower charges and better rates as you maintain higher balance levels. If your account is charged a monthly maintenance fee, you can receive a rebate of up to $2.00 off that fee by earning $1.00 for each of the following types of transactions during the statement period: - Two or more electronic bill payments you made by telephone or computer - An automatic deduction initiated by a third party that you authorized. There is no monthly service charge or per check fee if you recieve a direct deposit credit during this statement period. For current rates and charges, Citibank considered your average balances during the month of April in all of your qualifying checking, savings, investment, credit card, and loan accounts that you asked us to combine. These balances may be in accounts that are reported on other statements. i Ir 63 YVONNE ALIVIORE WATSON Account 7434011768 Page 2 of 6 112390rR!ic^FQt: Statement Period- Apr,. 23 - May 22, 2003 CITIBANK® EZ CHECKING RATES AND CHARGES Continued Rates and Charges Your Combined Balance Range > r $0-$1499 I Rates Standard fvlonthly Service Charge I $9.50(Waived) Ask about accounts eligible for preferred rates. Please refer to your Citibank Account Terms and Conditions for details on haw we determine your monthly fees and charges. Please note that when your qualified transaction activity exceeds the designated level, you may be subject to fees for transactions performed. All fees assessed in a statement period, including per check and non -Citibank ATM fees, will appear as charges on your next Citibank statement (to the account that is currently debited for your monthly service charge). CHECKING ACTIVITY Regular Checking I 7434011768 Beginning Balance: 53.24 Ending Balance: 25.31. . Date Description Amount Subtracted AmountPadded Balanc�7 4/23 Fee for Non -Citibank Atm Use 1 50 51,74 4125 Cash Withdrawal at CBC 72801 40.00 11' 74 1100 NEWPRT ON. NEWPRT SH, CA 4/30 Debit Card Purchase 10.00 1.74 WEE LAUNDRY CA0110902 NEWPORT BEACH CA 03119 5/01 Authorized Transfer 756.70 SOCIAL SECURITY FOR YVONNE ALMORE 5/01 Cash Withdrawal at CBC 72801 140.00 1100 NEWPRT ON, NEWPRT BH, CA 5/01 Point of Sale Purchase46.25 572.19 MAGS DONUTS&BAKERY NEWPORT BEACHCAUS80INS 5102 Authorized Transfer 944.00 SOCIAL SECURITY FOR YVONNE ALMORE 5102 Point of Sale Purchase 18.50 1,497.69 13331EUCLIDAVE. GARDEN GROVE CAUS801N8 5/05 Point of Sale Purchase on 05/041 16.40 2490 FAIRVIEW ROAD COSTA MESA CAUS801N8 5105 Debit Card Purchase on 05/031 19.16 RALPHS#0745 SF4 NEWPORT BEACH CA 03122 5/05 Point of Sale Purchase 63.59 2655 ELCAMINO REAL TUSTIN CAUS801N8 5/05 Cash Withdrawal on 05/031 at CBC 27401 40.00 2700 HARBOR SV, CSTA MESA, CA 5/05 Check#1895 277.00 1,081.54 5/06 Authorized Transfer 7467 SOUTHERN CALIFOR PAYMENTS 2121154165 5/06 Debit Card Purchase 71.00 SPRINTPCS-SPEEDPAYIVR TEL8882114727 KS 03123 5/06 Debit Card Purchase 44.24 WAL MART WESTMINSTER CA03125 5/06 Debit Card Purchase 28.84 JENNY'S FABRICS INC FOUNTAIN VAL CA 03125 5/06 Debit Card Purchase 2225 CATHAY NEWPORT NEWPORT BEACH CA 03123 5106 Debit Card Purchase 21.14 I �f I \ 1 11 YVONNE ALMORE WATSON Account 7434011768 Page 3 of 6 Statement Period - Apr. 23 - May 22, 2003 CHECKING ACTIVITY _ Continued 5/08 Check A 1898 5/12 Debit Card Purchase Return on 05/1 ='=L.'==T;E-36 HUNTINGTON EE CA 5112 Debit Card Purchase AOL'ONLINE SERVICE 0E03 5/12 Debit Card Purchase AOL'PRE6tUM SERVICE 0903 5/12 Point of Sale Purchase on 05/111 2536 A'AL-SAbIS HUNTINGTON EECAU. 5/13 Debit Card Purchase DEEIT CARD TRANSACTION 00000 5/13 Debit Card Purchase DEEIT CARD TRANSACTION 00000 5/16 Deposit 5121 Withdrawal 5121 Check # 1900 Total Subtracted/Added oo.vv 26737 21.38 23.90 7.14 5278 204.93 189.62 600 9.31 50.00 59.31 9.00 25.00 25.31 1.800.01 1.7:72.08 Transactions made on weekends, bank holidays or after bank business hours are not reflected it] ycuracccuntuntil the next business day. Checks Pafd Check Date Amount Check Date Amount Check Date Amount Check • Date Amount 1895 5/05 277.00 1898' 5108 36.00 1899 5/08 50,00 1900 5/21 25.00- 1896 5/06 30500 ' Indicates gap in check number sequence IF YOU HAVE QUESTIONS ON: YOU CAN CALL*: YOU CAN WRITE: Checking 800-274-6660 Citibank (West), FSB (For Speech and Hearing P.O. Box 348480 Impaired -Custorn ers Only Sacramento, Ca 95834-8480 TDD: 800-945-0258) *To ensure quality service, calls are randomly monitored. Please read the paragraphs below forimportant Information on youraccounts with us. Note that some of these products may not be available in all states. The ploducls leponed on this statement have been combined onto one monthly statement at your request The orphership and title of Indivldu31 products repotted hae may be diterent holm the add, essee(s) on the fit at page `1: y/ CHECKING AND SAVINGS K FDIC Insurance: Ploducts reported in CHECKING and SAVINGS ate insured by the Federal Deposit Insurance Colpo,ation Please consul[ your Citibank Custome, f.lanuai lot tall detrals and limitations of FDIC coverage In case of Errors or questions About Your Electronic Fund Transfers other than for Investment Transactions: If you think yow statement or,ecord is wrong at if you need more infonnahon about a transfer on the statement of record, telephone its or write to us at the adds ec s shown in the Custo nel Service Infounahon section on you, statement as soon as possible We must hear horn you no later than 60 days after ;tie sent you IIe'hrst statement on which the error of problem appeared Give us the following Information: (1) your name and accountnumber, (2) the dollar amount of the suspected erro,, (3) descube the enor or the hansiei you are unsure about and explain as clearly as you can why YOU believe there Is an enor or why you need mote infounation We will uwestigate yourrcompla,nt and vitl Colin( any. error promptly. It vie take more than 10 business days to do this, we will recredn your account for the amount you think is In enor, so that you will have use of the money tlul 1119 the time it takes us to complete our Investigation 63 k':, YVONNE ALMORE WATSON ACCOUnt 7434011768 Page 4 of 6 112392/R1,240170• Statement Period - Apr. 23 • May 22, 2003 Citibank Is an Equal Housing Lender. 1121 VVIL xw•t^a LENCE: Cihcard, Citicatd Eankino Centel. Checkrna Plus. MasterCard, Visa. Citibank Preferred Visa and MasterCard. Citibank Platinum Select. Checks -as -Cash. Equity Source Account MultlMoney and cisady Coati are regwtered in the U.S Patent and Trademark Office CIIIGold, Safety Check and CIIIPhene Banking sie setvpe marks of Citicorp TO RECONCILE YOUR CHECKBOOK WITH THIS STATEMENT, FOLLOW THESE SIMPLE RULES 1 Lict in youi checkbook any deposits withdrawals and service charges which are shown on Checks and Other Withdrawals Outstanding your statement, but not ieceided in your checkboon Adjust your checkbook accordingly (Mace by you but not yet indicated as paid on youi statement) 2 Mai eC n your checkbook all checks paid• withdrawals. or deposits listed on your statement Number of Date Amount 3 List and total in the "Checks and Other Withdrawals Outstanding" column at the right all Issued checks that have not been paid by Citibank together with any applicable check charges and all withdrawals made horn your account since youi last statement 4. Deduct from your checkbook balance any service or other charge (including pre -authorized transfers or automatic deductions) that you have not already deducted 5 Add to your checkbook balance any interest -earned deposit shown on this statement. 7 Add deposits or transfers you recorded which are not shown on this statement 6 Total (6 and 7 above) 9 Enter Total'Checks and Other Wnhchawals Outstancling'(Irom ncht) BALANCE IS less 9 shetiirl equal your checkbook balance). u ctibank° YVONNE ALMORE WATSON ACCCLInz 7434011768 Page 5 of 6 1123931R720F013 Statement Period - Apr. 23 - May 22, 2003 Meta: Imaged checks can be used ss evidence of payment. Imaged checks appear in numeric order. Non -numbered Checks will appear first. Non-cliccX isms will appear la3t. '!Sv< ^<Mn •mil L.'Li•' - : 1.. _ -.. • c r71.3 1:3 aaa7 i775L: iE5_ r..�L L7GS0 "u0Cc0 a77:M CA Data 051052003 Ck No. 1595 Amt $277.00 I 1:3222 �17 "r 9r: Lavl "743 iv5LF7ES�• '=CCCC03SCCr' • Ck Date, 05Me2003 Ck No, 1295 Aunt: $36 00 rCcrr • arise 1:n-� isju 5u �yFyu.. a•Xb Y: 3. 3:2d2L ']".$a �}� .. a ¢e rn rJF it:_fi•J^/ <`L Ct..,/L'•£-''��,,._. ! l�y_.1, 43222'r t7vSi; i9L'a fi'7y3 p>,'i1.7SC5' .+COnann v:nno Ck Date' 05MI2003 Ck No: 1900 Amt. $25.00 IM '1•Cu >6CtJ' Ml FYI" a a:;7:774C laaa 1.743 415L1'reSv' .•'ooc0a 3c5uo•• Ck Date, 05/0512003 Ck No, 1390" AIM: $305.00 ' �. r+cnni pru:• xr:•c 1:3222�8'7 ^rRl: ui In r•743 4 rt F9;er•,,'GC 0•JJ03CCC: Ck Cat- 05/032003 Ck No: 1899 Amt $50 00� YVONNE ALMORE WATSON t ce=:zeeaeo c.-az;-3e3 � a%Ea �sor-�aF6 cob v Account 7434011768 Page 6 of 6 11239a/q;r.:=or Statement Period - Apr. 23 - May 22, 2003 r 4 PSTa iYe3[r f n,,, :v Ck Date, 05/062003 Ck No: 1896 Amt: $305 CO Ck Date: 05/052003 Ck No 1695 Amt $277.00 i i I ._.—_—__{{••..1 _` ___�^ .. ;•, �hC.4:661g1 n [9•ta .� i G, � ?^fx)66/dt j :. •_ 'S' Sri W/i ? i L!- j :I. dint xr_t`< ct S -•'"': I m I 1- _•'.�fr:,:;, 31! a ,ta• !w •;µpia :b�'•oolFr_'a3 Csoacco3 jt� �F.rty7 nnrn1104.0 f•nn-on; t }[%'Yc.;=-^ • 'c°' ai :ILA PFO:E555p 0 n Gn- • ... nI'li �u9 ^•1_JJ _L •t' � v •[al r9i�eiCe I- i'lMzfE 3�y2::!• � ".i7t a..� z- I 1 _ i 172::rac1 tr � � DiM1 h + 1 1 Ck Date. 05/OM= Ck No, 1899 Amt $50 00 Ck Date. 05/082003 Ck No 1898 Amt $36 OC __ _ __ i-------------- uJe3nPl BamA Je-c 120U2 � y6093Any7 OS-Z_`:ji :iy:-4F�rxl • 1 ,061 LSS7262132 ewrix T 71ECL"8'iTFJ .i'• '::151'p901 =+o=J izw� AG ni�ir>=ri ci. �r I •e:3;Qc? fis�ez• as�i casc...canuz�,-r.2�,t�.72�, . I '• a�io';��iii `I Ck Data 05212003 Ck No. 1900 Amt• $25 00 i V I Y t 1../ 1-4 1 1 1 % 114761lR7,2_^Fi13 U.S. Semce Center 013 PO Box 769013 San Antonio, TX 7E2AE-e013 YVONNE ALNORE WATSON 146 LAURENT NEWPORT BEACH CA 92660-8303 CITIBANO EZ CHECKING AS OF APRIL 22, 2003 CITISANK0 EZ CHECKING SUMMARY: Checking S53.24 Savings ----- Investments ----- (not FDIC insured) Loans ..... Credit Cards ----- I SUGGESTIONS AND RECOMMENDATIONS 003 CITIBANK (WEST). FSB Account 7434011760 Statement Period Mar. 25 - Apr. 22, 2003 Page 1 cf b TRAVELING ABROAD? Citibank's World Wallet@ service offers next business -day delivery of Foreign Currency, Foreign Drafts and Travelers Checks anywhere in the U.S. Limits and fees apply. Call 1-800-627-3999 for details. Homeowners — Spring into action by applying for a Citibank Home Equity Loan or Line of Credit. Use the equity in your home to fund all those Spring projects quickly and easily... Whether landscaping your yard, adding on a deck, or buying new car - your money will be ready when you are. Stop by your nearest Citibank Financial Center today! . ,,. CITIBANk®EZCHECKINGRATE,S'AND,CHARGES';r-+^a::^�' Citibank gives you the benefit of lower charges and better rates as you maintain higher balance levels. If your account 1s charged a monthly maintenance fee, you can receive a rebate of up to $2.00 off that fee by earning $1.00 for each of the following types of transactions during the statement period: Two or more electronic bill payments you made by telephone or computer An automatic deduction initiated by a third party that you authorized. There is no monthly service charge or per check fee if you recieve a direct deposit credit during this statement period. For current rates and charges, Citibank considered your average balances during the month of March in all of Your qualifying checking, savings, investment, credit card, and loan accounts that you asked us to combine. These balances may be in accounts that are reported on other statements. Rates and Charges Your Combined Balance Range 0- 1 499 Rates Standard Monthly Service Charge $9.50(Waived) Transaction Fees Standard Your Transaction Activity and Fees this Statement Period Fee for non -Citibank $1.50 1 Qn $1.50 = $1.50 ATM transaction Ask about accounts eligible for preferred rates. Please refer to your Citibank Account Terms and Conditions for details on how we determine your monthly fees and charges. Please note that when your qualified transaction activity exceeds the designated level, You may be subject to fees for transactions performed. All fees assessed in a statement period, including per check and non -Citibank ATM fees, will appear as charges on your next Citibank statement (to the account that Is currently debited for your monthly -service charge). 63 YVONNE ALMORE WATSON CHECKING ACTIVITY Account 7434011768 Page 2 of 6 Statement Period - Mar. 25 - Apr. 22, 2003 114762/R120F013 743401 -1768 Date Description Beginning Balance: Ending Balance: Amount Subtracted Amount Added $6.55- $53.24 Balance 3125 Fee for Returned Check/Overdraft 30.00 36.55- 4101 Authorized Transfer 757.00 SOCIAL SECURITY FOR YVONNE ALMORE 4/01 Cash Withdrawal at 060 72801 500.00 220.45 1100 NEWP RT CN, NEWPRT BH, CA 4/03 Authorized Transfer 944.00 SOCIAL SECURITY FOR YVONNE ALMORE 4/03 Authorized Transfer 58.32 1,106.13 THE GAS COMPANY SIMPLEPAY 1267075792NETPY 4/04 Authorized Transfer 70.20 SO CAL EDISON CO PAYBYPHONE 090250047633960 4/04 Authorized Transfer 50.00 HOUSEHOLD BANK ONLINE PMT DB E HHFAFJ 4/04 Debit Card Purchase 1�9.95 AMERIPLAN USA " 4/04 Cash Withdrawal at Non -Citibank ATM 41.50 CHEVRON ATM NETWORK NEWPORT BEACHCAUS801N8 4/04 Check # 1893 303.00 4104 Check#15153 72.00 :54BAB 4/07 Point of Sale Purchase on 04/061 13.01 3015 W. 182NO ST TORRANCE CAUS801N8 4/07 Check#1891 27.61 -.'50B.86 4/08 Debit Card Purchase 215.45 AT&TSERVICES 800-2220300 NJ 03095 4/08 Debit Card Purchase 26.93 TJ. MAXX#654 LA HABRA CA 03097 4/08 Debit Card Purchase 20.00 WEB LAUNDRY CA0110902 NEWPORT BEACH CA 03095 4108 Debit Card Purchase 17.95 DOLLAR TREE 00019547 LA HABRA CA 03097 4/08 Debit Card Purchase 15.00 213.53 SINGER SHOP COM LAVERN TN 03097 4/09 Deposit 111.50 325.03 4/10 Debit Card Purchase 149.73 175.30 UNITED AUTO RENTAL INC NEWPORT BEACH CA 03099 4/14 Debit Card Purchase Return 42.99 GRC'Wnsr Pines 4/14 Debit Card Purchase on 04/121 63.89 COLLECTIONS ETC., INC. 620-584-8000 IL 03101 4/14 Debit Card Purchase 23.90 130.50 AOL'ONLINE SERVICE 0403 4/15 Debit Card Purchase 16.99 113.51 DANCE FOR LESS 702-262-7946 NV 03104 4/16 Debit Card Purchase 2a.00 85.51 AT&T SERVICES 900-2220300 NJ 03105 4/18 Deposit 15.00 100.51 4/21 Point of Sale Purchase on 04/201 10.35 90.16 3003 NEWPORT BLVD. COSTAMESA CAUS80INS 4122 Debit Card Purchase 36.92 53.24 UNITED AUTO RENTAL INC NEWPORT BEACH CA 03111 Total Subtracted/Added 1,810.70 1,870.49 1 Transactions made on Weekends, bank holidays or after bank business hours are not reflected in your account until the next business day. YVONNE ALMORE WATSON Account 7434011768 Page 3 of 6 114763lR1r_CF01', Statement Period - Mar. 25 - Apr. 22, 2003 CUSTOMER SERVICE INFORMATION IF YOU HAVE QUESTIONS ON: YOU CAN CALL': YOU CAN 1VRITE: v " Checking 800-7566-7047 Citibank (liVest), FSB (For Speech and Hearing P O. Box 348480 Impaired Customers Only Sacramento, Ca 9.5834-8480 TDD: 800-545-0258) "To ensure quality service, calls are randomly monitored. Please read the paragraphs below for Important Information on your accounts with us. Note that some oft he so products may not be available In all states. ma pwcu:t, mpulled an axis etateatant have Use,. comLined unto One mobmry statamenl al your requesL The owneiship and tilir of indrvidudl products Iepamlad imie may be dill -rent hom the addresses(s) on the first page CHECKING AND SAVINGS FDIC Insurance: Products repelled in CHECKING and SAVINGS are insured by the Federal Deposit Insurance Corporation. Please consult your Citibank Customer Manuallor full detam and limitations of FDIC coverage. In Case of Errors or Questions About Your Electronic Fund Transfers other than for Investment Transactions: If you think your statement or record is wrong or if you need more information about a transfer on the statement or record, telephone us Or wnteSD us at the address shown in the Customer Service Intonnatlon section on your statement as soon as possible. We must hear Itam you no later than 6C aays after we Beni you the first , statement on teh ch the error or problem appeared Give us the following fnformaflon: (1) your name and account number, (2) the dollar amount of the suspected ei lot. (3) describe the e:roi or thetransferyou aw- unsure about and explain as clearly as you can why you believe theie is an error or why you need more information We vnll invE<sar_.your ainplatnl and nut cones' any error promptly. It we take more than 10 business days to do this, we will recredd your account for the amount you think is in error, so that you will have use of the money during the time it takes us to complete our investigation. 1� Citibank is an Equal Housing Lender. EV'LENDER ti CitIcald, Cihcard Banking Centel, Checking Plus, MasteiCard, Visa. Citibank Preferred Visa and PdasterCard, Citibank Platinum Select, Checks -as -Cash, Equity Soulee Account, MultiMoney and Ready Credit are legislated in the U.S. Patent and Trademark Office. CdiGold, Safety Check and CitiPhone Banking are service marks Of Citicorp TO RECONCILE YOUR CHECKBOOK WITH THIS STATEMENT, FOLLOW THESE SIMPLE RULES 1. List in your checkbook any deposits, witlidrawals and service charges which are shown on your statement, but not recorded in your checkbook.. Adjust your checkbook accordingly. 2 Math ud et your checkbook all checks paid, witndrenals, or deposits listed an your statement 3. Lisl and total inthe "Checks and Othor Withdrawals Outstanding" column al the light all Issued checks that have not been paid by Citibank tcua-then with any applicable check charges and all •uithdi a•wals made hom your account since your last statement 4. Deduct from your checkbook balance any sannce or other charge (including pre•aulhorized transfers of automatic deductions) i tat you have not already deducted 5 Add to your checkbook balance any Inlerest•eamed deposit shown on this statement 6. Recotd Closing Balance here (as shown on statement). I I ME at transfers you recorded which are gout Checks and Other Withdrawals Outstanding (Made by you but notyet indicated as paid on your statement) 63 T YVONNE ALMORE WATSON . I V Account 7434011768 Page 4 cf.6 Statement Period - Mar. 25 - Apr. 22, 2003 [Purposely left blank] u 114764IR12CF-+3 a ctsbank10 YVONNE ALMORE WATSON ? \.rf- �+\ ` r r • � ^ .vim\, ..:5• Account 7434011768 Page 5 of 6 Statement Period - Mar. 25 - Apr. 22, 2003 Node: Imacted checks can be used as evidence of payment. Imaged checks appear in numeric order. Non -numbered checks will appear first. Non -check items will appear last. �e5'n�o¢s 3a rA.: LN�3� L.. �tTi�....✓�h_.n� ' a.'0.�-cJ itci�'f6�Y n i ':3i2i71749': SB4: :'94i 4.J 1: iE9: l000GU02ie 1F Ck Oita Ga/072G03 Ck Nn 1891 Amt•• 327.c"1 H_7 r i t••Np Cne ntMl m nNi^f:1 j 1.1'Ji C. •.i .2lrf4'SY. �. q'q wsart ua J f 1 MUsma r� 1 m:nmmv v.apamaio 4aa.,,,a„ i i i ai:i3x ql a:i::"4: ti 34L:1:00•' e0.3munece Ck Date 04/042003 Ck No. 15153 Amt. $72,00 M v v s s_y.re,c_r 15a3 � A, '13ii291i79'::a93 a"43 G�J 4:Fven' tU0JCC373JU: Ck C_ro. 04."J4,7.003 Ck NO: 13e3 Amt' $303.00 YVONNE ALMORE WATSON Account 7434011768 Page 6. of 6 114795/R120F013 Statement Period - Mar. 25 - Apr. 22, 2003 i�Z 0421074470 N0420rC0 •'• _ I 1 ~ yr. Faoe2ss_o aa2 u• �N • Irto aa. ���wa;;��'bl'•n 07ZE "L' 1 1 "'33d iL'l a 91 L�-, Ck Date. 04/042003 Ck No 1893 Amt: $303 00 v v :c.ew,z°o-a 4 °rods 2}Ae- s-Y ,D 36553i23C 04- t� FROCE9a20 002 05-0� nl' A.;i ilfi r e S.1 Si'fr ��Y�r�r��J �'�I•��� Ck Date: 041072003 OR No. 1891 Amt: $27.61 e , o�a�orn+t wwzx4 1 fi >gcetiio cot 2"N„ O�e fi j i i Gp.v8 S�Si. a s 2@227M* Ck Date: 04/042003 Ck No: 15153 Amt: $72.00 1 i r DECLARATION OF NO INCOME APPLICANT NAME: /= W i 5 cif SOCIAL SECURITY #: -5- W R, •- - 7� 4 G In order to continue processing your application for housing, the following "Declaration of No Income" must be signed by the person named below. TO BE COMPLETED BY APPLICANT I, LAILU/1 (<1 i do NOT receive income from limited to the following: Self Employment SSI Retirement Funds Alimony Income from Assets Educational Grants , do hereby certify that I source. I understand sources of income include, but are not AFDC General Assistance Disability Union Benefits Family Support Work Study Employment by Other Unemployment Compensation Social Security Worker's Compensation Child Support Annuities/Pensions I understand that should I become gainfully employed or begin receiving income from any sources I must report the information to the Resident Manager immediately. I certify that the foregoing information is true, complete and correct. Inquiries may be made to verify the statements therein. I also understand that false statements or omissions are grounds for disqualification and/or prosecution under the full extent of California law. Signature a Lf - Date 7 - / U -- O 3 ��JIL „tea Cera;icc'aa_�ro._rem:i. :n Una 1^tuber 31 INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designated to assist you in computing Annual Income in accordance with the method set forth in the Department of Housing and Urban Project t"HUD”) Regulations (22 CFR 3131. You should make certain that this form is at all times up to date with the HUD Regulations. All capitalized terms used herein shall have the meaning set forth in the Regulatory Agreement. CSCDA (pool) - Newport North r, I'bVe the undersigned state that Irwe have reed and answered fully, frankly and per <_onally each of the following questions for all persons who are to occupy the unit being applied for to the abote apartment project. Listed below are the names of all persons who intend to reside in the unit. 1 2. 3. 4. 5. Name of Members Relationship Of the to Head of Social Security Place of Household Household Age Number Employment Income Computation 6. The total anticipated income, calculated in accordance with this.paragraph 6, of all persons (except children under I3 years) listed above for the 12-month period beginning the earlier of the date that Vwe plan to move into a unit or sign a lease for aunit isS Z11604A6' Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real or personal property (without deducting expenditures for business expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets); (c) interest and dividends (including income from assets included below and other net income from real or personal property); , (d) the full amount of periodic payments received from social security, annuities, insurance policies, retirement funds, pensions, disability or death benefits and other similar types of periodic receipts, including any lump sum payment for the delayed start of a periodic payment; (e) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (F) the mamntttm amount of public assistance atailable to the above persons other than the amount of any assistance specifically designated for shelter and utilities; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts receit ed from persons not residing in the dwellings; (h) all regular pay, special pay and al low antes of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the household or spouse; and 0) any earned income Inx credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (1) casual, sporadic or irregular gifts; (b) amounts which are specifically for or in reimbursement of medical expenses; (c) lump sum additions to family assets, such as inherinnces, insurance payments (including payments under health and accident insurance and workers' compensation), capital gams and settlement for personal or property losses, (d) amounts of educational scholarships paid directly to the student or the educational Institution, and amounts (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (f) relocation payments under Title H of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970; (g) foster child care payments: (h) the value of coupon allotments under the Food Stamp Act of 1977: (i) payments to volunteers under the Domestic Volunteer Services Act of 1973; 0), payments received under the Alaska Native Claims Settlement Act: (k) income derived from certain submarginal land of the United States that is held in trust for certain Indian tribes: (1) payments on allowances made under the Department of Health and Human Services' Low -Income Home Energy Assistance Program: (m) payments received from the Job Partnership Training Act; (n) income derived from the disposition of funds of the Grand River Band of Ottowa Indians: and (a) the first S2000 of per capita shares received from judgement funds awarded by the Indian Claims Commission of the Court of Claims or from held in trust for an Indian tribe by the Secretary of Interior. 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necessary items of personal property such as furniture and automobiles and interests in Indian trust land) i( Yes No; or (b) have they disposed of any assets (other than at a foreclosure or bankruptcy sale) during the last two years at less than fair market value? Yes _ t No ( c) If the answer to (a) or (b) above is Yes, does the combined total value of all such assets owned or disposed of by all such persons total more than 55,000? Yes li No (d) If the anstter to ( c) above is Yes, state: (1) the combined total value of all such assets: S (3) the amount of income expected to be derived from such assets in the 12-month period beginning on the date of initial occupancy in the unit that you propose to rent: S — and (3) the amount of such income, if any, that ttas included in item 6 above. S S. (a) Will all the persons listed in column I above be or have been full-time strident during five �5 i calendar months of this calendar year at an educational institution (other than a correspondence school) with regular faculty and students? Yes X No (b) Complete only if the answer to Question SIM is "Yes"). Is any such person (other than nonresident aliens) married and eligible to file a joint federal income tax returns? Yes x No 9. This certificate is made with the knowledge that it will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and 1/we declare that all information set forth herein is true, correct and complete and based upon information I/we deem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. 10. I/we will assist the Owner in obtaining any information or documents required to verify the statements made herein, including either an income verification from my'our present employei(s) or copies of federal tax returns for the immediately preceding calendar year. it. Me acknowledge that all of the foregoing infomtation is relevant to the status under federal income tax law of the interest on bonds issued to finance the __31 N of the apartment building for which application is being made. We consent to the disclosure of such information to the issuer of such bonds, the holders of such bonds, any trustee acting on their behalf and any authorized agent of the Treasury Department or Internal Revenue Service. I/We declare under penalty of perjury that the foregoing is true and correct. Executed this 5�h dry of , 30 a 3 (year) in the City of NetN�l8egz , California licant V Applicant ppl' it Applicant (Signature of all persons (except children under the age of IS years) listed in number? above required) Iry FOR C0-WLrn0ii TY Ap.ARTMENT Oiai��31 OyLF: 1. Caiculation of eligible income: a• r"—.r amount mead for entire hou_caold is 6 above: b• (1) If the amount entered in 7(c)above is yes, enter the total amount entered in 7(d)(2), subtract f -or '•a figure the amount entered in 7(dx3) and enter the zema°'iinl (2) Multiply the amouL 'et 'nr(d) the current passbook savings rate -� � ermine what the total Annual eamin, ould be if invested in passbook savin, ��, subtract from that figure the amount ente, n 77(a)(3) and enter the remaining balance ($ (3) Enter at right the greater of the amount calculated under (1) or (2) above: c. TOTAL 13120 BILE INCOME (line La plus line 1.b(3): 2• The mnount entered in i •c: Qualifies the applicant(s) as a Moderate -Income Tenant(s), X Qualifies the applicant(s) as a Lower -Income Tenant(s). Qualifies the applicani(s) as a Very -Low Income Tenant(s). s g1(6o4.96 S NIA $ 41104.95 3• Numb,ar of apartment unit assigned: 3 14 Bedroom size: 1 1 I Rent: s 1130.Oa— rQ. This apartment ual (was not) last occupied for a period of 31 or more c omecutive days by persons whose aggregate anacioa annual income as certified in the above manner uncn their initial cmuoaucy of the apartment unit qualified theta as a Lower -Income Tettant(s). S. Method used to verify applicants) income: Employer income verification. Cco Qs of tax returns. • � 'y}I a Ii �hIC OML" ^"SET CA! CULAIO _ �1In•il Naiiin—'IOntlln'•--Ifol.illminlili "-"— --N 1 x Unlo Vf UIIIII VLIni SULur11• ! Yu.,NO —Lb.cld70.s �a:rnalerLl .� 10� I I—J 7-s'zs�l_ N 3 u n.Vcl M=11pliun Imputcdl "Ic , u1lClll __ l G(—I—yJLnI I or C 21 I'2ndscls Inclu�l IncomV lrancMhtEa1ia a el710!71,1 _ua l 1 Ihu'uuiuun:Orat:ruohtnBs¢Jc "' Box I- cx.etls Y',WVn loulliply Cllcctivc Data AI- CUyIlia Umwnlpnssbu0 "Ul05lwlU; X — ry1 VI Progr.UnR Inl.v It UVx UBVoc put UxcauV i'+,WN Unit No. 314 Ji[o lii Vuiur •V-LI UUx G: UOX G: S No. of Pcr.Vir._� INPUTED 114COIAL 1411. V Max, Incon10 Limit t IROMAB96T5 Ali- u�.. ,. ..O.cr— Earned Income Calculation Worksheet Name lAcYrr`� rmws a Most Recent Ending Pay Period Date Hire _Date 5'/3/03 - F I /O 3 YTD Income 613a2 .oq divided by 0 Start with hire date if at job for less than a year (_) -7oo.23 7 (how often paid) M I 26 1 =) Calculated Annual Income g�2o5,g8 Gross per Pay Period 737. 6a (_) .-2 t2o2.07I divided by 3 (_) 7 3 y •a 2- (how often paid) (x) Z6 (=) Calculated Annual Income f910rIq•52 4� Nay-2! 03 09:1$am Frcm- IALAH EUSIVESS 999093034E SOUTHWEST HBAI.THCARS: SYSTENI Employee Name: 3ACI-YN THOMA5 16435 INLAND VALLEY Cost Ccilmr: 000000903 WR.DOMAR, CA 92595 Employee Number: 0021028880 Social Security No' 261-87-5286 Hank Account(s): 6141003708 574.45 PTO His Remam: 153800 ELB Hr Remain: 3.7000 ;•TAY£SfDEDCT,TI. -Ts. DLSCZIp; ION 1 HOURS DOLLAIS PATE i ➢ 1R1PCI014 CURPENT Y.TD I REG 1 .25 _ 2.41 9.640 SOCIAL oEC TAX 4252 Nun REG 1 72.00 69e.22 9.642 MEDICARE TAX 9.94 9033 Orr 1 .21 1.21 4,340 FEDERAL INCOA!ETAX 43.77 413.19 ' STATE TAX G 92 6$ 43 SPATEDISABILITY 6.28 56.r PRE TAX FLX 12.09 7:,54 't POST TAX 1.87 11.2= Pay Dam: 05/09/03 Awke Number. 53866 Pay Pd Smt Dam: 04I20f03 Parr Pd EIA Dam: 05/03103 Ba"m Ram; 9,642 •Des"Innq I CURRENT Y.T.D — HOUTS CURRENT i 72.50_ YEAR TO DATE EARNINGS I TAXESIDEDUCTION<- .w---. 697.84�— .W.._. 12339 - 6302.09 1095.46 BENFFrfS NET 574,45 _�- II 520641 S01MIWEST HEALIMCARE SYSTEM Bank of America 36485 INLAND VALLEY cc Mne'ei61 erburaernont A.,M Ncr(rer4nY, R R'ILDOMAR, CA 92395 30.232aGiS PAYROLL ACCOLTI f PA7 DATE: 05/09;03 ADVICE NUMBER: 53S66 NOTIFICATION OF DEPOSIT lit I * * * 574.45 . . ASS,. x NA,.M' A. • ,. • .., d t .M : • Nay-21-03 09:1Sam Frcm- 14LARD EUSI4ESS 9095930$48 T-W P.01'!313 F-535 SOUTHWMT HEAWNCAR£ SYSTEIVI Employee name: ]ACL'YX TRObMAS Pay D2k: 04/25103 36485 INLAND VALLEY Cost Center: 000000903 Advi4:,Number: 53067 WILDOMAR. CA 92595 Employee Number: Q02202838D Pay Pd Scrt Date: 04/06:03 Social Sacunry NO: 261-S7-5286 Pay Pd End Date: 0411E Bank Aceount(s): 6141063705 026.20 PTO Hrs R-main; 7.6900 Base Rue: 5.642 ELS Hrs Remain 1 8fo0 . I;j • .'. • ,.. �� :.i: •TAXES717EF3ITG'!'IOi`iS: ��..••; •.. � BE:V�Fi,'TI',S:..•;• . ,...•. •, DESCRIPTION HOURS DOLLARS FATE DESCRIPTION CORaBNT Y.T.D DESCRIPrM CURRENT I Y.T.D. REG 1 79 50 766.54 9.642 SOCIAL SEC TAX IS.77 318M MEDICARE TAX 10.94 14.59 PEDERAL INCOME TAX 52.88 354.23 STATE TAX 8.29 55.67 STATE DISABILITY 6.90 46.84 i PRE. TAX FI.X 12-09 60,45 POST TAX I 1.87 I 9.33 HOURS EARNINGS T.AXESIDEDUCTIONS BENEFITS NET CURRENT 7950 7GG,Ss 139.74 626.SO YEAR TO DATE 5204.25 920.04 —T! ^I.�Y-.-41$4 J SOUT4TH'EST HEALTHCARE SYSTEM Ban1, of Amerlea SAY DATE! 04/25/03 36485 INLAND VALLEY C ercial DlaAu•:ement Aneount WO..DOMAR, CA 92595 70.232e015 ADVICE NUMBER- 53067 PAYROLL ACCOUNT NOTIFICATION OF DEPOSIT To The JACLYN THOMAS Older 44781 CORTE NAUTIA Of TEMECULA , CA 92592 .Ir�"" * 626.8tl NON-NEGOTIABLE A"%A/ " TA 11411. May-21-03 09:15ar Frcm-INLAND BUSINESS 9066930346 T-64-1 P 012/1313 F-639 SOUTHWEST 1iEALTHCARE SY-ST i 1 E:nnloyce Name; JACLYN THONIAS Pay Uat:: �• • •••^- Advice NUM7Ur•. 52283 e INLAND VALLEY 3648. Cost Center; OO0000903 Pay Pd Suit Dam; 03/23103 r 1VILDOMAR,CA 925J5 En 10 ce Number: y 002202S880 cf PayPdEndDetc: 04/03/03 Social Secarir/ NO; i 261•ST-_'..E6 Bank AeUoune(s)= G3elOE3708 605 32 FLO Hn Remain: 0.0000 T='' i ELB Firs Remain: 0.0000 v I:• • .,, .-,• • .,• •, PGI.➢5 DOL'ARs Rn"£ DFSCRIPT30N CVARLNT i.T.D DESCiIPrios CURRENT Y.T.D, DESCRIPTION AEG I 79.75 73'i.G^> 9150 SOCLLL SEC TA:< 45.M 27114 MEDICARE TAX 1052 6J•6S FEDERAL INCOME TAX 0 SS 301.35 STATE r,IX 7.71 47.3R STATE DISABILITY 6,68 33.S4 PAC• TAX FLY 12.09 4E,36 1 I I POST TAX I•S7 I ' 7•48 jI III 1 I .!r------- HOURS EAP-xINGS i TAXFS/PEDUCT102S EaGL7EFRS NET �•�— 79,75 605.32 - CURRENT - - -"�- a437.71 3657J`41 j 750.:) J YEAR TO PATE _- SOUTHHWEST HEALTHCARE SYS'TKA1 Bank of America Cammsre7➢I Oabutsrmeet ACWuri 36485 INLAND VALLEY Nv.hb,eok,M WILDOMAR, CA 92595 79-2328MO 3'AYROLL ACCOUNT NOTIFICATION OF DEPOWT To The JACLYN THOMAS Order 447b7 CORTE NAUTIA Of TEMECULA , CA 92592 PAY DATE: 04/11103 ADVICE NUMBER: 52283 •" •' 605.32 NON-NEGOTIABLE ,4k ; .. clay-21 03 09;16am Ficm INLAND EUSINDSS 9096930346 T-643 P 013/313 F-533 F. THOMAS SSA9 532-67-0359 / WEEK PAID 05-03-03 $260.00 41354 CLAIM EXPIRES 01-03-04 05-10-03 32D0.00 YOUR CLAIM BALANCE AFTER THIS PAYMENT IS #24-.5.00 UNEMPLOYMENT COMPENSATION I5 TAXABLE. A QUESTION ON THE CLAIM FORM A,LOWS YOU TO REQUEST FEDERAL INCOME TAX WITHHOLDING AT IV% OF YOUR PAYABLE AMOUNT. YOU AA E A NEW WITHHOLDING CHOICE CH EACH CLAIM FORM YOU SUBMIT. ALLOW TO DAYS FOR DELIVERY OF Z ICCY- DETACH THIS MIS FOR YOUR RECORD r J19042a3; F. TH08A5 SSA! 552-67-0359 / WEE< PAID OA-19-03 5260.00 41268 CLAIM EXPIRES 01-03-04 . 04-26-U3 7260. 00 •OUR CLAIM VALANCE AFTER THIS PAYMENT IS 42995.00 UNEMPLOYMENT COMPENSATION IS TAXABLE, A QUESTION OM THE CLAIM FORM ALOBS YOU TO REQUEST FEDERAL INCOME TAX WITHHOLDING AT 10% OF YOUR PAYABLE AMOUNT. YOU MA E A NEW WITHHOLDING CHOICE ON EACH CLAIM FORM YOU SUBMIT. ALLOW 10 DAYS FOR OEtNERY OF CHECK, DVAOH THIS STUB FOR YOUR RECORD 68219869 F. THOMAS $SAO 552-67-0359 / WEEK PAID 04-05-03 $260.00 39201 CLAIM EXPIRES OS-03-04 04-12-03 $260.00 YOUR CLAIM BALANCE AFTER THIS PAYMENT IS $3515.00 UNEMPLOYMENT COMPENSATION IS TAXABLE, A QUESTION ON THE CLAIM FORM .L.OHS YCU TO REQUEST FEDERAL INCOME TAX 147THHOLDINC AT 10% OF YOUR PAYABLE AMOUNT. YOU M.K' A NEW WITHHOLDING CHOICE ON EACH CLAIM FORM YOU SUBMIT. I_ ALLOW 10 DAYS FOR DE_I\'ERYOF CHIaCV DETACH THIS STUB FOR YOUR RECORD 6755 3153 A� y !14, 06/12/2003 11:20 9096766017 CFA LANDSCAPE & MATN -- — — New,,ort Borth Apartmei s 2 Milano Dr. Newport Beach, CA 92660 (949) 720-8765 (949) 720-1598 FAX Verification of Famiiv Sunp©rt a Address: 314 YYbj�r CrAci Nervnort Beach. CA 92660, 1. FEar frNT>O TnUMii S am receiving a monthly family support payment in the amount of S -150. U0 from ibin --Ttt'fh TnumR $ Social Security Number Jul g Thereby certify tinder penalty of perjury that the information provided above is true and complete. Signature of receiver: Signature of provider: State of California County of /chi r)tlt,dze&� Signed before the this ___ 6 ✓ day of 2Cg, California. 7b cel- v which witness my hand and seal ce. FC(ZNAW.>o rTtoa4A- ..��(�(/t�� 1i�v7(�• Notary Public in and for the said County and State (// —mil My connnissiou expires on: t� CMo11EIMC44s Notary Puh#6Gajti*m L !ty *m-ffq.JuIY22. Has Asset Calculation Worksheet Name f�, y Apt # Bank Name/Account Type Unim Ucnk a W ) Savlrtjs Ending Balance 706, HI I divided by (Bank Name/Account Type I I Ending Balance HI i divided by Bank Name/Account Type une1 &4 4 Q:1 1 6nT%'rn --? 5a clyn lller2 Ending Balance y41.3H (+) MI (_) I I i 634.6 Z 1 divided by 0- MI Ti-7 .31 . Bank,Name/Account Type Ending Balance (+) HI I divided by 1 i ..•r. ,•.lam � , � , , 1 •' ,laid f Stay-21 03 03:13am Frc IYLANO BUOIo°SS 803u83834B T-340 P.004/013 F-139 i7 1 f4 6. A C C 0T 5 UNION BANK OFICAUFORNIA Ste :.Num 14106370$ 3/24/ 3 4/24/03 hI85X0N GROVE T.VTaRE 614 1Ek�r 80X 80 Pa 123 5 L0.S Box125 CA 90951-0380 For 24 -,..ut Aw1crnwed Urect Somlc 800• 3 4436 $00-8' ,i 7345(TD0) Repre :eilarives ore avc4oble hem • nm 10 I 1 pm • To q ::i; additional =ounts. V or ac >I a iotr loans, call your conk ';l ofriee. at 909.78h-O l4 I CY20 Z OA :030 JACL-YN ADAN Visil 's or wv+v.,ubec.eom 44781 CORTE NAUTIA TEMFCULA CA 92592 Thar! you for barking rfiihus since t001 ® News this good needs to be shared with everyonei Online Bill Pay with 8c ik atiomeO on The Web is now FREE. Spend less time paying hills and have greater control over your finances. T 1 del started, log on to UBCC.com/inaanf or contact an Online Banking Spec;olist at B00`79656 it, option I REGULAR CHECKING SUMMARY Account Number: 614106370$ S Balance on 3/29 $ 1 193.28 Additions 2 9 8; 2 Subtractions O Cheeks 2,041.49 Paymenls-101.50 Purchases-933.97 ATM withdrawals •503.00 Other WhIldrmvgis •130.00 Balance on 4/29 $ 441.34 StotemenlAverage Ledger Balance $ 590.83 McINaR4 le cesttipllon _ 11e1aranEa Awiourl_ 4/1 ATM/LOBBY DEPOSIT # 0000098713 46602345 S 40.00 4/4 OFFICE DEPOSIT AB206699 500.00 4/9 ATM/LOBBY DEPOSIT #0000837166 A5514438 49.95 4/10 A•TMILOBBY DEPOSIT # 0000837281 46205524 300.00 4/I1 SOUTHWEST HEAL1HDIRECT PAY PPD 50060607 605,32 4/18 A7M/L0B$YDEPOSrr 47427412 IS0.00 4/21 ATM/LOBBY DEPOST 46319280 520.00 - 4/21 1AACY'5 WES , TEMECULA CA 71080024 63.95 4/22 ATM/LOBBY OEPOSIT E 0OWS48367 46411452 100.00 4/25 SOUTH WEST HEALTH DIRECT PAY PPD 53498150 626.80 4/29 CHECK SAFEKEEPING DISCOUNT 1.00 4/29 DIRECT DEPOSIT DISCOJNT Ta1al $ 1.00 4,958 Cbo 6 Nrm691 Data Raiorenca Amount r �mLar C 4 {:oTmo�cc _� _ Am:enl 0746 3/3) 18700758 3 201.00 0754 4 '0 75000812$ 93.02 May-21-03 00;13sm Fro-14WID EUSIMPSS 9N3930348 I w T-643 P 005/013 F-538 51ckn. I Im6or. 6141063708 3/29/C I4/29/03 online cnd _ .4/4 MERCURY CASUALTY PAYMENT PPD electronic 6cnkiny 4/2 O:. SA I'NC$ L N{rER o Os 1 d1337302207J1TT Tala1 3aranQ9 Am_wnr -.. :':769684 $ 76.50 5', 1-22Z -75 CO--- $ 10i.50 v FYYC{rQ3PA Daln DwuiA•ion; loescn Cr kenr- An•ovn• ATM card cnd 3/31 STARBUCKS 000530dA TEMECULA CA 67653441 7)$622^1 $ 6765344/ 73862234 3.50 4.00 MoslerMoneyTN 3/31 STARBUCKS 00059493 TEMECULA CA EXXONMOBIL 59 01201763 MURRIEA CA 67653441 70860338 15.80 card surcne es 3/31 4/2 STATER 139 25050 HANCOCK A MURRIETA CA 67653441 70921 144 23.97 4/3 RALPHS 40545 CALIFORNI murriolo CA 67653d41 7 D921554 26.35 4/7 ALBERTSON' 4 1000 CAUFORNIMURRIETA CA 67653441 70951510 13.16 d/7 EXCAUBER 40646 CAUFORNIMURRIETA CA 67653441 :0951359 24.24 4/7 TARGET 128 4104C CALIFORNI MURRIETA CA 67653441 70951441 A6.02 A/11 MOBIL 18 8 39960 LOS ALAMO MURRIETA. CA 6765344: 1010704 16.34 d/ 14 ELECTRIFYI NG TAN INC MURRIETA CA 6765344 71020158 49.79 4/1 A STATER 139 25060 F-ANCOCK A MURRIETA CA 6765344 :11021946 33.02 4/ 14 ALBERTSON' 41000 CAUFORNI MURRIETA CA 6765344 '1021428 '71051450 36.39 4/ 15 MOB;. 18 B 39850 LOS AL :MO MUP.R:EiA CA 6765344 15.33 4/ 16 PUER.0 NUE 4469 MURRIEA MURRIETA CA 6765344 '105125: 8.06 4/16 TJPPERWARE 14901 SORANGE 888.887.9273 FL 6765344 7/051424 11.58 A/17 STARBUCKS 00067256 MURRIETA CA 6765344 7L062238 3.45 4.49 4117 5U3WAY 25377 MADISON A MURRIETA CA 6765344 7106065' 4117 STATER 139 25050 HANCOCK A MURRIETA CA 6765344 71062126 54.98 4/18 TUPPERWARE.C-TJPPERWAR 8003663800 FL 676534c 71072316 67653441 71071222 36.64 45.22 4/18 4/18 JCPENNEYCA0640WINCHESTETEMECULA CA MACYS WESTA0780 W'INCHESTETEMECULA CA 676534.1 71072155 64.24 4/21 ALBERTSON' 41000 CALIFORNI MURRIETA CA 67 6S34. ' 710$2033 47.9A A/23 EDS HEALTH Y FAMILIES P 800.8805305 CA 676534, 711 10327 16.00 4/24 CHEVRON W 31669: WY 79 SO TEMECU A CA 676534. , 71121850 19.75 d,24 PECHANGA 45000PALA ROADTEMECULA CA 676534.1 71121241 26.00 4/24 ADAM MAIL 800794.3316 NC 676534 1 71132312 31.90 5.25 A/28 PECHANGA 45000PALA ROAD TEMECULA CA 676534 1 71160952 4/28 JUICE BAR 40525 CAUFORNI MURRIETA CA 676534 •1 71160530 7.50 4/28 ELECTRIFY) NG TAN INC MURRIETA CA 676534.1 71160156 18.00 4/28 ELECTRIFYI NG TAN INC MURRIETA CA 6765340 71160156 41.99 4/28 RALPHS 405d5 CALIFORNI murriolo CA 676534 11 7117191.6 28.80 4/28 TARGET 128 41040 CALIFORNI MURRIETA CA 676534:., 71151719 6216 4/ 29 PIZZA HUT 07053341 MURRIETA CA d7653. 71172232 13.24 4/29 PIZZA HUT 07053341 MURRIETA CA 4 67653 4 7117251 1 54.31 4/29 4/29 EIECTRIFY1NGTANINC MURRIETA . CA TOYS R US 39855 ALTA MURI MURIETTA CA 67653. •1: 71181946 5.37 4/29 RALPHS 40473 MURRIETA MURRIETA CA 67651.1. 71181902 933.973.97 Total $5 ATM vilth4rawA Dora Coln iion/lomfon Relaronrn Amoen: 3/3' UBOC MENIFEE LBY MENIFEE CA 67653 :41 70881827 $ 80.00 4/7 UBOC MENFEE [BY MENIFEE CA 67653 1e l 70961605 80.00 A/7 B OF A SUNSET.WETHERLY WEST HOUYWOO CA 6765° 141 70961937 41.50 4/7 8 OF A SUNSET-WETHERLY WEST HOLLYWCO CA 6765i :• 1 70962341 41.50 4/21 UBOC TEhiECULAD/U TEMECULA CA 6765:•,•.) 71081715 40.00 4/21 UBOC TEMECULA D/U TEMECULA CA 6705,.:).:l 71091726 100.00 4/22 U80C TEMECULA D/U TEMECULA CA 6765: 4 .1 71121220 20.00 A/28 USOC TEMEC'ULA D/U TEMECULA CA 6765:.t 11 71 161534 icoloo TOW $ 503..00 OLhor witt'j"nIs Ome Jd=•icbon _ Rofe.once Amowi Inclod,ny laea and 4/3 OEPOSITED iTEM RETURNED 99313799 S 99303800 2500 603 odjusimenrs 4/3 RETURN ITEM FEE ,#7rN : rA.1 A44 May-21-03 09t13am Fro-IYLAN9 BUSIucSS 9098930340 1-643 F 006/013 F-S39 Ste. .c Plumbor. 6141063708 L 3/29r :: •4/29/03 Other Withdrawals C�h 1%mnioh'on _'Potence Amount 4/7 WITHDRAWAL ti0000887130 .16602311 S 30.00 W continued 4/9 NSF ITEM PAID FEE 99529202 50.00 4/17 WITHDRAWAL tt 0000897080 iP.304523 10.00 4/29 SERVICE CHARGE 900 Total $ 130100 About Your Monthly S rvice CFserae - - you eon avoid a monthly service charge in one tithe following ways • keep or least $1,000.00 in your account at all limes -the first day you had �r st. was on 3/31 • keep an average balance of at least $2,500.00 in your checking account-; air average checking balance bch,veen 3/29 and 4/29 was $ 590-65 ■ keep a Combined Balance ofat least $3,G00,00 in your combined checkinc-.ay.ngs, lime deposit and money market accounts -your Combined Balance between 3/29and 2/25 has $ 590.86 Your account was charged a monthly service charge. You may be able io a• n d this charge in -he future by changing to a different type of account Call Teleservices at BM238-441 6 for details. Information and tiankitta Ctffien Bonitos _.�� ^+� for "ch monthly statement period your aceaunt incfudn: ■ Unlimiled Fee Information $erv:ces calls to 24-hour Au:omaled Dirac 53rvice ■ $ free Information Services colts to speak with Personal Serv:ce • 3 Free banking office Information Services calls ■ S Free banking office deposit: Far the current monthly statement period you called: Aulomalod Direct Service on: 3/26, 4/4. 4/5, 4/7, 4/8, 4/8, 4/8, 4/9 e /9, 4/ i0, 4/11, 4/16, A/18, A/19, 4/26. Personal Service on: 4/8. For the current monthly statement period you made: 1 banking office deposil. Your account was nor charged for information and banking office sarv'ce c'vrira the statement period may-iil-03 09114211 Frcm-INLAND B' ",;SS OF ACC0 JS UNI<')N BANK Or CALIFORNIA POBOX TNSTORE B12360 O LOS ANGELUS In slatem901 9093930348 NO P.001/313 F-333 St., IVVTIT•n6,41VOJ/Ve 1H j••• 3/26/03 n 614 Teke ri.esC] CA 90651-0380 Fpr 2 0)vr Aa1am'ed Direct Skfvlce 8004 IE.4466 8004 i4•7345(I1)D.' 8epr ::I n:n!,ves are available from a )m to 11 Pm Cr20 2 O A I-00 JACLYN ADAN 44781 CORTE NAUTIA TEMECULA CA 92592 To e,acldr6onolaecounn, or a, f: y for loons, :alf your bans ,J office of 909•789.0141 vied ,,I rf vvww.vb0,:com Thar I oi, for banking wish us since 2 )01 For more titan 135 year,, we have been crealinq personaGzcrl imonciaf s. a.egias io help people jud like You ;heir unique retire,nenf goals. Come in and talk will, us about vour reliremi n PlcnNng needs loclay. Balance on 2/28 S 2.25 Additions 6,582.0 . Sublrachons •5.0 6.51 Checks 11,603.53 Purchasus -3.223.98 ATM wilhdraw•als .40.00 011•e, wdhdrawols •229.00 Oalance on 3/28 S 1,193.28 r Statement Averaee Ledger Balance 1.004.40 Account N, im be.: 614106:1 /b.' (`,ddidons Cn+r De:clipliet ,__�•(�rencr, ___,,,, ____ ,A,„'::": 2/28 PT:YERSAL OF CHECK,1 0727 2/28 SOUTHWEST HF.ALTLDIREC12&YZPQ -TREASURY 52275086 h54.'19 2/28 5 220 TAX REFUND PPD S 1 S0 I842 3,071.(R) 3/4 0 I D IT » 0 u' l 1 45522717 FROM L, • ;V6 ATM/LOBBY DEPO$IT # 0000337209 471 14016 260.00 2/7 fRANCHISETAX BID TAX•REFUVJPPD ::4242047 113P.00 3/ 1 1 ALL GEM ALI 340 E. FOOTHILL 909.5962991 CA 7067{X)¢4 :1.2.19. �/ 14 SOUTHWEST HEALTH DIRECT PAY PPD 56218120 66B.07 2/2.0 MiSCELLANEOL•S BANK ORIGINATED 17,EM 26:33280D 1130.00 3/24 OFFICE DEPOSI' 40000192436 46317003 110.00 3'/24 ATM; LOBBY DEPOSIT # 0000331644 45121675 2(A),(X) 3/26 ATM/LOBBY DEPOSIT # OCO0331739 45412735 4;, Lr;) y/27 i �FFIC,E pEVC?SIT . _ .. - - - - 48214360 a70.UC: 3 /28 CHECK SAFEKEEPING DISCOUNT 3/28 DIRECT DEPOSIT DISCOUNT I,CJ 3/22, SOUTHWEST HEALTh DIRECT PAY PPD 53219251 Total $ 6,582.04 CI,oC1Ls hay JWtr 8efnm- Arimnl Nu,4 •+• RekmO<t C725 3/4 80318988 $ 90.00 0732 : /3 7.501A3835 4'%6!A; 0726 2/28 11417429 39,6$ 0733 ri 22702036 IOE:/7 072.7 3/6 11221270 14.03 0734 :; 18310873 7E.?r 0728 3/4 22;19849 15.07 0735 A IA439073 152.8i 0730' ?,r-a 2Z337860 100.i)0 0736 /•`, ; 8310874 S"•'.`t.`• 0731 3/4 i4457171 150.00 0737 /7 10/26275 e.,0 4 77'w: TA 1 ,AJA 'Aar'-21-03 03:Main I'mr.-ML.ANO R' zS; SOM36343 T-W P 002/013 F-633 Stc it Numlrr: 6141063706 .� 2/28 _3-3/'i3X3 )r112C115 4uub<^, Cwtr -, Rdna,_�_ kn,evnt Nur:G,•; t'mr •. fi�to, rn :._.. .-- n•,,..,.•n __ 073E! 3/6 1161''099 5 72.47 0745 3/2. 7500184 cbnhnaed 0 4.54 0747' 32. 511i'(i:i4 2PSi0 0740 3/6 'W 15362 -92.99 074d 3/2. 46212'.1W 1:1w•J'; 07d2' 3/24 194006M 7.03 Total 5 1,603.53 0744* V26 18-SIAIO 13.29 ',:h.-ck.m,:cngn:agpen.e:�e,oJ.••".0 wecI.L nu m1w m.,,tf nl:, b+lotumri it, AK Pry,m i.:ac lid, ,.ol;•n.,:w�anl l PU: 411gs6s Do4 1Efn'nfan%L•440Mt _ Ar%, n,., •, u.q,.n A'M-crtia•ui 2/28J ARCOPAYPOA1555vdN h15_TETEhsECULA CA 07,534.1 7059130i Mu:leiM�ney rnC 3i3 S7ARBlJCi:S OCOSS49J TEMECULA CA 676534,' 705)1?49 3`:(i IXIrcl FCri.hoses 5/ 3 ri 'B21ES TO "S d MORE LA E ELSINORE CA 676534, ' 70501047 9 59 ;;/$ CHEES6 & `NINE SHOPPE n CORONA CA 676524.: 706GOP<2 I n.;•r, 3/3 1CPENNEY C 40640 WINCHESTE TEMECULA CA 676534.: 70610:'0; 1 v,3Y 3/3 ARCt- FAYFO 44239 MAP,%iARiTA 7EJ.iECULA CA 676534 1 7061 1212 313 TOM :ARM F 23QOTEM"eSCAL CORONA, CA 676524 1 i 0601743 16..111 3/3 TARi35T 1284;040 CALIF•ORNI MURPIETA Cc 676534 1 7G601747 .':`: ?/,I $1AlER139M50HANCOCKAMURRIE[A CA 676e34 1 7052 1R,32 , /3 ADVANCED 5 2675.5JEFFF?SON MURP.;ETA CA 06E04 , 70611141 e"'.0. l;) 3/4 EAKE ELSIN CRE OUTLET LvKE ELSd,10RE CA 676:34 1 706CO2140 ;:i.fll- 3/4 TOMS FARMS COLJNTCY FI A CCAONA CA 67b$34 ' 706C0327 $TATER139'l$>SOHAVC%CK.4MURRIETA CA 6.'653411 70e.41936 Sl3!, LJ/6 A07ANCEDS26%551WERSONMURRIETA CA 6.*5534I1 %0G�•I%Oi E41,:(1 3: JCPNNYC406"NINCHESTETMECULA CA 676534 706GUb2 4E'46 V7 TAR3E_- 128 410,10CALIFORNI MURRIETA CA 67655: 1 7I1661Ud2 8.1, l 3/10 ALL OEM AU34:E FOOTI-ILL909.54)0P91 C, c7653.: 70652347 3/10 ARCO PAY?O 44236 MARGARITA TEM.ECUTA CA 67653.: 70671334 3/10 Wdd.4m15tore MLIRRII'{:, CA 67653• a 70681906 `1 vJ 3/10 SAY -ON ORL 250M HANCOCK A MURRIET4 CA 67653.4 70662020 S: .dd SAY -ON DRU 25780 HANC^CK A MURRIETA CA 5765J• -it 70.701216 3112 MOBIL 18 6 39850 LOS ALAr4O MURRIETA. CA 57653• •t /071 1524 3/13 SIARRUCKS 0059493 :EMECJLA CA 47653..11 70'r6 27 '!A', 3/13 P4:10 PLAZA DENTAL CARE TEMF.CUTA CA 6765. e 7O700824 20S tD: 3/13 412G0M'JRRIE'IAHOT MURIETA CA 67653 41 7072115.'' 11.:7.J 3/13 BEST B7" 2500MADISON A MURRIETA CA 67653 :1 /0; 1 1522 1 5 1J/ 3/1A PAT d OSCA RS M020040 TEMECUL4 CA 67653 41 70712233 •�(>'%1 3/1d ALBERTO$M4r:'20WINCHESTETEMECULA r:A 67653 41 707?IOC14 11 14 3/l7 FA.MPLAZA D:NTALC4RE 'IEMECULA ::A 676$3 ..!1 70720154 i.,3:;0 3/17 A..MERICA'S 71RE00013854 TEMECULA CA - 67653;41 70732300 d3 L'J1 3/19 CTO--APFR•AHMANSON .OSANCE,,ES ;A 67653 in 170762349 3/20 AL. OEM AU 340 E, FOOTHILL 90.9.5962991 CA 67652 1-,1 707723?6 1 U111).1 3/20 tTA'ER 139 25(50 HNNCOCK A MUJIRLETA CA 67653 1,.1 707E 18 i6 L'1 !r•, 3/20 SAV•ON CRU 25060 HANCOCY. A MURRIETA CA 67655 . / 1 707 EI 1758 4t, 1r.1 3/21 MOBR 13 B 29r,50105 ALAMO MURRIETA �:A 6765: s, 1 7: 8014d9 79,11 3/24 '' RIZON1vIR:A$HCCNYROL IRVINE CA 065::'•.1 70Y,(X)732 16e,?r, 3/24 TARGET 128 4 1140 CA,.iFCRNI MURPIETA C'k _ 065, !.I l N.L, i 1 136 3/27 PIZZA HUT x527 -r µgCULA CA 6765; a.:l S6113.6 4_j' Total 5 3,223.98 ATM wilf,drgwals :W< nee -_-- 2/21 :J90C. TEtaFCULA 0/ Ll T EMCCULA CA 6765. 4 i 1 % O8C' 11.4 $ 2C`.( U 3/26 JBOC TEtAECLI.A D/ U TEMECULA CA 6765' . a 70850547 Taal $ 4U.00 UtherviLrawals Gmgir4m:�--____�___J__ __ REF�,eoc>_. _. �_�_--y••' .n YUnin3 'Ides cr.: _Dole "; 2/4 N5P ITEM kFT!CtNF3 FEE595'rEOF' ,i ?i1,C:L: p;;usunen;; 3.112 '+Y'ITH7?AYd11L 903006G704 43121576 2C;:OU 3/25 SERVICE CHARGE °ter Total $ 229.00 :i4am frcrr-!4Laj0 ar •ss ? ; .]-1i?f10 6nNK Qt` �A{,IFOKTfKN Char9? � rn °nn of Iha iolbwing w°7" had l ..: waa cn '71'ig k• 6al n'e .`"r"—•=c�:r seNice chars i6c f,rI day y e =,rt ins - ronfh'ry ovr ry,, you tort av°ic! a n 1 ) 1n our acco+lrt a. ail time, • ou, checking �1,UU0. Y OU.UU' Y "'I and • kn�o at least • e cE al Iea.152,5 a ncs ynr tep evc•a�e ba cnc i UUt,.dG , in o che.i<in; v,as r cat 29 and 3;`GE •na, i r-1A aG 6 w zn 2/jO °r°'/` aaat ss 0. ' Y 6alonce of rt I ire Balance berKG n / p ,pnc • keels a (°moncd our amhir st th r, sFrtvee ., n'- r:anay marks: accauats - Y ba a�'''e trot i far 6v a,is Var. acccun+wascrorg amcninlyOU-11-Callizfe:ero+1slice'�l-ateoc,•232• _. of accoun • �-- 4:y c noncing io a different typo-•-- count indutles� rrcc i:rvice enfh stat.metif period Y A hevr AulomoleC D• For °ach; n r nfnrmciion serv!ces calls la 1 - • ,In,in•.ilep fre. �. • 3 E e eif nlmna eE5cervn'tu;ma io^ Ser"'aes calls+ersonal Serv.c . froe barking CiRcc decosi' eriCjYovcalled: 3/5 3/6. o, onth statement pen 3 ! 3/3• 3/�E, 3/1? For the cvrr'rin m y g, 2/ putomalc Ca3c19"'/ 4 3/ 8 3/14'3/17• / ! YOU Made; For the <wrent n,nthfy statement Perlw Y 1 Lur•k ns office! deposits. Jriny Inc j1c"Ien' per a`i pr GiGOu;t) waa not c�crVoa icr informat;or and banking office ssrvica� r�� May-21-05 09:122m Frwi- INLAND EUSliv=S 9098930S48 ORCCO FA+..-c45 UHAoPI BANr OF CA11FORMA NENSFFE INSTORE 615 LOSBANOELES80 CA 94051-0380 GYo7Z CAW30 FERNAN9D THOMAS 44781 CORTE NAUTIA TEMECULA CA 92592 T-6�; P.002/013 F-533 5tc. .Jun 15d0l0'12CS 4/11/C, /9/03 Tcaaen :o• Mr 24.1 xr.Au!omaied "Direct Service 8M23 ...486 80G82-;345(TQ0) Repres r.ivives ore cvalltsL-le from 6 a: n 10 11 pm To op� n adalilicnal accounts, or art for Icons, cull your Lan:lu a o,Wlca of;A-1- 72•%74 visitu rtwwH'ubrc.Cam Thank , r for bunking wish ds since! )00 Z An car or a 3 oo69e got vacai on number.An 1 8n�8 LOAVS forcur t d equity. hemt �iras number aac o lean lher, fife. is oecy. for o Haw house, LP`J untNllmhRr: 515.'060i 90 %EGULAR SAVINGS SJMAMRY _Arm. )ays in slalcmeni parioat 29 I OB Inhn 0 Balance on 4/11 5 Acts nd ihls Period $ 0,00 Additions 85.0G Paid 1, s period $ 0.00 Sublrncl•ons Paid ,bar-io•dale $ 0.07 Balance on 5/9 S 86.0 Inlet -i Rate:, S!alentont Average Ledger Balance 5 7.7.80 a/1 03.5/9/03 Anne o Percentage Yield Earned G.OU °> Raferrrn Amo•nl • 1 JJ A CIEa.15 f r,11b tlICiN10:1 _..�� �.•.-�• 4/.21 CHECKING TRANSFER 030421 6141063708 0000 �•�•� ^_ 61112248 $ 25.00 40.00 5/5 OfFICE DEPOSIT V OODO544770 45609852 47318846 ,515 ATM/LOBBY DEPOSIT 1; 0000820492 $ 85.00 urol ... ':�•: `'tay vaY-21 03 00:12am cram-MLAi4D HSINcv 9096930348 T-640 P 003/013 F-53E S T A E t 1� C A? v tY� T C Sk +Nom6r.6153060220 BAT U wC7hl Nx GF CALIFGF WA 3/12r :,:.-4/10/03 NENIFBE INSTORE 615 7c6a rb• e Po 1!0%51'-38e LDS ANrELES CA 90051-0380 For 2• Nwr Automo:ud Diract Servlea 8004 ttr•4486 W0E :<-7345ir0D1 Repn a.)Melives c•e avrilobie from : am to 11 pm Teo •c a acdi6onal accounts, or a; p.y for Icons, call your ban;.aofficeat909672-7474 C(C7Z OA1C3Q FERNANDO TNOMAS Visit a: orwww•uboccom 4r,7S1 CORTE NAUTIA TEMECULA CA 92592 Thor . )ou far bcnkingwilh us anci 2:)00 ■ News this -good nueds ai be shared with cverfonel rrlino Bill Pay with.. 8, ijk@HomcG on the Wob is now WE Stocnel less time paying b91s and have grealer control over your finances. D gal storied, log on to JSCaC. mi Instant or con ocr an Online 8ony'ang Speciolistat 800.79&St 55, option 1. in stalement period; ;1V Balance on 3/ 12 $ 21.01 Addil!ons 0.07 S�ktroct:v s •20.00 ATA4 wlindrowo!s -20-00 B,16nco on 4/ 10 S 1.08 StalementAveroge Ledger Bc;ance , $ 9.03 A.ccounl Number: 6153060220 Ihj Inn rust Ac taed IhtN period 5 C 01 Pc ^ :his par,n 3 0.07 Po a fear -toddle $ O.C7 Int •net kates 3/I:./03-4/10X3 0.50 At ao! PercantageY{eld Earned 1.35% Addlhons Oola Oe cip lcn __Aafar Amooiy 3/31 INTEREST'AYMENT $ 0.07 ATM withdrawals GWn -_ aEOCI LCIVICCVttOR _`�, __ kol.mnce A•ncnnt 3/24 UWC CORONA C!0 CORONA CA 6597t 1 70821216 $ 20.00 New Certificates X_/ Recen........vn Unit Number �� 5 INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designated to assist you in computing Annual Income in accordance with the method set forth in theto date ith heent of Housing and HUD Regglations.LAll caan pitalized eras used hereject ('*FUDtin shall have the;mean meaning should forth in the Relgulatory Agre mn that this rorm tent� all times up CSCDA (Pool) - Newport North I/we the undersigned state that Ihve have read and answered fully, frankly and personally each of the following questions for all persons who are to occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit. I 2. 3 4. 5. Name ofllembers Relationship Place of Of the to Head of Social Security Number Employment Household Household Age Wn10 Erin C� Rc ins (4' COY, k Income Computation 6. The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children under 13 years) listed above for the 12-month period beginning the earlier of the date that Ihve plan to move into a unit or sign a lease for a unit is S_ja_�Ci Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, fees, tips al d bonuses and other compensation for personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real or personal property (without deducting expenditures for business expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets); (c) interest and dividends (including income from assets in below and other net income from real or personal property); (d) the full amount of periodic payments received from social security, annuities, insurance policies, retirement funds, pensions, disability or death benefits and other similar types of periodic receipts, including any lump sum payment for the delayed start of a periodic payment; (c) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; .r (f) the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter and utilities; (g) periodic and determinable allowances, p6 as alimony and child support pay�ntents and regular contributions and gifts received from persons not residing in the dwellings; (h) all regular pay, special pay and allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the household or spouse; and (i) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; (b) amounts which are specifically, for or in reimbursement of medical expenses: lump sum additions to family assets, such as inheritances, insurance payments (including payments under (c) health and accident insurance and workers' compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational Institution, and amounts paid by the government to a veteran for use in meeting the costs of tuition, fees, books and equipment. Any amounts orsuch scholarships or payments to veterans not used for the above purposes are to be included in income; (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; M relocation payments under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970; (g) foster child care payments; (h) the value of coupon allotments under the Food Stamp Act of 1977: (i) payments to volunteers under the Domestic Volunteer Services Act of 1973; (j) payments received under the Alaska Native Claims Settlement Act; (k) income derived from certain submarginal land of the United States that is held in trust for certain Indian tribes; (I) payments on allowances made under the Department of Health and Human Services' Low -Income Home Energy Assistance Program; (m) payments received from the Job Partnership Training Act; (n) income derived from the disposition of funds of the Grand River Band of Ottowa Indians; and (o) the first 52000 of per capita shares received from judgement funds awarded by the Indian Claims Commission of the Court of Claims or from held in trust for an Indian tribe by the Secretary of Interior. 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necessary items of personal property such as furniture and automobiles and interests in Indian trust land) _ Yes X No; or (b) have they disposed of any assets (other than at a foreclosure or bankruptcy sale) during the last two years at less than fair market value? Yes No ( c) If the answer to (a) or (b) above is Yes, does the combined total value of all such assets owned or disposed of by all such persons total more than 55,000? Yes No (d) If the answer to ( c) above is Yes, state: (1) the combined total value of all such assets: S (2) the amount of income expected to be derived from such assets in the 12-month period beginning on the date of initial occupancy in the unit that you propose to rent: S d� , and (3) the amount of such income, if any, that was included in item 6 above: S er 3. (a) Will all the persons listed in column I above be or have been full-time student during five (5) calendar months of this calendar year at an educational institution (other than a correspondence school) with regular faculty and students? Yes X No (b) Complete only If the answer to Question S(a) is "Yes"). Is any such person (other than nonresident aliens) married and eligible to file ajoint federal income tax retums? Yes 1—No 9. This certificate is made with the knowledge that it will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and I/we declare that all information set forth herein is true, correct and complete and based upon information I/we deem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. 10. IAVe will assist the Owner in obtaining any information or documents required to verify the statements made herein, including either an income verification from my/our present employer(s) or copies of federal tax returns for the immediately preceding calendar year. 11. IAVe acknowledge that all of the foregoing information is relevant to the status under federal income tax law of the interest on bonds issued to finance the 316 �f the apartment building for which application is being made. We consent to the disclosure of such information to the issuer of such bonds, the holders of such bonds, any trustee acting on their behalf and any authorized agent of the Treasury Department or Internal Revenue Service. IAVe declare under penalty of perjury that the foregoing -is true and correct. Executed this (!�t day of TUW 20 O 3 (year) in the City of �wpbi 1ge�Ck California Applicant Applicant Applicant Applicant (Signature of all persons (except children under the age of I S years) listed in number 2 above required) FOP COtWI.•ETIOIti BY APARTMENT OWNER ONLY: 1. Calculation of eligii71e incoa^--: a. Em-r amount entered for entire household in 6 above: 9 C. (1) If the amount entered in 7(c)above is yes, enter the total amount entered in 7(d)(2), subd=t fror zt figure the amount entered in 7(dx3) and enter the remaA•unl a (S ); (2) Multiply the amoui savings rate annual eatniq passbook savor,• the amount eate, the current passbook O to determine what the total /(d)(1) would be if invested in __-), subtract from that figure enter the remaining balance ($ (a) Eater at right the greater of the amount calculated under (1) or (2) above: TOTAL EL' MLE INCOME Dine l.a plus line Lb(S): 2. The amount entered in l.c: Qualifies the applicant(s) as a Moderate -Income Teaant(s). ' Qualifies the applirant(s) as a Lowat lacom Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenaat(s). S 3R t z25. 9- $ 'A $ 31, 22y .4r3. 3. Number of aparanent unit assigned: 3) 5 Bedroom size: I'i I Rent: $ 1A 3 0 -00 4. This apartment unit §/was not) last occupied for a period of 31 or more consecutive days by persons whose aggregate antkapated annual income as certified in the above manner uaon their initial cccupancy of the apartment unit qualified them as a Lower -Income Teaant(s). 5. Me'ltcd uszd to vetiiy applir�s) in:.otne; Bmployer income verificado , .- Cooles of tax returns. X me`( t'r CleGIL 21jk5 ) 5/21103 Manager Date v 'Pub 1 INCOME u f:�-=r— I VI.L L 11I 1 a r " r Rel:uemnlp 5-x elrh Age $ccl..==.....r _ .. ,.._.- I ^intxame I I I �r� HGH I 1 I I I I I I I I I I I I = I I I I I I I 1 1 1 1 1 Id 1 T I I I 1 11 1 -- d1V V V IYtG EM1iPLOYA1SiNT e I averace Annual I Farad Source ��__ ^^•� - y $ Hours 52 24 26 12 11 1cta Memb. m YM l sEM1•MO sl•vM I MO va I I I soS I I X I I 1 I =5 39 12Z5. t I S I I S I I I I Total Box A: S SOCIAL SECURITY, PENSIONS ETC. I e e n 1 Averace Annual I Fzmil Source... ^_�_ - y I $ HGUfS 52 24 15 12 1 TCta: Memb.: YM saMl•AIC sw. MO YFi I =s I S I I I =s $ I I =s s I I Total I cu..; IS PUBLIC A5515TANW: Family Source m Base Rase S us s2 24 verag 35 nnuzl'21To:�Memb. YM sEMI•MO ew+ N I MO TR :,arge $ I I I I $ I I $ I =s s I ToUI Box C: I S u Inca Family u.....�.��_- Source Base —Rate Average Average Annual 62 24 25 72 1 TOt� Memb." $ Hours vti+, SEnn•MO I el.Y,n Mo Ya I =s s I I Total Box 0: S TOTAL ANNUAL GROSEa rough D »>a»»»» 5 • A CCCTC 1!.1PUT'cO INCOME FP.OMASSETS Bex E erveds $5,000—multiply E by the cu.—en: passbcok in!eresl vale: its.. E deex not exceed $5,000 enter-0- Jr. box G: Enter the 5rea:er e! Bez F or Bcx G ir.: x AV %° Box G: INPUTEO INCOh!E FROH ASSETS EOX H: 1� E6'ediYe Date Tune Type 0!Pmcram 56 LuW — U.-,It N2.�i.�.— Uni: S xa clpersers I — W1.r/ Max. Irccme Limit S AR: 140%Umit S� Income Restricted Certification Questionnaire Name: v.; �j IAL.ol D Unit # 315 x Initial Certification Re -certification Other ves No Question Monthly Income I/we receive Family Support, Spousal Support, and/or any other cash contributions of gifts, including rent or utility payments from persons not living with me. Ihve receive Veteran's Administration, Pension, Unemployment benefit, Disability benefit, AFDC, Lottery winnings, Inheritance, or Annuities. I/we receive income from Rental Property. I,'c.c reeeive bcnciits!income from Sock] S_cur:• �• to include SSA, SSI and/or periodic social security payments. / ✓ The household receives unearned income for family members age 17 or under. Uwe are entitled to receive child support payments. `/ Ihve am currently receiving child support payments. Uwe am/are currently making efforts to collect child support owed to me. Ihve have other assets (example: 401K, IRA, Revocable Trusts, Stocks, Bonds, Treasury Bills, Money Market accounts, Certificate of Deposits, Whole Life insurance, Real Estate Ihve have cash on hand, Student Status: Does the household consist of persons who are all fitll-time students (example: College/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: ➢ Married and filing a joint tax return. Under penalties of perjury, I certify that the information presented on this form is true and accurate to the best of my knowledge. The undersigned further understands that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information will result in the denial of application or termination of the income restricted lease agreement. Resident Signature U Date . : 120 /0 3 nature of Owner/Agent Date Earned Income Calculation Worksheet Name Employer Most Recent Ending Pay Period Date F51j 5/ o 3 YTD Income ►2)675.3cl divided by�� V Start with hire date if at job for less than a year (how often paid) M 2y Calculated Annual Income :3313oi.lz Hire Date '3�-/2)G'z Gross per Pay Period ►Iq.36.2s H 4 i 5'6c\ (i) ilbcl7.50 (_) Z-I iqO 3, 13 divided by F--3—� (-) 1,63q, 31R (how often paid) M = (=) Calculated Annual Income 361 i 225. lz Pso ootf86.65o 0000200031 9 �a111111r'S 9iaiSf77Btli .J c ROBINSON, CALCAGNItz a HOBINSON INC 620 NEWPORT CENTER DR., 7TH FLR. NEWPORT BEACH, CA, 92660' Taxable Marital Status: Single Exemptions; Allowances: Federal: 1 State! 1 Social Security Number: 451-57-4838 Earnings rate hours this period year to date Regular 15.0000 86.75 1,301.25 Overtime 22.5000 6.00 135.00 Gross -Pay $11436.25 12,575.39 Deductions Statutory Federal Income Tax -174.13 1,601.09 Social Security Tax -89.04 785.87 Medicare Tax -20.82 183.79 CA State Income Tax -44.15 399.82 CA SUI/SDI Tax -12.93 114.08 Other Check-1,095.18 Net Pay - $0.00 Your federal taxable wages this period are $1.436.25 Period Beginning: 05101!2003 Period Ending. 05,15.2003 Pay Date: 05/15,2003 ERIN R WOLF 231 MARSALA NEWPORT BEACH CA 92660 :`/ HIF/U7:Jhl°11'r:J'ril!?J'fl.'I'(/-:'6LUF:5v ".r:_.. :SUf Eil:'u1LL-hl'7Ji1-_ i..JJ".__//a1P=/rr:7.d 4:.07.::r fJ?!L L!.'�ff3i:. f.... . ROBINSON, CALCAGNIE & ROBINSON INC 620 NEWPORT CENTER DR., 7TH FLR. NEWPORT BEACH, CA. 92660 ERIN R WOLF PrrNK��F �RICA --_— — ao�to�E• -_ 1409 dAi,Wfi4GMrYkNufi.. �! � WALNUT 4REEMNZ909489tr-�V Advice number: 00000200031 Pay date_ _ - 05/15/2003 _ _ �nnn ,nf n„mtier tr.neit ARA 0904780004 1220 0024 S1,095.18 VOID AFTER 180 DAYS NON-NEGOTIABLE 0 F-0 001181 CEv CtL?:3:J3"•£ , R061NSON.CA.LCAGNiE 4 nOE1NSON INC 620 NEWPORT CENTER OR., 7TH FLR. NEWPORT BEACH, CA. 92660 Taxable ivlantal Status: Single Eaenpiion s'Allowances: v F=decal: 1 :ate. I Scc:at Security Number: 451-57.4658 Earnings rate hours this period year to date Regular 15.0000 67.75 1,316.25 Overtime 22.5000 11.25 253.13 Gross Pay . ' ' Sl,669.38 11,239.14 Deductions Statutory Federal Income Tax-210.07 1,426.96 Social Security Tax -97.30 696.83 Medicare Tax -22.76 162.97 CA State Income Tax -54.80 355.67 CA SUI/SDI Tax -14.12 101.15 Other Check-1,170.33 Net Pay •$0.00 Your federal taxable wages this period are Si,569.38 ROBINSON, CALCAGNIE & ROBINSON INC 62o NEWPORT CENTER DR., 7TH FLR. F NEWPORT BEACH, CA. 92660 ERIN R WOLF rrPo�v�ouu�p — = c WAUN — d4V c•4,7,1EN:E. �I WCLV•IT 6AEEk',x'C>rc549 Larr;Ir-,is Statement R Period Begl,..,1ng: 0d•'16/2003 Period Endinn_: 04/30/2003 Pay Date: 04130i2003 ERIN R WOLF 231 MARSALA a NEWPORT BEACH CA 92660 Advice number: Pay date_ 00000180032 04,r3012003 0904780004 1220 0024 S1,170.33 VOID AFTER 150 DAYS NON-NEGOTIABLE PIED Oci I 050 „_y_ . CC col ^'.CC31 , ROBINSON. CALCAGNIE & ROEINSON INC efo NEV/PORT CENTER OP.., 7 i H FLR. NEWPORT SEACH, CA 92660 Taxable Marital Status: Single Exemptions_ Allowances. Fe2eray I State: 1 Social Security Number: 45 i-57.48z5 Earnings rate hours this period year to date Regular 15.0000 95.75 1,436.25 Overtime 22.5000 20.50 451.25 Gross ,Pay S1,897.60• 9,669.76 Deductions Statutory Federa! Income Tax-298.67 1,21 A. E9 Social Security Tax-117.65 599.53 Medicare Tax -27.51 140.21 CA State Income Tax -S3.36 300.67 CA SUI;SDI Tax -17.08 87.03 Other Check-1,353.23 Net Pay So:00 Your federal taxable wages this period are $1,897.50 Earn`- -s Statement Period Eeelnninc_: 0_ 0112003 Period Endinc_: 01! 1 Ei2003 Pay Date: 0415/2003 ERIN R WOLF 231 MARSALA NEWPORT BEACH CA 92660 %_i;l=%LJ�Ui�I �1'f::�.rf�:=1f::i((•70!rJi:=O:..=... JAI !.'i,....._... i:..._ v�._•!:�i I!I=r _..-.: i., .. ..:('f�,Y".�,LI-•i7?Gi2-6- ROSIN SON, CALCAGNI E E ROBINSON INC 620 NEWPORT CENTER DR., 7TH FLR. NEWPORT BEACH, CA. 92660 ERIN R WOLF rmJu• = v c Advice number: 00000160031 Pay date:_ _ - 04!15/2003 arnnunt number transit ABA 0904780004 1220 0024 S1,353.23 VO!D AFTER ISO DAYS NON-NEGOTIABLE Asset Calculation Worksheet Name Fri /l WolO Apt # 3i Bank Name/Account Type. Bank Name/Account Type Lw Ending Balance 61y • Ro (+) I, Z 2G • q 3 divided by Z M �9z Ending Balance E:::� divided by _,----------------------------- �Ban`k Name/Account Type L �1I Ending Balance divided by Bank Name/Account Type Ending Balance E=:::= (+) E=� (+)E=::= divided by Account Statement N'larch 12 through April 9, 2003 Account Number: 090-4780004 Paue 1 of 5 ERIN RAE WOLF MICHAEL F WOLF DEBORAH NULL WOLF 231 MARSALA NEWPORT BEACH CA 92660-8311 Thankyou for banking with Wells Fargo. For assistance, call: 1.800-TO-WELLS (1.800.869.3557), TDD number (for the hear! Impaired only): 1.800.877.4833. Or write: WELLS FARGO BANK, N.A., P.O. BOX 6995, PORTLAND, OR 97228.6995. A HOME EQUITY ACCOUNT CAN HELP YOU IMPROVE YOUR HOME, PAY FOR COLLEGE. OR CONSOLIDATE BILLS APPL TODAY. CALL 1-866.847-6410 OR APPLY ONLINE AT WELLSFARGOSPECIAL.COM AND ENTER KEYWORD. HE RESOURCGz WELLS FARGO BANKS. EQUAL HOUSING LENDERS. Studen(Checking Erin Rae Wolf Michael F Wolf Deborah Null Wolf Account Number: 090.4780004 Activity summary l3ahuiee on 03;11 lleposits Withdrawals $104.76 3,859.01 - 3,..W.87 .......................................................................................... Balance on U4; 09 $614.90 DIRECT DEPOSIT ADVANCE - ADDITIONAL TERMS: IF NO REPAYMENT HAS OCCURRED BY THE 35TH DAY. WELLS FARGO BANK NEVADA, N.A. WILL AUTOMATICALLY DEDUCT THE OUTSTANDING BALANCE AND FINANCE CHARGES FROM YOUR CHECKING ACCOUNT. IF THE AUTOMATIC REPAYMENT OVERDRAWS YOUR ACCOUNT, YOU WILL NOT HAVE ACCESS TO DIRECT DEPOSIT ADVANCE UNTIL THE OVERDRAFT IS PAID IN FULL. INCLUDING ANY OVERDRAFT AND OTHER CHECKING ACCOUNT FEES THAT MAY APPLY. IF THE OVERDRAFT IS I'1.)T PAID WITHIN 8 DAYS. THE SERVICE WILL BE DISCONTINUED HOWEVER. IF YOUR ACCOUNT IS ALREADY OVERDRAWN AT THE TIME THE AUTOMATIC REPAYMENT TAKES PLACE, THE SERVICE WILL BE DISCONTINUED AFTER THE AUTOMATIC REPAYMENT AND THE ACCOUNT HAS BEEN OVERDRAWN FOR AT LEAST 8 CONSECUTIVE DAYS (THE 8 DAYS MAY OCCUR BEFORE OR AFTER THE AUTOMATIC REPAYMENT). PLEASE NOTE: ALTERNATIVE FC%RP:IS OF SHORT-TERM CREDIT EXIST THAT MI ,H T BE LESS EXPENSIVE AND MORE SU:I'AGLE AND ADVANTAGEOUS TO Y01J AS 1'f�E BORROWER. Nlurch 12 through April 9. 2003 Account 'Number: 090-4M)004 Activity detail )epusits )ate Description $Amount ............................................................................................................................ )3;14 Robinson ( dcagn Payroll 030314 668(1004575061191) Wolf..Erin R ....................._ ... 1,13).38 13;14 A'[ :.M Deposit - 03;13 Mach 11) 06Y3C: 5 Corporate Plaza. Newport Beach, C'a 7133 36.53 )3;17 (:heck Crd Pur Rtrn 0.3; 14 Amazon.Com *superstor 800-201-7575 Wa 5.3.347()XXXXXX7133 3.99 7843286290u.%iP5'1'nk . MCC=5942 121042S82DA )3,24 ATM Deposit - 03122 Mach 11) 2680V 1'c Irvine, Irvine, Ca 7133 3.80 7r)t) 2 )3; 28 Us Treasury 220 Tax Refund 032,903 !Wolf, Ilrin R • )3:28 ATM Deposit - 03127 Mach 11) 26S6V Cc Irvine, Irvine, Ca 7133 100.00 )3; 28 Deposit - 03,127 Mach 11) 2686V Cc Irvine, Irvine, Ca 7133 50.00 )3;28 Online'1'nnsier Ref�II31i4XV8Nhg From 0930221734 On 03,127;03 300.00 13; C31 Robinson alcaen Pa%'roll 030331 1500002`<6058P91) WolUrin R 1,153.40 14,04 A'I:.•[ Deposit - 04, Mach 11) 2686V 1'c Irvine, Irvine, Ca 7133 13.94 14;07 AT.VI Deposit - 04104 Mach 11) 4276P 1935 Newport Avenue, Costa Mestt, (::t 7133 14.75 k4;118 ATM Deposit - 04;07 Mach 11) 06921) 4590 McArthur Blvd, Newport Beach, Ca 7133 245.97 )4;09 Discount PorAC11 Direct deposits 2.01) ..................................................................................................................................................... fora! deposits 53,859.01 Withdrawals Checks Dumber Date $ Amount Number Date $ Amount Number Date $ Amount .......................................... )22 ............................................ ......................................... 03; 21 40.23 930 04,104 6.4._3 940 04r 09 5.50 )23 03; 25 15.00 931 04; 04 30.00 1094* 03,,26 18.00 )24 04,04 15.00 932 04;07 30.00 1095 03;14 12.00 )25 04; 03 25.(lu 934* 04' 09 27.87 1096 03,17 22.00 )26 04; 04 155.10 936* 04;111 798.00 1099* 03113 74.35 )27 04.102 2656 937 04; 04 150.00 )29* 03'24 35.69 938 04,107 30.00 ..................................................................................................................................................... Total checks $1,574.53 ' Cap in Check Sequence )then withdr awals We Description $ Amount .4l13 Check Card Purchase 03; 12 C:htmtpagtres Nfarket Newport Beach Ca 5D470XXXXXX7133 5.49 80181962M\'C;1'9S;kd' MCC= 5499 121()42882DA 13;14 Check Crd Purchase 03;12 The Gypsy Den Cafe Costa Me a Ca 53347UXXXXXX7133 23.(N 7(14111728233Nttvxz ?�1(.'C:= 5812 1210A2882DA ;.1 14 Check Crd Purchase 03; 13 Champagnes Market Newport Beach Ca 533470.\XXXXX7133 6.25 Sol819629MA19SIM '?MCC= 5499 121042882DA Check Cal Purchase 03,11 Oce liooktiriore Asocc Costa Ca 53.347t)XXXXXX7133 3.45 70483792813 �11.S4Kif ?M (:C = 8220 1210 42882DA :3;17 ATM Withdrawal - 03;14 Mach 11) 06431) 5 Corporate Plaza, Newport Beach, Ca 7133 40.00 13;17 POS Parch,~- - 03,115 Vlach 11) 000000 701 Newport C:irbloomys Newport 13eachca 7133 14,8.70 March 12 throu_sh April 9, 2003 Account Number: 090.4780004 Page 3of5 $42,497 Other withdruwalo -c tnuinued Date DescripGen ................................................................................................................................. 03j17 (.heck Cal !'urchu-,113•I5 \fac)°s wes1 =058 Co:aa \Mesa Ca 533471)XXXXXX7133 $ Amoun i ..................... .. . Sb{=r173?IiCiR5IX11'I',3 7�'!(:C=531 I I311j43x82I):\ 031'17 Check Crtl Purchase 03 15 Cos*or Co Com Ph.Nv R71 949.240.1212 Ca 5,3,3470XXXXXX7133 9U 432862A00\9.15\m '.'.\ACC = 4S99 121(1428821):\ 03/17 Cheek Crd Purchu,". 03:15 Sephora-S Coast Plaza Costa Mesa Ca 533470.KXXXXX7133 705475121331 W\'lSD87'?),1CC=5309 1210428S2DA 03/17 Check Crd Purchase 03: I5 Chevron-0201!193 Newport Beach Ca 53347OXXXXXX713.3 23-46o422I3QGF08Ppn ': \iC<:= 5542 121142882])A 03/17 (:heck Crd I'urehase 03: 15 (:os*or Co Cam Phsv 1171 949-240-1212 Ca 53.3470XXXXXX7133 90432S62,101(\ 9.) 5 \ x ?\ ICC: = 4899 121(}428821)A 03,117 PUS Purchase - 03; It, Mach 11) 000000 4541 Campus Drialbertson'Inine Ca 7133 03117 PUS Purchase - 03; 16 Mach ID OW000 Tower RecNidemoNver Rec:Costa Mesa Ca 7133 03;17 Check Crd Purchase 03i 13 OAplute'S Cirek (:l)slzt M Costa Mesa Ca 53347OXXXXXX7133 71A0f,2929256'!'8\•l6'1 ?\ICC=5812 121042882DA ' 03117 Check Crd Purchase 03: 13 Blockbuster Video =061 Newport Bette Ca 53.470XXXXXX7133 785418tb2,\231'1'1054 :'\I(:(:= 7841 1210428821),\ 03:17 (:heck Crd Purchme 03: 14 13ar;kin Robhin>; \e•,cpor( Beach Ca 533471jXXXXXX7133 7l>-481!'720ti139uTI']39 ?�!C:i;- 5451 1310-43i821):\ 031'18 Check Crd Pttrchuse 112, 15'Ihe (nps) Den Cad (:o,t;t Mesa Ca 53347UXXXXX\ 7133 70411172Q26%Q3Gk1 ?MCC= 5812 1211142882DA 03,'20 (:hack Crd Purchase 03: 19 Champagnes Market Newport Beach Ca 5.33470NNNNXX7133 S01S19621•\\'Cil19SM4\I?,\f(:C=5.40Q 121W2882DA 0.3,'2I ATM Withdrawal - 03:20 Much 11) 0WC 5 Corporate Phvat, Newport Beach. Ca 7133 I1.3,124 Check Crd Purchase 03;20 Princeton Review mine Cat 533470XXXXXX7133 78442982G03K86M2P 9MCC= 8299 121042882DA 03,124 Check Crd Purchase 03:21 Blockbuster Video =061 \ew[1011 13eac Ca 533470XXXXXX7133 705415631231'1'11S26 :!\I(:C:= 7841 121042882DA 031;25 (:heck Crd PLLl'ChU.W 03:23 Chevron 7,421)i8S7 Iluntin_nun Be Ca 533470,\XXXXX7133 234(sW22KQGF0Akdc 9.MCC=5542 121W2882DA 03;25 Cheek, Crd, Purchase 03:22 I'red'S MexiC:ul Cade I0.uttington Be Cat 533470XXXNXX7]33 704492P)2 K 9851 1prna ! .\�1 CC = 5812 121042882DA 03126 Arma ni l:xcha nge Ii1•'1' 030.126 928 Sant. Ca 03:26 ('heck Crd Purchase 03:25 1'I1 #24 hour I:itneee 700-018-489S (:at 5.33470,XXXXXX7133 78432S621.008'I'll-IM, ?.%1CC= 5969 1210428821),\ 03;26 POS PurchM,- - 03;26 Mach 11) 000000 3 Milano Dr Web Laundrnewporl 13eaC Ca 7133 0.3,•'27 Overdraft Fee 03:27 Oterdratt Fee 03:28 Check Crd Purchase 03:20 blockbuster Video =061 Newport 13eaC Ca 533470XXSXXX7133 7U54!8P21'231Rcc b'1\1(:(:=7841 121G42NUDA 03,131 110.S Purchase - 03:28 Mach 11) 000UtU1 45.41 Campus Driadhertson'lr•ine Ca 7133 03,+31 PUS Purcha>e - 03:.30 NI. h 11) (100000 4541 ('aunpus Dri;dhartson'Ircine Ca 1133 03;31 Check Crd Purchase 03,25 C'ltce.ecakc Inine Irvine Ca 53347UXXXXXX7133 7.054W,Z12322A30P :1.\1(:(:=5512 121042S421).\ 03:31 Ch.cl•. Crd PIVOWSe 03+28 (:ubaut Cig.tr laCton Irvine Ca 533470XXXXXX7133 704507S2149251'1'4V "Mt:C:=.w9.3 121u42882DA 03131 (:hec4. (:nl Punha e i 3;28 13aune, fi \(1hle =2141 Irvine Ca 5.3..147i)NNNNXX7133 804441102l'GX\1i387\ ".\(C:C=n942 121042S:02DA 04,;01 POS Purchase - 0.3:31 \lark 11) OulAnu) 4541 Gunpu. Driadhertson'ir•ine Cat 7133 15.07 )vla March 12 through April 9, 2003 \ct Account Number: 090-4780004 '•ag ,5; Page 4 of 5 5=:149ti P Other withdrawals -continued - Date Description $Amount kc1...................................................................................................................................................... >1 (9:01 Check Crd Purchase 03;30 Chevron =1)201093 Newport Beach Ca 533470XXXXXX7133 14.16 )ate 23.46(A23SQC;1:01313K :!MCC=5542 121042882DA 04101 Check Crd Purchase 03,,29 Newport Beach Bre"ing Newport Beach Ca 533470XXXXXX7133 14.01 ... 13: 70470822S1.NS4.v1%D0?MC(:= 5312 1210428S21)A 1.1: 04;04 A7'M Withdrawal - 04;03 Nlach ID 2686V l:c Irvine, Irvine, Ca 7133 40.00 J3; 04:04 Check Crd Purchase 04?01 Celebrity Cleaners Newport Beach Ca 5:3.3470XXXXXX7133 45.35 70431942XOOJ9(3706'?MCC= 7216 121042882DA )?': 03,'04 Check Crd Purchase 04:03 Sionecreek Cate Newport I3each Ca 533470XXXXXX7133 6.89 1.?.: 804I6012Y'2NXY61iK5'?MCC=5411 121042882DA ' 13•: 04;07 Check Crd Purchase 04;04 Cox*or Cu Com Phsv 949-240-1212 Ca 533470XXXXXX7133 69.49 13; : 78432862%00SXY839 '?MCC = 4899 121042882DA J3;: 04,'07 (heck IT Purchase (}4,t15 Chicago Bikes Newport Beach Ca 533.47OXXXXXX7133 50.00 13;: 80184533OWGN 1IVY9.J '?%1C:(,= 5571 121042882DA 4.1 04; U7 POS Purchase - 04' (µ Mach II) 000000 3030 I ltubor 131vtarget 129C:osta Mesa Ca 7133 25.65 14;1 04; U8 110S Purchase - 04; 07 Mach 11) 000000 4225 Campus Dr'l'rader Joeir•ine Ca 7133 26.74 µ:l 04;09 Check Crd Purchase 01:07 Banana Republic 7630 Newport Coast Ca 53347OXXXXXX7133 94.82 4:1 7041117322V8N4Nyd'?MCC= 5999 1210428821)A ... 04'09 POS Purchase - 04:08 Mach ID 000000 1195 Baker Stretower linrgeosta Me Ca 7133 02 l5.0o rot 04f09 Monthly Service Fee1.Up . 04:09 110S Usage Pee Ni ................................................... Total other withdraH;tls b1,77 }.3 4 :ht Jun ..............................................................................................................................................348.87 'rotaf withdrawals 122 Daily balance summary t23 Date $ Balance Date $ Balance Date $ Balance 124 ..................................................................................... '25 ............................................ 03:11 104.76 03/24 196.42 04;02 1,245.93 26 03/13 1 24.92 03j25 135.84 0411U3 1,220.93 27 03?14 1,152.09 0.3?26 26.42 04!04 728.30 29 03,'17 705.30 03; 27 - 86.42 04? 07 537.85 (rt?18 686.14 U3,'23 1,152.10 04 08 757.11 ut 03,20 675.40 03131 2,114.33 04?09 614.90 Cc 03:21 615.17 04.101 1,272A9 )th ate Direct Deposit Advance (Lender - 3: Outstanding balance as of last statement Outstanding balance as of this statement 3: t; 3:: 3:1 .3.1 Wells Fargo Bank Nevada, N.A.) DO SOMETHING FAST TO AVOID OVERDRAFTS AND RELATED FEES! CHOOSE THE DIRECT DEPOSIT ADVANCE SERVICE TO ACCESS UP TO $500 PRIOR TO RECEIVING YOUR RECURRING DIRECT DEPOSIT INCOME. JUST USE THE ATM, ONLINE OR CALL THE PHONE BANK. SEE YOUR CONSUMER ACCOUNT FEE AND INFORMATION SCHEDULE FOR COMPLETE DETAILS. 10.00 $0.00 Are you n Purchasing a home or rernand rig your current one? :311 ue at 1-800-866.0743 interested n Getting a student loan? eau us at 1-888.945.5373 in ■ Optimizing the equity in your home? :all us of 1.800-777-3000 Fur more injurmution on our products and senives unit tin at wellsfargo.com Account Balance Calculation Worksheet 1. Use the loacwutg wor0.sneel to calctlate your overall account b3lan"'. 2. GO through your MOVE' and nlalk each Chatk, vnlixitawal ATM lunsactlon. payment. deposit or ollier credit lu;eV on your SlAenlenl. Be stile that your r-gisler shows any Interest I:a+J into your ecceunt and any saiwca charges. autcnlatic; aynrenie of ATM transactions w.lhdfatvn from your account during INS sata'cent period. 3. Use the unan below. list any deposits. trarivera to your aocrum. eulsfanang checks. ATM vatndra.vals ATM payments or any other wimdrawafs Uncfuaing any from previous Inonals which are lu,led In yCur te(p51<I but not shown on your statement. ITEMS OUTSTANDING NUMBER ,;, ._ „AMOUNT, i '1. ENTER FA The NEW BALANCE shown on yea, dfaL)d8n1 ... ....... ................. ... J ADD ® Anydepo:dsldledn yovl S wp,cti, of uan,lels into S your amawe which me not S cllmen on your stateln2nt •s TOTAL .. S )IIi CALCULATE THE SUBTOTAL ..... S ,Add f1.ats A a 1ty b1 SUBTRACT © Lie total ovmlardntp checks and rnnd�rvals Lon: pie cn.ul aL•we.... ... •� ® CALCULATE THE ENDING BALANCE ,P.utA,Pca16 F..n CI Tlu[I d ciuma bal.ld be tie crane yw.ch zk n tin: , e sluivm tit �� yw, Niect iefl+:al .. ..... . . Line of Credit Information aeon plirtlpal !)31a114•e allowl; C❑ file frvofsa Sid, fdpr Es20'S lh? tn•I:ald allCUIll :I S• alPian:es antler y.td fine vt iac,i to (het day mtd alai act•. Ir e'Eaae: Lnu, O a:_age • ir, pti clpai l:Azince IS silo:tit The Finance Charge will be datel•n:n., as follos" :'lamnne th&;,nnuq;all)a1a1.E;ol each asy daring ors staff=urtn: tdnoa•alar rtlalt!.y the III InC:pal balaMv 101 each day during :tits tldj�ri fell, ;:druid b+ rile :la: Y pvuoLlA 1a:e n: ellrl'I la El.eh .:ry. and Add m-,a resells It YJUf aCCCU'll le SUMerl IC balance `!set: PnCIIlg. Ih•l dail; peflad;t rtc ails: wrier rr,uar; Annual PerC=merge Rate IAP;.1 will !:id de!e•ma'ar; as: 1 day L_url : n c e owsUind1na balance or pour 3.:wUnl. Tha daily oeacm'. rate ant l.lydel:CatUln J AZ,. 3ppicable to each 11a13ooe lal..,•e are shown a. Ilia $LinMaty Ct lrn3nc- Charges iacLG a the , averse :.Ida. II your account is subject to a Promotional Olscc Ullt. YCtII total hn3nce nhaa„O I✓ fold statement period is calculated oy SUUIrOClfll.l front the atove-desented sidndac nrance charge c3lculatfon a prole obcnat im.rEst ciedd applicable 10 all Prtrlofronal Peril n=: advances on ycut account dura:J the Idling cycle. Yot.r "flat advances" me that!wrt.:tt CI Ihs daily balances during Ina PlOotouonal Period site' aaduty new advances a••U subfrscunq all paylnet's of credits If, exce?d the pnn:Ipai balance Ill your acxnr; imnfedtalely balore your Plomouonal Per!ou LeJan !"PIlnc,paf bola n:� balote plolncucla, advance period becalij. This promotional (rarest credit E cafculalen by addend yc..r 11 advance IV each jay, during Ilse Pr011nol,on:u Period In file billing cry:,a and dividing INS minicar by rile number of Prollotienel Pencil days Ill tile biting cyu? resulhnJ it; yCc' average clLeIv cronnoknal balance. Ycur ; vara7e dimly promcllonal balance Is it'd': nunliPbdd by the nunlhet of PICnlObcnal Pe:i.0 days in Ilia bluing cycle and Ly Ilia Cs y paliodic rate for Ina promotional interest credit rate resul:Illg In the prmcfwnal III Credit. Thpr LIOLL11a! Interest credit is (her, stibllalted I::II' the told• Illlaltce Olta',e 3! your standard fatels, to obtain ME total finance crib Ige slicyni oil the l2m 01 this sialemin: Any Ilaflsa.1ron charges Cr Lrv^CaSSiltg Cbalges "h.'yrt CI: Ilia ra)e'se side of I':.z statelllein also mud be ledded Ic BrIve at vies coCd Finance Charge -.r tlas pe rod Lca- payments rEcaved sitar flotilla: OUSn16SS IlCt.f s :vdl be CIEcaeo !lie knowing business nay Normal business hCUIS ate PCs 0 If; Each 3uice .it cianch and fro:; L•e Immshed request 01 .lay he Oblanlea by callnlg Ilia C_alomat sarvca fa+one -.I ill:er listed on II.E wo tt of Iltis sfatertlem In Case of Errors or Questions About Your Credit Line Transactions It ycu muik yetir bill I; w¢ng, or d yco nee^ o-faE adaA' ;tit _xu a ;rsi 1sa•:Lan or! yC.' I:dl. write US at ILe 3.lalcss SL;::n• tin Ilia tr•e of II•m Saten'a-'! vs x_n a5 ptssdXE INS nnKt hear 1170111 yCa 110Ialvr Thai: pit) tldys ane: we sdnl yCu ;I1` "'is; tlll -I which the e•'cl c' pfoolarn appeared You CSri IelepnOne us, ca• eand aE .vdl 1,01 Orbser'/'a your 11OIAS. In your IEd-r give US th=_ lNorniallc:' Your name and account number l Ile d0al amount of this suspected error Describe Ilia a cr and ExPlain. it you oaf .frilly YOU to'EVE there 'Sall error I; 1:a need ❑(era ntcnnaaon, descn!)e Ilia lien; yet• are UnStife atxul. YOU do nbl nave to pay alry 20:0un1 In ques L.n white wa sa Invaslinai r.g. bit you ?sib obagaled to pay the parts of your bill that ere not ill quas;u,. While we Inv=sligala you' question. we cannot lepo t you as dehnq.iei.r,r tans_ any acbcll to cc' acl the cmouh' y: Question Special Rule for Credit Card Purchases. it yal have a grcderl wily file gdahty of ,:cos Or berVICES that ytU PUICh35ed W Ill a Credit -'s:d, antl You 113v? tried in j.:od I:alll 10 ore: Ile problem Will the Merchant YOU may 1101 Cave to pay We rEmamll.g alllut iv due of Ilse goods or services You h:we this plolacncr arty when and purchase i.rcd was more ire•• $50 antl the purchase Was tirade In you, licme Slate. or withal I OO I- LES Of Your WSMII„ address. (II we own or operate me merchal,t, or it we Ilia i?d ycu the a:lvamsdrdem to 11'a property of services. all Purcitses are covered legardess Ot anic"In 0' Icce!"". C poollasa'! if You Suspect Errors or Have Questions About Electronic Transactions Including Direct Deposit Advance it Transactions) on Your Regular Deposit Account, Please Call Us Immediately. fit. d you teileve jnera a at. E•:.t :n your sit -Ind ;: a AT:: •EC01p; ]' d 1G ..e n: ' :; •, 111101111AIL011 sbOU;::llalft= Oil Ls:el On this s'a'anent pa:S- nlJrsmm�aaia.d•1 tic ale avadal:la =a hods a d=Y s_,on :lays . v.Er Please call the Wephona number pointed on the !font of this statement. (.v y:u miry writ. uc a Vld n Fargo U411k P.(. Box eipi5 Panland OR 97228.55g5. ' 1. (EII US YOt: n:niaasdaacanlor AThl:c¢I nviloet _ As d.:vly as yCu den. tlExnL•? Ilia eau err Ina lea,: dr y: I a:? :n15U,E a!l,u x :: explain wily you l:E?d 11a1E-nlOnnaitzc 3 1 eA Its the d,dar aniouni Ot the susPdC!?C E.qr. You rLisi rr.:01I I!iE slspeciea error IO Us n: late; Ina;. CC days ,fa: Vie Sent y:a II'-. set V:ilenl oil wlllJh Ina pf--livni nppaarri we tval dPr-ahJa:E Yt / :I'Id_trn .d'• CC i rest :Illy euor Iacfnpily. It cur dlvastigaler. lanes leap! I: T•1 tU t.anfaa•. clays •:• 'e'. do v,, in tale case Ld dfeofroos .3 ircbj,,asi V1,1 Vill IeI;1y C,='d, Jtdtlli l_ W a:l:r' IA P. am:tan yea Leaavd Is tit a;.cr S. 0l.d YOU I '.2 tsd Of V E NCrE j tin' :U1 Il1•r?>ndd " if Ilia snot con.;enls � Diiect Deposit Advance ;nf:naC :n ;nil JJ •arm. is p.v : 3II1CIIItl Ill Ciu?>II'M wills y.E a:.. rn'eSOdanry but yeti Or.i :W f :L, Jd W pal b.e 1... '..' ycul Direct Deposit Advance ha•li3elt:o that Mil net I q.o-s i.•n vA.ie W% l niveal;JaunU yo'n (Ill?sGv.l.wJ' Itilo; Iaptll YT0.1 CWWnt Let :5l lake 'a'fy ar Lr,n lC .. a . RlE:unauln you q•t:Ilan Q Moobe s FOIC Page: 1 Document Name: Untitled STFD 3 THE TRANSACTION STMT FORMAT 03/05/10 13.59.48 ACDT CO 114 OP MS 50852 ACTION COMPLETE ACTION COID 114 ACCT COND PROD CODE DDA ACCT 90478000A SHORT NAME WOLF, ERIN RAE CURR CODE PAGE 1 SEARCH FROM 103/03/13 THRU 103/03/17 ACTN POST. EFFECTIVE CHECK NUMBER TRAN AMOUNT D/C n°ALANCE TRACE ID DESCRIPTION _ * 03/13 1099 74.35 D 30.41 00160024000727694576 CHECK _ * 03/13 EX 5.49 D 24.92 00000034009900892000 CHECK CRD PURCHASE 03/12 CHAMPAGNES MARKET _ * 03/14 EX 1,135.38 C 1,160.30 021000021688184 ROBINSON CALCAGN PAYROLL 030314 668000457506 * 03/14 EX 36.53 C 1,196.83 00000147000368977117 ATM DEPOSIT - 03/13 MACH ID 0643C 5 CORPOR _ * 03/14 EX 23.04 D 1,173.79 00000034009900996937 CHECK CRD PURCHASE 03/12 THE GYPSY DEN CAFE _ * 03/14 1095 12.00 D 1,161.79 00160024000921291841 CHECK _ * 03/14 EX 6.25 0 1,155.54 00000034009901330824 CHECK CRD PURCHASE 03/13 CHAMPAGNES MARKET _ * 03/14 EX 3.45 D 1,152.09 00000034009900996936 CHECK CRD PURCHASE 03/11 OCC BOOKSTORE ASOCC PF- 1-HFI_P 3-PLVL 6-INQ 7-S8 8-SF 9-ASUM ..-STMT 4-0 A 3270 Ses 10.103.30.202 ss 0/0q ' �;�!' 1'�'•�r� � � :r1k2�7? J JL'r_%LI.:�C�� i1.A. ANAL'40M HILLS OFF!' C:. -,3A04i-A ANA CANYON I=D Name: cu007217 - Date: 05/10/2003 Time: 12:00:34 Page: 1 Document Name: u::citled _ STFD 3 THE TRANSACTION STMT FORMAT 03/05/10 14.00.35 E ACDT CO 114 OP MS 50852 ACTION COMPLET ACTION COID 114 ACCT COND PROD CODE DDA ACCT 904780004 SHORT NAME WOLF, ERIN RAE CURB CODE PAGE 2 SEARCH FROM 103/03/13 THRU 103/03/17 AC;FN POST EFFECTIVE CHECK NUMBER TRAN AMOUNT D/C BALANCE TRACE ID DESCRIPTION _ * 03/17 EX 3.99 C 1,156.08 00000034009901672601 CHECK CRD PUR RTRN 03/14 AMAZON.COM *SUPERSTOR _ * 03/17 EX 40.00 D 1,116.08 00000031009951658592 ATM WITHDRAWAL - 03/14 MACH ID 06430 5 COR _ * 03/17 EX 148.70 D 967.38 00000113009916311094 POS PURCHASE - 03/15 MACH ID 000000 701 NEW _ * 03/17 EX 53.88 D 913.50 00000034009901672608 CHECK CRD PURCHASE 03/15 MACY*S WEST 4058 _ * 03/17 EX 49.49 D 864.01 00000034009901672607 CHECK CRD PURCHASE 03/15 COX*OR CO COM PHSV R71 _ * 03/17 EX 28.02 D 835.99 00000034009901672606 CHECK CRD PURCHASE 03/15 SEPHORA-S COAST PLAZA _ * 03/17 EX 26.31 D 809.68 00000034009901672605 CHECK CRD PURCHASE 03/15 CHEVRON #0201093 _ * 03/17 EX 23.56 D 786.12 00000034009901672604 CHECK CRD PURCHASE 03/15 COX*OR CO COM PHSV R71 PF: 1-HELP 3-PLVL 6-INQ 7-SB 8-SF 9-ASUM ..-STMT 4-0 A 3270 Ses 10.103.30.202 shy Name: cu007217 - Date: 05/10/2003 Time: 12:00:37 Page: 1 Document Name:"Untitled _ STFD 3 THE TRANSACTION STMT FORMAT 03/05/10 14.00.37 ACDT CO 114 OP MS 50852 ACTION COMPLETE ACTION COID 114 ACCT COND PROD CODE DDA ACCT 904780004 SHORT NAME WOLF, ERIN RAE CURR CODE PAGE 3 SEARCH FROM 103/03/13 THRU 103/03/21 ACTN POST . EFFECTIVEv CHECK NUMBER TRAN AMOUNT D/C BALANCE TRACE ID DESCRIPTION _ * 03/17 1096 22.00 D 764.12 00160024001121151980 CHECK _ * 03/17 EX 21.92 D 742.20 00000113009916311095 POS PURCHASE - 03/16 MACH ID 000000 4541 CA _ * 03/17 EX 15.07 D 727.13 00000114009972124161 POS PURCHASE - 03/16 MACH ID 000000 TOWER R _ * 03/17 EX 11.79 D 715.34 00000034009901672603 CHECK CRD PURCHASE 03/13 OAPHNE'S GREEK COSTA M _ * 03/17 EX 6.44 D 708.90 00000034009901672602 CHECK CRD PURCHASE 03/13 BLOCKBUSTER VIDEO #061 _ * 03/17 EX 3.60 D 705.30 00000034009901672600 CHECK CRD PURCHASE 03/14 BASKIN ROBBINS _ * 03/18 EX 19.16 D 686.14 00000034009902920450 CHECK CRD PURCHASE 03/15 THE GYPSY DEN CAFE _ * 03/20 EX 10.74 D 675.40 00000034009904194342 CHECK CRD PURCHASE 03/19 CHAMPAGNES MARKET PF: 1-HELP 3-PLVL 6-INQ 7-SB 8-SF 9-ASUM ..-STMT 4-0 A 3270 Ses 10.103.30.202 3/9 Name: cu007217 - Date: 05/10/2003 Time: 12:00:39 Page: 1 Document Name: Uiicitied STFD 3 THE TRANSACTION STMT FORMAT 03/05/10 14.00.40 ACDT CO 114 OP MS 50852 ACTION COMPLETE ACTION COID 114 ACCT COND PROD CODE DOA ACCT 904780004 SHORT NAME WOLF, ERIN RAE CURB CODE PAGE 4 SEARCH FROM 103/03/13 THRU 103/03/25 ACTN POST , EFFECTIVE CHECK NUMBER THAN AMOUNT D/C BALANCE TRACE ID DESCRIPTION * 03/21 EX 20.00 D 655.40 _ 00000031009955244315 ATM WITHDRAWAL - 03/20 MACH ID 06430 5 COR * 03/21 0922 40.23 D 615.17 _ - 00160024000228743145 CHECK * 03/24 EX 3.80 C 618.97 _ 00000147000203452080 ATM DEPOSIT - 03/22 MACH ID 2686V UC IRVIN * 03/24 EX 373.00 D 245.97 _ 00000034009904949981 CHECK CRD PURCHASE 03/20 PRINCETON REVIEW * 03/24 0929 35.69 D 210.28 _ 00160024000520783779 CHECK * 03/24 EX 13.86 D 196.42 _ 00000034009904949980 CHECK CRD PURCHASE 03/21 BLOCKBUSTER VIDEO n061 * 03/25 EX 25.58 D 170.84 _ 00000034009906150683 CHECK CRD PURCHASE 03/23 CHEVRON r0201887 * 03/25 EX 20.00 D 150.84 _ 00000034009906150682 CHECK CRD PURCHASE 03/22 FRED'S MEXICAN CAFE PF: 1-HELP 3-PLVL 6-INQ 7-SB 8-SF 9-ASUM ..-STMT 4-0 A 3270 SeS 10.103.30.202 3/9 Name: cu007217 - Date: 05/10/2003 Time: 12:00:42 Page: 1 Document Name: u.citled STFD 3 THE TRANSACTION STMT FORMAT 03/05/10 14.00.42 ACDT CO 114 OP MS 50852 ACTION COMPLETE ACTION COID 114 ACCT COND PROD CODE DDA ACCT 904780004 SHORT NAME WOLF, ERIN RAE CURR CODE PAGE 5 SEARCH FROM 103/03/13 THRU 103/03/28 ACTN POST EFFECTIVE CHECK NUMBER TRAAN AMOUNT D/C v BALANCE TRACE ID DESCRIPTION * 03/25 0923 15.00 D 135.84 _ 00160024000721574192 CHECK * 03/26 EX 0928 95.26 D 40.58 _ 071100268048090 ARMANI EXCHANGE EFT 030326 928 S * 03/26 EX 39.00 D 1.58 00000034009906624228 CHECK CRD PURCHASE 03/25 FIT*24 HOUR FITNESS * 03/26 1094 18.00 D 16.42- _ 00160024000722263036 CHECK * 03/26 EX 10.00 D 26.42- _ 00000113009926482186 POS PURCHASE - 03/26 MACH ID 000000 3 MILAN * 03/27 30.00 D 56.42- _ OVERDRAFT FEE * 03/27 OVERDRAFT FEE 30.00 D _ * 03/28 EX 799.25 C 111036171958548 US TREASURY 220 TAX REFUND 032803 PF: 1-HELP 3-PLVL 6-INQ 7-SB 8-SF 9-ASUM ..-STMT 4-0 A 3270 Ses 10.103.30.202 86.42- 712.83 JE Name: cu007217 - Date: 05/10/2003 Time: 12:00:44 Page: 1 Document Name: u,.«tled STFD 3 THE TRANSACTION STMT FORMAT 03/05/10 14.00.44 ACDT CO 114 OP MS 50852 ACTION COMPLETE ACTION COID 114 ACCT COND PROD CODE DDA ACCT 904780004 SHORT NAME WOLF, ERIN RAE CURR CODE PAGE 6 SEARCH FROM 103/03/13 THRU 103/03/31 a ACTN POST EFFECTIVE CHECK NUMBER TRAN AMOUNT D/C BALANCE TRACE ID DESCRIPTION * 03/28 EX 100.00 C 812.83 _ 00000147000214334760 ATM DEPOSIT - 03/27 MACH ID 2686V UC IRVIN * 03/28 EX 50.00 C 862.83 _ 00000147000214336368 ATM DEPOSIT - 03/27 MACH ID 2686V UC IRVIN * 03/28 EX 2873686 300.00 C 1,162.83 _ 00000064009936390156 ONLINE TRANSFER REF #IBE4XV8NHG FROM * 03/28 EX 10.73 D 1,152.10 _ 00000034009907477484 CHECK CRD PURCHASE 03/26 BLOCKBUSTER VIDEO #061 * 03/31 EX 1,153.40 C 2,305.50 _ 021000028155373 ROBINSON CALCAGN PAYROLL 030331 150000286058 * 03/31 EX 60.61 D 2,244.89 _ 00000113009930251179 POS PURCHASE - 03/28 MACH ID 000000 4541 CA * 03/31 EX 42.22 D 2,202.67 _ 00000113009930251180 POS PURCHASE - 03/30 MACH ID 000000 4541 CA * 03/31 EX 37.76 D 2,164.91 ' _ 00000034009908138475 CHECK CRD PURCHASE 03/28 CHEESECAKE IRVINE PF: 1-HELP 3-PLVL 6-INQ 7-SB 8-SF 9-ASUM ..-STMT 4-0 A 3270 Ses 10,103.30.202 319 Name: cu007217 - Date: 05/10/2003 Time: 12:00:46 Page: 1 Document Name: untitled STFD 3 THE TRANSACTION STMT FORMAT 03/05/10 14,00.47 _ ACDT CO 114 OP NIS 50852 ACTION COMPLETE ACTION COID 114 ACCT COND PROD CODE DDA ACCT 904780004 SHORT NAME WOLF, ERIN RAE CURB CODE PAGE 7 SEARCH FROM 103/03/13 THRU 103/04/04 ACTN POST EFFECTIVE CHECK NUMBER TRAN AMOUNT D/C BALANCE TRACE ID DESCRIPTION * 03/31 EX 32.27 D 2,132.64 _ 00000034009908138474 CHECK CRD PURCHASE 03/28 CUBAN CIGAR FACTORY * 03/31 EX 18.31 D 2,114.33 _ 00000034009908138473 CHECK CRD PURCHASE 03128 BARNES & NOBLE #2141 * 04101 0936 798.00 D 1,316.33 _ 00160024000823338103 CHECK * 04/01 EX 15.07 D 1,301.26 _ 00000113009932083282 POS PURCHASE - 03/31 MACH ID 000000 4541 CA * 04/01 EX 14.76 D 1,286.50 _ 00000034009909356007 CHECK CRD PURCHASE 03130 CHEVRON #0201093 * 04/01 EX 14.01 D 1,272.49 _ 00000034009909356006 CHECK CRD PURCHASE 03/29 NEWPORT BEACH BREWING * 04/02 0927 26.56 D 1,245.93 00160024001125390918 CHECK * 04/03 0925 25.00 D 1,220.93 _ 00160024000522953706 CHECK PF: 1-HELP 3-PLVL 6-INQ 7-SB 8-SF 9-ASUM ..-STMT 4-0 A 3270 Ses 10.103.30.202 4/12 Name: cu007217 - Date: 05/10/2003 Time: 12:00:51 Clarification Record Applicant/Resident Name:: -u" \/Vol Date: G3 2 Initial Certification ❑ Re -certification Means of Clarification: Date of Clarification Contact Name: _ G on: 0......_......1 . f 6122 Explanation or Clarification Date of Expected Move -In: 6116 h3 Effective date: ® Phone Conversation ® Person -to -Person Conversation ❑ Other: r w Employee Name: YVbmS 6da;l-1 Title: —ter Employee Signature: Date: .i'/25IU3 q, •', • fr }- ti /• Y New Certificates K_/Rec, artcation Unit Number 1330 INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designated to assist you in computing Annual Income in accordance with the method set forth in the Department of Housing and Urban Project ("HUD") Regulations (24 CFR 913). You should make certain that this form is at all limes up to date with the HUD Regulations. All capitalized terms used herein shall have the meaning set forth in the. Regulatory Agreement. CSCDA (Pool) - Newport North 1/We the undersigned state that 1/we have read and answered fully, frankly and personally each of the following questions for all persons who are to occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit. 1 2. 3. 4. 5. Name of Members Relationship Of the to Head of Social Security Place of Household Household Age Number Employment Income Computation 6. The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children under 18 years) listed above for the 12-month period beginning the earlier of the date that I/we plan to move into a unit or sign a lease for aunit isS _()�7.3k Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real or personal property (without deducting expenditures for business expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets); (c) interest and dividends (including income from assets included below and other net income from real or personal property); (d) the full amount of periodic payments received from social security, annuities, insurance policies, retirement funds, pensions, disability or death benefits and other similar types of periodic receipts, including any lump sum payment for the delayed start of a periodic payment; (e) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; /' (f) the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter'and utilities; (g) periodic and determinable allowances, s�as alimony and child support payments and regular contributions and gifts received from persons not residing in the dwellings; „, ,• , ....'.1 .. -. J .,,-.. C �-L C.L- A -..-�J L- ..- /...L-•L..- n-..n• I:•rl.... i.. •Ln (a) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (1) relocation payments under Title 11 of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970; (g) foster child care payments; (h) the value of coupon allotments under the Food Stamp Act of 1977; (i) payments to volunteers under the Domestic Volunteer Services Act of 1973; Q) payments received under the Alaska Native Claims Settlement Act; (k) income derived from certain submarginal land of the United States that is held in trust for certain Indian tribes; (1) payments on allowances made under the Department of Health and Human Services' Low -Income Home Energy Assistance Program; (m) payments received from the Job Partnership Training Act; (n) income derived from the disposition of funds of the Grand River Band of Ottawa Indians; and (a) the first $2000 of per capita shares received from judgement funds awarded by the Indian Claims Commission of the Court of Claims or from held in trust for an Indian tribe by the Secretary of Interior. 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necyssary items of personal property such as furniture and automobiles and interests in Indian trust land) 7C Yes No; or (b) have they disposed of any assets (other than at a foreclosure or bankruptcy sale) during the last two years at less than fair market value? Yes X No ( c) If the answer to (a) or (b) above is Yes, does the combined total value of all such assets owned or disposed of by all such persons total more than $5,000? Yes Jf No (d) If the answer to ( c) above is Yes, state: (1) the combined total value of all such assets: $ —' (2) the amount of income expected to be derived from such assets in the 12-month period beginning on the date of initial occupancy in the unit that you propose to rent: $ — , and (3) the amount of such income, if any„that was included in item 6 above: $ -- 8. (a) Will all the persons listed in column 1 above be or have been full-time student during five (5) calendar months of this calendar year at an educational institution (other than a correspondence school) with regular faculty and students? Yes X No (b) Complete only if the answer to Question 8(a) is "Yes"). Is any such person (other than nonresident aliens) married and eligible to file a joint federal income tax returns? Yes V No 9. This certificate is made with the knowledge that it will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and I/we declare that all information set forth herein is true, correct and complete and based upon information Uwe deem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. 10. I/We will assist the Owner in obtaining any information or documents required to verify the statements made herein, including either an income verification from my/our present employer(s) or copies of federal tax returns for the immediately preceding calendar year. it. I/We acknowledge that all of the foregoinP�information is relevant to the status under federal income tax law of the interest on bonds issued to finance the O of the apartment building for which application is being made. We consent to the disclosure of such information to the issuer of such bonds, the holders of such bonds, any trustee acting on their behalf and any authorized agent of the Treasury Department or Internal Revenue Service. I/We declare under penalty of perjury that the foregoingis true and correct. uti . 2003 (year) in the City of _Na &4Te±ft&alifomia Applicant Applicant (Signature of all persons (except children under the age of 18 years) listed in number 2 above required) M FOR COlY1PLMON BY APARTAMNT 07ir t ONLY: 1. Calculation of eligible Income: a. Enter amount entered for entire household in 6 above: b. (1) If the amount entered in 7(e)above is yes, enter the total amount entered in 7(d)(2), subtext frayPLO `figure the amount entered m 7(dx3) and enter the rema°•iinl (2) Multiply the amoue bt in,s the current passbook savings rate -� e to determine what the total annual earnin d)(1) would be if invested ro passbook saviuk " ^ _), subtract from that figure the amount enm, 'n 7(a)(3) and enter the remaining balance ($ (3) Enter at right the greater of the amount calculated under (1) or (2) above: e, TOTAL E1I0I1 Lt INCOME (line la plus line l.b(3): 2. The amount entered in I & Qualifies the applicant(s) as a Moderate -Income Teaant(s). Qualifies the applicant(s) as a Lower -Income Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenant(s). S q 1', 592. 34 /A S. Number of apartment unit assigned: 13 3 o Bedroom size: Z+ 7 Rent: $ 12 71. 6 a 4. This apartment unitqDtwas not) last occupied for a period of 31 or more consecutive days by persons whose aggregatd andcipated annual income as certified in the above manner upon their initial occupancy of the apartment unit qualified them as a Lower -Income Tenant(s). 5. Method used to verity applicant(s) income: i �( Employer income verifieadoty�t Copies of tax reaurns. x citbex ( V Manager—= Date ) asrcmncawt •• i:af l"' t,d r= Ai;SC t C.Fha LCULA I M VV(CFK6.-iC2I 2 v laatp , First Name Relationship HOH Sol Sex M Oale nt Birth I S Age Social security �F73- -711 Ffr EStudent or NO wo No tj 5 6 I I Income Restricted Certification Questionnaire Name: h `iQ %)e Unit 1 �J __XzInitial Certification Re -certification Other Yes No Question Monthly Income ` O L%we receive Family Support, Spousal Support, and/or any other N cash contributions of gifts, including rent or utility payments from persons not living with me. l; we receive Veteran's Administration, Pension, Unemployment benefit, Disability benefit, AFDC, Lottery winnings, Inheritance, or Annuities. V%ve receive income from Rental Property. I'v.c :eceivc bed--fitzlineonlc form, Scchl Saeunty to includc SSA, SSI and/or periodic social security payments. {�o The household receives unearned income for family members age 17 or under. Ywe are entitled to receive child support payments. I l e am currently receiving child support payments. I we am•'are currently malting efforts to collect child support owed to me. FNve have other assets (example: 401K, IRA, Revocable Trusts, Stocks, Bonds, Treasury Bills, Money Market accounts, Certificate of Deposits, Whole Life insurance, Real Estate) \� ` L'tve have cash on hand. Student Status: Does the household consist of persons who are all full-time D students (example: College/University, trade school, etc.)? \0 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 qJ you:, Married and filing ajoint tax return. Under penalties of perjury, I certify that the information presented on this form is true and accurate to the best of my knowledge. The undersigned further understands that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information will result in the t lial of . rplication or termination of the income restricted lease agreement. t 2*7/6 Resident Signature / Date Signature of Otlner Agent 5 /Z 7/03 Date ,MPLOYMENT VERIFICATIC"- RE: 1 1+ Vn I' y R— Nu 1 Y ApplicanUl'enant Name 1 hereby information. M (Name & address of employer) D+T R sSoO-(a+C1: PD. is 9 .-- W-91H SocialSecurity Number Date: )3,30 Unit # (if assigned) /S% 3 Date The individual named direcWabove is an applicant/tenant of a housing program that requires verification of income. The information provided will remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial and eat] appreciated. Project owner/Management Agent Return Form To: NearulGu,4- No►4h 2 milam We-vjvOrt- $eolcllt employee Name: /!/PAli A911—tl Job Title: Presently Employed: Yes Date First Employed �� �'Y No _ Last Day of Employment arrant Wages/Salary: $ o2.Ot'�•0D (circle one) hourly weekly bi-weekly sgmi-monthly monthly early other Average # of regular hours per week: 00 Overtime Rate: $ per hour Shift Differential Rate: $ per hour 3wo- Commissions, bonuses, tips, other: S_ b2 '(circle one) Year-to-date earnings: S. through Average # of overtime hours per week: Average # of shift differential hours per week: " C- hourly weekly bi-weekly semi-monthly monthly arly other List any anticipated change in the employee's rate of pay within the neat 12 months: If the employee's work is seasonal or sporadic, please indicate the layoff period(s): Effective date: Employer's Printed Name -- Date ROW `%% / �° A0 / E-mail Phone # Fax # 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) Earned Income Calculation Worksheet Employer v, ir,r 4 Coa%4- Child i�,o,n4- Most Recent Ending Pay Period Date Hire Date L yI4/p3 6/1101 YTD Income 2,gyo.o0 divided by Start with hire date if at job for less than a year (_) 3q2 . oo (how often paid) M 1 26 =) Calculated Annual Income 10 ,142,0a Gross per Pay Period 2gg, 00 (+) 3 so . a a (-) 6 4 i-. Go divided by 1 2, (how often paid) W 1 26 (=) Calculated Annual Income NEWPORTCOAST CHILD DEVELOPMENT � OL 010635 :HECK NO, SOCIAL SECURITY NO. EMPLOYEE NAME NUMBER DAILY STATUS DEPT. DATE 10635 573-35-7114 MONIQUE E. DAILY S 01,00 ASST TCHER 03/21/2003 I I EARNINGS *=cur hrs TAXES MISCELLANEOUS DEDUCTIONS TYPE $/HR CURRENT YTD TYPE CURRENT YTD TYPE CURRENT YTD RegHrs 12.00 288100E 241100 MCWH 4118 37147 CASDI 2159 23122 Sub -total 288100 2580100 SSWH 17186 159196 HEALTH 0100 0100 FITW 6188 117126 ADVANCE 0100 0100 I I I I I I I I I I I I 1 SITW 0100 i I I I I 1 1 6120 i I 1 I I 1 I 1 i 1 I I 1 I 1 1 I I I I I I I I 'OTALS 002 28 92 83 2 59 23122 256149 2235i IET PAY NEWPORT COAST CHILD DEVELOPMENT PRESCHOOL eg8rs 12.011 Sub -total SECURITY N0. J EMPLOYEE NAME 35-7114 MONIQUE E. DAILY RNINGS *=cur hrs CURRENT YTD TYPE 360100E 30 �00+ MCWH 360100 2940 �00 SSWHFIT! ! I SITW 315 NUMBER DAILY STATUS DEPT. s 01.00 ASST 5j22 42j63 CASDI 3 22132 182128 HEALTH I 0 0 14108 131134 ADVANCE Oi00 6120 1 010646 I Beginning Balance on 03/20/03 $749.53 Bank of America,% IM 0097 EO-5 )r�unir�r��nulOu)r(i)r)1)nl)�(ul))uu(r)r)�nur)�r) MONIQUE DAILY 150 STONECLIFFE AISLE IRVINE CA 92612-5700 Our free Online Banking service allows you to check account balances, transfer funds, pay bills and more. Enroll at www.bankofamerica.com. Your Bank of America Combined Account Statement Statement Date: April 18, 2003 At Your Service Call: 949.837.3482 Online: www.bankafamerica.com Written Inquiries Bank of America Laguna Beach Branch PO Box 37176 San Francisco, CA 94137-0001 Customer since 1994 Bank of America appreciates your business and we enjoy serving you. 1 ❑ Summary of Your Deposit Accounts ❑ Bank of America News I Account Account Number Your Balance VERSATEL Checking 00979-02782 $ 696.03 Regular Savings 00971-01364 68.20 Total Balances $ 764.23 Right now, you can save 15% on your Mother's Day purchases at 1-800-FLOWERS.COM when you pay with your Bank of America Check Card(R). Just'enter VBV to redeem your special offer. And remember'cur Total Security Protection Package, which includes Verified by Visa, helps guard against theft, loss, or unuathorized use, even online. You could win up to $15,0001 First, register for the Online Banking Sweepstakes and read the official rules at bankofamerica.com/paymybills. Then, see for yourself why so many customers love free Online Banking with free Bill Pay, Track balances, transfer funds, pay bills - and every bill you pay Is a chance to win. No transaction necessary to enter. Now you can visit: bankofamerica.com/cdladdering and discover how•you can increase earnings potential and liquidity with CD Laddering. ❑ Your VERSATEL Checking Account Account Number: 00979.02782 Statement Period: March 20 through April 18, 2003 Number of ATM withdrawals and transfers 5 Number of purchase transactions 34. Number of 24 Hour Customer Service Calls Self -Service 1 ' Assisted 0 6 of your customer service Calls are free or charge each statement period ankofAmerica. ONIQUE DAILY M Statement Date: April 18, 2003 i Branch/ATM Deposits Amount Number Date Posted Amount Number Date Posted int 04/10 312.00 03/21 $ 556.49 04/14 24.00 03127 400.00 04/17 10 03/31 324.00 1,000.00 Total of 8 deposits $3 53� 63 10 04101 04/07 615.14 ] Checks Paid ' Gap in check sequence Amount Date Paid Number Amount Date Paid ' D Number 22.96 04101 1956 1957 $ 120.00 36.00 04101 1966 1968 73.00 300.00 03/31 03/31 1958 63.67 04/ Ot 03/01 1969 49.63 03/28 1959 117.62 14.98 03128 131 1970 20.60 79.92 03/27 03/31 1960 1961 10.00 03131 04/04 1971 j 1972 1,386.00 03/31 1962 1963 32.65 120.19 04/18 " 1976 ' 1978 69.20 15.00 03/28 03131 1964 131.99 04/15 Total of 19 Checks Paid $2,716.03 03/28 1965 52.62 3 Account Activity Date Posted 03/21 04/01 04/01 04/17 03/20 03/20 03/24 03124 03/27 03/28 03/31 03/31 03131 03/31 Description Deposits and Credits Account Fee Reversal Transfer from savings 00971-01364 on 04/01, Bank of America ATM #098701 (Card #315370486) Transfer from savings 00971. 1364 on 04/01, Bank of America ATM #098701 (Card 315370486) CheckCard Purchase Mesa Cr Adj en 04/16(Card 315370486), Ref.# 1000000190493229 Total Deposits and Credits Withdrawals, Transfers and Account Fees rt,-L- Corn Purchase an 03/19 (Card #315370486), VA Purchase on 03127 Voris Store 1 Check Card Purcha Crown Hardt Ref # 100001 Purchase on 03/29 Mothers MY Check Card Purchz Me-N-Ed's P Ref # 10000i Purchase on 03129 Target1293 Purchase on 03/29 Target 1293 ,d Costa Mesa CA lase Debit on 03/14/03 Card Smarte Carte Hnla,,p H( on 03/21 (Card #315370486), Tanta Ana CA 30372752 rd #315370486), awport Beach CA on 03/27 (Card #315370486), e #3 949644857 CA 30#70911 ird #315370486), :he Costa Mesa CA on 03/28 (Card #315370486), a Costa Mesa CA 90188840 and #315370486), sta Costa Mesa CA and #315370486), sta Costa Mesa CA 1276794732 Reference Number 008586 008583 292049 450153 029556 675249 643049 5 Amount I $2.00 75.00- 200.00, 25.86• $302.86 $14.95 34.95 2.00 20.01 45.34 13.84 8.72 9.45 12.60 21,54 ., ,�� ate,. • . �' .. •y*+, ' YV BankofAmerica,�% MONIQUE DAILY Statement Date: April 18, 2003 ,--. n........n1 enf8.ifv f`nnfinuod Dale fosled Description Reference Number Amount Withdrawals, Transfers and'Account Fees 802082 23.92 03/31 Purchase on 03/30 (Card #315370486), 03/31 Ralphs 5331 nive Irvine CA Purchase on 03/29 (Card #315370486), 392997 31.03 Sou Anchor Blue # Costa Mesa CA 45.69 03/31 Check Card Purchase on 03/27 (Card #315370486), L I C - Anaheim Anaheim CA Ref # 1000000190337714 5172 03/31 Check Carii Purchase on 03129 (Card #315370486), Target 0001 Costa Mesa CA 03/31 Ref# 1000000190063480 Purchase on 03/31 (Card #315370486), 628719 58.73 04/03 Trader Joe's # 11 wine CA Cash withdrawal on 04103, 000005220 21.50 Non -Bank of America ATM #RX8017 (Card #315370486) 000005220 2.00 04/03 ATM withdrawal fee on 04/03, Non -Bank of America ATM #RX8017 ((Card 315370486)' 27.95 04/04 Check Card Purchase on 04/02 (Card #315370486 Sportmart 654 Irvine CA 04/04 Ref# 1000900190033941 Check Carl! Purchase on 04/02 (Card #315370486), 34.72 Shell Oil 2045376 Newport Beach CA Ref# 1000000190208427 321099 13.98 04/07 Purchase on 04/06 (Card #315370486), Sou Blockbuster V wine CA 16.94 04/07 Check Card Purchase on 04105 (Card #315370486), Ruby's Corona Del Corona Dal a CA Ref ## 1000000190254453 21.36 04/07 Check Card'Purchase on 04103 (Card #315370486), Wal Mart Corona CA 04/07 Ref# 1000000190083058 Purchase on 04/06 (Card #315370486), 153283 29.36 Vans Store 1 Newport Coast CA 552777 37,69 04/07 Purchase on 04/07 (Card #315370486), 04/07 Target 0336 Ervin Irvine CA Purchase on 04/07 (Card #315370486), 628087 78.28 '04107 Trader Joe's # 11 Irvine CA Cash withdrawal on 04104, 006098 100.00 Bank of America ATM 408946 Card �315370486) 7 84 04/08 Check Card Purchase on 04/011 (Card 315370486), Souplantation #98 Irvine CA 04/09 Ref# 1000000190551995 Purchase on 04/09 (Card #315370486), .. 646515 19.48 Vons Store 1 Newport Beach CA 53.36 04/09 Check Card Purchase on 04/07 (Card #315370486), Shell Oil 2043714 Irvine CA Ref # 1000000190186386 23,29 04/10 Check Card Purchase on 04/09 ((Card #315370486), Jiffy Lube ##1969 949-6E05823 CA 04/10 Ref# 1000b00190393325 Cash withdrawal on 04/09, 003406 40.00 Bank of America ATM #098704 (Card #315370486) 40.00 04/14 Cash withdrawal on 04/14, 000727 Bank of America ATM #101502 C#315370496) 04114 )ard se Check Card Purchaon 04/11 (Card 315370486 , 43.02 Annn v--,- A-- hA R•.rl.� w . bank ©fAmerica. ���y> MONIQUE DAILY Statement Date: April 18, 2003 ❑ Account Activity Continued Date Posted Descriptlon Reference Number Withdrawals, Transfers and Account Fees 04/15 Check Card Purchase on 04113 (Card #315370486), 19nnn Bath & Body Works Newport Beach CA Ref# 1000000190448418 04/16 Purchase on 04/16 (Card #315370486), 612004 Trader Joe's # 11 Irvine CA 04/17 Cash withdrawal on 04/16, 007562 Bank of America ATM ##098704 Card ##315370486) . 04/18 Check Card Purchase on 04/f6 (Card 315376486), 7.32 Oaphne's Greek Cos Costa Mesa CA Ref # 1000000190116650 04/18 Check Card Purchase on 04/16 (Card #315370486), 44.49 Shell Oil 2045376 Newport Beach CA Ref# 1000000190241707 Total Withdrawals, Transfers and Account Fees $1,166.46 Service Charge 04118 Monthly Service Charge $5.50 ❑ Overdraft Protection Plan Savings Account00971-01364 Overdraft coverage available $43.20 ❑ Bank of America: In Balance To assist you in reconciling your account, we have provided the following summary information. A reconciliation worksheet is printed on the reverse of this page. • Your ending balance from this statement.................................................................................................................................$696.03 • Subtract other account fees from your checkbook register....................................................................................................... 2.00 • Subtract the monthly service charge from your checkbook register......................................................................................... 5.50 ❑ Your Regular Savings Account Account Number: 00971.01364 Statement Period: March 20 through April 20, 2003 Beginning Balance on 03/20/03 $343.05 Annual Percentage Yield earned this period 0.50% Total Withdrawals, Interest paid year-to-date $1•04 Transfers, Account Fees - 275.00 Number of ATM withdrawals and transfers 2 Interest Paid + .15 Ending Balance $68.20 ❑ Important Information About Your Account s. . .. . Bank of America.%rP MONIQUE DAILY Statement Date: April 18, 2003 ❑ Account Activity 1 Date Posted Descriptlon Reference Number Amount Withdrawals, Transfers and Account Fees 04101 Transfer to checking 00979-02782 on 04101, 008586 $75.00 04101 Bank of America ATM ##098701 (Card #315370486) Transfer to 00979-02782 checking on 04/01, Bank of America ATM #098701 (Card #315370486) 008583 200.00 Total Withdrawals, Transfers and Account Fees $275.00 Interest Paid 03l31 Interest Paid from 03/01/03 Through 03/31/03 $ 15 ❑ ATM Information This period, you visited the following ATM locations: Bank of America's ATM Network I • #098701 Westcliff Plaza, Newport Beach, CA • #098704 Westcliff Plaza, Newport Beach, CA • #101502 Woodbridge, Irvine, CA 1 • #408946 Newport Center 550, Newport Beach, CA I Non -Bank of America ATMs ,• I • #RX8017 Xtracash, 4115 Campus Dr, Irvine, CA ` I I i t •.�f. .) . .. . Bankof America 0097 EO-4 ((1)IIII(111(( till l(jll(Ijlji(1(il/) j(III)(1111('(1((Ilpl((Ij MONIQUE DAILY 150 STONECLIFFE AISLE IRVINE CA 92612-5700 Our free Online Banking service allows you to check account balances, transfer funds, pay bills and more. Enroll at www.bankafamerica.com. Your Bank of America Combined Account Statement Statement Date: March 19, 2003 At Your Service Call: 949.837.3482 Online: www.bankofamerica.com Written Inquiries Bank of America Laguna Beach Branch PO Box 37176 San Francisco, CA 94137-0001 Customer since 1994 Bank of America appreciates your business and we enjoy,serving you. ❑ Summary of Your Deposit Accounts ❑ Bank of America News Account Account Number Your Balance VERSATEL Checking 00979-02782 $ 749.53 Regular Savings 00971-01364 343.05 Total Balances $ 1,092.58 Mortgages with 80% less paperwork from you and only from Bank of America. It's home buying made easy. Visit www.bankofamerica.com/loans or contact us today to get started. Not all applicants will qualify for reduced paperwork benefits. Now you can use your Bank of America Visa(R) Check Card to pay your personal Federal and participating State income taxes. Your payment will be processed within minutes and the money comes right out of your checking account. Once you've filed your tax return, just go to www.bankofamerica.com/taxpayment for detailed information. ONLINE BANKING GUARANTEE: With our Online Banking service, you can be confident that your Bank of America accounts will be secure and protected. We guarantee $0 liability for any unauthorized activity originating from Online Banking, including Bill Payment. For terms and conditions, or to learn more about Online Banking, visit www.bankofamerica.com. Sign your student loan application with the click of a mouse. Choose Bank of America as your Stafford loan lender and complete the paperwork from the comfort of your own home. Learn more at www.bankafamerica.com/studentbanking. Bankof America MONIQUE DAILY Statement Date: March 19, 2003 ❑ Your VERSATEL Checking Account Account Number: 00979.02782 Statement Period: February 19 through March 19, 2003 Beginning Balance on 02/19/03 $597.10 Total Deposits + 2,919.23 Total Checks, Withdrawals, Transfers, Account Fees - 2,757.30 Service Charge - 9.50 Ending Balance $749.53 ❑ Important Information About Your Account Number of ATM withdrawals and transfers 0 Number of purchase transactions 12 Number of 24 Hour Customer Service Calls Self -Service 0 Assisted 0 VERSATEL Checking customers who take advantage of Direct Deposit can reduce fees every monthl To find out more, contact your employer or visit your local Bank of America banking center. For Social Security or SSI direct deposit, call the Social Security Administration toll -free at 1-800-772-1213. ❑ Branch/ATM Deposits Number Date Posted Amount Number Data'Posted Amount 02120 $ 300.00 M/-14 02/24 1,372.78 03117 365.00 03/05 300.00 [Total of 5 deposits $2,1D4.05 ❑ Checks Paid Data Paid Number Amount Date Paid Number Amount 02/28 1848 $ 5.00 03/04 1953 6.14 02/26 1949 62.13 02/28 1954 1,386.00 ' 02/26 1950 155.15 03/10 1955 22.30 02127 1951 36.00 Total of 8 Checks Paid $1,699.29 02/26 1952 26.57 r1 Account Activity Dale Posted Description Reference Number Amount Deposits and Credits $60.55 02/28 Savings Overdraft Coverage Transfer 29.63 03/03 Savings Overdraft Coverage Transfer 03/04 Savings Overdraft Coverage Transfer 25.00 Total Deposits and Credits $115.18 Bankof America MONIQUE DAILY rt Arrnunf Aefivifv Cnntimierl Statement Date: March 19, 2003 Date Posted Description Reference Number Amount Withdrawals, Transfers and Account Fees 459923 22.34 02/26 Purchase on 02/26 (Card #276794732), Ralphs 1150 )rvin ewport Beach CA 657137 86.46 02/28 Purchase on 02/27 (Card #276794732), Trader Joe's # 11 Irvine CA 03/03 Check Card Purchase on 02/28 (Card #276794732), 29.63 Haleiwa Joe's Kaneohe I Ref # 1000000190094851 51.92 03/07 Check Card Purchase on 03/06 ((Card #276794732), Dollar Rao Hnl Honolulu HI 03/07 Ref # 1000000190281806 Purchase on 03107 (Card #276794732), 615169 93.73 Trader Joe's # 11 Irvine CA 42 52 03/10 Check Card Purchase on 03107 (Card #276794732), USA Petroleum 044 Irvine CA Ref 1000000190183464 03/17 Check Cavil Purchase on 03115 (Card #315370486), 38.64 Union 76 2763 Costa Mesa CA 03/18 Ref# 1000000190634667 Purchase on 03/18 (Card #315370486), 643156 87.00 03/19 Alber[son's 6507 Irvine CA Purchase on 03119 (Card #315370486), 628699 54.99 Trader Joe's # 11 Irvine CA Total Withdrawals, Transfers and Account Fees $1,058.01 03/19 Service Charge In -Branch Transaction Fee - Deposits $4.00 03119 Monthly Service Charge 5.50 Total Service Charges S9.50 ❑ Overdraft Protection Plan Savings Account 00971-01364 Overdraft coverage available $318.05 ❑ Bank of America: In Balance To assist you in reconciling your account, we have provided the following summary information. A reconciliation worksheet is printed on the reverse of this page. • Your ending balance from this statement.................................................................................................................................5749.53 • Add amount transferred to your account from your overdraft protection plan to your checkbook register ................... 115.18 • Subtract the monthly service charge from your checkbook register......................................................................................... 9.50 ❑ Your Regular Savings Account Account Number: 00971.01364 Statement Period: February 19 through March 19, 2003 Beginning Balance on 02/19/03 $481.98 Total Withdrawals, Transfers, Account Fees - 130.18 Interest Paid + .25 Service Charge - 9.00 Ending Balance $343.05 Continued on next page 0065364.003.T15 California Annual Percentage Yield earned this period 0.50% Interest paid year-to-date $.89 Page 3 of 4 :.Y . Bankof America Pp MONIQUE DAILY Statement Date: March 19, 2003 ❑ Important Information About Your Account Your account earned $.16 in interest this statement period. The Interest Paid shown above reflects interest earned since your last payment date. Total Interest paid to your account in 2002 : $1.80 r1 Arenunt Activity Dale Posted Description Reference Number Amount Withdrawals, Transfers and Account Fees $5.00 03/03 Savings Overdraft Coverage Transfer Charge 03/03 Savings Overdraft Coverage Transfer 0097-9.02782 (effective dated 03/04 02/28) Savings Overdraft Coverage Transfer Charge 60.55 6.00 03/04 Savings Overdraft Coverage Transfer 0097-9-02782 (effective dated 03/03) 29.63 6.00 03105 Savings Overdraft Coverage Transfer Charge 03/05 Savings Overdraft Coverage Transfer 0097-9-02782 (effective dated 25.00 03/04) Total Withdrawals, Transfers and Account fees $130.18 02/28 Interest Paid Interest Paid from 02/01/03 Through 02/28/03 $.25 Service Charge 02/28 This Fee Was Charged Because Your Account's Minimum Balance During The Month Was $ 481.98 on 02-11 And The Account Had 3 $9.00 Excess Withdrawal(s). J Clarification Record Applicant/ResidentName: : Mo4iave� _—Date: 6121193 Initial Certification Date of Expected Move -In: 6 6 U 3 ❑ Re -certification Effective date: Means of Clarification: ❑ Phone Conversation Person -to -Person Conversation ❑ Other: Date of Clarification: Contact Name: Summary of Clarification Explanation or Clarification 1Pcus IWC arxeel Title: 14ssfa kstl — owwr ^ Employee Signature: Employee Name: Date: 9/5/03 Ate— U Newport North 2 Milano Dr, Newport Beach, CA 92660 (949)720-8765 Verification of No Child Support M 0 M_ �Cl, Resident Name: �j Apartment Number: 1 ✓ 5 O cc_J I, hereby certify that I do not receive monthly child support payments. I hereby certify under penalty of perjury under the laws of the State California that the information provided above is true and complete. Resident 5/ 7 r7/ I3 Date 1• [RVINE APARTMENT MANAGEMENT COMPANY BOND SUMMARY JULY 2003 NEWPORT NORTH OC85 Move -ins Her to 5/25/95 Apt. Resident Size # of 11'M M/O House Rent Recert Address Name Oce. Date Date Income Due 1. 2112 Lynch 2+2 1 6/17/92 $40,047.00 $1,361 N/A 2. 2132 Sintich 3+2 4 12/27/93 $39,600.00 $1,417 N/A 3. 2202 Miller 2+2 3 4/22/95 $32,015.00 $1,361 N/A 4. 2204 Ohanesian 2+2 1 8/1/91 $39,746.00 $1,326 N/A 5. 2242 Cona 3+2 3 6/13/87 $31,481.00 $1,451 N/A G. 2342 Platt 2+2 1 12/26/87 $24,377.00 $1,280 N/A 7. 2401 .Johnson 2 F2 1 11/7/89 $27,853.00 $1,310 N/A 8. 2454 Ocleuard ,q2 1 3111189 $35,230.00 $1,380 N/A 9. 2534 Cattaneo 3+2 7 112/17/94 $32,650.00 $1,392 N/A 10. 2731 Duli a 2+2 1 4/7/95 $42,006.00 $1,280 N/A OC95 Move -ins after 5/25195 Apt. Resident Sire # of M/I M/0 House Rent Recert Address Name Oce. Date Date Income Due 1. 102 Guthrie/Fletcbei 2+2 2 6/7/02 42,31333 1361 06/04 2. 104 Etchells 1+1 2 10/4/02 38,660.00 1160 10/03 3. 10S Cheit/Milne 2+2 2 11/23/02 47,37i 98 1361 11/03 4. 1 22 Halstead/Girton 2+2 2 5/5/02 43,733.30 953.25 05/04 5. 124 Szaz 2+2 2 311196 27592.50 1280 03/04 6. 125 Monteity 2+2 2 12/31/93 40,362.G0 1271 12/03 7. 138 Petez/Malone 2+2 2 10/1S/Ol 40,79G.70 1326 09/03 8. 146 Almore/Watson 2+2 2 6/20/97 23,407.00 1361 R/04 TTP=307 9. 214 OTA 2+2 2 12/1/99 34,978.24 1361 12/03 10. 2 88 Riveta 2+2 2 6/28/97 51,112.08 1361 6/04 11. 220 Bolt 2+2 1 3/8/02 39,991.61 1326 03/04 12. 23l Rubio/Walsh 2-2 3 1 7/5/03 47,39U.01 1271 07/04 13. 236 Balcazar 2 -2 3 1 06/30/01 42=21 '. i 3 960 06/04 14. 237 Hoanu 2,2 2 1/23r99 35,03-1.51 1280 1/04 15. 239 Emirs/Bernard 2 F2 2 12/9,98 51'892.IS 1271 12/03 16. 244 Vacant 1-r I 17. 245 Feel 1+1 2 09/15/02 42,365.50 1210 09/03 18. 251 molts/Flynn I-F] 2 7/10/00 36,923.33 1210 07/04 19. 302 Won Wong 2+2 2 05/09/02 43,315.70 1280 05/03 20. 304 Karo 2+2 1 03/28/03 25747.06 1280 03/04 21. 308 Falchouri 2+2 2 6115100 25,890.00 1326 06/04 22. 311 Elliott 1+1 1 7/1/03 38,400.00 1210 07/04 23. 312 Golden 1+1 1 08/07/01 35,840.00 1160 08/03 24. 313 Rhontberrs I'I 2 � 10/2/02 I � ; 43,_7._16G 1210 10/03 25. 314 Thomas 1 3 6/1/02 41,60.1,52 1130 06104 2G. 315 Wo1F Irl 1 G/15/03 3922i.12 -- 1l30 06/04 27. 1100 Lee/Won Hober 3+2 4 05/22/03 55,500.UU 1413 OS/04 23. 1104 mcconney 1T1 2 1 8/13/01 51,172.G0 1160 8/03 1 1 IRVINE APARTMENT MANAGEMENT COMPANY BOND SUMMARY ,JU LY 2003 NEWPORT NORTH 29. 1106 Meyer I-�I 1 7/08/00 35,508.70 LIDO 7/03 30. 1107 Aviles 1 1T1 4 03/23/O1 23416.2 S84.25 08/03 31. 1108 Romcro/Sertano 2-2 5 11/05/01 56,534.90 1026.7 5 I1/03 32. 1118 Hardison I"I 2 01/18/03 37,171.60 1100 01/04 33. 1122 Hiles 2+2 2 7/13/98 33,262.00 1361 7/03 34. 1128 DelFante 3-2 4 11/06/99 83,450.10 1512 11/03 35. 1144 Se ehrband 1+1 1 11/16/00 14,022.00 1 1160 11/03 36. 1145 Axelrid I-F] 1 8/30100 41,424.20 1 1160 3/03 37. 1154 Pilon 2+2 1 01/11/03 42,037.55 1 1361 01/04 38. 1159 Goddard 1+1 1 02/14/03 40,413.69 1210 02/04 39. 1183 Pouter 1+1 2 6/1/96 1 52312.86 1210 06/04 40. 1184 Olson 2+2 1 7/28/03 1 32800.58 1361 07/03 41. 1200 Wood 2+2 3 08/04/01 1 48,871.20 1361 08/03 42. 1203 Gallicino 2•1-2 1 11/07/01 1 37729 53 1280 11103 43. 1206 Bottiaux 2-2 2 110/19/02 34927 OS 11,61 10/03 44. 1207 Robbs/Stotts 2+2 2 7/14/96 37,060.54 1271 5/04 45. 1231 Mmtdclbauni 7717 1 12/26/99 35,627.51 1210 12/03 46. 1330 Dail 2+2 1 2 6/6/03 41992.34 1271 6104 47. 1408 Amor 2+2 2 08/15/02 18,255.30 1361 03/03 48. 1411 Loran,er 2+2 1 02/22/02 52,208.34 1326 02/04 49. 1412 Fujioki 2+2 1 7/10/98 47,632.21 1361 7/04 50. 1418 Lee 1+1 2 7/12/02 40,277.29 1160 07/04 51. 1441 Geri y 1-1 2 12/03/01 60,83.4.24 1210 1 12/03 52. 1444 Douglus 2=2 1 2/1199 5133S.75 1326 02/04 53. 1502 Smith I2-2 14 3/31,96 72908.%9 1351 03/04 54. 1557 Ramirez I•.I I ! 02/08/03 40,000.00 1210 02/04 55. 2116 Vacant 1 2-2 56. 2 223 Ross 1T1 3 11/16/01 49,894.73 1210 11/03 57. 2134 Huish 2!-2 3 9/13/99 22,574.20 1361 9/03 58. 2224 Anjozian 1+1 1 5/27/98 21,860.37 1160 5/04 59. 2225 Ziese 1+1 2 01/10/0 37,71?.74 1210 01/04 60. 2226 Syrt uin 2+2 1 12/17/96 21,458.48 1361 12/03 61. 2301 Aithen/Mchugh 2+2 2 05/10/01 39,661.38 1361 01/04 62. 2309 I-latney 1+1 1 11/23/02 39418.03 1210 11/03 63. 2312 Delgido/Gamboa 2+2 2 7/JV03 1 41,581.92 1271 07/04 64. 2322 Marino 1-1 1 8/8/96 15,840.00 1115 8/03 65. 2402 Westbrook 2-2 2 1 12/21/02 28289.27 1361 12/03 66. 2423 Malkin 2,2 2 SW!96 24,000.00 1280 S/03 67. 2426 McKee 2r2 2 6/4/02 56,736.00 1271 6/04 68. 2507 Nora 2+2 3 0 1/3 1/03 49,572.00 1280 01/04 69. 2600 3'-2 70. 2612 Van Nieuwenhu se 2-.-,3 OS/US/02 14,OGZ90 13GI OS/03 71. 262S Fi azlitr 13T2 1 12/lU/O1 43,583.02 1512 12/03 72. 2633 Gltun /Ro 2+2 2 08/20/02 40,636.30 1280 08/03 73. 2712 Lisotta 2+2 1 02/01/03 41,071.60 1361 02/04 74. 2719 Sutherland I+I l 6/30/U3 36,731.36 1130 6/04 75. 2720 Larson1 1+1 1 10/10/99 56,922.30 1 10103 [RVINE APARTMENT MANAGEMENT COMPANY BOND SUMMARY JULY 2003 NGWPORT NORTH VERY LOW (Phase In - beginning 4/1/98) Apt. Address Resident Name Size #of Oce. 111/1 I Date M/O Date House Income Rent Recert I Due 1. 106 Lausen 1+I I 4/11/93 $30,630.15 $ 756 4/04 2. 122 Gaxiola/Mullinax 2+2 2 03/OS/03 29500.00 1 $ S51 3/04 3. 126 Francis/Vidal 2+2 4 1 12/28/00 S49393.92 S 851 12/03 4. 208 Tarta lh i I) I 2 04/01/01 S27,46S.74 $ 756 04/04 5. 224 Cronin 1-,1 I 13/1/03 $23,322 $ 756 03/04 6. 228 Jones 2+2 2 5/S/'T5 $25,650.08 $ 851 5/04 7. 243 BaM 1+1 1 5/1/')9 $24,.M.00 $ 756 5104 8. 301 Francis 2-2 2 1 2/08 02 S22.503.20 S 851 02/04 9. 318 Radford I+l 1 7/3/()9 $28,419.36 $ 756 7/04 10. 320 McGinley 1+1 1 4116199 $21,360.01 $ 756 4/04 11. 333 Steinman 1+1 1 2/10103 $24,700.00 $ 756 2/04 12. 1180 Siroonian I+I 1 4/7/02 $11196.00 $ 756 04/04 13. 1323 Buoncristian 1+1 3 11/10/01 $2768437 $ 737 09/03 14. 1324 Hale 12:2 I 1 4/1/01 $33.843.96 $ S51 04/04 15. 1333 Stork i I -:I 1 9/7/02 s23A68,00 $ 756 09/03 16. 1419 Ray/Brown 1-1 2 1 5111 03 28,139.00 $ 756 5/034 17. 1530 Siddi i 1+1 3 6111 00 S38,900.04 S 756 06104 18. 212S Johnston 2+2 2 6/5/00 $31,673.20 S 851 06104 19. 2140 Vise 2-1-2 1 102/01/02 S20,736.00 S 851 02/04 20. 2210 Perrao 2-r2 2 01/12103 S26030.00 $ 851 01/04 21. 2300 Mohler 2+2 3 6/1199 S11748.00 $ 851 06104 22. 2408 Shoeibi/Mottaghi 2+2 2 5112 02 $16,128.00 $ S51 05/04 23. 2425 Uchida 2+2 3 04/11/01 $37,372.40 $ 851 04/04 24. 2423 Winslett 2+2 1 03/17/00 $23616.00 $ 851 3/04 25. 2440 Afshar/Afshar 2+2 1 2 05/0,1/01 S22,205.16 $ 851 05104 26. 2450 Warfield I:: -I 1 4/11.98 S13,S82.00 $ 756 4/04 27. 2519 Cutter I -1 1 5/29 Ol S25.635.36 S 756 5/04 28. 2608 Vidal/Gaxiola 2=2 2 6/l/99 )29,980.00 S 851 06/04 29. 2702 Delgado 2+2 4 1 3/1/b2 ti16224.00 $ S51 03104 1998 Phase in-106-122-224-318-320-2450 1999 Phase in- 228-243-1180-2608-2300-126 2000 Phase in - 2423- 1333-2519-1530-2128 2001 Phase in - 333-208-1323-2425.14192140,2440,30:1 2002 Phase in - 2210,2408,2140.2702,1324 Total number of apartments on this property: 570 % of property deemed Income Resu acted ( Low): 15.261%, of property deemed Income Item acted (Very Lott): 4.74%, TTP = Total Tenant Payment (Resident is on Ce) tificate or Voucher) Total vacant as of 053103 - 33 IRVINE APARTMENT MANAGEMENT COMPANY BOND SUMMARY JU LY 2003 NEWPORT NORTH EXFIIBIT C Property Name: NEWPORT NORTH CERTIFICATE OF CONTINUING PROGRAM COMPLIANCE AS OF July 2003 The undersigned, being an Authorized Borrower Representative of Irvine Apartment Communities, L.P. (the "Borrower"), has read and is thoroughly familiar with the provisions of the various documents associated with the Borrower's participation in the California Statewide Communities Development Authority's (the "Issuer”) Apartment Development Revenue Bond Program, such documents including: The Amended and Restated Regulatory Agreement and Declaration of Restrictive Covenants dated as of May 15, 1998 among the Borrower, the Issuer and U.S. Bank Trust Nationdl Association (the "Trustee"). 2. The Loan Agreement dated as of May 15, 1998, between the Issuer and the Borrower. During the preceding month 5 applications were received from Restricted Tenants (as defined in the Regulatory Agreement): 4. As of the date of this certificate, the following percentages of completed residential units in the Project (i) are occupied by Restricted Tenants, or (ii) are currently vacant and are being held available for such occupancy and have been so held continuously since the date such unit was vacated, as indicated: 1 2 3 Studio Bdrm. Bdrm. Bdrm. Total Occupied by Original Low Income Tenants N/A 0 6 4 10 Unit Nos.: 1.93% Occupied by Lower Income Tenants N/A 27 42 2 71 Unit Nos.: 12.81 % Occupied by Very Low -Income Tenants N/A 14 15 0 29 Unit Nos.: 5.09% Held vacant for Occupancy continuously N/A 1 1 1 3 Since last occupied: Unit Nos.: 0.17% Total Number of Units: Unit Nos.: 20.00% N/A 42 64 7 113 Since last occupied: I r J The undersigned hereby certifies that the Borrower is not in default under any of the terms and provisions of the above documents, and no event has occurred which, with the passage of time, would constitute a default thereunder, with the exception of the following: TIE IRVINE Irvine Aparti Vice President, Controller a ^ra rcur aatd p.l Now Ceni(icares hX _i Rece in ' U UnilYrr..oer 7-31 •__ INQ 7VIE C0MPT-ITATIONA11'D CF-RTIY7CATI0N NOTE TO.VARThIENT OWNER is farm is desi ate to asset yInconto Milt the in ca Ruin in the Depulmert of Housing and Urb n Project ("HUD")Rgguletona(14 CFR 1'ou should male: certain that this forthis enlitimesort to date with the HUD pxgulations. At eapimiizcd terms uaequman shah have gig). hth 1 meanin35erhnnh in tthe Re u�iatlen n^recnthod set forth CDA (Pool) - Newport North VWe the undersigned state that ]Ss a haveread and ansybered fully, frankly and personally each of the following questions for all Persons who are to occupy the uni being applied for int he above apartment project. Listec below arc the names of all persons who intend to reside in the unit. i NameofMembersorthe Relalio2uhili Household to Head o" Social securiy Place of Household• Age Number Employment K(J?jpy-_1iEe�1_07=474k imp UtoiS�L.t�1 _ 26 2Ro.ft4-40�3 UCnvris Wa (o fFsa7c. Vn I Inc me Computation G. The total anticipated inn a, calculated in ace rdancc with tills paragraph 6, of all persons (except children under 15 Yeats) fisted above for the 3month period be inning [hc earlier of the date that 1;we plan to muse into o unit or sign no lease for a unit Is S f� O Included m tta total antici ated income Listed a ovc are: (a) all wages and sal ties, overtime pay, ontmissions, fees, tips and bonuses and other compensation for personal scn•ica Ibefore payroll ded coons; (b) the not income fr •m the ooemtion of business or profession or from the rental of rent or personal property (whim C doducti expenditures for b niness expansion or amonicodnn of caprsl indebtedness or any allowances for do reciarion ofeapital assets); (c) interest and divid nds (including laC.p a from assets included below and other net income from Teal or Personal property ; (d) the full amount o periodic payments II ccivcd from social security, annuities, insurancepolicies, retlremem funds, pensions, isability or death beheFits and other similar types of periodic receipts, including anylamp sum payment for hedelayedstarrof a periodic payment, (e) pa. lent$ in lieu feamings, such n; nemploymeat and disability compensation, ioorkers' compensation and severance pay; (� tilt mavmum am unr ofpublic assis ce available t he above per other Char. tilt amount of any assistance speel fi Ily designated for s c17knit utilities: (g) periodic and dete Linable allowances, tth as alimony and child support payment. and regular conatbutians and gifts received ore persons not res ding in the dwellings; (h) all regular pay, sp cial pay and al lowat ces of a member of the Armed 1`01ces(whether or not living in file dwelling) who is t c head of the house old or spouse; and (i) any earned incom lax credit to the ext at that it exceeds Income tax liability. E%cludcd from such anticpaled intone rite: I (a) easual,sporadie erlireegular gins; I (b) amounts which arclspeeiftnlly for or fq reimbursement of medical expenses: (c) lump sum adrtuionls to family assets. Sip as inhcdmaces, insurance payments (including payments under health and accidend insurance end workers' compensation), capital gains and settlement for personal or property losses; ; (d) amounts of educational scholarships paid directly to Ihesmdent or the educational institution, and amounts paid by the government to a veteran forpsc in meeting the costs of coition, fees, books and equipment. Any amounts of such scholarships or paymr'ts In veterans non used for the ?Cove Purposes are to be included in income; p.3 FOR COW17ON B A-P o ONL 1. Caktdado of c4iblo i come: a. PfIJ= ampunt en fox entire household is 6 shave: b, (1) time ammal toured in 7(c)at we is r the total ed is 7( d mad amount (2), subtract fivr- -.V &gore amoaoten dm. hex theteon�riot •e g (2) dre flags rate yt tn. W e u pcm to dereolPaa54cok m what 60 p book sav' total • L('�(1) would be if iavmt d to amnia ca ---^ -- )• subtract from that Bgnre n 7(a)(3) and eater the xemam°;B baianec (S (3) 0 ter at dght or (2) abo a gxcatez of tare amount as minder ; o. TOT M.IGM INCO!4f); (13ae l.a plus line I. b() 3 : 2. 'Abe amomi, 4�uered is — —/--_ es dtn applicant(s) as a I Aoderatnbconie Tena ur s), Chtal the applicam(s) a: a Lowerdncame Tcaaut(S). the applicant(s) as a YerY•Law 7acome lenaal(s). 3, Number of ap umieat unit 4. Thts aprtmMnt milt 299mgate antic paced VaUed them as a L S. M a,cd used to verify. — —x Bm ---- — Y Omer aAW-Q* w . $ 4 7 �4 . c,__�_I___— S N /A s q7 3gG.a( �lgxd: 2T .&dmom si+e:z i Rear:wt) rae jast ooeapied fur a Period of 31 or mocc 00n=11tive days by pc vat, fiq , dome Te �etf t1Je above raanaar upon their 63kW occopaecy of the apartment unit ;s) income: ome vaZiamdon,fr ram=. Date ZL G ? Date •ter.-J{JJU P.2L 1 (Fax to Bond Administrator with 0 Very Low Property Name: Newport North Leasing Consultant: Marcus Ipcizade Number of Residents:3 TTON SHEET talifying documentation for approval) Eloderate Applicant Name(s): Stephanie Rubio, Christian Walsh, Unborn Child Maximum Income Limit:$50.850.00 Apartment Number: 231 Marsala (Proposed) Move -In Date:7/5/2003 Date: 7/3/2003 Total # Pages:26 To Be filled out by Bond Administrator: Date Received: Appiroved � ❑Denied Comments: y INCOME ( iSSFT rnt r.I u A rinnt tnrnG ' �Ia r' ` irs` K ' Wat Nam a First Nnll_ Rolatlonehip Sez Onto of Olrth Ago soeiaisocurity6 Frr Student S I HOH 2 7-0 4 4€ Yfu or NO 2 i 1517? 26 80- 9 4-4079 No 3 n Q0 A 5 6 7 0 I i IIVI:UMt EMPLOYMENT Family Memb• 1A Source ' Base Rate $ Average Hours Average Annual 52 2e 26 12 1 '— Total WK sEMI-MO e1-YM MO Ylt 14m$ _$ 0 $ $ _� _ =$ 27 cm.cro _$ Total Box A: $ Family Memb. 1A Source - Base Rate $ Average Hours Average Annual 62 24 26 12 1 Total WK SEMI•MB ei•YM MO Y11 i Total Box lL; $ ^ Family Memb. it • Source Base Rate $ Average Hours Average Annual 52 24 26 12 1 Total wx SEMI NCO or "IrT Mo v1i ' Total Box C: $ inrla:aletnnrd�i Family Memb. AA Source Base Rate $ Average Hours Average Annual 52 24 26 12 1 Total Wx SEMI -MO el•YM I IAO Ylt $ _$ $ _$ $ $ Total Dox D• $ TOTAL ANNUAL GROSS I qCOME A through D DADADADDAYYD �, L17. ZR9T72 ASSETS Asset Descnph n IinpuletllFOross/rair cost to NE r Actual Aulual Annual Member (savings, checking, stock , bonds, Currant 1 or C Gel Cash ramifyAss lls Valuo Interest Rate Income Iromale Assets t = (%°.0.45 /e �OP ( T I TnIaI6 IBox E: Box F- IMPUTED INCOME FROM ASSET Box E oxcoeds $5,000- mu111P1y E by life current passbook Interest It Box C does not exceed $5,000 enter •0• In box G: Enter the greater of Box F or Box 4 in: m' X BOX G: S 0. qq INPUTED INCOME r-ROMASSETS S 0.2q BOX H: Fwnlly NW1110 Fier ftcL ••�.•,•_ Effective Dato To LY 2003 Typo or Program%- �oW UnItNo. UnitSizo 2-12 No. of Persons htll: '� Max. Income Lim1l $—.2c,R5n o r, AR; 1A0%Limit $ ,•7e P. TOTAI_ASSETS$ A. Pei =S 47. Zaa 01 Name S4 , Employer I Most Recent Ending Flay 5/25 /o l3 i i YTD In pn 3b'GFs.lk divided by Start at job d Date Hire Date 312L]1�3 hire date if less than a year Gross per Pay Period I TO.06 N 7s9'.44 (+) (_) 9156g. 4 4 divided by (_) 79-q.22 II'I ' (how dtten paid) (how often paid) (x) 6 2 6 (x) Calculated Annl! al Income (=) Calculated Annual Income 201 ?N •72 A]P4arurealq'/�I; �,b:MOli3 Y`aaa 'I@6:CAi1�fl�2aN 'i�; t, - 5�"a�4'T•�'•- ' VI F'P§E P,QSIT.�;;MQ i- r g.. r t a•'v a�.-a•:: MY•Y': •.• as2'nc._,r,-: :, xrF: E 9 F,.. f a • : ,. _ : ; r " ; "4 :nc �3:49: . !A84 - '�:. Hba 0100')Q.-M,' i;, •' �'� £287A•L?I9Bl.• ; - - ;;, r.� -. +1, •" c 57EPI A46dv i`0 ;j ;, (.>. 24661 LA"CRE51'A I B DANA•P,OfNT, C4.92629' NOrS' i� .�_.�...�..-----•--'�'..=.�y_u-�'s=:.�f••>- - _�i<:=.,.-.�.���-ram-_..rL_.-�.�,.�:r_,•_�`,.e=.= _ 4 j R MOVE D06UMENT ALONG THIS PERFORATION 4 Bm o , .Ifl.•,.i-+'5ocle15i uri .'.steals ,,.- ke i Hb Allowanc .. Ntuolukr- . 4Pa _�3�,3�..`•,YI7.r47f�>i7�a.�i�leRie3lt"t":a:r�'UxS+sY.11F"4Aq!1"LOart.�,.j,y:�;.,'�Nf�u4 Cock _.,. n Divuti�'ir.'•:-._. tuf .`::f11reDaTea`.^Feriod;8tert_,: PenodBed,.. :.._PaDate •"r� �;',:::.:Sc:(¢.<,r j:cr-?•�. O1D0''� " :.iQO. ti a:U3/24/b3:r �;i ti's04i2 70$'%".•'r.'.'••:OS/tG'I`(.OS'y.t i:05)316'/03r 1}oltioce . !� :a=•'°': •� •' .�:3�SDU" •': �.r 84i0U:�"•'�FL8Oi_Q �>,r2,6��.9, 5j13��kftlhli�"fiPbi`'�.�•' .:�•?,.:�il:rr, ..: r:; s•✓� �'!s��`'�D�`�TT- - �ft4ci'Plkt[�: •Ay:(yy,';`�5;.;,�.: "o`�t,�k^?J(0_�. �''i1+H �.�;:� ,b ;'a��:hP.-,7�!�,�-`1F 7, �✓,�, �4.Fi�IMRl��.��ti�,..'.,q � •SS ��' r�4�'4'x �i�-:.?•K"'�7xg �.•t"o,:C:'c'r... id• ;+`s. 'f.�.�wt���y v.r,8p•:OX . - -�. Lt;,C•*- "?-cA-AY..w• :z.^.-:;zx ��`. rS DI]tefDetwsttAimunis. .Amount 756.44, .. 2698.U4 1tl1�ecWtlo4t'�i9}1271320 v7. r:... 77:5 7 t!-,T%.Sb73:i49i. `'htrinb'HaCieB'. t •1Y g ( `r,':?' r tn" t�'1'•:n���.a '' , '. . Cunebt ..: YC9i'.To Data i':aJ^ };s��C�'1'4:' '$A :a�y�p `;Ai'. dB .b�a8' 11SP. FlptireiWeY�tu..:::.:.'^.e, z:a JcY�:•:� . 6;60�.: a N� a'Ft51ya'i;rr'3#97f,.�d'•. a,, 45. • is-fbr'. 1,' win p.uk'i>:,'^�Ss': k�.:'T i7 . .(.Event.' .'YeaeTo liaoe.' Total .' T-...98:95 , M9486 'Y�Ts•Oroa3FW - :i•.:,�,.?i.�•'+>• '•+�'--;i592n' >;S''"2512.;td- .... ,1'S. t>reTazlkda'ctliins - tl' k :"Savid .r " 'UninOpY,'.;';,�y26:` - - - j4 36_00 .126.00 I Irvine Apmbnent Manage tent Comp '- 43 Discovery, Suite 150 Irvine, CA 92618-3118 Name . Account Type Asset Calculation Worksheet I►;8q5. Z5 led by I I I,?3c (average acc 'est rate: me frpm asset: Asset Calculation Worksheet Name . Account Type ( + ) II P 10.22 (=) II 1' (0-V- by LEI (average account balance) ( x) j Interest rate: % f� (_) ! In ;ome from asset: $ �' 0 0 0 0 0 0 05/07 63.56 i VISA -BLOOMS 8 BEARS 949-252-9419 CA 05/07 7.00 i SERVICE CHARGE go 04/21 04/21 04/22 04/22 04/23 04/23 04/23 04/25 04/25 04/28 04/28 04/28 04/28 05/01 Washington IN jai SThr'EMENT OF ACCOUNT THE FEE FOR EACH OVERDRAWN TO REACH CUSTOMER SERVICE, PLEASE CALL WHETHER PAID OR RETURNED, I [ANSACTION, $22.00. TELEPHONE BANKING AT 1-800-788-7000. 129700000020479 37,772 04-E-84 STEPHANIE RU.IO PO BOX 308 LAGUNA HIL S C 92654-3082 STATEMENT PERIOD: FROM 04-08-03 THRU 05-07-03 BE A CELEB ITY> EVERY DAY! SIGN UP FOR GOLD CHECKING AND GET OUR VISA(R) GOLD CHECK CARD. GET FREE C OL P RSONAL CHECKS AND FEE -FREE TRAVELER'S CHECKS, ALL FOR A LOW MONTHLY FEE. SAVE UP TO 507 N HOTELS, MOVIE TICKETS AND MORE. ASK US FOR DETAILS. FOIC:TNSURED. GOLD CHECKING WASHINGTON MUTUAL BANK, FA FDIC INSURED STEPHANIE D RUBII ACCOUNT NUMBER: '194-127620-5 YOUR OVERDRAFT LIMIT, AS OF THE STATEMENT END, -DATE, ' WAS S 1,000.00. THIS MAY BE,,LHANGED' Av NNY: TIME WITHOUT NOTICE. OVERDRAFTS ARE SUBJlE= T(r:A(PER TRANSACTION CHARGE. ' BEGINNING BALANCE TOTAL WITHDRAWALS TOTAL DEPOSITS `ENDSNG BALANCE 699.89 1,252.41 2,247.77 1,695.25 YTD INTEREST PAID 7C YTD INTEREST WITHHELD: .0 DATE WITHDRAWALS i D POSITS TRANSACTION DESCRIPTION )4/14 21.54 VISA-MARSHALLS 658 ALTON CA )4/14 53.83 VISA -MOTHERHOOD 94018 LAGUNA HILLS CA )4/14 17.94 VISA-IHOP IRVINE CA )4/14 6.89 i r VISA -LA SALSA 06 NEWPORT BEACHCA )4/15 43. 99 I VISA -TARGET OOOOIRVINE CA )4/18 903.83 ATM-NCHG S1C08814 551 NEWPORT BEACH NEWPORT BEACH 77 0418 )4/18 81.74 POS SOU MICHAELS 1212 IRVINE BLVD TUSTIN 58 0418 53.34 VISA -EXPRESS # 0543 NEWPORT BEACHCA 10.86 VISA-RALPHS #0744 NEWPORT BEACHCA 3.53 VISA-BRUEGGER'S 004000RONA DELMARCA ID2.00 MERCURY CASUALTY PAYMENT 021AP2725783902 157.32 I VISA-ROBINSONMAY FASHIONEWPORT BCH CA 38.79 VISA-VICTORIA'S SECRET NEWPORT BEACHCA 139.32 VISA-ROSAS SHOP CULVER CITY CA 669.00 US TREASURY 220 TAX REFUND XXXXX4748 25.86 I VISA-DAVID'S BRIDAL #1000STA MESA CA 20.46 VISA-MERVYNS OOOOIRVINE CA 64.00 VISA -HAPPY NAILS /BARRAIRVINE CA 31.00 VISA -TARGET OOOOIRVINE CA 17.95 VISA -CORNER BAKERY OOOOCOSTAMESA CA 49.62 VISA-SPRINTPCS-SPEEDPAY888-211-4727 KS 5/01 21.65 VISA-SAN FRANCISCO USA SAN FRANCISCOCA 5/02 i 674.94 IRVINE APARTMENT REG.SALARY IAMC100538 5/05 40.00 ATM-NCHG SIA07607 4543 CAMPUS DR. IRVINE 62 0505 5/05 7.80 VISA-DIEDRICH COFFEE #ONEWPORT BEACHCA 5/06 14.63 VISA-FATBURGER RESTAURAIRVINE CA 5/07 66.79 I VISA -BLOOMS 8 BEARS 949-252-9419 CA PAGE 01 (CONTINUED ON NEXT PAGE) w wasmngto F wilrojai S7.4(EMENT OF ACCOUNT 1 I 129700000020479 i i 17,773 04-E-84 STEPHANIE R BIO PO BOX 308 LAGUNA HIL S (A 92654-3082 STATEMENT PERIOD: FROM 04-08-03 THRU 05-07-03 I GOLD CHECKING i I (CONTINUED FROM PREVIOUS PAGE) ACCOUNT.'NUMBER: 194-127620-5 DETAIL OF CHECKS PA D: CHECK DATE CHECK DATE 'CHECK DATE NUMBER PAID A AUNT NUMBER PAID AMOUNT NUMBER PAID AMQUI 2088 04/09 I 1.00 STATEMENT SAVINGS WASHINGTON MUTUAL BANK, FA FDIC INSURED STEPHANIE D RUBII ACCOUNT NUMBER: 485-603456-0 BEGINNING BALANCEI TOTAL WITHDRAWALS TOTAL DEPOSITS ENDING BALANCE 16.2j 3.00. .01 13.22 INTEREST EARNED: 1.01 ANNUAL PERCENTAGE YIELD EARNED .75 % YTD INTEREST PAID .L I YTD INTEREST WITHHELD: .0 DATE WITHDRAWALS D POSITS TRANSACTION DESCRIPTION IETAIL OF CHECKS PAID: IETAIL OF CHECKS PAID: (CONTINUED) " )ATE WITHDRAWALS DIPOSITS TRANSACTION DESCRIPTION 15/07 I I .01 INTEREST PAYMENT 15/07 3.00 I SERVICE CHARGE 0 Washington M6 I STAI-IZMENT OF ACCOUNT THE FEE FOR EACH OVERDRAIN T I �NSACTION, TO REACH CUSTOMER SERVICE, PLEASE CALL WHETHER PAID OR RETURNED IS 1.00. TELEPHONE BANKING AT 1-800-788-7000. 129700000020479' i 17,630 I 'd I 04-E-84 STEPHANIE D RU 1 0 2222 COLONY PL NEWPORT BEACH 92660-6354 STATEMENT PERIOD: FROM 05-OB-03 THRU 06-06-03 BE A CELEBR�0;' TY, tVERY DAY! SIGN UP FOR GOLD CHECKING AND GET OUR VISA(R) GOLD CHECK -CARD. GET FREE COL PE SONAL CHECKS AND FEE -FREE TRAVELER'S CHECKS, ALL FOR A LOW MONTHLY FEE. SAVE UP 70 O HOTELS, MOVIE TICKETS AND MORE. ASK US FOR DETAILS. FDIC •'lIt=REED. GOLD CHECKING ! WASHINGTON MUTUAL BANK, FA '.F.DIC INSURED I STEPHANIE D RUBIO ACCOUNT NUMBER '+.]i94r22,7620-5 YOUR OVERDRAFT LIMIT, AS OF THE STATEMENT,+END ,VATB, i WAS $ 1,000.00. THIS MAY IB,E'.GHANGED JATIBINY 7MME WITHOUT NOTICE. OVERDRAFTS ARE SWB.7ECT.:TO.•10. PER TRANSACTION CHARGE. " BEGINNING BALANCE TOTAL WITHDRAWALS TOTAL DEPOSITS �ENDII'NT'ZA'LANCE 1,695.25 II 1,289.40 1,359.85 I,765.70 I - YTD INTEREST PAID .00 YTO INTEREST WITHHELD: .00 I DATE WITHDRAWALS DEPOSITS TRANSACTION DESCRIPTION 05/12 17.34 POS NCC PETROLEU MCC PETROLE1550 JAMSORNEWPORT BEACH 89 0512 05/12 26.72 VISA-CALIFORNIA PIZZA OIRVINE CA 05/12 9.24 I VISA -BLOCKBUSTER VIDEO NEWPORT BEACHCA 05/16 r 1623.49 IRVINE APARTMENT REG.SALARY IAMC100538 05/16 186.00 FRANCHISE TAX BD TAX -REFUND XXXXX6554 05/19 3399 VISA-BASKIN ROBBINS NEWPORT BEACHCA 05/19 18:73 VISA-RALPHS 410744 NEWPORT BEACHCA 05/19 8.98 I VISA -CARD AHERICA LAGUNA HILLS CA 05/20 102.00 MERCURY CASUALTY PAYMENT 021AP2725783902 05/27 5.66 POS CARL'S JR #0 18032 CULVER DR IRVINE 47 0527 05/28 75.00 DISCOVER SMART CHK 601100071022589 05/29 63.90 ' VISA-SPRINTPCS-SPEEDPAY888-211-4727 KS 05/29 15.01 VISA -CHEVRON #00096698 IRVINE CA OS/30 1650.36 ATM-NCHG SIC08814 551 NEMPORT BEACH NEWPORT BEACH 03 0530 06/02 8.98 VISA-EINSTEIN NOAH BGL IRVINE CA 06/02 6.40 i VISA-STARBUCKS 0005NEWPORT BEACHCA 06/02 55.00 I VISA -HAPPY NAILS/NEWPORNEPIPORT BEACHCA 06/05 11.98 VISA -CHAMPAGNES MARKET NEWPORT BEACHCA 06/06 150.00 VISA -GARDEN GROVE HOSPIGAROEN GROVE CA 06/06 13.47 VISA -CHEESECAKE IRVINE IRVINE CA 06/06 7.00 i SERVICE CHARGE DETAIL OF CHECKS PAID: CHECK DATE CHECK DATE CHECK DATE NUMBER PAID AMOONT NUMBER PAID AMOUNT NUMBER PAID AMOUNI 2090 06/02 254.00 2091 06/03 350.00 2092 06/02 60.0• I w wasimington lUltiadl STAlrMENT OF ACCOUNT 71 129700000020479 STEPHANIE D 2222 COLONY NENPORT BEA 91 04-E-86 92660-6354 27,631 STATEMENT PERIOD: FROM 05-08-03 THRU 06-06-03 BE A CELEBRITY, EVERY DAY! SIGN UP FOR GOLD CHECKING AND GET OUR VISA(R) GOLD CHECK CARD. GET FREE COO PE ONAL CHECKS AND FEE -FREE TRAVELER'S CHECKS, ALL FOR A LOW 110UTHLY .FEE. 5 SAVE UP TO % O!gHOTELS, 14OVIE TICKETS AND MORE. ASK US FOR DETAILS. FDIC INSURED. STATEMENT SAVINGS STEPHANIE D RUBIO WASHINGTON MUTUAL BANK, FA 'FDIC INSURED ACCOUNT NUMBER: :485r603436-0 k� BEGINNING BALANCE TOTAL WITHDRAWALS TOTAL DEPOSITS XNDIMG XALANCE 13.22 3.00 .00 10.22 INTEREST EARNED: 0 II ANNUAL PERCENTAGE YIELD EARNED .00/. YTD INTEREST PAID .04 .� YTD INTEREST WITHHELD: .00 I DATE WITHDRAWALS DE OSITS TRANSACTION DESCRIPTION 06/06 3.00 SERVICE CHARGE PAGE 02 OF 02 Name . Account Type 0 (X) I Asset Calculation Worksheet 2 99 . 3T% 2" . 3S ed by (average account balance) ;t rate: % 0.1 (_) In ome from asset: $ G . 29 i i I 1 I 1 THE IRVINE COMP, The Irvine Company STEPHANIE RUBIO 24661 LA CRESTA 128 DANA POINT, CA 92629- Unified Savings Plan Statement IR CuslomerService: (800) 835.5098 6'Xfd'd6lii JrnMUWi1Af0`shlatcdelSeXGIc'es<ibi F 82 Devonshire Street Boston, MA 02109 Your Account Summtry I I I' Statement Period: 04/01/2003 to 06/30/2003 Beginning Balance $0.00 Your Contributions $220,50 Employer Contributions I, 468.60 Change In Market Value $0.28 Ending Balance $289.38 Additional Information - Dividend B Interest $0.28 Your Personal Rate of R turn This Period 0.1% Your Personal Rate of Retu Is ca tulated with a time -weighted formula, widely used by financial analysts to calculate Investment earnings. It rell cts th results of your Investment selections as well as any activity in the plan account(s) shown. There are other Pe onal I ate of Return formulas used that may yield different results. Remember that past performance Is no guarante of fu ure results. li Your Asset Statement Period: 04/01/2003 to 06/30/2003 e-Learning: What is asset allocation? Short Term)nvestments ($289.38),100.00% .fidelity.com/netbenefits/savings/sod/soddetail?sodPreview=N... 19W 'krQ GARDEN (TR V4'1-I0SPYTAI-., DIAGNOSTICIM GIVG 1?r,61 Garden Gmve Hlvd I J Garden Gmvt, G0.'3]843 1 Phunt (714) 741•2776 A4T( NTDEA106 t 'PII CSr PATIENT MAI 0 p ! IBIRTIMVIEa AGF@EXA I ,X RACE 9117i 79 F white ORDERS ORDERDA l E IACCOL:NT: 12,r,78 61/03 1 572161S PHPSICL4IVS DATA ADM111ING PRYSICIAN : TORDAY, STEPHEN I A'17ENDINGPH1;51L•L-No Tt'RDAY. STEPHEN I EXAM P.aTIE-NTTSTE -NIED RF,C k OuTadmt 0001819•D Svc LOCATION IVIG RSA ADMISSION DATE 614103 10:55 tVNI RESULT ID !All➢Eoum 113186 / 0 ' i"• - u�M1Y L41�2',J VI"lLili`ri •. H - F'iSTCriY: S& versus dates.V FR<iCED=.: Multiple static images of an in raiaertre cregnanc, +e obtained in multiple planes. ;i.'b 3at i r'er ;iRSr$1•G�. _ b - -- PIOMETRI V�LJES DEMONSTRATES: BV,' : 47 I mm I'= 20 weeks 1 stays HC: 181 mr, i'= 20 weeks 4 days AC: .1::7 mm [= 20 weeks 6 clays FL: yur 21 Weeks 0 clays ADD r.Trc'I•:, I � ac�1.�:�N•rs: ialt'mictic i1 lici index _s within ncrlual li-riit:;. _st , ated metal vie ghU is 407 ti— 53 i IrKPRE,`ISC I N: IRIGLE 1, I VINU INTRAi]TERTNn FETUS _IN VIER':'E:: rk 3E;Ld`1'A_'PiCt1. CC?raP S'I4'_ iTim_-".TED GESTATIOIJAL AG.' Is 2`: 42SKS S DAY::,. ES:'7?ATE, llUTE CIF DEL=VERY BASED ON TO2, RY'S STUDY IS 1 ti! ' Applicant/Res Initial ❑ Re Clarification Record I i deft Name:t5A Ic✓1 Wa 156 Date: i l3163 I pCertification Date of Expected Move -In: 7/5/03 I: I: certification Effective date: -TUjH 200S Means Date of Clari Contact Name r i f Cllarification: j; 6 4 u catiPn: •7 U to 3 ❑ Phone Conversation Person -to -Person Conversation ❑ Other: I C bCL-L 'icn Wn►cif I Company/Or naation: Summary of Clarification: C s i5 r t r 7 i! Explanation o Given: i; Clarification i AAWyncm T� ' I i I Employee Nar Employee Sig i e: ' M6'cus IV2d2 atu�e: 19 Title: 14rs;s�.rr1-1 Date: 713/6-9 . " V r�\ � V 7WHO 2222 Colony Plaza, Newport Beach, CA 92660 9 800.423.1122 • walshdt@aol.com v Date: June 5� 2003 Attn: Christian Walsh Dear This agreeme t is to serve as confirmation for your employment in the capacity of Project Manager/Edit r to oversee the development of our new subscription' based quarterly newsletter dir cted to real estate professionals. It is agreed th4t your employment in this capacity will begin June 20, 2003 with;the following pro uction schedule: :• The first newsletter mock-up is due on or before July 15 for preliminary,desigu and layout review. 3 The first draft, including editorial content for the first issue is due onvr'bc-kre Augusi I for editorial review. Revise I drafts must be completed and accepted by August 15 for publication of the first newsletter by September 1, 2003. A production schedule for subsequent newsletter drafts will be set after comph tion of the first newsletter. Additional responsibilities include the development and update of an active email contact list and coordination of a companion marketing campaign to drive newsle er subscription growth. As agreed, coi weekly on the We agrde to Christian Caine pion for your work in this capacity will be $2250 per month, paid bi- H Name Asset Calculation Worksheet Account Type (x) '4 baII n vY riA 0213 EO-3 CHRISTIAN WALSH TERESA WA SH 2222 COL O Y PLZ NEWPORT B Op CA 92660-6354 Our free Online Banking iservice allows you to check account balances, transfer funds, pay bills Ond more. Enroll at www.bankofamerica.com. ❑ Summary of Your I Beginning Balance on Total Deposits Total Checks, Withdraw Transfers, Account Fee Service Charge Ending Balance ❑ Important Informati MyAccess checking cust monthl To find out more, center. For Social Securi toll -free at 1-800-772-121 Remember MyAccess pl charge, simply set up a to your account. Learn t by any Bank of America Need cash? As a valued free access to America': 13,00o ATMs across the kccess checking Account ?9/03 $1,249.69 + 3,732.50 - 4,751.21 - 5.95 $225.01 About Your Account 'Your Bank of America MyAccess checking Statement Statement Period: o May 29 through June 26, 2003 Account Number: 02134.07165 At Your Service Call: 310.247.2080 Online: www.bankofamerica.com Written Inquiries Bank of America Beverly -Wilshire Branch PO Box 37176 San Francisco, CA 94137-OQ01 Customer since 1998 Bank of America appreciates your business and we enjoy servingyou. Number of ATM withdrawalsand:transfers 2; Number of purchase transactions 4/ Number of 24 Hour Customer Service Calls Self -Service iJ- Assisted 0 ' mers who take advantage of Direct Deposit can reduce fees every contact your employer or visit your local Bank of America banking y or SSI direct deposit, call the Social Security Administration is free with direct deposit. To avoid the monthly service e direct deposit, such as a payroll or social security check, out direct deposit by calling us at 1.800.900.9000 or stopping 1 center. of America customer, it is easy'to get to your money with st bank -owned ATM network. Bank of America has nearly y. Visit www.bankofamerica.com to locate an ATM near you. i CHRISTIAN WALSH TERESA WALSH Statement Period: May 29 through June 26, 2003 Account Number: 02134-07165 ❑ Bank of America News Track transactions as t iey occur - Online. With Online Banking you can view your account activity throughout the day - no waiting on your monthly statement. See your ATM deposits v and withdrawals or Check Card purchases from stores and restaurants within minutes of making them. Access C nline Banking at www.bankofamerica.com. Because the security o your Bank of America Check Card(R) is a top priority for us, it is now equipped with Ver, reed by Visa. This integrated part of Bank of America's Total Security Protection(TM) packagc is a free service that gives you password protection when you shop online. Shop at a participating merchant listed at www.visa.com/verified to activate. ❑ Branch/ATM Deposits er Date Posted Amount Number Date Posted Amount Num 06/04 $ 2,145.00 Total of 2 deposits - ' ' $3,732.50, 06119 1,587.50 ❑ Checks Paid " Gap in check sequence Date Paid Number Amount Data Paid Number Amount 06/06 608 $ 200.00 06/17 ":663 t 4200•. 06/11 609 35.00 Total of 3 Checks Paid S277.0 ❑ Account Activity Date Posted Description Reference Number Amount Withdrawals, Transfers and Account Fees 08/04 Cash withdrawal on 06/03, 007711 $20.00 Bank c f America ATM #102001 (Card #258152321) 06/06 Amer Exp 3 1 Bill Payment 350.00 06/06 American x ress BIII Payment 1,700.00 06/16 Check Card urchase on 06/14 (Card #258152321), 114.10 Fry's lectronics #7 Fountain lly CA 06/17 Ref#2 Purchase on 492153168769010059287 6/17 (Card #258152321), 018379 21.59 Trader Joe's #125 Newport Beach CA 06/19 Cash withdra al on 06/18, 000327 100.00 Bank af America ATM #102001 (Card #258152321) 06/20 Great Lake, H Ed Bill Payment 75.00 06/23 Purchase on 6/22 (Card #258152321), 664356 64.61 Trader Joe's # 11 Irvine CA 06/23 Wells Fargo got ine Of Credit Bill Payment 200.00 08/23 06/23 General Amer Exp #3 rs Acceptance Corp BIII Payment 1 Bill Payment 386.67 431.52 06/23 Chase Platin m MasterCard Bill Payment 1,000.00 06/24 Check Card Purchase on 06/22 (Card #258152321), 10.72 Wahoo s Fish Taco Irvin Irvine CA Ref #2 403693174900317400121 , Total Wilhdra als, Transfers and Account Fees $4,474.21 Service Char e 06/26 Monthly Sery ce Charge $5.95 Continued on next page 0096810.002.T21 California Page 2 of 3 co nxcydm CHRISTIAN WALSH I ERESA WALSH Statement Period: May 29 through June 26, 2003 Account Number: 02134-07165 ❑ Bank of America; I i Balance To assist you 16-reconci ing your account, we have provided the following summary information. - A reconciliation worksh •et is printed on the reverse of this page. ! Your ending balance from this statement.................................................................................................................................$225.03 • Subtract the month) e service charge from your checkbook register......................................................................................... 5.95 ❑ ATM Information This period, you visited the following ATM locations: Bank of America's ATM Network • #102001 Newport Cen er, Newport Beach, CA 0 v 0213 EO-2 CHRISTIAN WAILSH TERESA WALSHII 2222 COLONY PLZ NEWPORT BEACH CA 92660-6354 Our free Online Banking ser Ice allows you to check account balances, transfer funds. pay bills and more Enroll at www.bankofamerica.com. Your Bank of America MyAccess checking Statement Statement Period: April 29 through May 28, 2003 Account Number: 02134-07165 At Your Service Call: 310.247.2080 Online: www.bankofamerica.cam Written Inquiries Bank of America Beverly -Wilshire Branch PO Box37176 San Francisco, CA 94137-0001 Customer since 1998 Bank nY America appreciates your business• and we enjoy serving you. ❑ Summary of Your MyA ccess checking Account Beginning Balance on 04/2 /03 $743.80 Number of ATM withdrawais and transfers 2 Total Deposits + 2,210.00 Number of purphase.transactinns 0 Total Checks, Withdrawals, Number of 24 Hour. CustomerBervfoe•Calls Transfers, Account Fees - 1,704 11 Self -Service 0 Assisted 0 Ending Balance $1,249.69 ❑ Important Information kbout Your Account With Total Security Protectic n, your Bank of America Check Card(R) is a secure and easy way to pay for your winning bids at online auction sites, such as eBay or Yahoo, And since payment is immediate, they 's no delay in shipping. Plus when you use your Bank of America Check Card(R) with online payment services such as PayPai, your transactions are secure. ❑ Bank of America Nevgs Receive and pay your bills 211 in one place with our free Online Banking with Bill Pay service. Instead of visiting multiple biller sites, Online Banking allows you to receive a -bills from more than 200 compan es. To•pay bills, just tell us who, how much and when you want to pay. Sign up today at www.bankofamerica.com. ❑ Branch/ATM Deposits Dale Posted Amount Number Date Posted Amount . Number 05106 $ 100.00 Total of 2 deposits $2,210.00 05/23 2,110.00 Continued on next page 0095576.001.T21 California Page 1 of 2 1 io neryakd Paper rvr ' Og11n V i rtiuc� tlasa� �y- . � . CHRISTIAN WALSH TERESA WALSH Statement Period: April 29 through May 28, 2003 Account Number: 02134-07165 ❑ Checks Paid Number Amount Date Paid 05/22 607 $13.00 ❑ Account Activity Date Posted Description Reference Number Amount Withdrawals, Ticd nsfers and Account Fees 05/06 Cash withdraw on 05/06, 003046 $20.00 Bank ofmerica ATM #102001 (Card #258152321) 05/15 American Exprs Bill Payment 25.00 05/19 Cash withdraw on 05/18, 005075 40.00 Bank ofmerica ATM #408946 (Card #258152321) 05/20 Great Lake HI Bill Payment 75.00 05/20 Chase Platinum MasterCard Bill Payment „ , . 500.00 05/27 General Motor Acceptance Corp Bill Payment A '3b6.617 05/27 Amer Exp #371 Bill Payment •644:44 Total Withdrawi Is, Transfers and Account Fees $f,6S1.71 ❑ ATM Information I This period, you visited th1550, following ATM locations Bank of America's ATM Ntwork • #102001 Newport Cente Newport Beach, CA • #408946 Newport Cente Newport Beach, CA New Certificates/Recertx..etion Unit Number 2S INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designated to assist you in computing Annual Income in accordance with the method set forth in the Department of Housing and Urban Project ("HUD") Regulations (24 CFR 813). You should make certain that this form is at all limes up to dale with the HUD Regulations. All capitalized terms used herein shall have the meaning set forth in the Regulatory Agreement. CSCDA (Pool) - Newport North We the undersigned state that IAve have read and answered fully, frankly and personally each of the following questions for all persons who are to occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit. 1 2. 3. 4. 5 Name of Members Relationship Of the to Head of Social Security Place of Household Household Age Number Employment 1M�A l S N t iG[ td�� �uxd 22- S4(.-`t.i-C6t{I ✓✓�•��Lt a t >�✓�µ�L t �lyv,,,t� �b-��- YLor.+,.+.r•ric 2t Lyt-l-�3G-`�155 f��tasrzc�a.-l�;K..t-����. Income Computation 6. The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children under 18 years) listed above for the 12-month period beginning the earlier of the date that I/we plan to move into a unit or sign a lease for a unit is $ .946412. °S . 3 R Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real or personal property (without deducting expenditures for business expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets); (c) interest and dividends (including income from assets included below and other net income from real or personal property); , (d) the full amount of periodic payments received from social security, annuities, insurance policies, retirement funds, pensions, disability or death benefits and other similar types of periodic receipts, including any lump sum payment for the delayed start of a periodic payment; (e) payments in lieu of earnings, such as unemployment and disability compensation, workers'`ompensation and severance pay; (l) the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter and utilities; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not residing in the dwellings; (h) all regular pay, special pay and allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the household or spouse; and (t) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are (a) casual, sporadic or irregular gills; (b) amounts which are specifically for or in reimbursement of medical expenses; (c) lump sum additions to family assets, such as inheritances, insurance payments (including payments under health and accident insurance and workers' compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational Institution, and amounts paid by the government to a veteran for use in meeting the costs of tuition, fees, books and equipment. Any amounts of such scholarships or payments to veterans not used for the above purposes are to be included in income; 07/12/2003 17:02 9497561238 Jul 11 03 03:26p p' 4PQRT N SANPAULO APTS 9497 1598 PAGE 03 p. 4 (a) hazardous duty MID a household member In Ilia Armed Forces who is away from home and exposed to hostile fire; (t1 relocation payments under Tale 11 of the Uniform Relocation Assistance and Real property Acquisition Policies Act of 1970; (9) fosterchdd care payments, (h) the value Of coupon allannenis under the Food Stamp Actor 1977; (I) payments to volunteers under the Domestic Voluateergervices Act of 1973; 0) payments received under the Alaska Native Claims Settlement Act; M income derived from certain submarginal land of the United States that tribes; is held in trust forcetain Indian 0) payments on nllowanecs made under the Department of Health and Hdmao Services' Low-income }tome Energy Aislstmrce Program; (m) payments received from thelob partnership Tmin)ngAct (n) income derived from die disposition of funds ofthe Grand River Sand of Ouowa Indians; and (o) the first $2000 oPper capita shares received from)udgement funds awarded by the Indian Claims Commission of the Court of Claims or from held in trust for an Indian tribe by the Secretary of Interior. 7. Do the persons whose income or contributions are included in item G above: (a) have savings, stocla, bonds, equity in real property or other form Of capital investment (excluding the values of necessary items (Personal propenysuch as fumtnre and automobiles and interests in Indian trust land) Yes No; or (b) have theydisposed of anyassets (other dean at a foreclosure or bankruptcy sale) during the last two yens at less than fair market ralue? Yes X No ( c) If the answer to (a) or (b) aboveis Yes, does the combined total value of oil such assets Owned ordisposed of byal) such persons total more Ilion S.5,0000 Yes , No (d) f f the answer to (c) above is Yes,state: (1I the combined total value of all such assets; S -- (2) the amount of Income expected to be derived from such assets in trust 11-month period beginning onthe date of Initial occupancy in the unit that you propose to rent: L — and (3) the amounrof such income, if any, that was included initem 6 above: g , 8. (a) Will all the persons listed in column I above be or have been full-time student during five (5) cafrndarmonths of this calendar year at an educational institution (other than a correspondence school) wit), regular racultyandsmdem s? Yes _ X NO (b) pomnlete nniv if the answer to Question S(a) is "Yes"1 is any such person (Other than nonresident allms) married and eligible to file a joint federal income tax Iuums? Yes _fit No 9 This certificate is made will) (he knowicdge that it will be relied upon by the Ovvmer to determine maximum income for eligibility to occupy the unit; and Vwe decline that all information set forth Imercm is trite, correct and complete and based upon information 1/we deem reliable and that the statement of total anticipated income combined in pmagmph G is reasonable and based upon such investigation as the undersigned deemed necessary. to. h9Ve will assist the Owner in obtaining any information or documents required to verify the statements made herein, including either an income verification from my/our present employcr(s) or copies offederal tax returns tot the immcd iorcly preceding calendar year. IL IAVe acknowledge that all orthe foregoing information is relevant to the stntbs under federal income taw law of the interest an bonds suit to finance the 9 5i of Ilia apartment building far which application is being made. 1Ve consent to die disclosure ofsuch information to the issuer of such bonds, the holders of such bonds, any It Mice acting on their bchalfund any authorized agent of the Troasury Department or In-ernal Revenue Service. IAVC declare under penalty of perjury that the foregoing is Inc and coricci. 20e5 (year) in the City of {!.ft.�ew ll hlifomia' pplicant Applicant (Signature oral] persons (cacept children under tine nse of ill years) listed In number" nhove required) FOR COMI2LMON BY APARTMENT OWNER ONLY.- 1. Calculation of eligible income: a. b. c. Enter amount entered for entire household in 6 above: (1) If the amount entered in 7(c)above is yes, enter the total amount entered in 7(d)(2), subhact f =- figure the amount entered in 7(dx3) and enter the remai rinle ($ ); (2) Multiply the amo , savings rate annual earniq paseboolc savior, " the amount ante, the current passbook 0 to determine what the total /(d)(1) would be if invested In __J, subtract from that figure enter the remaining balance ($ (3) Enter at right the greater of the amount calculated under (1) or (2) above: TOTAL BIYOIBLB iNCOMz; (line La plus line 1.b(3): 2. The amount entered in Le: Qualifies the applicant(s) as a Moderate -Income Tenaat(s). XQualifies the applicants) as a Lower -Income Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenaut(s). � A 1g23,3S $ 36 t_gt 23.3 .Ss 3. Number of apartment unit assigned: 2 ( Bedroom size: I+- ( Rent: $1 2 Iy 4. This apartment unit (w was not) last occupied for a period of 31 or more consecutive days by persons whose aggregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartment unit qualified them as a Lower -Income Temant(s). S. Method used to verify applicant(s) income: Employer income verification. Copies of tax returns. 7/12 /03 Bate a jA1 , • ;�f . •s • ' as •. r ''- • �: 07/12/2003 18:29 9497561238 1 HEET f10 l `°Ip•Ilm wnunl y09eU0uk lnlorosl Amlo, Eft°�Urc Odlu_ '�-•� L' U..F IIoln...... nm135,0411 X R TYPO ofllro,glpy � t:nnf-o-In Los O• IMM0.9 U0il Sizo l+. 80)(0: L•T�� Nn, oflkno ___ a{ PAGE 04 / Income Restricted Certification Questionnaire \nine: �'/C��CLI�f tioit- �J• Initial Cer—drication Re -certification Other Ouestion llonthlv Income \ ! L we receive =a,—rIy Support,. Spousal Support, and or any other .x` cash ccntriburacs of.gifts. including rent or utility paymzrts from 2ersons no, living will: me. 1. we receive 1•eteran's Administration, Pension, Unemployment benefit, Disability benefit, AFDC, Lottery winnings, Inheritance, or Annuitie§. Lwe receive income from Rental Property. I t ...: • __::•: c ".._ c._`t :_on:_ f:.:::t Sc_:,1. Sccur::; to :::cl::c_ SSA, SSI and'or periodic social security payments. t li The household receives unearned income for family members ace 17 or under. - fI 1 I we are Conned to receive child support payments ue am cures y receivia_ child support payments. I we a -'ere ccrrerdy coaling e tors to collect child support i I e:ved to me. I we have other assets (example 4131K. IRA, Revocable Trusts, i Stocks, Bonds, Treasury Bills, Money Market accounts, Certificate of Deposits, Whole Life insurance. Real Estate) I we have cash on hand. i x Student Status: I QAl T bPW, Does the household consist o:`persons who are all full-time sn:den:s (example: College University, trade school, etc.)? ! XIDoes your household anticionte becoming a fill -time student household in the next 12 months? If volt answered ves to either of the previous two questions are you: Married and filing a join[ tax return. Under penalties of perjury. I certify thnt the information presented on this form is true and accurate to the best of my knowledge. The undersigned further understands that providing false representations yereit onstitutes an act of fraud. False. misleadinn or incomplete information «ill result ' the d.n nl ica `on or termination of the income restricted lease agreement. F.o7d-Zut SiSllatlt••e Date Si_nrurcofCh.t:::.z__nt ---- Date Clarification Record Applicant/Resident Name:: IG� V411-o► %y" Date: Orr 1K Initial Certification Date of Expected Move -In: "� • 1 nZ `03 ❑ Re -certification Effective date: Means of Clarification: ❑ Phone Conversation Person -to -Person Conversation Other: ; 7 Date of Clarification: 0-1 • IA • OS Contact Name: .5G6* �oh✓�So�'\. Summary of II a Explanation or Clarification Employee Name: �a� 01 __a4 Title: P�k Employee Signature 1 Date: "d 1. L2 23 5- ELEPHANT' o BAR RESTAU RANT - A Dima Aovir O![ To whom it may concern, 7-5-03 This is to verify that Aaron Michael Moats has been working at Irvine Elephant Bar for the last two years. He will be working full-time this summer(around 35 hrs/week@ approx. $17/hr total earnings)for us. He has always been a very good and reliable server and we are glad to have him back this summer. Sincerely, Victor Bidarian General manager J Account Type Asset Calculation Worksheet o6.LI4 (+) III Vo.IT divided by Z (-) I143.61 (average account balance) ( x ) Interest rate: % (=) Income from asset: $ 9 Account Statement `✓ 1"j May 9 through June 9, 2003 Account Number: 235-2758292 Page 1 of 3 I-1,3 v• MICHAEL AARON MOATS WS 41 S SHANNON RD TUCSON AZ 85745-2547 Thank you for banking with Wells Fargo. For assistance, call: 800-869-3557 (1-800-TO-WELLS), TDD number (for the hearing impaired only) 1-800-877-4833. Or write: WELLS FARGO BANK ARIZONA, N.A., UNIVERSITY MEDICAL OFFICE, P.O. BOX 6995, PORTLAND, OR 97228-6995. You could save up to 70% on term life insurance. Call 1-800-421--VA13 ext. 7011 or visit wellsfargo.com/freequote. Compare rates from highly rated insurance companies. Available in most states through Wells Fargo Insurance, Inc. or licensed affiliates in cooperation with Insurance Central. *Insurance products are not insured by FDIC or any Federal Government Agency* *Insurance products are not a deposit of or guaranteed by any bank* Important Account, Information: If the bank receives an Item (as'defined in the Consumer Account Agreement) against your account and there are insufficient funds to cover the Item, the bank may pay the Item and create an overdraft to your account. You will be charged an Overdraft Paid Item Fee as disclosed in the Consumer Account Fee & Information Schedule. To avoid these fees, we encourage you to discuss Overdraft Protection options with your banker or call us at 1-800-TO-WELLS (1-800-869-3557). ----------------------------------------------------------------- Wells Fargo Free Checking Michael Aaron Moats Account Number: 235-2758292 Activity summary Balance on 05/08 $1,106.44 Deposits 3,555.41Y Withdrawals - 3,119.02 Balance on 06/09 $1,542.83 hone# LSZ)7% 54308.011 Wells Fargo Bank Arizona, N.A. University Medical Office AU# 6361 May 9 through June 9, 2003 Account Number: 235-2758292 Page 2 of 3 Activity detail " Deposits Date Description Amount ................................................................................ OS/19 ATM Deposit - OS/18 Mach 1D 4650A Campbell Plaza Tucson Az 6405 $1,177.00 05/23 ATM Deposit - 05/22 Mach ID 2632X Broadway & Swan Tucson Az 6405 40.00 06/02 ATM Deposit - 06/02 Mach ID 4655W 1370 N.Silverbell Rd S Tucson Az 6405 500.00 06/02 ATM Deposit - 05/30 Mach ID 2632X Broadway & Swan Tucson Az 6405 13.00 06/03 ATM Deposit - 06/03 Mach ID 4655W 1370 N.Silverbell Rd S Tucson Az 6405 1,409.41• 06/09 ATM Deposit - 06/07 Mach ID 4469S University Medical Tucson Az 6405 416.00 ................................................................................. Total deposits $3,555.42 Withdrawals Checks Number Date $ Amount Number Date $ Amount ..................................... 208 OS/],9 83.23 ..........................-.......... 213 06/OS 925.00 209 05/13 20.00 214 06105 113.47 210 05/15 18.00 215 06/04 24.88 211 05/23 1,000.00 216 06/09 100:00 212 06105 406.80 Total checks '$2,691.38 Other withdrawals Date Description $ Amount ................................................................................ O5/09 ATM Withdrawal - OS/OB Mach ID 57390 U Of A Student Union Tucson Az 6405 60.00 05/12 POS Purchase - 05/09 Mach ID.000000 6255 E. Grant Rcostco Whotucson Az 6405 47.64 05/23 ATM Withdrawal - 05/22 Mach ID 2632X Broadway & Swan Tucson Az 6405 40.00 05/27 ATM Withdrawal - 05/26 Mach ID 0643C 5 Corporate Plaza Newport Beach Ca 6405 200.00 05/29 ATM Withdrawal - 05/29 Mach ID 57390 U Of A Student Union Tucson Az 6405 40.00 06/02 ATM Withdrawal - 05/30 Mach ID 2632X Broadway & Swan Tucson Az 6405 40.00 ................................................................................ Total other withdrawals $427.64 ................................................................................ Total withdrawals $3,119.02 Daily balance aummary Date $ Balance 05/08 1,106.44 05/09 1,046.44 05/12 998.80 05/13 978.80 05/15 960.80 05/19 2,054.57 Date $ Balance 05/23 1,054.57 05/27 854.57 05/29 814.57 06/02 1,287.57 06/03 2,696.98 I OC �ho�p,@# `—% 4308-011 ells Faf 4 a k Ari ona, N.A. W .9 I Inivarcifv AAarfiral nffira Aug 6361 f` 1�✓ May 9 through June 9, 2003 Account Number: 235-2758292 Page 3 of 3 Daily balance summary -continued Date $ Balance ..................................... 06/04 2,672.10 06/05 1,226.83 n u Date $ Balance ..................................... 06/09 1,542.83 fw 5 07/07/2003 12:54 FAX ~ µ account Statement through MarAprl 8, 2003 Account Humbert 235-27SS292 Page 1 of 2 US MICHAEL AARON MOATS 41 S SHANNON AD TUCSON AZ 95745-2547 WS Thank you for banking with Wells Fargo. For assistance, call: 000-869-3557 (1-600-TO-WELLS), TOD number (for the hearing impaired only) 1-800-677-4833. Or write: WELLS FARGO BANK ARIZONA, N.A., UNIVERSITY MEDICAL OFFICE, P.O. BOX 6995, PORTLAND, OR 97228-6995. A HOME EQUITY ACCOUNT CAN HELP YOU IMPROVE YOUR HONE, PAY FOR COLLEGE, OR CONSOLIDATE BILLS. APPLY TODAY- CALL 1-866-847-9410 OR APPLY ONLINE AT WELLSFARGOSPECIAL.COM AND ENTER KEYWORD! HE RESOURCES. WELLS FARGO BANKS. EQUAL HOUSING LENDERS. Mello Fargo Free Checking Michael Aaron Moats Account Number: 235-2756292 Activity summary Balance on 03/10 $1,648.49 Deposits 442.00 Withdrawals - 909.60 Balance on 04/08 , $1,180.78 DIRECT DEPOSIT ADVANCE - ADDITIONAL TERMS: IF NO REPAYMENT HAS OCCURRED BY THE 35TH DAY, WELLS FARGO BANK NEVADA, N.A. WILL AUTOMATICALLY DEDUCT THE OUTSTANDING BALANCE AND FINANCE CHARGES FROM YOUR CHECKING ACCOUNT. IF THE AUTOMATIC REPAYMENT OVERDRAWS YOUR ACCOUNT, YOU WILL NOT HAVE ACCESS TO DIRECT DEPOSIT ADVANCE UNTIL THE OVERDRAFT IS PAID IN FULL, INCLUDING ANY OVERDRAFT AND OTHER CHECKING ACCOUNT FEES THAT MAY APPLY. IF THE OVERDRAFT IS NOT PAID WITHIN 8 DAYS, THE SERVICE WILL BE DISCONTINUED. HOWEVER, IF YOUR ACCOUNT IS ALREADY OVERDRAWN AT THE TIME THE AUTOMATIC REPAYMENT TAKES PLACE, THE SERVICE WILL BE DISCONTINUED AFTER THE AUTOMATIC REPAYMENT 8 CONSECUTIVE DAYS (THE 8 D�ACCOUNT AYYSMAYE OCCUR ORBEEN �AFT R THE ERDRAWN OAUTOMAR AT TICTREPAYMENTT). PLEASE NOTE: ALTERNATIVE FORMS OF SHORT-TERM CREDIT EXIST THAT MIGHT BE LESS EXPENSIVE AND MORE SUITABLE AND ADVANTAGEOUS TO YOU AS THE BORROWER. 520.62D-3494 S4391-011 Wells Fargo Bank Arizona N.A. 9pe2dwa" A, �n.,c• n n A0 7944 0001/002 07/07/2003 12:54 FAX March 11 through April B, 2003 Account Number: 235-2738292 - Page 2 of 2 0 002/002 Activity detail Deposits Date Description Amount ,,,,_...r 03/12 .........................................................rrr.........,. ATM Deposit - 03 /12 MaCh ID 57390 II Of A Student Union, Tucson, Az 6405 $150.00 03/21 ATM Deposit - 03/20 Mach ID 0963C 4850 Barranca Pkwy, Irvine, Ca 6405 240.00 03/31 ATM Deposit - 03/30 Mach ID 4469S University Medical, Tucson, Az 6405 52.00 Total deposits $442.00 Nithdrawala' checks Number Date $ Amount. Number Date $ Amount 197 03/21 60.52 199 04/O1 406.80 198 03/17 16.00 200 03/31 200.00 Total checks $683.32 Other withdrawals Date Description $ Amount 03/13. ,................ ...... .A1M Withdrawal. - 03/13... Mach'ID'57390.. V.......... . .. Of A Student Union, Tucson, Az 6405 40.00 03/14 Pos Purchase - 03/13 Mach ID 000000 802 W, Speedwayarco Paypotuceon Az 6405 26.36 03/27 ATM Withdrawal - 03/26 Mach ID 4650A Campbell Plaza, Tucson, Az 6405 40.00 03/28 ATM Withdrawal - 03128 Mach ID $7390 U Of A Student Union, Tucson! Az 6405 40.00 04/02 ATM Withdrawal - 04/02 MaCn ID 57390 U Of A Student Union, Tucson, Az 6405 40.00 04107 ATM withdrawal - 04/07 Mach ID 57390 U Of A Student Union, Tucson, Az 6405 40.00 ................................................................................ Total other withdrawals $226.36 Total . .. . . . . ... ........ withdrawals $909.68 Daily balance summary Date S Balance Date $ Balance . . ....................... 03/10 1,.648.....46.. ..................................... 03/27 1,B55.s0 03/12 1,795.46 03/28 1,815.58 03/13 1,758.46 03/31 1,667.56 03/14 1,732.10 04/01 1,260.70 03/17 1,716.10 04/02 1,220.78 03/21 1,895.58 04/07 1,1B0.78 I I Account Statement April 9 through May �.- 2003 Account Number: 235-2758292 Page 1 of 2 I-1,2,3 MICHAEL AARON MOATS 41 S SHANNON RD TUCSON AZ 85745-2547 u WS Thank you for banking with Wells Fargo. For assistance, call: 800-869-3557 (1-800-TO-WELLS), TDD number (for the hearing impaired only) 1-800-877-4833. Or write: WELLS FARGO BANK ARIZONA, N.A., UNIVERSITY MEDICAL OFFICE, P.O. BOX 6995, PORTLAND, OR 97228-6995. -Make this your last paper statement. Get free online statement delivery and have access to your deposit account statements online anytime, anywhere. It's simple, safe and convenient. Online statements look just like your -paper statements. Simply use your computer to view, print or save your statement anytime. No more searching for misplaced paper statements. Enroll today at wellsfargospecial.com and enter keyword: statement. ------------------------------------------ Wells Fargo Free Checking Michael Aaron Moatd Account Number: 235-2758292 ------------------------------------------------------ Activity summary Balance on 04/08 Deposits C2,305.00 Withdrawals - Balance on 05/08 $1,106.44 --------------- Activity detail Deposits Date Description Amount ....09 04/ AT..........T..M......Deposit...-•.....04/09.....Mach.....ID......4655W..1370............................... N.Silverbell Rd Suit, Tucson, Az 6405 $150.00 04/21 ATM Deposit - 04/19 Mach ID 0692D 4590 McArthur Blvd Newport Beach Ca 6405 900.00 04/23 ATM Deposit - 04/23 Mach ID 57390 U Of A Student Union Tucson Az 6405 300.00 05/05 ATM Deposit - 05/03 Mach ID 4655X 1370 N.Silverbell Rd S Tucson Az 6405 300.00 05/06 ATM Deposit - 05/05 Mach ID 4655W 1370 N.Silverbell Rd S Tucson Az 6405 655.00 ................................................................................ Total deposits $2,305.00 I Phone# 7ci�/��j S4308 011 Wells Fargo Bank Arizona, N.A. University Medical office Au# 6361 I M April 9 through May �-2003 Account Number: 235-2758292 Page 2 of 2 Withdrawals Checks Number Date $ Amount. Number v Date $ Amount 201 04/15 356.00 205 04/29 171.00 202 04/21 164.00 206 04/29 406.80 203 04/24 56.29 207 05/08 925.00 204 04/22 17.00 Total checks $2,096.09 Other withdrawals - Date Description $ Amount 04/09 ATM Withdrawal 04/09 Mach ID 4655W 1370 N.Silverbell Rd Suit, Tucson, Az 6405 40.00 04/09 ATM Purchase - 04/09 Mach ID 4655W 1376 N.Silverbell Rd Suit, Tucson, Az 6405 7.75 04/16 ATM Withdrawal - 04/16 Mach ID 57390 U Of A Student Union Tucson Az 6405 40.00 04/17 ATM Purchase - 04/16 Mach ID 4655W 1370 N.Silverbell Rd S Tucson Az 6405 15.50 04/24 ATM Withdrawal - 04/24 Mach ID 57390 U Of A Student Union Tucson Az 6405 60.00 04/29 ATM Withdrawal - 04/29 Mach ID 57390 U Of A Student Union Tucson Az 6405 40.00 05/05 ATM Withdrawal - 05/03 Mach ID 4655X 1370 N.Silverbell Rd S Tucson Az 6405 40.00 05/06 ATM Withdrawal - 05/05 Mach ID 4655W 1370 N.Silverbell Rd S Tucson Az 6405 40.00 ................................................................................ Total other withdrawals $283.25 Total withdrawals $2,379.34 Daily balance summary Date $ Balance 04/O8 1,180.78 04/09 1,28303 04/15 927..03 04/16 88703 04/17 871..53 04/21 1,607.53 04/22 1,590.53 Date $ Balance 04/23 1,890.53 04/24 1,774.24 04/29 1,156.44 05/05 1,416.44 05106 2,031.44 O5/08 1,106.44 0 r Inctime Restricted Certification Questionnaire ! tiame: a ✓f��h trait_ �S% Initial Certification Re-cerritication Other Yac \n Ouestion lIonthh•Income Y ' ne receive Fam-.il•r Support, Spousal Support, and%or any oche: cash ccntributiors of Gifts. ircludine rent or utility payments IL I from persons not living with me. i 1. we receive Veteran's Administration, Pension, Unemploymec: benefit, Disabiliv; benefit. AFDC, Lottery winnings, Inheritance, or.4ttnuities. I:se receive income from Rental Property. - .•. bcn.: ::.tl.:Lor::_ f'e.: Se-::'. S_cttr« y to :acicd_ SSA, SSI andlor periodic social security payments. XThe household receives unearned Mcome for family members ace 17 or under. I the a.e entitled to receive child suopotT payments. I I w, a-i cu.—army receiving child support payments. i i i I uvz amare cu.,ertly main_ efforts to collect chid suppo—t ov;ed to me. I we have other assets (example: wIK. IRk, Revocable Trusts, Stocks, Bonds, Treasury Bills, Money Market accounts, i Cetditcate of Deposits, Whole Life insurance, Real Estate) XI I w, have cash on hand. I ' Student Status: Does the household consist o.`persots who are all full-time students example: Colleee.Liniversity, trade school, etc.)? I Does }.our household anticipate becoming a full-time student I j household in'the next 12 months? answeredves to either of the previous nvo questions ere 7l1ou :r D4atTted and filing, a joint [1\ return. m Undor penalties o:rperjitrv, J certify that the information presented on this form is true and accurate to the best of my knowledge. The undersi-cried further understands that pro•: idina false % -.m;" nnnni9na: ran rant ni r.'J'A 1J ,— .....1 n.. el:m ..r ...ran mnL t, l..r,,..... , ':— ..:11 W" J Earned Income Calculation Worksheet Name _ �oberk iFtH„� Employer I�leercrcmbie_/Y trAsl . Most Recent Ending Pay Period Date Hire Date 7 61,2 s/63 2/1010 3 YTD Income 233y.5o divided by Start with hire date if at job for less than a year (_) ZIZ.23 (how often paid) M 1 26 _) Calculated Annual Income 5�517.G 8' Gross per Pay Period z9-4 .25- -77 (+) divided by '�71 (how often paid) M 1 2G (_) Calculated Annual Income 5�gS3.38 � • Q • �F u d COMPANY: CAL DEPT: A5L..i8768-018767 LO TION: A523 Abercrombie & Fitch P O Box 182168 Columbus, OH 43218-2168 Taxable Marital Status: S Social Security Number: 604-56-9155 Exemptions/Allowances Federal: o, 0.00 Additional Tax State: 0, 0.00 Additional Tax Local: o, 0.00 Additional Tax Earnings Rate Hours This period Year-to-date Regular 7.000 40.75 285.25 2297.75 Holiday 110 0.00 36.75 Grass..PaY .................... .. 285.25 ..2.334,50 Deductions Statutory Federal Withholding Tax -18.33 -134.72 Social Security Tax -17.69 -144.74 Medicare Tax -4.14 -33.85 SDI Tax -2.57 -21.01 2.42=52 ' Net Pays ....... ..... _........ J Earninc, Statement Page 001 of 001 Period Ending: 06/28/2003 Check Date: 07/03/2003 Check Number: 0000273027 Batch Number: W27150003 Robert E Flynn 1 SUNRIVER IRVINE, CA 92614 Other Benefits and Information This period Total to date Important Notes 1 '�'`!f. Viz.• .��C': ' u COMPANY: CAL 018098-018098 LOCATION: A523 Abercrombie & Fitch P O BOX 18216E Columbus, OH 43218-2168 Taxable Marital Status: S Social Security Number: 604.56-9155 Exemptions/Allowances Federal: 0, 0.00 Additional Tax State: 0, 0.00 Additional Tax Local: o, 0.00 Additional Tax Earnings Rate Hours This period Year-to-date Regular 7.000 19.75 138.25 1848.00 Holiday Wo 10.500 3.50 36.75 36.75 Grc@s, Pal 175,.OD ISE4 7$ Deductions Statutory Federal Withholding Tax -7.31 -110.13 Social Security Tax -10.85 -ii6.85 Medicare Tax -2.54 -27.33 SDI Tax -1.57 -16.96 3�. Earnings Statement Page 001 of 001 Period Ending: 05/31/2003 Check Date: 06/06/2003 Check Number: 0000233864 Batch Number: B11110003 Robert E Flynn 1 SUNRIVER IRVINE, CA 92614 Other Benefits and Information This period Total to date Important Notes 1 L Asset, Calculation Worksheet Name R06err+- FIL Account Type Chgc ,,%,j . ff — 37.9.6- divided by (average account balance) S� 'A' r ,j- � W Account Statement 27876-080-UL03 March 7 through April 4, 2003 Account Number: 241-4161410 Page 1 of 4 I-4 ROBERT E FLYNN 1 SUNRIVER IRVINE CA 92614-5402 Thank you for banking with Wells Fargo. For assistance, call: 800-869-3557 (1-800-TO-WELLS), TDD number (for the hearing impaired only) 1-800-877-4833. Or write: WELLS FARGO BANK, N.A., P.O. BOX 6995, PORTLAND, OR 97228-6995. -------------------------------------------------------------------------------- A HOME EQUITY ACCOUNT CAN HELP YOU IMPROVE YOUR HOME, PAY FOR COLLEGE, OR CONSOLIDATE BILLS. APPLY TODAY. CALL 1-866-847-6410 OR APPLY ONLINE AT WELLSFARGOSPECIAL.COM AND ENTER KEYWORD: HE RESOURCES. WELLS FARGO BANKS. EQUAL HOUSING LENDERS. -------------------------------------------------------------------------------- Student Checking Robert E Flynn Account Number: 241-4161410 ------------------------------------------------------ Activity summary Balance on 03/06 $53.49 Deposits 743.41 Withdrawals - 562.86 ....... o'n........................................... ' Balance on 04/04 $234.04 -------------------------------------------------------------------------------- DIRECT DEPOSIT ADVANCE - ADDITIONAL TERMS: IF NO REPAYMENT HAS OCCURRED BY THE 35TH DAY, WELLS FARGO BANK NEVADA, N.A. WILL AUTOMATICALLY DEDUCT THE OUTSTANDING BALANCE AND FINANCE CHARGES FROM YOUR CHECKING ACCOUNT. IF THE AUTOMATIC REPAYMENT OVERDRAWS YOUR ACCOUNT, YOU WILL NOT HAVE ACCESS TO DIRECT DEPOSIT ADVANCE UNTIL THE OVERDRAFT IS PAID•IN FULL, INCLUDING ANY OVERDRAFT AND OTHER CHECKING ACCOUNT FEES THAT MAY APPLY. IF THE OVERDRAFT IS NOT PAID WITHIN 8 DAYS, THE SERVICE WILL BE DISCONTINUED. HOWEVER, IF YOUR ACCOUNT IS ALREADY OVERDRAWN AT THE TIME THE AUTOMATIC REPAYMENT TAKES PLACE, THE SERVICE WILL BE DISCONTINUED AFTER THE AUTOMATIC REPAYMENT AND THE ACCOUNT HAS BEEN OVERDRAWN FOR AT LEAST 8 CONSECUTIVE 11J 27876-08JUL03 March 7 through April 4, 2003 Account Number: 241-4161410 Page 2 of 4 -------------------------------------------------------------------------------- Activity detail Deposits Date Description Amount ................................................................................ 03/07 ATM Deposit - 03/07 Mach ID 0983F 4850 Barranca Pkwy, Irvine, Ca 4704 $167.89 03/18 ATM Deposit - 03/17 Mach ID 0983E 4850 Barranca Pkwy, Irvine, Ca 4704 191.22 03/27 ATM Deposit - 03/27 Mach ID 0983E 4850 Barranca Pkwy, Irvine, Ca 4704 120.38 04/02 ATM Deposit - 04/02 Mach ID 0983F 4850 Barranca Pkwy, Irvine, Ca 4704 263.92 ................................................................................ Total deposits $743.41 Withdrawals Other withdrawals Date Description $ Amount ................................................................................ 03/10 POS Purchase - 03/09 Mach ID 000000 3765 Alton Pky Mobil Oil Irvine Ca 4704 14.65 03/10 Check Crd Purchase 03/07 Nutri Sport Uc Irvine Irvine Ca 533471XXXXXX4704 2345917233Gggkagm ?MCC=5499 121042882DA 5.98 03/11 Check Crd Purchase 03/08.Abercrombie & Fitch #0 Costa Mesa Ca 533471XXXXXX4704 804440025GMZF3Fld ?MCC=5691 121042882DA 44.88 03/11 Check Crd Purchase 03/09 Webmasters On Line Inc Saint Petersb F1 533471XXXXXX4704 78503632509AOWNR4 ?MCC=5969 121042882DA 12.99 03/13 Check Crd Purchase 03/11 Chevron ' 40093530 Seal Beach Ca 533471XXXXXX4704 234604227QGFOBQ9T ?MCC=5542 121042882DA 15.00 03/13 Check Crd Purchase 03/11 Jacks _ Surfboards Nepor Newport Beach Ca 533471XXXXXX4704 70470822796F7R8Dx ?MCC=5941 121042882DA 6.25 03/14 Check Crd Purchase 03/13 76 / Circle K 00272625 Irvine Ca 533471XXXXXX4704 2341019286QYMJ6Ms ?MCC=5542 121042882DA 20.49 03/17 POS Purchase - 03/14 Mach ID 000000 5760 E. 7Th Strralphs Long Beach Ca 4704 22.91 03/17 Check Crd Purchase 03/16 Cheesecake Newport Bea Newport Bch Ca 533471XXXXXX4704 70541862Q23223L9A ?MCC=5812 121042882DA 18.41 03/17 POS Purchase - 03/16 Mach ID 000000 3765 Alton Pky Mobil Oil Irvine Ca 4704 11.06 03/17 Check Crd Purchase 03/13 Wahoos Sc Plaza Costa Mesa Ca 533471XXXXXX4704 704708229S6F7YQ08 ?MCC=5812 121042882DA 7.76 03/18 Check Crd Purchase 03/15 Abercrombie & Fitch #0 Costa Mesa Ca 533471XXXXXX4704 80444002QGRWALMNI ?MCC=5691 121042882DA 18.48 03/18 POS Purchase - 03/18 Mach ID 000000 3765 Alton Pky Mobil Oil Irvine Ca 4704 15.49 03/19 POS Purchase - 03/18 Mach ID 000000 3875 Alton Parkrite Aid #Irvine Ca 4704 12.69 03/19 POS Purchase - 03/18 Mach ID 000000 3 Dollar Tan TU3 Dollar Ttustin Ca 4704 7.00 ,jam • 27876-08JUL03 March 7 through April 4, 2003 Account Number: 241-4161410 Page 3 of 4 Other withdrawals -continued Date Description $ Amount ................................................................................ D3/20 POS Purchase - 03 /19 Mach ID 00000D 3765 Alton Pky Mobil Oil Irvine Ca 4704 22.02 03/20 Check Crd Purchase 03/19 Planet Beauty/Irvine Irvine Ca 533471XXXXXX4704 70480772F61Jkrllg ?MCC=7230 121042882DA 13.95 03/21 ATM Withdrawal - 03/20 Mach ID 138003 Albertsons 6577E Of A Newport Beachca 4704 21.50 03/21 Non -Wells Fargo ATM Transaction Fee 2.00 03/21 Check Crd Purchase 03/19 Wahoos Sc Plaza Costa Mesa Ca 533471XXXXXX4704 70470822FS6FBGmns ?MCC=5812 121042882DA 3.99 03/24 POS Purchase - 03/23 Mach ID 000000 3765 Alton Pky Mobil Oil Irvine Ca 4704 30.14 03/24 Check Crd Purchase 03/21 Wahoos Sc Plaza Costa Mesa Ca 533471XXXXXX4704 70470822JSGF8WWE4 ?MCC=5812 121042882DA 7.97 03/24 Check Crd Purchase 03/22 Wahoos Sc Plaza Costa Mesa Ca 533471XXXXXX4704 70470822JS6F8WWQ0 ?MCC=5812 121042882DA 7.97 03/24 Check Crd Purchase 03/20 Wahoos Sc Plaza Costa Mesa Ca 533471XXXXXX4704 70470822GSGFSKphm ?MCC=5812 121042882DA 3.99 03/25 Check Crd Purchase 03/24 Planet Beauty/Irvine Irvine Ca 533471XXXXXX4704 70480772L8B501A9K ?MCC=7230 121042882DA 3.91 03/28 POS Purchase - 03/28 Mach ID 000000 3765 Alton Pky Mobil Oil Irvine Ca 4704 21.89 03/28 Check Crd Purchase 03/26 Wahoos Sc ' Plaza Costa Mesa Ca 533471XXXXXX4704 70470822NS6F961Ls ?MCC=5812 121042882DA 7.97 03/31 ATM Withdrawal - 03/28 Mach ID 2686R 200 Palm Street, Balboa, Ca 4704 40.00 03/31 Check Crd Purchase 03/28 Islands Rest #006 Irvine Ca 533471XXXXXX4704 70460292P7YTEZZBQ ?MCC=5812 121042882DA 21.00 03/31 POS Purchase - 03/31 Mach ID 000000 140 E 17Th St St -Shirt Whcosta Mesa Ca 4704 , 8.27 04/02 POS Purchase - 04/01 Mach ID 000000 3765 Alton Pky Mobil Oil IrvineCa. 4704 15.51 04/03 Check Crd Purchase 04/01 3 Dollar Tan - Tustin Tustin Ca 533471XXXXXX4704 70460052WS662ZKX3 ?MCC=7298 121042882DA 12.00 04/04 ATM Withdrawal - 04/03 Mach ID 138003 Albertson 6577E Of A NP.wnorr Raarhna r 27876-08=03 March 7 through April 4, 2003 Account Number: 241-4161410 Page 4 of 4 Daily balance summary Date $ Balance 03/06 53.49 03/07 221.38 03/10 200.75 03/11 142.88 03/13 121.63 03/14 101.14 03/17 41.00 03/18 198.25 03/19 178.56 03/20 142.59 Date $ Balance 03/21 115.10 03/24 65.03 03/25 61.12 03/27 181.50 03/28 151.64 03/31 82.37 04/02 330.78 04/03 318.78 04/04 234.04 .J Account Statement May 7 through June 5, 2003 Account Number: 241-4161410 Page 1 of 4 671,499 1-1,3 Ilrlrr�rl�l�llr�rrrll,lr�l,I,I��ti�rlllrrrr�irlll�rr��rllrll,.I ROBERT E FLYNN 1 SUNRIVER IRVINE CA 92614-5402 Thank you for banking with Wells Fargo. For assistance, call: 1.800-TO-WELLS (1-800-869-3557), TDD number (for the hearing Impaired only):1.800.8774833. Or write: WELLS FARGO BANK, N.A., P.O. BOX 6995, PORTLAND, OR 97228.6995. You.could save up to 70% on term life insurance. Call 1-800.421-6413 ext. 7011 or visit wellsfargo.com/freequote. Compare rates from highly rated insurance companies. Available in most states through Wells Fargo Insurance, Inc: or licensed affiliates (CA license #0831603) in cooperation with Insurance Central (CA license #OC26165). 'Insurance products are not insured by FDIC or any Federal Government Agency* Insurance products are not a deposit of or guaranteed by any bank" Important Account Information: If the bank receives an Item (as defined in the Consumer Account Agreement) against your account and there are insufficient funds to cover the Item, the bank may pay the Item and create an overdraft to your account. You will be charged an Overdraft Paid Item Fee as disclosed in the Consumer Account Fee & Information Schedule. To avoid these fees, we encourage you to discuss Overdraft Protection options with your banker or call us at 1-800-TO;WELLS (1-800-869-3557). Student Checking Robert E Flynn Account Number: 241-4161410 Activity summary Balance on 05/06 - $1.34 Deposits 469.39 Withdrawals 505.90 Balance on 06/05 - $37.85 As of July 14, 2003, Wells Fargo Student Checking will become Wells Fargo College Checking. No other changes are being made to your account at this time. V4. May 7 through June 5, 2003 Account Number: 241-4161410 Page 2 of 4 671,500 V Activity detail Deposits Date Description $ Amount ...................................................................................................................................................... 05/09 A'I'M Deposit - 05/09 Mach ID 0983E 4850 Barranca Pkwy Irvine Ca 4704 239.69 05/27 ATM Deposit - 05/24 Mach ID 0983E 4850 Barranca Pkwy Irvine Ca 4704 229.70 ...................................................................................................................................................... Total deposits S469.39 Withdrawals Other withdrawals Dale Description .........................................................................................................................._.._.. 05112 Check Crd Purchase 05110 Chevron #0093901 Long Beach Ca 533471XXXXXX4704 2,34604243QGF01) 1 OL '?MCC= 5542 121042882DA 05/12 POS Purchase - 05/09 Mach Ill 000000 5760 H. 7rh Strralphs long Beach Ca 4704 05/12 Check Crd Purchase 05110 3 Dollar Tan - Tustin Tustin Ca 533471XXXXXX4704 704600543S662Ztig ?MCC = 7298 121042882DA 05/12 Check Crd Purchase 05,110 Diedrich Coffee #01114 Irvine Ca 533471XXXXXX47()4 7043273438AJTRL' OY '?MCC = 5812 121042882DA 05/12 - POS Purchase - 05111 Mach ID 000000 3825 Alton Pkwyalbertsonsirvine Ca 4704 05/13 Check Crd Purchase 05/11 Webmasters On Line Inc Saint Petersb Fl 533471XXXXXX4704 78503634409A 15RAO ?MCC= 5969 121042882DA 05/ 14 POS Purchase - 05/13 Mach ID 000000 5345 Alton Parkralphs Irvine Ca 4704 05/14 POS Purchase - 05113 Mach Ill 000000 3765 Alton Pky Mobil Oil Irvine Ca 4704 05115 Check Crd Purchase 05114 Nutri Sport Uc Irvine Irvine Ca 533471XXXXXX4704 80459174731.10KIJN0 ?MCC= 5499 121042882DA 05/16 ATM Withdrawal - 05/15 Mach ID 80754169 Stag Bar Stag Bar Newport Beachca 4704 05/16 Non -Wells Fargo ATMTransaction Fee 05/16 POS Purchase - 05115 Mach ID 000000 Chev Stn # 180OChev Stn #Irvine Ca 4704 05/16 Check Crd Purchase 05/14 Wahoos Sc Plaza Costa Mesa Ca 533471XXXXXX4704 704708247S61;dvjkr ?MCC= 5812 121042882DA 05/19 Check Crd Purchase 05/17 76 / Circle K 33107400 Costa Mesa Ca 533471XXXXXX4?04 23410194A6DP921,nl ?MCC:= 5542 121042882DA 05/19 Check Crd Purchase 05/17 Wahoo S Fish Taco Laguna Beach (a 533471XXXXXX4704 70470824A321,3GXJ8 ?MCC= 5812 121042882DA 05/19 Check Crd Purchase 05115 Wahoos Sc Plaza { ost.j Mrci Cm i1,A?,YYYYVvnvi1n $ Amount ................... 20.10 16.18 12.00 6.80 5.38 12.99 17.71 13.33 32.27 42.00 2.00 15.00 7.97 15.12 13.31 :,� May 7 through June 5, 2003 Account Number: 241-4161410 Page 2 of 4 671,500 V Activity detail Deposits Date Description $ Amount ...................................................................................................................................................... 05/09 A'I'M Deposit - 05/09 Mach ID 0983E 4850 Barranca Pkwy Irvine Ca 4704 239.69 05/27 ATM Deposit - 05/24 Mach ID 0983E 4850 Barranca Pkwy Irvine Ca 4704 229.70 ...................................................................................................................................................... Total deposits S469.39 Withdrawals Other withdrawals Dale Description .........................................................................................................................._.._.. 05112 Check Crd Purchase 05110 Chevron #0093901 Long Beach Ca 533471XXXXXX4704 2,34604243QGF01) 1 OL '?MCC= 5542 121042882DA 05/12 POS Purchase - 05/09 Mach Ill 000000 5760 H. 7rh Strralphs long Beach Ca 4704 05/12 Check Crd Purchase 05110 3 Dollar Tan - Tustin Tustin Ca 533471XXXXXX4704 704600543S662Ztig ?MCC = 7298 121042882DA 05/12 Check Crd Purchase 05,110 Diedrich Coffee #01114 Irvine Ca 533471XXXXXX47()4 7043273438AJTRL' OY '?MCC = 5812 121042882DA 05/12 - POS Purchase - 05111 Mach ID 000000 3825 Alton Pkwyalbertsonsirvine Ca 4704 05/13 Check Crd Purchase 05/11 Webmasters On Line Inc Saint Petersb Fl 533471XXXXXX4704 78503634409A 15RAO ?MCC= 5969 121042882DA 05/ 14 POS Purchase - 05/13 Mach ID 000000 5345 Alton Parkralphs Irvine Ca 4704 05/14 POS Purchase - 05113 Mach Ill 000000 3765 Alton Pky Mobil Oil Irvine Ca 4704 05115 Check Crd Purchase 05114 Nutri Sport Uc Irvine Irvine Ca 533471XXXXXX4704 80459174731.10KIJN0 ?MCC= 5499 121042882DA 05/16 ATM Withdrawal - 05/15 Mach ID 80754169 Stag Bar Stag Bar Newport Beachca 4704 05/16 Non -Wells Fargo ATMTransaction Fee 05/16 POS Purchase - 05115 Mach ID 000000 Chev Stn # 180OChev Stn #Irvine Ca 4704 05/16 Check Crd Purchase 05/14 Wahoos Sc Plaza Costa Mesa Ca 533471XXXXXX4704 704708247S61;dvjkr ?MCC= 5812 121042882DA 05/19 Check Crd Purchase 05/17 76 / Circle K 33107400 Costa Mesa Ca 533471XXXXXX4?04 23410194A6DP921,nl ?MCC:= 5542 121042882DA 05/19 Check Crd Purchase 05/17 Wahoo S Fish Taco Laguna Beach (a 533471XXXXXX4704 70470824A321,3GXJ8 ?MCC= 5812 121042882DA 05/19 Check Crd Purchase 05115 Wahoos Sc Plaza { ost.j Mrci Cm i1,A?,YYYYVvnvi1n $ Amount ................... 20.10 16.18 12.00 6.80 5.38 12.99 17.71 13.33 32.27 42.00 2.00 15.00 7.97 15.12 13.31 :,� Other withdrawdls-continued Date °Desotiptlon $Amount ..................................................................................................................................................... 06/02 ATM Withdrawal - 05/31 Mach ID B811F355 Circle K #3037 Pulse Wi Costa Mesa Ca 4704 . 62.00 06/02 Non -Wells Fargo ATM Transaction Fee 2.00 06/02 Check Crd Purchase 05/31 Planet Beauty Irvine Irvine Ca 533471XXXXXX4704 13.95 70500364R8AGS81LA7 ?MCC= 5977 121042882DA 06/02 POS Purchase - 06/02 Mach ID 000000 3765 Alton Pity Mobil Oil Irvine Ca 4704 6.01 06/03 Overdraft Fee 30.00 06/05 Continuous OD Level 2 Charge 5.00 06/05 POS Usage Fee 1.00 ...................................................................................................................................................... Total other withdrawals $505.90 Daily balance summary Date $ Balance Date $ Balance Date $ Balance ............................................ 05/06 ............................................ - 1.34 05/16 34.62 ............................................ 05128 169.82 05/09 238.35 05/19 - 1.78 05/29 149.81 05/12 177.89 05/20 - 31.78 05/30 82.11 05/13 164.90 05/22 - 36.78 06/02 - 1.85 05114 133.86 05/23 - 41.78 06/03 - 31.85 05/15 101.59 05/27 181.97 06A5 - 37.85 0 Are YOU ■ Purchasing a home or refinancing your currenw.A? Callus at 1.800.866-0743 interested ■ Getting a student loan? Call us at 1.888-945.6373 in... • Optimizing the equity in your home? Call us at 1-866-259-0890 For more information on our aroducts and services visit as at wellsfarao.com Account Balance Calculation Worksheet 1. Ubu the following worksheet to calculate your overall account balance. 2. Go through your mclisler and mark each check, withdrawal, ATM I: ansachon. payntenl, deposit or other credit listed on your statement. Be sure that your register show§ any mlerest paid into your account aIIU any, service charges, automal!c payments or ATM transactions wilhdramn fram your account during lies stalementpetiod. 3. Use tho chart below, list any deposits. transfers to your account, oulsiandmg checks. ATM wnhdlavals, ATM payments or any other wllhdrnwals (including any frum previous months) which are listed in your register but nor shown on your statement. ITEMS OUTSTANDING NUMBER AMOUNT i TOTAL $ ENTER �A Tho NEW BALANCE shown on yourstaiamenl ....................... ...... ....... .. .. s )11�,ADD ® Any deposits listed in your register or translers into .your account which are not shown on your statement. s 9 +g TOTAI.................. s r CALCULATE THE SUBTOTAL ................. s (Add Pans A and B) ;Y SUBTRACT © 1 he total oulemiding checks and withdmwnis horn the chit above . ......... t6- CALCULATE THE ENDING BALANCE (Pan A+ Pan B - Pan CI Tills amount should be the same its the current balance shown in your check register ...................... .. Line of Credit Information Each principal balance shown on the reverse side represents the unpaid amount of loan advances under your line of credit for that day and each day Iherealler until a change In the principal balance is shown. The Finance Charge will be determined ab follows: Determine the principal balance for each day during this statement period. Ilion Multiply the principal balance for each day during this statement period by the daily periodic rate In effect for such day: and Add these results It your aceeunl is subject to Balance Based Pricing, the daily periodic rate and corresponding Annual Percentage Rate (APR) will be determined each clay based on the outstanding balance of your account. The daily periodic rate and corresponding APR applicable to each balance range are shown in the Summary of finance charges section on the reverse side. If your account is subject to a Promotional Discount, your Iola] finance charge for the statement period Is calculated by subtracting from the above -described standard finance charge calculation a promotional Interest credit applicable to all Promotional Period net advances on your account during the billing cycle. Your "net advances" are that portion of the daily balances during the Promotional Period after adding new advances and subtracting all payments or credits [hat exceed the principal balance in your account farm lately before your Promotional Period began ("Principal balance before promotional advance period began'. This promotional interest credit is calculated by adding your net advance for each day during the Promotional Part od In the billing cycle and dividing this number by the number of Promotional Period days In the billing cycle resulting in your average daily promotional balance. Your average daily promotional balance is then multiplied by the number of Prbmollonal Period days in the billing cycle and by the daily periodic rate for the promotional Interest cradn rate resulting in the promotional interest credit The promotional interest credit is then subtracted from the total finance charge at your standard rate(s) to obtain the total Imance charge shown on the front of this statement. Any transaction charges or processing charges shown on [lie reverse side of this statement also must be added to arrive at the total Finance Charge for this period Loan payments received allernormal business hours will be credited the following business day. Normal business hours are posted in each office or branch and will be furnished upon request, or may be obtained by calling the customer service phone number listed on the front of this statement. In Case of Errors or Questions About Your Credit Line Transactions 11 you think your bill is wrong, or if you need more information about a transaction on your bill, write us at the address shown on the front of this statement as soon as possible. We must hear from you no later than 60 days after we sent you the first bill on which the error or problem appeared. You can telephone us, but doing so will not preserve your rights. In your letter, give us the following information. Your name and account number The dollar amount of the suspected error Describe the error and explain, if you can, why you believe there Is an error. II you need more information, describe the item you are unsure about. You do not have to pay any amount in question while we are investigating, but you are still obligated to pay the pans-ol your bill that are not in question. While we investigate your question, we cannot report you as delinquent or take any action to collect the amount you question. Special Rule for Credit Card Purchases. II you have a problem with the quality of goods or seruces.[hal you purchased with a credit card, and you have bred lit good taint to correct the problem with the merchant, you may not have to pay the remaining amount due on the goods or services. You have this protection only when the Purchase price was more than $50 and the purchase was made in your home stale, or within 100 miles of your marling address. (II we own or operate the merchant, or it we mailed you the advertisement for the properly or services, all purchases are covered regardless of amount or location of purchase.) It You Suspect Errors or Have Questions About Electronic Transactions /Including Direct Deposit Advance a Transactions) on Your Regular Deposit Account Please Call Us Immediately. Or. it you believe there is an error on your statement or ATM receipl or If you need more informallonabout a transaction listed on this statement, please contact its Immediately. We are available 24 hours a day, seven days a week. Please call the telephone number printed on the front of this statement. Or you may write us Of Wells Fargo Bank. P.U. Box 6995, Portland, OR 97228.6995. 1 Tell us your name and account or ATM card number. 2. As clearly as you can, describe Ilia error or the transfer you are unsure about and explain why you need more information. 3 Tell us the dollar amount of the suspected error. You must report the suspected error to us no later than 60 days after we sent you the fast statement on which the problem appeared. We will investigate your question and will correct any error promptly. It our Investigation lakes lodger than 10 business days (or 20 days in the case of electronic purchases) we will temporarily credit your acceunl for the amount you believe is in error, so that you have use of the money until our Investigation is completed. It the error concerns a Direct Deposit Advance transaction, you do not Have to pay any amount in question while we are investigating, but you are still obligated to pay the parts of your Direct Deposit Advance transaction that are not fit question. While we are invesllgating your question, we cannot report you as delinquent or lake any action to collect Ilia amount you question. l� f Members FDIC, u'euu 11 Unit Number 3 New Certificates— —/ Recertificatioonn.t�q,,,y ^� INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER.I this form is designated to assist you in computing Annual income in accordance with the method set forth in the Department of Housing and Urb an Project ("HUD') Regulations (24 CFR 813). You should make certain that this form is at all times up to date with the HUD Regulations. Al capitalized terms used herein shall have the meaning set forth in the Regulatory Agreement. C CDA (pool) - Newport North I/We the undersigned state that I/ a have read and answered fully, frankly and personally each of the following questions for all persons who are to occupy the uni being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit. 1 2. 3. 4. 5. Name of Members Relationship Social Securi Place of Of the to Head of tY Household Household Age Number Employment E IPo - j4gtr _ .— 25 Coo- 2N-IsgB Islonm 124wyvcs I Income Computation 6. The total anticipated inc me, calculated in accordance with this paragraph 6, of all persons (except children under 18 years) listed above for tde 12-month period beginning the earlier of the date that I/we plan to move into a unit or sign a lease for a Unit is$ 13g ti1tb. rU� Included in the total anticipated income listed above are: — (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net incom from the operation of a business or profession or from the rental of real or personal property (without dedu ting expenditures for business expansion or amortization of capital indebtedness or any allowances fad depreciation of capital assets); (c) interest and di idends (including income from assets included below and other net income from real or personal property); (d) the full amount of periodic payments received from social security, annuities, insurance policies, retirement funds, pensions, disability or death benefits and other similar types of periodic receipts, including any lump sum payment for the delayed start of a periodic payment; (e) payments in li a of earnings, such as unemployment and disability compensation, workers' compensation and severance ay; (f) the maximum mount of public assistance available to the above persons other than the amount of any assistance spe iftcally designated for shelter and utilities; (g) periodic and d!tcnninable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not residing in the dwellings; (h) all regular pay special pay and allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the household or spouse; and (i) any earned inci me tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; (b) amounts whic}� are specifically for or in reimbursement of medical expenses; (c) lump sum additions to family assets, such as inheritances, insurance payments (including payments under health and accident insurance and workers' compensation), capital gains and settlement for personal or property losses; (d) amounts of eddeational scholarships paid directly to the student or the educational Institution, and amounts paid by'the go I emment to a veteran for use in meeting the costs of tuition, fees, books and equipment. Any amounts of su h scholarships or payments to veterans not used for the above purposes are to be included in income; I (a) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (f) relocation payments under Title it of the Uniform Relocation Assistance and Real Property Acquisition , Policies Act of 1970; (g) foster child care payments; 1 (h) the value of coupon allotments under the Food Stamp Act of 1977; , (i) payments to volunteers under the Domestic Volunteer Services Act of 1973; 0) payments received under the Alaska Native Claims Settlement Act; (k) income derived from certain submarginal land of the United States that is held in trust for certain Indian tribes; (I) payments on allowances made under the Department of Health and Human Services' Low -Income Home Energy Assistance Program; (m) payments received from the Job Partnership Training Act; (n) income derived from the disposition of funds of the Grand River Band of Ottowa Indians; and (o) the first 52000 of per capita shares received from judgement funds awarded by the Indian Claims Commission of the Court of Claims or from held in trust for an Indian tribe by the Secretary of Interior. { I 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necessary items of personal property such as furniture and automobiles and interests in Indian trust land) Yes )< No; or (b) have they disposed of any assets (other than at a foreclosure or bankruptcy sale) during the last two years at less, than fair market value? Yes - No I ( c) If the answer to (a) or (b) above is Yes, does the combined total value of all such assets owned or -disposed -of by all such persons total more than $5,000? Yes _No (d) If the answer to ( c) above is Yes, state: _ (1) the combined total value of all such assets: S (2) the amount of income expected to be derived from such assets in the 12-month period beginningDn the.date ci j initial occupancy in the unit that you propose to rent: $ 1 , and (3) the amount of such income, if any, that was included in item 6 above: S — 8. (a) will all the persons listed in column I above be or have been full-time student during five (5).calendarmdnthsiof this calendar year at an educational institution (other than a correspondence school) with regular,"facuiryand students? Yes n No (b) Complete only if the answer to Ouestiou 8(a)Is "Yes"). Is any such person (other than nonresident aliens) married and eligible to file a joint federal income tax retums? Yes No I 9. This certificate is made with the knowledge that it will be relied upon by the Owner to date name maximum incomelfor -- eligibility to occupy the unit; and Uwe declare that all information set forth herein is true, correct and complete and based upon information Ihve deem reliable and that the statement of total anticipated income contained in paragrap) 6 is reasonable and based upon such investigation as the undersigned deemed tecessary. 10. Me will assist the Owner in obtaining any information or documents required to verify the statements made herein, including either an income verification from my/our present employer(s) or copies of federal tax returns for the immediately preceding calendar year. 11. 1/we acknowledge that all of the foregoing information is relevant to the status under federal income toe law of the interest on bonds issued to finance the :3 11 of the apartment building for which application is being made. We consent to the disclosure of such information to the issuer of such bonds, the holders of such bonds, any trustee acting on their behalf and any authorized agent of the Treasury Department or Internal Revenue Service. I VWe declare under penalty of perjury that the foregoing is true and correct. Executed this I S i' day of Diu{ 20 0(Year) in the City ofr f3�6� California Applicant Applicant Applicant I Applicant , (Signature of all persons (except children under the age of 18 years) listed in number 2 above required) A FOR COMPLIMON BY APARTMENT OWNER ONLY! 1. Calculation of eligible income: a. Enter amount entered for entire household in 6 above: b. (1) If the amount entered in 7(e)a entered in 7(d)(2); subtract ftua 7(dx3) and enter the reiw_:-i n; (2) Multiply the anon �t to savings rate -� 8nnual eamiq passbook SaVA "• the amount eme, aK is yes, eater the total amount t figure the amount entered in k�'e (S ); the current passbook O to determine what the total !(d)(I) would be if invested in _ -), subtract from that figurn enter the remaining balance ($ (a) Enter at right the .greater of the amount calculated under (1) or (2) above: e, TOTAL EUGTM.E INCOME (line l.a plus line I.b(3): s 3$/ 900.06— $ 331 4610,00- 2. The amount entered in 1.c: Quallfies the applicant(s) as a Moderate -Income Tenant(s). Qualifies the applicant(s) as a Lower -Income Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenant(s). 3, Number of apartment unit assigned: 311 Bedroom size: I + l Rent: 4 ) 2 l !G . 4. This aparhaeat unit (was not) last occupied for a period of 31 or more consecutive days by persons whose aggregate anticipated annual income as eertl8ad in the above manner upon their HdaI c ccupauay of the apartmantunh qualified them as a Lower -Income Tenant(s). S. Method used to verify applicant(s) income: tC Pmoloye: income verification. Copies of = returns. a.nxcusr�t Date INCOME r ASSET CALCULATION WORD • HFFT 1 LmtNam- Flrot Nor.._ Tn RcloUamhlp NOH Sax DA1001Birth Ago Social Security it FIT Student uborNO 2 3 4 5 g 7 n 8 r iNGvmt Family Memb, iP Source Base Rate Average Average Annual $ Hours 52 24 20 12 1 Total WK SEMI -MO el-M MO YA - $ k =$38 — 0 $ — =a $ _$ SOCIAL SFCIlP1TV RFNmnue ern Total Box Family Memb.OP • Source Base Rate Average- Average Annual $ He 52 2n so tz 1 Total SeM1il•MU U •WK MO Yll $ _$ OTHER IN(:num Base Rate •$ Average Average Annual Hours 52 24 2e 12 1 Talal WK SEMI• 0 al•WK M YR aFamilySource $ =S TOTAL ANNHAr GRnee imr•naxc n ...._.._. I Total Boxox D: $ _ ASSETS Asset Description imputed/ Member (savings, checking, stocks, bonds, Current iF eta I or C Grass/Fair Cost t- Mkt. Value . Gel Cash NET Family Assets Value $ Actual Actual Altnuai Interest Incomfront Rate Asseets corals BOX E: 7 3, 17 BOX F: :� ' Total NE ola AGual name Family Income FletuAsseL^ IMPUTED INCOME FROM ASSETS Box E "wads 45,000—multiply E by the current passbook Interest mlo: If Box E does not exceed $5,000 entor •0• In box G: Enlor Iho greater of Box F or Box G In: lZ . X •BOXG: u_—,T INPUTED INCOME FROM ASSETS BOX H: Effedty-Dalo. Typo ofprogmm % tow Unit No. 3It Unit Slzo +J 1_ No. of persons MA: v Max.Income Limit$_34r$.Ta,oa- AK'140%Limit $ Income Restricted Certification Questionnaire I Name: T unit T 311 Initial Certification t/' Re -certification Other Yes No Question I�I I ate receive Family Support, Spousal Support, and/or anv of cash contributions of gifts, including rent or utility payments !.'tee receive veteran s.vumin—La-v,., • •�•�•„ �— benefit, Disabiliry benefit, AFDC, Lottery winnings, Inheritan or Annuities. I we receive income from Rental Property. :i: bcn-:"z!L'aJOm7 f!on-, Sc...l S._...., o ..._l..d_ SSA, SSI and/or periodic social security payments. The household receives unearned income for family members aee 17 or under. i'tve are entitled to receive child support payments. I we am currently receiving child support payments. I %v- am'are currently making efforts to collect child support owed to me. I awe have other assets (example: 401K, IR4, Revocable Trust: Stocks, Bonds, Treasury Bills, Money Market accounts, Certificate of Deposits, «`hole Life insurance, Real Estate) I ue hzwe cash on hand. Student Status: Does the household consist of persons twho are all full-time snudents (exam le: Colleselnitersit , trade school, etc.)? Does your household anticipate becoming a Alil-time-time student household in the next 12 months? If you answered ves to either of the previous two questions are you: i Married and filing a joint tax return. Income Under penalties of perjure, I certify that the information presented on this form is true and accurate to the best of my latotcledge. The undersigned further understands that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information aetll resul ' the denial of application of the income restricted lease agreement. uag Reside, t 'ana Date Si_nuure of0wrwr Agent Dale Rug 13 03 o9:13a NFWVUKI Il TAIS SECTION TO BE COMPLETED BF 11ANAGE v11 i T AND EXECUTED BYTENANT ^^ (Name & address of employer) Date: 5�121 G 3 {VD vn 12P�V.E L� Iq 131 „�sti .� � • I 911itz-4 Cno-2u-i596 311 RE: TO 0rplieent/Tenant `ame Social Securty Number Unit # (if assigned) '�-7- Api I hereby autho ' se of - ,Fm yment information. �. 2A V6-S Date ( �SignAune 6CAppiieafiTiTonant The individual named directly above is an applicant/tenant of a housing program that requires verification of income, n,The information provided will remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial and greatly appreciated. I Project Owner/Management Agen[ Return Form To: t�t2w t�^-F NirTh rq�'I•'nc''(Fs Q milaoc�f.LwpOr{"�ah Cy{g266o nurployeeName; IOO/ ty JobTitle: presently Employed: Yes.,. Date First Employed �' ZZ V'� No— Last Day of Employment Current waseesalary: S. 2oO (circle one) hourly weekly bi-weekly semi-monthly(month) yearly other Average # of regular hours per week: Year-to-date earnings: S '7?-) qO 0 through 5 1 / 0s overtime Rate: S per hour _ Average # of overtime hours per week: Shift Differentia) Rate: S / per hour Average # of shift differential hours per week: Commissions, bonuses, tips, other: S (circle one) hourly weekly bi-weekly semi-monthly monthly yearly other List any anticipated change in the employee's ram of pay within the next t2 months: Iv o f'f L ; Effective date: If the employee's work is seasonal or sporadic, please indicate the layoffperiod(s): Additional ,lFJ�11 Imo` Employer's Pnnted N3mt Date I �—� PhoneN Faz# E-mod NOTE: Section 1001 of Title IS of the U.S. Code makes it a criminal offense to make ndllrul false statements or mismilreacntations to any Dcpanmeni or Agency or the United States as to any matter within its jurisdiction. Employment Verification (Seplemher?000) Name, Account Type Asset Calculation Worksheet 25'6 1 15- ( + ) )IIgO.Iq divided by 2 (—> .72-7 (average account balance) (x) Interest rate: % d Income from asset: $ 0 Account Statement June 24 through July 23, 2003 Account Number: 090-4362985 Page 1 of 4 443,53e TXYLOR ELLIOTT 311 MONTE CARLO NEWPORT BEACH CA 92660-3273 Thank you for banking with Wells Fargo. For assistance, call: 1.800-TO-WELLS (1.800-869.3557), TOD number (for the hearing impaired only): 1 .800-877-4833. Or write: WELLS FARGO BANK, N.A., P.O. BOX 6995, PORTLAND, OR 97228.6995. Wells Fargo offers FREE.convenient services including direct deposit, online banking, online statements and more. For more information on these and additional FREE Wells Fargo services visit www.wellsfargospecial.com and enter keyword: FREE. Sign up for BIII Pay between June 2 and August 31, 2003 and Wells Fargo will donate $10 to local school districts. To qualify, at least one bill payment must be completed by September 30, 2003. For more details, see your local banker or go to wellsfargospecial.com and enter keyword: Schools. Custom Checking Taylor Elliott Account Number: 090.4362985 Activity summary Balance on 06,123 Deposits Withdrawals $1,190.19 2,908.09 - 3,842.13 .. ........................................................................................ Balance on 07/23 $256.15 June 24 through July 23, 2003 Account Number: 090-4362985 Page 2 of 4 443,537 Activity detail Deposits Amount Date Description $ .. ........................................................................................................................... 06/30 Online'Transfer Ref #IBE77'LNYW8 From 2136128085 On 06/28/03 . ........................ 1,00().()0 07/07 Deposit Made In A Branch/Store 1,000.00 07/15 Overdraft Xfer From Credit Card Or Line 108.09 07/18 Online 'Transfer Ref #IBF.QC9Tyym From 2136128085 On 07/17/03 800.00 ...................................................................................................................................................... S2,908.09 Total deposits Withdrawals Checks Number Date $Amount Number Date $Amount Number Date $Amount ...................................................................................... 1087 06/25 100.00 1093 07/07 197.48 ........................................... 1098 07/15 300.00 1088 06/24 100.00 1094 07/14 16.01 1099 07115 200.00 1090* 07/01 323.11 1095 07/10 132.70 736489* 06/24 57.05 1092* 07/02 1,216.00 1097* 07/14 39.37 ............................................................................................................................................. l'otal checks $2 ,681.72 • Cap in Check Sequence - Other withdrawals Date Description $Amount ..................................................................................................................................................... 06/25 Ymca Of Orange ACH 062403 090-000018530 Elliot, Taylor 39.00 07/07 Doed'treas 310 Fedpreauth 070703 600241596910200 Elliott 54.81 07107 POS Purchase - 07/04 Mach ID 000000 711 Weir Canyonralphs Anaheim Ca 9123 28.72 07/07 Check Crd Purchase 07/04 76 / Circle K 34611434 Huntingtn Bch Ca 446024XXXXXX9123 26.12 24164075V6bSA0Rfw ?MCC= 5542 121042882DA 07/11 ATM Withdrawal - 07/11 Mach ID 7222C 3325 E Chapman Ave Orange Ca 9123 100.00 07/11 ATM Withdrawal - 07/10 Mach ID V981Y806 Chevron ATM Netchevron Atnewport Beachca 41.50 07/11 9123 Non -Wells Fargo ATM Transaction Pee 2.00 07/14 Wellsf'argo Card C ieckpayrnt 030714 1096 90141000186340 200.00 07/14 Check Crd Purchase 07/11 Studio 486 Newport Beach Ca 446024XXXXXX9123 50.00 241583862JQ702QOM '?MCC= 7230 121042882DA 07/14 Check Crd Purchase 07/10 Chevron #00201093 Newport Beach Ca 446024XXXXXX9123 26.86 246251260QllDY63Rq ?MCC= 5542 121042882DA 07/14 Check Crd Purchase 07/13 Chevron #00201093 Newport Beach Ca 446024XXXXXX9123 5.70 246251262QI-IEA9Qxx ?MCC= 5541 121042882DA 07/14 Check Crd Purchase 07/13 Ccbill.com *sunny Med 888-596-9279 AY 446024XXXXXX9123 3.00 241206163EKQ978lz ?MCC= 5967 121042882DA 07/15 POS Purchase - 07/14 Mach ID 000000 18972 ]leach Blvarco Paypohuntington Beca 9123 20.59 07115 POS Purchase - 07/15 Mach I1) 000000 18972 Beach Blvarco Paypohuntington Beca 9123 7.26 07/15 Check Crd Purchase 07/14 Chevron #00202016 Newport Beach Ca 446024XXXXXX9123 6.45 246251263Q1IECi6I)wa ?MCC= 5541 121042882DA June 24 through July 23, 2003 Account Number: 090.4362985 Page 3 of 4 443,538 Other withdrawals -continued $ Amount Date Description ............................................ II....................................................................................................... 07/14'1'ully'S COh1�1?E000M239 Newport Beach Ca 446024XXXXX (9123 4.55 07/15 C,I Card Purchase 243990063Rvbjvhdr. ?MCC= 5814 121042882DA U7/16 Tully'S C:OFFIiF,00030239 Newport Beach Ca 446024X`CXXXX9123 5.10 07l17 Check Crd Purchase 243990065RVBJL4Ph ?MCC= 5814 121042882DA 07/17 Mach ID 000000 Bbb #122 Bed, Bath Irvine Ca 9123 57._l 07/I8 POS Purchase - Check Crd Purchase 07/16 Chevron #00201093 Newport Beach Ca 446024.1'XXXXX9123 24.31 07/18 246251266Q 11I; OsN2Ci5 '?MC:C: = 5542 121042882DA 07j16 Chevron #00201093 Newport Beach C a 446024XXXXXX9123 5.74> 07!18 Check Crd Purchase 246251266QHF0N2Fx ?MCC= 5541 12I042882DA - 07/20 :Vlach ID 7222C 3325 li Chapman Ave Orange Ca 9123 300.00 07/21 ATM Withdrawal Withdrawal - 07/19 Mach Ill V98IY806 Chevron ATM Netchevron Atnewport Beachea 81.50 07!21 KI'M 9123 2.00 07/21 Non -Wells Fargo ATINI Transaction Pee Check Crd purchase 07/17'1'arget 00012395 Irvine Ca 446024XXXXXX9123 47.02 07/21 24164076621,R7V275 ?MCC= 5310 121042882DA 07!19 Chevron #00208554 Fountain Vail C a 446024XXXXXX9123 13.01 07,121 Check Crd purchase 246251269QIII:I,VOON ?MCC= 5541 121042882DA 8.00 07/23 Monthly Service Pee................................ ........................................................................................I............................. $1,160.41 Total other withdrawals. ..................S3, ........................................................................................................................ 842.13 'rota) withdrawals Daily balance summary $ Balance Date $ Balance Date $ Balance Date ...+� ............................ 06. .....U2 ..............................355.....03 07/15 .. i,190.19 07/. U.00 - 5.10 _3 065 I,1,047.90 07/ 17 .14 0707/18 915.20 707.69 U612294 06130 lU 894.14 07110 1,894.14 07/11 771.70 07121 264.15 256.15 07/01 1,571.03 07/14 430.76 07/23 Are you ■ Purchasing a home or refinancing your current one? Call us at 1-800-866.0743 interested a Getting a student loan? Call us at 1-888-945.5373 in... ■ Optimizing the equity in your home? Call us at 1.866-259-0890 ANFor more information on our products and services visit as At wellsfargo.com Account Balance Calculation Worksheet 1. Use tine following workshee[ to calculate your overall account balance. 2. Go Through your register and (nark each check, withdrawal. ATM transaction, payment.pepostl or other credit listed on your statement. Be sure that your register shows any interest paid into your account and any lervica charges. aufomaric payments or ATM transactions w,thdravnn I,om your account during this statement period. 3. Use ins chat balow, lust an y9 deposits, transfers to your account, outstanding checks, ATM withdrawals, ATM payments or any other withdrawals (including any from previous months) which are fisted in your register but not shown on your statement. IT_E_MS_OUTSTAN01NG AMOUNT _ I --'- ----- TOTAL_ ENTER ® The NEW BALANCE shown on your statement ................................................... s- 00- ADD ® Any daposks Gstad in your $ regimor or transfers Into S your account which are not S shown on your statement. ♦s TOTAL ................. $ CALCULATE THE SUBTOTAL $ (Add Pats A and B) ji SUBTRACT © The total outstanding checks and withdrawals from the chart above ................... 00- CALCULATE THE ENDING BALANCE (Pan A * Pan B - Pan C) This amount should be the same as the current balance shown In your check register ....................................... .s A Line of Credit Information Each principal balance shown on the reverse side represents the unpaid amount of loan advances under your Ilne of credit for that day and each day thereafter until a change in the principal balance is shown. The Finance Charge will be determined as follows: Determine the principal balance for each day during this statement period: then Multiply the principal balance for each day during Thus statement period by the daily periedre rate in effect for such day; and Add these results It your account is subject to Balance Based Pricing. the daily periodic rate and corresponding Annual Percentage Rate (APR) will be deleimined each day based or, the outstanding balance of your account. The daily periodic rate and corresponding APR applicable to each balance range are shown in the Summary of finance charges section on the reverse side, our total finance charge for Ilse II your account is subJecl to a Promotional Discount y statement period is calculated by subtracting from the above -described standard finance charge calculation a promotional interest credit applicable for all Promotional Period net advances on your account during the billing cycle. Your "net advances" are that portion of the daily balances during the Promotional Period alter adding new advances and subractna all oavmenls or credits that exceed the principal balance In your account nuuicum,cp w,...., r....... _.__ _ advance period began`). This promotional interest credit is calculated by adding your net advance for each day during the Promotional Period in the billing cycle and dividing this number by the number of Promotional Perfodt.days in the billing cycle resulting in your average daily promotional balance. Your average daily promotional balance is then multiplied by the number of Promotional Period days in•the billing cycle and by the daily periodic rate for the promotional interest credit tale resulting in the promotional interest credit The promotional Interest credit is then subtracted from the total finance charge at your standard rate(s) to obtain the Iola[ finance charge shown on the front of this statement. Any transaction changes or processing charges shown on the reverse side of this statement also must be added to arrive at the total Finance Charge for this period. Loan payments received alter normal business hours will be credited the following business day. Normal business hours are posted in each office or branch and will be furnished upon, request, or may be obtained by calling the customer service phone number listed on the front of this statement. ! In Case of Errors or Questions About Your Credit Line Transactions II you think your bill Is wrong, or it you need more Information about a transaction on your bull, write us at the address shown on the front of this statement as soon as possible. We must hear hom you no later than 60 days after we sent you the first bill on which the error or problem appeared. You can telephone us, but doing so will not preserve your rights. In your letter, Hive us the following Information: Your name and account number The dollar amountol the suspected error out believe theta Is an error. II you .---Describe [he error and explain, if you can. why y y _ need more Information, describe the ilem you are unsure about. You do not have to pay any amount in question while vie are investigating, but you are still obligated to pay the parts of your bill that are not in question. While we investigate your question, we cannot report you as delinquent or take any action to collect the amount you quesnon. Special Rule for Credit Card Purchases. II you have a problem with the quality of goods or services that you purchased with a credit card, and your have tried in good faith to correct the problem with [he merchant, you may not have to pay the remaining amount due on the goods or services. You have this protection only when the purchase price was more than $50 and the purchase was made in your home state, or within 100 mules of your mailing address. (11 we own or operate the merchant, or if we mailed you [lie advertisement for the property or services, all purchases are covered regardless of amount or location of purchase.) if You Suspect Errors or Have Questions About Electronic a Transactions including Direct Deposit Advance Transactions) on Your Regular Deposit Account, Please Call Us immediately. Or, it you believe there is an error on your statement or ATM receipt or it you need more informalion about a transaction listed on this statement, please contact us immediately. We are available 24 hours a day, seven days a week. Please call the telephone numbet printed on the hold of this statement. Or you may write us at Wells Fargo Bank, P.O.. Box 6995. Portland. OR 97228-6995. 1. Tell us your name aid account or ATM card number. 2. As clearly as you can, describe [he error or the transfer you are unsure about and explain why you need more information. 3. Tell us the dollar amount of [lie suspected error. You must report the suspected error to us no later. that) 60 days after we sent your Ilse Furst statement on which the problem appeared. We will Investigate your question and will correct any error promptly. II our investigation lakes longer than 10 business clays (or 20 days in the case of electronic purchases) we will temporarily credit your account lot the amount you believe is In error, so that you have use at the money until our Investigation Is completed. If fine error concerns a Direct Deposit Advance transaction. you do not have to pay any amount in question while we are Investigating, but you are still obligated to pay the, Parts of your Direct Deposit Advance transaction that are not In quesnon. While we are mvestgatmg your question, we cannot report you as delinquent or lake any action to collect the amount you question. Members FDIC. M.— Account Statement May 23 through June 23, 2003 Account Number: 090-4362985 Page 1 of 5 453,790 1-3 TAYLOR ELLIOTT 311 MONTE CARLO NEWPORT BEACH CA 92660-3273 Thank you for banking with Wells Fargo. For assistance, call: 1.800-TO-WELLS (1-800.8693557), TDD number (for the hearing Impaired only):1-800.8774833. Or write: WELLS FARGO BANK, N.A., P.O. BOX 6995, PORTLAND, OR 97228-6995. You could save up to 70% on term life insurance. Call 1-800-421-6413 ext. 7011 or visit wellsfargo.comtfreequote. Compare rates from highly rated insurance companies. Available in most states through Wells Fargo Insurance, Inc. or licensed affiliates (CA license #0831603) in cooperation with Insurance Central (CA license #OC26165). 'Insurance products are not insured by FDIC or any Federal Government Agency' 'Insurance products are not a deposit of or guaranteed by any bank' Important Account Information If the bank receives an Item (as defined in the Consumer Account Agreement) against your account i and there are insufficient funds to cover the Item, the bank may pay the Item and create an overdraft to your account. You will be charged an Overdraft Paid Item Fee as disclosed in the Consumer Account Fee & Information Schedure. To avoid these fees, we encourage you to discuss Overdraft Protection options with your banker or call us at 1-800-TO-WELLS (1-800-869-3557). Custom Checking Taylor Elliott Account Number: 090.4362985 Activity summary 13alance on 05/22 Deposits Withdrawals $2,902.40 2,471.40 - 4,183.61 .................................................................................. I3alance......on..U6/23 $1,190.19 May 23 through June 23, 2003 Account Number: 090-4362985 Page 2 of 5 453,791 Activity detail Deposits Date Description ........................................................................... I............................ 06/06 Deposit 06/23 Deposit Made In A Branch/Store $ Amoun ............................................. 1,558.29 913.11 .......... Total deposits Withdrawals Checks Number Date $Amount Number Date $Amount ........................................... 1079 05/23 15.23 ........................................... 1083 06/13 51.01 1081* 05/27 323.11 1084 06/16 150.00 1082 06/02 1,216.00 1085 06/16 134.36 Total checks * Cap in Check Sequence Number . :Date, $Amoum ........................................... 1086 06/16 197A4. i Other withdrawals Date Description ..........................................................................................................................I............ 05/23 Check Crd Purchase 05/22 Paypal *hotomot Co 402 935 7733 Ca 533472XXXXXX9114 78429504EPWQZ15135 ?MCC= 8999 121042882DA 05/27 Check Crd Purchase 05/23 Gary'S & Company Newport Beach Ca 533472XXXXXX9114 80181964HWGPOSdjb ?MCC= 5691 121042882DA 05/27 Ymea Of Orange ACI-I 052303 090-000018530 Elliot, Taylor 05/27 Check Crd Purchase 05/25 Hurricanes Bar & Grill I•luntington Be Ca 533472XXXXXX9114 70547504117DQ M G I La ?MCC= 5812 121042882DA 05/27 Check Crd Purchase 05/24 Sam S Seafood Huntington Be Ca 533472XXXXXX9114 9243273411606BX(ir4 ?MCC= 5812 121042882DA 05/27 Check Crd Purchase 05/25 Denny'S #7659 Costa Mesa Ca 533472XXXXXX9114 80483074J48A7WGOY '?MCC= 5812 121042882DA 05/27 Check Crd Purchase 05/24 Sam S Seafood Huntington Be Ca 533472XXXXXX9114 92432734FI606Bxggf ?MCC = 5812 121042882DA 05/28 ATM Withdrawal - 05/28 Mach Ill 9982r 19840 Beach Blvd Huntingtn Bch Ca 9114 05/28 Check Crd Purchase 05/25 Hyatt I"Iotels Californi Huntington Ca 533472XXXXXX9114 705418641,2328SLI G ?MCC= 5812 121042882DA 05/29 Check Crd Purchase 05/27 Chevron #0202425 I luntington Be Ca 533472XXXXXX9114 234604241,QGPOBOW8 ?MCC= 5542 121042882DA 05/29 Check Crd Purchase 05/28 I•funtington Beach C Huntington Be Ca 533472XXXXXX9114 80536064M7F,R0Agfe '?MCC= 7542 121042882DA 05/30 Check Crd Purchase 05/28 Isbatts Com 1 877 432 2 805-4994332 Ca 533472XXXXXX9114 78505944066311,' j '?MIX:= 5732121042882DA 05/30 Check Crd Purchase 05/29 Seoul Garden Bbq BufPe Tustin Ca 533472XXXXXX9114 70421354MI32OIA44N ?MCC= 5812 121042882DA 06/02 Check Card Purchase 05/30 Yard House Irvine Ca 533472XXXXXX9114 70547514P3DL7N3Ve ?MCC:= 5812 121042882DA .........I .. $2,087.19 $ Amount 5.95 296.31 39.00 23.50 20.00 18.61 14.00 100.00 •27.05 24.65 15.95 190.85 25.00 89.00 May 23 through June 23, 2003 Account Number: 090-4362985 Page 3 of 5 453,792 Other withdrawals -continued I v Date Deeoription $Amount 06/02 Check Crd Purchase 05/130 Yard House Irvine Ca 533472XXXXXX9114 70547514P3DI,7N33L 12.50 06/03 ?MCC= 5812 121042883DA Check Crd Purchase 061,01 Chevron #0201093 Newport Beach Ca 533472XXXXXX9114 25.31 23460424TQGF0Enzz '?t 1CC= 5542 121042882DA 06/05 XI'M Withdrawal - 06/I;4 Mach ID 4806L 8440 B Chapman Ave Orange Ca 9114 100.00 06105 Check Crd Purchase 06/,03 Ibilles.Com * 800-307-3558 Fl 53.3472XXXXXX9114 33.95 75442984V 1T314Wmk ?MCC = 5967 121042882DA 06105 Check Crd Purchase 06/103 Blockbuster Video #061 Newport Beach Ca 533472XXXXXX9114 4.62 78541864W231Tgkpa ?MCC= 7841 121042882DA 06/09 lloed l'reas 310 Iredpre uth 060903 600241596910200 Llliott 54.81 06/09 POS Purchase - 06/07 Nach ID 000000 18972 Beach 131varco Paypohuntinl ton Beca 9114 23.20 06/09 Check Crd Purchase 061,06 Norm Reeves Honda Supe Huntington B Ca 533472XXXXXX9114 20.63 704805147VNZFOAke ?MCC= 5511 121042882DA 06/12 Check Crd Purchase 06/f10 On'I'he Border 00200022Irvine Ca 533472XXXXX�G91.14 . 31.07 754101952GY1SV 1 Fj '?�ICC= 5462 121042882DA 06/12 Check Crd Purchase 06/I10 Petco Newport Beach Ca 533472XXXXXX9114 9248307524P73P5f '•4.31 ?MCC= 5995 121042882DA ? 06/13 POS Purchase - 06/12 Mach ID 000000 18972 Beach Blvarco Paypohuntingt on Beda 91,14 25.90 06/13 Check Crd Purchase 06/d3 C:cbill.com T1iL8885969279 Az 533472XXXXXX9114 17.95 884204254EKQ9X L20 'IMCC 5967 121042882DA 06,113 Check Crd Purchase 06/p2 Chevron #0201093 Newport Beach Ca. 533472XXXXXX9114 9.26 234604253JAPF91ir2?MCC = 5541 121042882DA 5.7h 06/13 Check Crd Purchase 06/ 1 Chevron #0201093 Newport Beach Ca 533472XXXXXX9114 234604253JAPb'9Lzp ?MCC= 5541 121042882DA - -- 06/16 ATM Withdrawal - 06/14 Mach ID 9982'f' 19840 Beach Blvd Huntingtn Bch Ca 9114 100.00 06/18 POS Purchase - 06/17 Njach Ill 000000 18971 Beach Blvhuntingtonhuntin, on Beca 9114 6.99 O6/19 Check Crd Purchase 06/16 Pf Changs #1200 Newport Ca 533472XXXXXX9114 100.00 755475159401-192Kwx ?MCC= 5812 121042882DA 06/19 Check Crd Purchase 06J 7 Chevron #0202016' Newport Beach Ca 533472XXXXXX9114 28.20 234604259QGFODrsj ?MCC= 5542 121042882DA 06/23 ATM Withdrawal - 06/22 Mach 11) 9987f 19840 Beach Blvd Huntingtrt Bch Ca 9114 100.00 06/23 Check Crd Purchase 06/k The (tome Depot 6646 I-Iunington Bch Ca 533472XXXXXX9114 483.81 92541865Q091-,F1265 ?M,CC= 5200 121042882DA 06/23 Check Crd Purchase 06122 Paypal *hotornot Co 402 935 7733 Ca 533472XXXXXX9114 5.95 78429505DPW7SS641, '?N4CC= 8999 121042882DA 06/23 Check Crd Purchase 06/?1 Starbucks 00057695 fountain Vall Ca 533472XXXXXX9114 4.35 92410195DAAXR21131 ';MCC= 5814 121042882DA 06/23 Monthly Service Fee 3.0 ...................................................................................................................................................... Total other withdrawals $2,096.42 Total withdrawals I 54,183.61 Daily balance summary Date $ Balance I Date $ Balance Date $ Balance .... .............................� 05/22 ............................................................................................ . _,902.40 05 _8 2,019.64 06/02 . 445.65 05/23 2,881.221 05,'29 1,979.00 06/03 420.34 05/27 2,146.69; 05,30 1,763.15 06/05 281.77 May 23 through June 23, 2003 Account Number: 090.4362985 Page 4 of 5 453,793 Daily balance sumn4ary-continued Date $ Balance! 06 j 06 ...........................1, 840.061 06/09 '" "� 06/12 Date $ Balance Date $ Balance ............................................ ............................................ 06/13 1,596.__ 06,119 879.19 n4, i a 1.01438 06/23 1,190.19 Are you Is Purchasing a home or refinancing your current one? Callus al 1.800.866.0743 interested a Getting a studentloan? Call us at 1,888,945.5373 in... ■ Optimizing the equity in your home? Call LI5 at 1.866-259.0890 For more information on our products and servieea visit us at wellsfargo.com Account Balance Calculation Worksheet 1. Use the following worksheal to calculate your overall account balance. 2. Go through your •fagister and mark each check, withdrawal, ATM transaction, payment, deposit or other Credit listed on your statement. Be sure that your register shows any interest paid into your account and any service charges. automatic payments or ATM transactions withdrawn from your account during this statement period. 3. Use file chart below, list any deposits. transfers to your account. outstanding checks, ATM withdrawals, ATM payments or any other withdrawals (Including any from previous months) which are listed in your register but not shown on your statement. ITEMS_ OUTSTANDING Nf1MBER I AMOUNT S 1 t r ENTER A] The NEW BALANCE shown on yoursmtemenl............................................. ... S ADD 3] Any deposits listed In your 5 register or hansfers into s your account which are not $ shown on your statement. +$ TOTAL .............. $ ► CALCULATE THE SUBTOTAL .............. (Add Paris A and B) 5 ► SUBTRACT a! © The total outstanding check. and w,mdrawals Iran the chart a Iiwe.............. . CALCULATE THE ENDING BALANCE (Pail A+ Pan B • Pan C) This:mrount should be the same as the curtent balance shown In your check register ........................................ .5 'Ill C� Line of Credit Information Each principal balance shown on the reverse side represents the unpaid amount of loan advances under your line of credit lot that day and each clay Iherealler until a change fir the principal balance is shown. The Finance Charge will be determined as follows: Determine the principal balance for each day during lhr statement period: then Multiply the principal balance for each day during this statement period by the daily periodic rate in ellect lot such day: and Add these results II your account is subject to Balance Based Pricing, the daily periodic rate and corresponding Annual Percentage Rate (APR) will be determined each clay based on the outstanding balance of your account. The daily periodic rate and corresponding APR applicable to each balance range are shown In the Summary of finance charges section on the reverse side. II your account is subject to a Promotional Discount, your total finance charge for the statement period is calculated by subtracting from the above -described standard finance charge calculation a promotional interest credit applicable to all Promotional Period net advances on your account during the billing cycle. Your "net advances' are that portion of the daily balances during the Promotional Period alter adding new advances and subtracting all payments or credos that exceed the principal balance in your account immediately before your Promotional Period began (`Principal balance before promotional advance period began'). This promotional interest credit is calculated by adding your net advance for each day during the Promotional Period In the billing cycle and dividing this number by the number oI Promotional Period days tin the bdlnty cycle iesultiny in your average dolly pramotionel balance. Your average daily promotional balance Is than multiplied to the number of Promotional Period days in the billing cycle and by the Italy periodic tale for Ilia promotional interest credit rate reselling in the promotional Interest credit. The prof of.. at (merest credil is IlteIn su6lraeted from the total finance charge at your atantlarc1 rate(') to obtain the total Ilitance charge shown on the front of [Ills statement. Any Transaction charges or processing charges shown on the•reverse side of this slalement also must be added to arrive at the total Finance Charge for this period. Loan paymens received alter normal business hours Will be credited the following business day. ,- Normal business hours are posted In each cities or branch and will be furnished upon >, request, or may be obtained by calling One customer service phone number listed on Ihh Iront of this statement. _ r In Case of Errors or Questions About Your Credit Line Transactions It you think your bill is wrong, or it you need more information about a transaction on your bill, wide us at the address sliown oil the Iron) of Ihis statement as soon as possible. We must hear from you no later than 60 days allerwe sent you the first bill on which the error or problem appeared. You can telephone us, bill doing so will not preserve yocir rights. In your letter, give us the lollowing Information: Your name and account number The dollar amount of the suspected error Describe the error and explain, it you can, why you believe there is an error. It you need more mlormalion, describe the item you are unsure about. You do nor have to pay any amount in question while we are investigating, but you are still obligated to pay the pans of your bill that are not in question While we Investigate your question, we cannot report you as delinquent or take any action to collect the amount you question. Spacial Rule for Credit Card Purchases. If you have a problem with the quality of goods or services Thal you purchased wish a credit card and you have It' In flood faith io correct the problem with the merchant you may not have to pay the remaining amount due on the goods or services. You have this protection only when the purchase price was more than $50 and the purchase was made in your home stale, or within 100 rules of your mating address. (II we own or operate the nn..chant. or it we mailed you the advenfsem Ill for Ilse property or services, all purchases are covered totalities' of arnounl or localion of purchase.) If You Suspect Errors or Have Questions About Electronic Transactions Including Direct Deposit Advance ° Transactions) on Your Regular Deposit Account, Please Call Us Immediately. Or, it you believe there is an error on your statement or ATM receipt or if you need more inlormalion abed a transaction listed on Ihis slalement, please contact its immediately. We are available 24 Italics a day, seven days a week. Please call the telephone number pi inted on the front of this statement. Or you may write its at Wells Fargo Bank, P.O. • Box 6995. Portland, OR 97228-6995. 1 Tell its your name and account or ATM card number. 2. As clearly as you can, describe the error or the transfer you are unsure abbul and explain why you need more information. 3. Tell us the, dollar amount of the suspected error. You must report the suspected error to us no later than 60 days alter we sent you the first statement on which the problem appealed. We will investigate your question and will correct any error piomptly. II our Investigation lakes longer than 10 business days (or 20 days in the case of electronic purchases) we will temporarily credit your account for the amount you believe is in error, so that you have use of the money until our investigation is completed. II the errol concerns a Direct Deposit Advance transaction. you do not have to pay any amount in question while we are unvesi gating. but you are still obligated to pay file parts of your Direct Deposit Advance Iransaclion that are not in question. While we are Investigating your question, we cannot report you as delinquent or lake any action to CDyecl the ailnaLint you question. 9 Members FDIC. M= Are you a ,Purchasing a home or refinancing your current one? Callus at 1.800-666.0743 O OWN .N interested III Getting a student loan? Call us at 1.U88-946.5373 in... III Optimizing the equity In your home? Call us at 1.866-269.0890 For more information on our products and services visit as at wellstargo.eom Account Balance Calculation Worksheet 1. Use the following worKsheet .to calculate your overall account balance. a 2. Go through your register and mark each check, withdrawal, ATM transaction. payment, depositor other credit listed an your statement. Be sure that yyoour register shows any interest paid Into your account and any serNce charges, automatic payments or ATM transactions withdrawn from your account during this statement period. 3. Use the chart below, list any deposits, transfers to your account, outstanding checks, ATM withdrawals, ATM payments or any other withdrawals (Includin any from previous months) which are listed in your register but not shown on your statement. ENTER ® The NEW BALANCE shown an your statement...................................................... ADD ® Any deposes lisledin your s register or'ransleminto $ your account which are nil s shown op your statement. +$ TOTAL ................ . CALCULATE THE SUBTOTAL ................. IS Pens A and B) SUBTRACT © Tire total outstanding checks and withdrawals from the Chan above ..................... •s CALCULATE THE ENDING BALANCE (PmIA*Pan B•Parl C) ' This amount should be the same your churren Wier.. shown in your Checkntbaar................................. ......... s Line of Credit Information Each principal balance shown on the reverse side represents the unpaid amount of loan advances under your line of credit for that day and each day thereafter until a change In the principal balance is shown. The Finance Charge will be determined as follows: Determine the principal balance for each day dunng this statement period: then Multiply the principal balance for each day during this statement period by the daily periodic rate in street for such day; and Add these results It your account is subject to Balance Based Pricing• the daily periodic rate and on [he outstandingl balance annual t your account. Rate The dallyl be periodicmined each ate and corresponding APR applicable to each balance range are shown in the Summary of finance charges section on the reverse side. II your account is subject to a Promotional Discount, your total finance charge for the statement period is calculated by subtracting from the above described standard finance charge calculation a promotional Interest credit applicable to all Promotional Period net tadvances an he daffy balancesour ccount duri during the Promotional the lPeriod Youre. "net adding advances"are advances nn of and suhtrachno all oavments or credits that exceed the principal balance In your accountt aevan6e peaou ucyan r. um p.v......-..•• ...._. __. _. advance for each day during the Promotional Period in the billing cycle an dividing t Is number by the number of Promotional Period days in the billing cycle resulting In your average daily promotional balance Your average daily promotional balance Is then multiplied by the number of Promotional Period days in the billing cycle and by the daily periodic rate for the promotional interest credit rate resulting In the promotional interest credit. The promotional Interest credit Is then subtracted from the total finance charge at your standard rale(s) tooblain the total finance charge shown on the frontal [his statement. Any transacton charges or processing charges shown on the reverse side of this statement also must be added to arrive at the total Finance Charge for this period. Loan payments received after normal business hours will be credited the following business day. Normal business hours are posted In each office or branch and will be furnished upon request, or may be obtained by calling the customer service phone number listed on the front of this statement. In Case of Errors or Questions About Your Credit Line Transactions If you think your bill is wrong. or If you need more information about a transaction on your bill, write us at the address shown on the Iron) of this statement as soon as possible. We must hear from you no later than 60 days alter we sent you the first bill on which the error or problem appeared. You can telephone us, but doing so will not preserve your rights. In your letter, give us the following information: Yeur name and account number The dollar amount of the suspected error Describe the error and explain, If you can, why you believe there is an error. If you need more Information, describe the Item you are unsure about. You do not have to pay any amount in question while we are Investigating, but you are still ate your quobligated es on, we Cannot report yots of uur asdelinquent or lake e not In any action o Collect on. Whis we ithe amount you question. Spada) Rule for Credit Card Purchases. II you have a problem with the quality of goods or services that you purohesed with acredit card, and you have tried in good lailh to correct the problem with the merchant, you may not have to pay the remas, amount due on the golds or services. You have this protection only when the purchase price was more than $50 and the purchase wPas ma is in your home slate, or within 100 miles ,your mailing prfoperty off servlces,rell purchasesaareacovera eragaidlea, ofhamount lormocalont of purchase.) If You Suspect Errors or Have Questions About Electronic Transactions /Including Direct Deposit Advance Transactions) on Your Regular Deposit Account, please Call Us Immediately. or, If you believe there is an error on your statement or ATM receipt or )I you need more Information about a transaction listed on this statement, please contact us immediately. We are available 24 hours a day, seven days a week. Please call the telephone number printed on the front of this statement. Or you may write Lls at Wells Fargo Bank, P.O. Box 6995, Portland, OR 97228-6995. 1. Tell us your name and account or ATM card number. 2. As clearly as you can, describe the error or the transfer you are unsure about and explain why you need more information. 3. Tell us the dollar amount of the -suspected error. You must report the suspected error to us no later than 60 days after we sent you the first statement on which the problem appeared. We will investigate your question and will correct any error promptly. If our investigation takes longer than 10 business days (or 20 r the am unt you believe is in the case of s terror, ronic purchases) orthat you have uswe will e of the money ulntil our Investigour account ation is completed. ou do not Have to pay any If file error concerns a Direct Deposit Advance transaction, y amount in question while we are investigating, but you are still obligated to pay the parts of your Direct Deposit Advance transaction that are not In question. While we are investigating your question, we cannot report you as delinquent or lake any action to collect the amount you question. n Members FOIC. u'x w Clarification Record Applicant/Resident Name:: � or 4EW.r/ i '7 Date: /1 I0 3 ® Initial Certification Date of Expected Move -In ❑ Re -certification Effective date: 71 003 Means of Clarification: ❑ Phone Conversation Person -to -Person Conversation ❑ Other: Date of Clarification: 1/1/6-5 Contact Name: Taular ♦~\iiG H Company/Organization: �w6r*n le a s C..i Mar of Explanation or Clarification Given: V�riD a�, rl er►o1ruLZi^� -- Y' M . Employee Name: Title: As - Employee Signature: Date:_ -111 /0 3��L Unit Number 276 — New Certificates X I Recertl Aon INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This forth is designated to assist you in computing Annual Income in accordance withform is t in the,m«t set forth to date Department th HUD Regulations. All capitalized erns used herein shall have the me meaning should e� forth in the Retgulatory n that tAgr� is at all times up with CSCDA (Pool) - Newport North I/We the undersigned state that I/we have read and answered fully, frankly and personally each of the following questions for all persons who are to occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit. S. 2. 3. 4. I Relationship Place of Name of Members to Head of Social Security Employment Of the Household Age Number Household 6s� Nh�nrl 4r �+i9 t=iV�7• 11 �n � Pa�ric(tx_ �r1 .�-- JC5— g � 06 -5 - Income Computation h this h 6, of all ren under 18 6. years) list dtabove for the 12 month period beginning hed income, calculated in accordance tearlier of the date that I/we plan sto move into da unit or sign a lease for a unit is g -6 Included in the total anticipated income listed above are: ensation for (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other comp personal services, before payroll deductions; the rental of real or ion (b) the net income from expenditures for business expnsiofess n or amortization of capitaindebtedness or property (without deducting allowances for depreciation of capital assets); (c) interest and dividends (including income from assets included below and other net income from real or personal property); (d) the full amount of periodic payments received from social security, annuities, insurance policies, any, men funds, pensions, disability or death benefits and other similar types of periodic receipts, including ny.lump sum payment for the delayed start of a periodic payment; (e) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; r the maximum amount of public assistance available to the (f) above persons other than the amount of any assistance specifically designated for shelfgr and utilities; ents and regular contributions (g) periodic and determinable allowances, sad} as alimony and child support paym and gifts received from persons not residing in the dwellings; (h) all regular pay, special pay and allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the household or spouse; and (I) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; under (b) amounts which are specifically for or in reimbursement of medical expenses; including payments (c) lump sum additions to family assets, such as inheritances, insurance payments health and accident insurance and workers' compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational Institution, an amounts paid by the government to a veteran for use in meeting the costs of tuition, fees, books and equipment. Any amounts of such scholarships or payments to veterans not used for the above purposes are to be included in income; Applicant 7. 10. 1_.) (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (t) relocation payments under Title 11 of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970; (g) foster child care payments; (h) the value of coupon allotments under the Food Stamp Act of 1977; (i) payments to volunteers under the Domestic Volunteer Services Act of 1973; 0) payments received under the Alaska Native Claims Settlement Act; (k) income derived from certain submarginal land of the United States that is held in trust for certain Indian tribes; (1) payments on allowances made under the Department of Health and Human Services' Low -Income Home Energy Assistance Program; (m) payments received from the Job Partnership Training Act; (n) income derived from the disposition of funds of the Grand River Band of Ottowa Indians; and (o) the first 52000 of per capita shares received fromludgement funds awarded by the Indian Claims Commission of the Court of Claims or from held intrust for an Indian tribe by the Secretary of Interior. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necessary items of personal property such as furniture and automobiles and interests in Indian trust land) Yes No; or (b) have they disposed of any assets (other than at a foreclosure or bankruptcy sale) during the lastYwo years at less than fair market value? Yes X No ( c) If the answer to (a) or (b) above is Yes, does the combined total value of all such assets owned or disposed of by all such persons total more than $5,000' X Yes No (d) If the answer to ( c) above is Yes, state: (1) the combined total value of all such assets: S 12 5� 7' $ 2 (2) the amount of income expected to be derived from such assets in the 12-montanderiod beginning on the date of initial occupancy in the unit that you propose to rent: S 2 Sl. 76 (3) the amount of such income, if any,.that was included in item 6 above: S 25_ 1. % 6 _ (a) Will all the persons listed in column I above be or have been full-time student during five (5) calendar momhs of this calendar year at an educational institution (other than a correspondence school) with:regular faculty and students? Yes (b) Complete only if the answer to Question 8(al is "Yes"1. Is any such person (other than nonresident aliens) married and eligible to file a Joint federal income tax returns? Yes X No This certificate is made with the knowledge that it will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and Uwe declare that all information set forth herein is true, correct and complete and based upon information Ilwe deem reliable and that tstatement of total anticipated income contained in paragraph 6 he statem is reasonable and based upon such investigation as the undersigned deemed necessary. I/We will assist the Owner in obtaining any information or documents required to verify the statements made herein, including either an income verification from my/our present employer(s) or copies of federal tax returns for the immediately preceding calendar year.of the I/We acknowledge that all of the foregoing information is relevant to apartment status building for which i applicationtax , s being interest on bonds issued to finance the 271G of the aP made. We consent to the disclosure of such information to the issuer of such bonds, the holders of such bonds, any trustee acting on their behalf and any authorized agent of the Treasury Department or internal Revenue Service. �r I/We declare under penalty of perjury that the foregoing -is true and correct. 11 r� , 20,C� (year) in the City of PCWtxr� 'nC�.1 California .�i_ 1 � day of 11 Al. Applicant id (Signature of all persons (except children under the age of 18 years) listed in number 2 above requre) FOR CO?"L JnON By AFAR'TAmNT OYMR ONLY., 1, Calculation of e4ible income: a. Enter amount entered for entire household in 6 above.- b. (1) If the amount entered in' entered in 7(d)(2), subttac 7(dx3) and enter the rem (2) Multiply the atnoUL tt i ingsrae tiarinebooY savinc lire amount enM, �a 7(c PWA )above is yes, enter the total amount or, ''at figure the ==t entered in to , the current passbooY 1 t1 to determine what the total ® _ /(d)(1) would be if invested m _), subtract from that figure ) and -enter the remaining balance ($ (3) Enter at right the greater of the amount calculated under (1) or (2) above: c, TOTAL El.%G1BLP, INCOME (line l.a plus line I.b(3): 2. The amount entered in 1.c: Qualifies the applicant(s) as a Moderate -Income Tenani(s). Qualifies the apolicant(s) as a Lower-lncame Tenant(s)- Qualifies the applicant(s) as a Very -Low Income Tenaut(s). $ 36,731- 79 S N/A 36j731.7! 3. Number of apartment unit assigaed: 23 Q -- Bedroom size: Rent: $ 14 30 .00 — 4. This apartment unit ( F�Otww not) last occupied for a period of 31 or more consecutive days by persons 'whose aggregate anticipated annual income as certified in the above manner ucan their initial occupancy of the apartment unit qualified them as a Lower -Income Tenant(s). 5. Method used to verify applicants) income: x &rployer income verincadotyr Cootes of tax returns. 7/1107 Date -- -----'---_ --"--' -' INCOME," ^ 'SL'.r CALCULATION-- VVOI;-' =ET fi INCOME IMI�i_OYMENT — I IIj I I 1 I I ULILIC ASSISTANCE —yi--- I'allllly MOM). f/ "— — ! ! OTNEI2 INCOME- i I I —�-- I I i i "ram,• I ralollllJf— . lulnl-nduxl aiwlpu 1- ollly 111Wllla Ilmn A=N llvx I:I LACCed.DMLFROM0 0-m ltiply S Effedlvo Date 2LLy 9or.3 l:ux C exceeds $5,OUa-multiply , j Typo of Program 11. 1 n,,A, by Ilia curfunt passbook bltmost rate: X 2 % Unlf No. 27161 Uoitsizo 1+1 If Box E duos pot oxcoad $5,000 S ,� — No. of Pawns I untur-0- In bok G: BOX G: INPUTED INCOME I+111:y Mex.Inconm Limit $ 39 f$$o.0, PROMASSETS Aft' 1A0°k Limit 5 s 751. 7G l:lAm lhu glealal of Box 1: al llaxGin: BOXII: INCOME CONTRIBUTED rROld ASSETS �:l`Ol'!\L P.NNU.�L INCOME$ 6 Po.ou & TOTAL ASSETS $=2ELJ6 =$—_ice-7-,3-[��—__ I I --- C� 1I. no tat .�uv1Pr^�2J�C%>=rc, irk I(aLLLlunamp HOH sax dale or ulllU ri{7o Socloi suvufll% 0 —Pfr sduluni YL•S or NO I-:I11lIlY ':I;IIIU. Source Dase RatB Averagu Avcragc Annual tI S Flours 5x zn 2a 1z 1 Total INN SLfAl h1U-01-VJK I.I(1 YT( �.,— f Wr�lo.• rr L .•�c C.�• h � 5 00 ,_ — %C— S — _S�r-er-�..so_ Uoa A: •• Total SUCIAL SECURITY�PENSIONS. 6TC I :ITllly Source Dase Bate Avcragc AvuraDc Annual— ---- Id�nlU.0 S Flours 52 xa xc 1z 1 Total aL1A1LfU UI•V✓R MO Ylt — 7oWl Uoz U� P SourcD Uase Ratc Average Avcragc Annual ' Y I'IOUrs 5'L 2A 20 12 1 'total WK SUTA4Afl) UINdI( Llll —YII — -- S---- -S 'I ol. I Ooa C: I'umliy _ _ __Source Uase Rale Average Avenge Annual — ffloulU, yl $ Flours 52 2n za tz 1 Total wrc s[nn:MS .—L—�2(.'2s1iQLS+I.P.�,� S 2 9n nn Y --y-1$4.6BII.d,z Total fiox D 8 Soon O'I'AL ANNUAL CROSS INCOME A Through 0 nnnvnnnnnnnn :,_. •.36 c go�.[1rc _—..-. Asscl UDscupbun pnputuu/ Gross/Pair Cost to IVL'I' Adu'al Acl—ua!Nmual ',1CIIIIII'f (saving;, cllc(k(ug, stork;, sodas, CUrrCfll Mkt. Value Got Gd517 pellllly Assols II1tL`ff:at ICdellla ffe111 - 11 c0= I or C VAluo I?:tin A•.•.0!: _ ..L_ a�s52.zL_1n—cam)=-_ •A lsti�.�f �, �T�'s cr _ -r---- f uestionnaire Incone Restricted Certification Q L'nit- 27Q ame: mcS n Initial Cerdtic. r. It2-Ce.'a[.i'aaUr. - Oth-r "es 10 Question 4 ccc. 4cu ' scnnor,. ax or any OL. ails. L:cludi:._ rent or uci I pzy- z: s `v'z:eran's Adsini-..^: on. znston, a .. •. .... . Di=bil:;: Eznzf::. � FDC. Loczr: �'.'ir� �rzs, Inhz:.ta.^.--e o; _itiz4. I;vz ; czi e ir-corne proce fror.. Renr_! ,a:. g::•, c�I zad e; gzricdi: Social Security pay- =zrs. V - receive; is^.e3 :Come for faS1lV rr.'T['e5 ame i or Under. [ c;e a:z ectided to recely' CfS!d sap=Gr. pa;•rents. h!" ; o- ca; I c•e are cU:7 rtl nc:- r eff�rs PG COl!eCC Ck:l :•: rile. I •::e :±:e R Gtl:er:;sets (z::z lz. :1;.I `a•, zvoca '.e Trusts, -4, Bond;. Tr. Ber �IGney' �I°:tee[ aCCOI'nis, _... 1 RPaI Fstare) �• ; I:ave cash On. a-- v P.11 btt•uc a..•.+�••• Doe; ar household znr.cina a . •_ zco:^:n � _ _--- j;J;:Se� Old in'ti:e next 12 roam"' ev101:; rvG ll2;riOns are o:: ansv:ere� c_s to either of t e pr 4 po'a: a jn .'t tax return.\!atcied and f:l..._ a _lIonthly Income 213`tC.cc' i•ntler pennities or perjury, I certirc that fir information prevented oft this form is true and accurate to the best ofill'- l:^.et:9edge. TL+z undersianetl farther understands that pror•idll" rnlse rcpre;entation; I:erein constitutes an act or mud. False. misleading Gr it eG:uplat, inrorn!ntio❑ ;:ill res 4 t i ! the deuitr4 aPPlication or termination or t}u' ittcGnte rest, le, agrzement. \ Date/3 — r Date _�— L' � ....., i:;tx•-� 1 b'ER1F1Cr�1'101 � . LTED B1' TENANT � TH1S SSC It6t; TCti COMPLETED fit' DaT'�� eE addras of empiuycr) m S�oo� b-- —.—_ ...... .... — a — $58_o6'3456 RE: Pp� ri Ci cL- _arm �--- A77hcanc rtnar.: "ar..t . e reieas_ ni !Yloynent :n c"- z sun. J hereby utho ,}•-� /(� D:tt I J.Snatorc of.�7j;ie:nL reran• ( cur.:'•c.'t of a .`.ouiin G an;rpr tha: rejwres yea�cat:on of :ncnme Tnt .nforanon e:rnnded n'•!• ( p ras onst is :racial and Fe�' z"'"''°°d The fnd;n idual named dr. eedy atava Is as s aped, rcrs,.: eenlidao:i'd r^ tn,ii`OClion oftha: s:atad pmpcsc only. Yoar ompt p i r--r ? � _ �•— I �1�}� a2b6a �- fN; e<t Gn'nenM¢nagsmer.: ABc:¢ \�_W ,��.}• Return Form To: _,(.�iJ',' of Ellptoymenl l I ` t.,y. D'a;e First Employes — t,t,1,y yearly present:c Emp:u, ee. Pucrly ayetkly bi-teat}:); semo-rnonlhl: .� i (.•.role one} ' tt:roua}:�`�—'• Oar. en N'aees:S¢iary: 5 -- 1'eu•to•dale eamiays: S� wool i_� Axcragc � of regular hrc•s per - _-- _ - - pf owrlime ftatlfi pet v:acL•:.—�- - -- --- - --- -- iV twanime Raper haur se: AvMge d o:'shift diffetca:ial hour. per wra:. —..— per hot.: yealy oincr_�-- shiit f)il'R ndal Fate S_ haurlp wee'nl} ti.waesly senti•mct.tltly month)} oti:er. $�lchcleenq r,•� .Ef;cctivcdare:__s Crnnmis;ians, bonuses, uPs, oths: � V _—�-�' in the ample} ce s r;.tc of pay "whir. the n:.ct 12 mo------• r �;.;; •_.y amicipa:ed change - aadt., +:last trcc:de fnt I¢yoff Paned{si• ------- ..._ If &t err ploycc's «•ark 1�se:+tuna ur sp } Addrt— �N ititi �t matks .— � r�L•r-tP�' — Er---` u Cl •- G•vr'-'C�1.—S.�-r't;;.y.i;,::arca:d.Wd::t=-- ,y! _2Q-_ _ ,r«= to r}'Dc.�art•r�n: o-At:ct•. nt]{:^"5 ar J S. e.Ode ^ai:ci n, a •„ a, o.••"- ... _ o-r.e•mbtr _ It p;I%,Tile:^a eft ...,. ,. ,,., KOT f.: S,; ;.L°.: . ....... ... .. . ^ ,r•e:.�ithir. ut l.nid 94972015 Jun 23 03 11:18a tIEWPD"T N Newport North Apartments 2 Milano Dr. Newport Beach, GA 92660 (949) 720-8765 (9499) 720-1598 FAX Verifi__ atio oof__ _ Fa Support Address: 27161 A N wv ort Beach CA 92660. 11:18am P. 001 P^2 am receiving a monthly family support payment in the from jC�1 _3 L—� = Social Security Number amounta£S ? �q0. I hereby certify under penalty of perjury that the information provided above is true and complete. Signature of recei '",� Signature ofprovi VCr: � der: Siatc of ca,' om1 C County or __�� day of LT4% 0— h20 California. Signed before me tis ban and se.'d office. _ r To certify which witness my cLll ( ctV! iM i/reSe lCL ecrsr'� U N ry public i an f r the said my and Staf .�— SONIAI.At4fARitfHl p CommsnignR13SS918 s NotgrpPublic-Cgllfamiq ly ommission expires on: t�"rwdscou* �^.,�n � N(yGr,::m.Explrea.4l?.7,29L19 Yl MrunuMl PAGE 02 8 N 06/11/2003 11:52 925-672-4398 AIM MAIL CENTER CONC SO (��(' 4dsloFl f A C C 4 u N 7 S 5 wt Nwn6w. 6SIODS823 uNON BANK OF CAUFORNIA 4/5/03. 5/5/03 638 7 T.Leervias® ! POCO COXD512�38T8RE Las AWOELES CA 94053-e3ee For 24hour Awomcled DIr"I Service 800.238.4486 80008267345(TDD) Reprosenialivos are available liom 6 am to 1 I pm v To open addWonal accounts, or apply for loans, call your j banking office at 925.246.64p0 CY03 Z oA D230 PATRICIA A SUTHERLANO Visit us of www.uboc.com 3 BARCELONA WAY CLAYTON CA 94517 Thank yov lot banking with us elrxe 1995 ® An easy number. A roli•free number. An anything your heart desires number. When life is calling lot a new houso, car or a great gel away vacation, call 1.866-U840ANS for an equity, home or auto loan today. In Balance, on 4/3 $ 1,352.21 Additions 1,505.00 Subtractions •760•00 Checks •260.00 Payments 40000 Babnw on 5/5 2,097.21 Slolamam Average ledger Balance $ 1,726.24 We waived your service charge this statement period. 4/7 OFFICE DEPOSIT 9ODOOD90416 ----4/14--OFFICE DEPOSIT-;Y0000420555—___-_-_ 4/16 OFFICE DEPOSIT p 000042OS86 Total y Ncmber Date Refewnd Mom) , 000354 4/9 B0112808 j 260.00 �r$s D te Dwalyt'on and 4%7 TRANSFER TO ACCOUNT NUMBER 0713891877 2nic banking 438IA205 $ _ ______42712519__- 42802089 65037091 $ i Z 06/11/2003 11:52 925-672-4398 AIM MAIL CENTER CONIC PAGE 05 STAT Ek�)NT OF ACCOUNTS UNION DANK OF CALIFOXNA IXVINE 124 ra BOX 512300 Lao ANOELE3 CA 90052-0330 CY07 M 210230 PATRICIA A SUTHERLAND 3 BARCELONA WAY CLAYTOM CA 94517 `erGge 1 of 3 Slnhment Member:1241023231 3/12/03.5/9/0"{�—� Telwnic.s� For 24hour Automated Dirad Service 800,238.4d86 800.826-73451TDD) , Representatives are available from 6 am to I 1 p%, To open additional accounts, or apply for loans, call your banking office at 94900-0584 Visit us atwww.uboc.com Thonk you for banking with us since 1995 ■ An easy number. A rollfree number. An anything your heart desires number. When life is calling for a new house, car or o grool gar away vacofion, call 1.866-U&LOANS loran equity, home or auto loan Icdoy. i s in statemenl period: 69 ' he account service 6� low are the A wolver is based otn your previous statement's llify Average edgervaiver of your Balance for your designated combined accounts and Ihaccurrent A rags ledger Bolanoe for this primary account, (Note: IF any of your desi9naiad accounts is a time dep03144ipn the previous d 's lime deposit balance from•Ihe dole shown on this statement will be used toward computing your Combined'9alance.) i . , , :t'ndine bola Rthulor Checking 1141023231 ular Savings D 13891877 v oveltrying bw6n . - on 302 $ 120.29 $ 68.59 S 500.00 S 524:97 b d3.62 10,986.99 $ 11,107.28 5 48.59 5 $00.00 S •524.97 S 43.62 Account Numbe : 12I102321 1 UMA9ARY Balance on 3/12 5 68,39 500.00 Addlllons 524,97 Subtractions Checks S24 97 Balance on 5/9 5 43.62 Sysiemenl Average Ledger Balance $ ) 20.29 We waived your service charge this siotemeni period, 4/14 TRANSFERFROM ACCOUNT NUMBER 0713891077 65022272 $ 6VU.UD Number Date RsAnna Amaunr Nvmbr Data R.I.nna. Amoy~ 1201 4/21 IOA29622 $ 500,00 1202 A/22 144409545 4 52A. Total l i M 925 672 8619 P.01 J .1N-11-2003 02:11'PM JOHN�-PRTTI. HRYERKRMP ,,� i image 2 of 3 skhment Nw6 r! 1241023231 3/12/03.5/9/03 Int'rrrmgfion and lankma (>Hfa Sa^riea Fa►awteh maMhly shtfemenf periai yarn acsaunJ inefudea; ■ Unlimited has Information Services calla 10 24-hour Automated Direct Service a 3 from Information Services C0113 Io Speak with Peraanal Service ■ 3 flee banking offiee Information Servlcoa Calls e 5 free bonking office deposits Your account wo: not charged for ink mafion and banking office services during the statementperiod. P.04 JUN-11-2003 02:07 PM JOHNtPRTTI.HRWERKRMP F M d• ruuliwwM�� 3 &(e6si+Wa,1 -1201 ,mr-mn.w.re• y..P.ww, hYLN•V.I6r�jW'1� MAI { ,Q1%�'x�s ••� ^uL�al�;.t.�S.I,>fhcrlt1,x1..._� ,•w mnirw�rwaw r.,uen� Ci1t000496�:It4iU2]13 925 672 8619 Page 3 of 3 Statement num6ar 1241023231 3/12/03.5/9/03 rmiTM g '��".\ctlnw k1tm1 1202 6f\ 2iiiF0 Ate � Asset Calculation Worksheet Name Account Type OurLas 12 4 10 23 (+) divided by (average account balance) ( X) Interest rate: % (_) Income from asset: $ eo, a Asset Calculation Worksheet Name ri ,2719f VYlurscel� Account Type Say �� �� �� f3�9IS77/ Vnfn� �r�F n.� CQIi-nis. IG,9S6.a4 (_) 10, 9,06. 9Q divided by 'I (_) 10,936•q� (average account balance) ( X ) Interest rate: % (_) Income from asset: $ C-/ Asset Calculation Worksheet Name Ipr 'i c h Su%1� �Irnf� _ 271q ✓hCt Y 9^i,r� , Account Type C�rt2cki�a 3� 1ao s� 23 - 41G )7.21 (+j Z10q-7. 21 -------------- 42 divided by, % (average account balance) ( X ) Interest rate: % _ 1011 (-) Income from asset: $ 10' qQ C��1 ir, @6111/2003 11:52 925-672-4398 AIM MAIL CENTER CONC PAGE U3 STATE ''NT "'.Al OF A C Cad LI N T S SlownentNumbw:63SIOD5823 r UNON RANG OF CAUFORNA 5/6/03. 6/d/03 COWDSO INSTORE 638 TeleserviaesQD !o BOX 512340 10 LOS ANGELES CA 90452-0380 For 24•hour Automated Direct Service , statement 600-238-AAO 800-826-734SRDD) Represenkdives are available from 6 am to I 1 pm i a To open additional accounts, or apply for loans, cull your CYW Z OA0000 banking office at 925.246.6400 PATRICIA A SUTHERLAND Visit us at wwW.ab0c'COm , 3 BARCELONA WAY CLAYTON CA 94517 Thank you for banking with us since MS ® News this goodneeds to be shared with everyonol Online Bill Pay with Bonk9PHame(&oat ilia WBB is now Free k Spend less time paying bills and have grearer control over your finances. To gor startdd log on to UBOC.cominstant or contact an Online Bonking Specialist at 8047965656, option 1. 'Basic checking account holders: Restrictions may apply. For derails, see ilia description of your account in our di.clo.uro and agroamaui. t CRY Account Number: 638100589 Balance on 5/6 $ 2,097.21 Additions 450.00 Subtractions •1,530.00 Checks A30.00 Other wllhdravrols -1 100 00 Bolan on 6/4 $ 1,017.21 StatemonlAverage Lodger Balance $ 1,725.B7 We waived your service charge this stalement period. 5/7 OFFICE DEPOSIT a ODDOA22041 42919327 $ 000356 5/13 89039019 $ 430,00 fees and 3/23 WITHDRAWAL # 0000817437 42821515 $ 1, c Clarification Record 1•� iGi S�,K. \mri Date: C I l_ Applicant/Resident Name: 1 C } X Initial Certification Date of Expected ylor•e-In: f_-- 121 63 - r lI Re -certification Effective date: Tb`qe 2C 3 :deans of Clarification: j?0 Phone Conversation J Person -to -Person Conversation Other; Date of Clarification: Contact lame: Company'/Organization: Summary of 'S ' Clarification: R6132i �,' r' Pill Explanation or Clarification Given: �� r r 1 Title: Yi5i - x --� En1ployee Name: la, Q.Date: b /— Employee Signature: 5 ,1 � '• • r% . %jam ' ;N :`' v New Certificates / Re6�cation UnitNumber INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This fore is designated to assist you -in computing Annual Income in accordance with the method set forth in the Department of Housing and Urban Project ("HUD") Regulations (24 CFR 813). You should make certain that this form is at all times up to date with the HUD Regulations. All capitalized terms used herein shall have the meaning set forth in the Regulatory Agreement. CSCDA (pool) - Newport North I/We the undersigned state that I/we have read and answered fully, frankly and personally each of the following questions for all persons who are to occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit. 1 2 3. 4.5. Name of ivlembers Relationship place of Of the to Head of Social Security Household Household Age Number Employment iiCarJ 0 _�y7-04-242G c•,,� f�MaSclml YJiy{. Ines ►17a}ha= -13 602 -4a-3W SST Income Computation 6. The total anticipated income, calculated in accordance w ith this paragraph 6, of all persons (except children under 18 years) listed above for the 12-month period beginning the earlier of the date that I/we plan to move into a unit or sign a lease for a unitisS C•11 SS'�•a2 Included in the total anticipated income listed above are:j (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real or peisonal property (without deducting expenditures for business expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets); (c) interest and dividends (including income from assets included below and other net income from real or personal property); (d) the full amount of periodic payments received from social security, annuities, insurance policies, retirement funds, pensions, disability or death benefits and other similar types of periodic receipts, including any lump sum payment for the delayed start of a periodic payment; (e) payments in lieu of earnings, such as unemployment and disability compensation, �voikers' compensation and severance pay; (f) the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter and utilities; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions -_a ,-: n_ _......:,,,,.i �.,,,,. .,r.�rn�.,rt rrcidino in thr dwrllinac• 1 1 (e) lFl Y v hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile Fire; relocation payments under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970; foster child care payments: the value of coupon allotments under the Food Stamp Act of 1977: payments to volunteers under the Domestic Volunteer Services Act of 1973; payments received under the Alaska Native Claims Settlement Act; income derived from certain submarginal land of the United States that is held in trust for certain Indian tribes; payments on allowances made under the Department of Health and Human Services' Low -Income Home Energy Assistance Program; payments received from the lob Parmership Training Act; income derived from the disposition of funds of the Grand River Band of Ottowa Indians; and the first 52000 of per capita shares received from judgement funds awarded by the Indian Claims Commission of the Court of Claims or from held in trust for an Indian tribe by the Secretary of Interior. 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necessary items of personal property such as furniture and automobiles and interests in Indian trust land) _ Yes X No; or (b) have they disposed of any assets (other than at a foreclosure or bankruptcy sale) during the last two years at less than fair market value? Yes --A—NO (c) If the answer to (a) or (b) above is Yes, does the combined total value of all such assets owned or disposed of by all such persons total more than 55,000? Yes X No (d) If the answer to ( c) above is Yes, state: (1) the combined total value of all such assets: S (2) the amount of income expected to be derived from such assets in the 12-month period beginning on the date of initial occupancy in the unit that you propose to rent: S I , and (3) the amount of such income, if any, that was included in item 6 above: S 8. (a) Will all the persons listed in column I above be or have been full-time student during five (5) calendar months of this calendar year at an educational institution (other than a correspondence school) with regular faculty and students? Yes X No (b) Complete only if the answer to Question Sfa) is "Yes"), Is any such person (other than nonresident aliens) married and eligible to file a joint federal income tax returns? Yes X No 9, This certificate is made with the knowledge that it will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and I/we declare that all information set forth herein is true, correct and complete and based upon information IAve deem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. 10. I/We will assist the Owner in obtaining any information or documents required to verify the statements made herein, including either an income verification from my/our present employer(s) or copies of federal tax returns for the immediately preceding calendar year. II. I/We acknowledge that all of the foregoing information is relevant to the status under federal income tax law of the interest on bonds issued to finance the �✓2 12 U42L-3 of the apartment building for which application is being made. We,cbnsent to the disclosure of such information to the issuer of such bonds, the holders of such bonds, any trustee acting on their behalf and any authorized agent of the Treasury Department or Internal Revenue Service. I/Wc declare under penalty of perjury that the foregoing is true and correct. Executed this 31 s4 day of T U 11 , 2o6 _ (year) in the City of N� California Applicant X ApplitfbnPl nnn ICa ,:.,.. FOR COMELMON BY AYARTIM[EN T OAR ONLY! 1. CalcalatSon of eligible !name: a. E=r amount entered for entire hou_rhold in 6 above: S b. (1) If the amount entered is 7(c)above is yes, enter the total amount entered in 7(d)(2), subtract fromVO ''t figure the amatnt entered in 7(dx3) and enter the Tema°zinca (2) Multiply the amotu. % ins the current passbook savings rate -� e to determine what the total annual earain(d)(1) would be if invested in passbook savM __ ), subtract from that figure the amount eute. a 7(a)(3) and enter the, remaining balance ($ ry (3) Enter at right the greater of the amount calculated under /� (1) or (2) above: S 9 //AAA c, TOTAL ELIGIBLE INCOME (line La plus line l.b(3): $ f'1� � �S 1 •�! ? l 2. The amount entered in l,c: Qualifies the applicant(s) as a Moderate-lncome Ter ant(s). Qualifies the applicant(s) as a Lower -Income Tenant(s). 1 Qualifies the applicant(s) as a Very -Low income Tenant(s). 3. Number of apattment unit assigned:. 2319 Bedroom size: 2+ 2-• Rent: $ 12 7j • O e — A. This apartment unit (ias not) last occupied for a period of 31 or more consecutive days by persons whose aggregate adtieipated annual iacome as certified in the above manner won their initial occupancy of the apart rb=unit qualified them as a Lower -Income Tenam(s). S. Method used to verity applicants) income: Employer income verh3cation. Cooles of tax returns. .". .. _ •jam � _We +enruorr imputed/ Gross/Pair _ Member (savings, checking, storks, bonds, Current Cos''o N: Aclual 'erQ Mk(. Valuo Gel Cash Family Assets In'erect nlncomor from Valuo T 86F,R f .T,= _ Ralo I .J Income Restricted Certification Questionnaire I Name: � G r ✓ Initial Certification Re -certification Other N uestion Unit #__C93� Monthly Income Yes o Uwe receive Family Support, Spousal Support, and/or any other cash contributions of gifts, including rent or utility payments fro ersons not livingwith me. e receive Veteran's Administration, Pension, Unemployment benefit, Disability benefit, AFDC, Lottery winnings, Inheritance, or Annuities. Uwe receive income from Rental Property, I/we receive benefits/income from Social Security to include SA, SSI and/or periodic social security payments. The household receives unearned income for family members age 17 or under. I/we are entitled to receive child support payments. e am currently receiving child support payments. I/we am/are currently making efforts to collect child support owed to me. it have other assets (example: 401K, IRA, Revocable Trusts, tocks, Bonds, Treasury Bills, Money Market accounts, C ificate of Deposits, Whole Life insurance, Real Estate we have cash on hand. Student Status: Does the household consist of persons who are all full-time students (example: College/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 ou: D Married and filing a joint tax return. Under penalties of perjury, I certify that the information presented on this form is true and accurate to the best of my knowledge. The undersigned further understands that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information will result in ie denia plication or to minatio of the income restricted lease agreement. 0 3 Resident Signature Date Signature of Owner/Agent Date 1J Earned Income Calculation Worksheet Employer SQn 3,r, 14nw 3choeJ OIsAr i r-A Most Recent Ending Pay Period Date Hire Date F�16 / 30 A3 YTD Income M 31Q.00 divided by iz Start with hire date if at job for less than a year (_) Iy43.2S (how often paid) (x) I a C, Calculated Annual Income N,43$ r- - Gross per Pay Period F—t 25 3. ?-5 (+) 11 L 5.2. Z S 21,504. 50 divided by 1 Q (_) 'fir 25 3. 2 S- (how often paid) (X) L 2-4 1 (=) Calculated Annual Income 30,4-79r ..�_... 9i , a .. • ,iM. FIf E . 'DEpT Ct;'009..VCHR tJo: Wd :, HNG ',000258 800,.' 1000260049;1:1,,, ST. ANNE SCHOOL 32451 BEAR BRAND ROAD LAGUNA NIGUEL, CA 92677 Taxable Marital Status: Single Exemptions/Allowances: Federal: 2 •• State: 2 Social Security Number: 547-04-2429 arnings rate hours this period year to date egular 1253.25 1,253.25 17,319.00 prose pay 17,319.00 )eductions Statutory Federal Income Tax -117.99 1,664.55 Social Security Tax -77.70 1,073.78 Medicare Tax -18.18 251.13 CA State Income Tax -28.87 397.72 CA SUI/SDI Tax -11.28 155.87 Other Chking -999.23 'Net pay .. . $0:00 ' Your federal taxable wages this period are $1,253.25 Earninr` Statement Period Beginning: 05/16/2003 Period Ending: 06/30/2003 Pay Date: 06/30/2003 LETICIA DELGADO 1927 HARBOR 13LVD- #248 COSTA MESA, CA 92627 I 4U. rlLu. uii!t. ulygK VUHR'NU+•470 HNs, oagzss.aog , Qogg2goo5s.:r. Earnings Qtatement ST. ANNE SCHOOL 32451 BEAR BRAND ROAD LAGUNA NIGUEL, CA 92677 Taxable Marital Status: Single Exemptions/Allowances: Federal: 2 State; 2 -/ Period Beginning:" 05/01/2003 Period Ending: 05115/2003 Pay Date: 05/15/2003 Social Security Number: 547.04-2429 Ings rate hours this period ilar 1253.25 1,253.25 Caross Pay' uctions 2 i2 0ry eral FedIncome Tax Social Security Tax Meoicare I ax CA State Income Tax CA SUI/SDI Tax Other Chking Nef. Pay . Your federal taxable $1,253.25 year to date 13,559.25 LETICIA DELGADO 1927 HARBOR BLVD. #248 COSTA MESA, CA 92627 Asset Calculation Worksheet NamWe Account Type C e .� ra - 24315 - 27.5y (+) 1u5,62 divided by 2 (average account balance) (x) Interest rate: % P� 6ankofAmerica. 2431 EO-3 0 LETICIA DELGADO INES GAMBOA 82 BERKLEY IRVINE CA 92612-4614 Our free Online Banking service allows you to check account balances, transfer funds, pay bills and more. Enroll at www.bankofamerica.com. ❑ Summary of Your MyAccess checking Account Beginning Balance on 06/13/03 $145.62 Total Deposits + 656.66 Total Checks, Withdrawals, Transfers, Account Fees - 774.74 Ending Balance $27.54 ❑ Important Information About Your Account Your Bank of America MyAccess checking Statement Statement Period: June 13 through July 15, 2003 Account Number: 24315.04669 At Your Service Call: 714.973.8495 Online: www.bankofamerica.com Written Inquiries Bank of America Eastbluff Branch PO Box 37176 San Francisco, CA 94137-0001 Customer since 1998 Bank of America appreciates your business and we enjoy serving you. Number of ATM withdrawals and transfers 3 Number of purchase transactions 17 Number of 24 Hour Customer Service Calls Self -Service Assisted In September we will make changes to the information describing automated clearing house transactions posting to your account. These technical changes provide you with more reference information in an easy -to -read format. ❑ Bank of America News Marc Chagall at the San Francisco Museum of Modern Art July 26-Nov 4, 2003 ONLY U.S. VENUEI Bank of America is proud to sponsor the Marc Chagall exhibition. Visit SFMOMA for the retrospective of this universally renowned artist including many works never before seen in this country. For tickets, visit ticketweb.com or call 866.468.3399. Now, Online Banking lets you monitor your money in real time and view up-to-the-minute account activity. You can track transactions throughout the day - from ATM deposits and withdrawals, to Check Card purchases, direct deposits, loan payments and more. Access Online Banking at www.bankofamerica.com. Sign up for direct deposit and get faster access to your pay or any regularly recurring deposit. If you haven't yet discovered direct deposit, you're missing out on one of the most convenient ways to have access to your money. There is no sign-up fee and no monthly charge. For more details, visit www.bankofamerica.com/directdeposit, Continued on next page Page"I of 3 0076151.00 LT I California 'l ,• 'et • • 1' Bank ofAmerim 'rs"s ®� Statement Period: June 13 through July 15, 2003 LETICIA DELGADO LETI I Account Number: 24315-04669 ADELG INES❑ Branch/ATM Deposits Number Date Posted Amount 06/24 : $/25.00 ❑ Account Activity Dale Reference Number Amount Pasted Descriptlan D6/24 D6/30 07101 06/13 O6/13 06/13 06/16 O6/19 06120 06/23 06/30 07/01 07/01 07/02 07/02 07/07 07/07 07108 07/08 07/09 07/09 07111 Deposits and Credits NSF Fee Reversal Telephone Transfer from Checking 10203-05298 CSR SUPP SEC US Treasuryy 310 Cc ID: 3101736121 Leticia Delgado For ID# Xxxxx3523 SSI Ref:000031209587601 Total Deposits and Credits Withdrawals, Transfers and Account Fees Cash withdrawal on 06/13, ## Purchase on n 06/13 e(Card #281212779)(Card #281212779) Purchase on 06113 (Card #281212779), Wildcats Irvine CA Purchase on 06114 (Card #281212779). Albertson's #6507 Irvine CA Purchase on 06/18 (Card #281212779), Trader Joe's # 11 Irvine CA Purchase on 06/19 (Card #281212779), Ralphs 5331 nive Irvine CA Insufficient Funds Fee Purchase on 06/29 (Card #281212779), Ralphs 5331 Unive Irvine CA Purchase on 07/01 (Card #281212779), Web Laundr105 COR Irvine CA Purchase on 07/01 (Card #281212779), Albertson's 6507 Irvine CA Purchase on 07/02 (Card #281212779), Web Laundr105 CO Irvine CA Cash withdrawal on 07/02, Bank of America ATM #243101 (Card #281212779) Purchase on 07/06 ( Albertson's #. Purchase on 07/07 ( Mothers Mt/l< Purchase on 07/08 Trader Joe's Cash withdrawal on Bank of Amei Purchase on 07109 Trader Joe's Purchase on 07/09 Ralphs 5331 Purchase on 07111 CA Irvine CA ATM ##383613 (Card #281212779) d #28i212779). 1 Irvine CA d #281212779), ie Irvine CA d g28'212779),0 002656 101085 937843 643801 614446 507324 561206 308817 644708 322769 004734 667631 145514 615569 006858 657342 746670 027479 $28.00 25.00 578.66 5631.66 $20,00 26.73 45.84 6.99 43.78 26.88 28,00 22,78 10.00 27.28 10.00 200.00 4.27 23.20 22.24 200.00 6.72 22,58 6.96 BankofAmerica. LETICIA DELGADO Statement Period: June 13 through July 15, 2003 LETI I ADELG Account Number: 24315-04669 INES❑ Bank of America: In Balance To assist you in reconciling your account, we have provided the following summary information. A reconciliation worksheet is printed on the reverse of this page. a • Your ending balance from this statement..................................................................................................................................$27.54 • Subtract Insufficient funds fees from your checkbook register...............................................................................................28.00 ❑ ATM Information This period, you visited the following ATM locations: Bank of America's ATM Network • #098701 Westcliff Plaza, Newport Beach, CA • #243101 Eastbluff, Newport Beach, CA • #383613 Santa Ana Main Op, Santa Ana, CA Z 0076151 003.T11 California Page 3 of 3 Bank ofAmerica. " 2431 EO-2 LETICIA DELGADO INES GAMBOA 82 BERKLEY IRVINE CA 92612-4614 J Your Bank of America MyAccess checking Statement Statement Period: May 14 through June 12, 2003 Account Number: 24315-04669 At Your Service Call: 714.973.8495 Online: www.bankofamerica.com Written Inquiries Bank of America Eastbluff Branch PO Box37176 San Francisco, CA 94137-0001 w Customer since 1998 _ Our free Online Banking service allows you check account balances, Bank of America appreciates your transfer funds, pay bills and more. Enroll at ww.bankofamerica.com. business and we enjoy serving you. ❑ Summary of Your MyAccess checking Account f 1 Beginning Balance on 05/14/03 $208.72 Total Deposits + 578.66 Total Checks, Withdrawals, 641.76 Transfers, Account Fees Number of ATM withdrawals and trans ers Number of purchase transactions Number of 24 Hour Customer Service Calls Self -Service Assisted 10 , 1 0 Ending Balance $145.62 ❑ Important Information About Your Account 1 Remember MyAccess checking is free with direct deposit. To avoid the monthly service charge, simply set up a monthly direct deposit, such as a payroll or social security check, to your account. Learn more about direct deposit by calling us at 1.800.900.9000 or stopping by any Bank of America banking center. Need cash? As a valued Bank of America customer, it is easy to get to your money with free access to America's largest bank -owned ATM network. Bank of America has nearly 13,000 ATMs across the country. Visit www.bankofamerica.com to locate an ATM near you. ❑ Bank of America News Track transactions as they occur - Online. With Online Banking you can view your account activity throughout the day - no waiting on your monthly statement. See your ATM deposits and withdrawals or Check Card purchases from stores and restaurants within minutes of Bank of America, -% LETICIA DELGADO INES GAMBOA ❑ Account Activity Date Posted 05/30 05/15 05/19 05/19 05/22 05/22 05/23 06/02 06/04 O6/04 06109 06/10 06/12 Statement Period: May 14 through June 12, 2003 Account Number: 24315-04669 Description d Deposits and Credits SUPP SEC US Treasury 310 Cc ID: 3101736121 Leticia Delgado For ID# Xxxxx3523 SSI Ref:000003902294301 Withdrawals, Transfers and Account Fees Purchase on 05114 (Card #281212779), Mothers Mt/Kitche Irvine CA Purchase on 05/19 (Card #281212779), Albertson's 6507 Irvine CA Purchase on 05/19 (Card #281212779), Trader Joe's # 11 Irvine CA Purchase on 05/21 (Card #281212779), Wildcats Irvine CA Purchase on 05/21 Card #281212779), Albertson's 6507 Irvine CA Insufficient Funds ee Cash withdrawal on 06/02, Bank of America ATM #120501 (Card #281212779) Purchase on 06/04 (Card #281212779), Wildoats Irvine CA Purchase on 06/04 (Card #281212779), Mothers Mt/Kitche Irvine CA Purchase on 06107 (Card #281212779), Mothers Mt/Kitche rvine CA Purchase on 06/10 (Card #281212779), Albertson's 6507 Irvine CA Purchase on 06/12 (Card #281212779), Albertson's 6507 rvine CA Total Withdrawals, Transfers and Account Fees Reference Number 161660 628270 627471 245555 659036 009522 527395 132995 002808 620488 644435 Amount $578.66 $49.07 23.12 54.14 45.82 56.71 14.00 200.00 40.32 57.20 23.65 26.98 50.75 $641.76 ❑ Bank of America: in Balance To assist you in reconciling your account, we have provided the following summary information. A reconciliation worksheet is printed on the reverse of this page. • Your ending balance from this statement.................................................................................................................................$145.62 • Subtract insufficient funds fees from your checkbook register................................................................................................ 1400 ❑ ATM Information This period, you visited the following ATM locations: Bank of America's ATM Network. • #120501 Newport Hills, Newport Beach, CA 0075200 002.T1i California Page 2 of 2 co Recyded P. � "yr 'f V Asset Calculation Worksheet Name Account Type 1020-05M C G6�.oy divided by 2 53fr.2y' (averaae account balance) Bank of America. s LETICIA DELGADO 82 BERKELEY IRVINE CA 92612-4614 1020 EO-3 Our free Online Banking service allows you to check account balances, transfer funds, pay bills and more. Enroll at www.bankofamerica.com. Your Bank of America MyAccess checking Statement Statement Period: May 23 through June 23, 2003 Account Number: 10203.05298 At Your Service Call: 949.837.3492 Online: www.bankofamerica.com Written Inquiries Bank of America Newport Center Branch PO Box 37176 San Francisco, CA 94137-0001 Customer since 1998 Bank of America appreciates your business and we enjoy serving you. ❑ summary of Your MyAccess checking Account 2 Beginning Balance on 05/23/03 $723.20 Total Deposits + 2,873.66 Total Checks, Withdrawals, 2,g35.81 Transfers, Account Fees Ending Balance $661.05 Number of ATM withdrawals and transfers I Number of purchase transactions 20 Number of 24 Hour Customer Service Calls 10 Self -Service 0 Assisted ❑ Important Information About Your Account , Remember MyAccess checking is free with direct deposit. To avoid the monthly service charge, simply set up a monthly direct deposit, such as a payroll or social security check, to your account. Learn more about direct deposit by calling us at 1.800.900.9000 or stopping by any Bank of America banking center. Need cash? As a valued Bank of America customer, it is easy to get to your money with free access to America's largest bank -owned ATM network. Bank of America has nearly 13,000 ATMs across the country. Visit www.bankofamerica.com to locate an ATM near you. ❑ Bank of America News Track transactions as they occur - Online. With Online Banking you can view your account activity throughout the day - no waiting on your monthly statement. See your ATM deposits and withdrawals or Check Card purchases from stores and restaurants within minutes of making them. Access Online Banking at www.bankofamerica.com. .. _1...... n--I, -f A..,—;— r6e111 r-M(Pl is a tnn nrinrity for us it is ati 4�. ' .Yi• --------------------- BankofAmerica. Statement Period: May 23 through June 23, 2003 LETICIA DELGADO Account Number: 10203-05298 ❑ Branch/ATM Deposits Number Date Posted Amount •Number Dale Posted Amount 06/09 $ 529.46 Total of 2 geposits $781.46 O6/13 252.00 ❑ Checks Paid Gap in check sequence Date Paid Number Amount Date Paid Number Amount 06/12 1 $ 200.00 06/20 225 32.09 $626.39 06/19 .5 358.00 Total of 4 Checks Paid 06/20 " 224 36.30 ❑ Account Activity Reference Number Amount Dale Posted Description Deposits and Credits Check Card Purchase Cr Adj on 05/21(Card #287850515). $96.76 05/23 Nordstrom -Rack #03 Costa Mesa CA 05/30 Ref.# 1000000190066128 Payroll St Anne School Cc ID: 9111111101 Delgado,Leticia Lin 996.20 ID# 075001392783hn6 Ref:000053796824900 Pa St Anne School Co ID: 9111111101 Delgado,Leticia Lin 999.24 06116 roll IDZ 681000564876hn6 Ref:000079875216300 $2,092.20 Total Deposits and Credits Withdrawals, Transfers and Account Fees 833472 $10.01 05123 Purchase on 05/23 (Card #287850515), 05/27 Mobil Oil Cr l Mr CA Purchase on 05/25 (Card #287850515), 450008 37.66 Marshalis Marshal Costa MesaCard CA 250.00 O5/27 Check Ver'z n W reless 800-922(0204 "NJ87850515), Ref # 1000000190258546 237833 68.14 05/28 Purchase 05/28 (Card sAngeles )CA Fiesota And Follklo Lon 008394 100.00 05/28 Cash withdrawal on 05/28, Bank of America ATM #120502 (Card 287850515) 515), 37.89 05/29 Check Card Purchase on 05/2 (Card 2878 Rough Trade Silver Lake CA O5129 Ref # 1000000190469337 ( Check Salsa Brava Produc05Belifiower 7850515), 60.00 05/30 Ref# 1000000190244630 Check d Purchase on (Card #287850515), 20.51 Casa Bernal Los Angeles C Ref # 1000000190233433 050497 42.64 O5I30 Purchase5/30 (Card 5), 0s MotherMt/ K tche Irvine CA nnnaRR 300.00 i 1 ---------------- B nkofAmericaa��'� LETICIA DELGADO Statement Period: May 23 through June 23, 2003 Account Number: 10203-05298 ❑ Account Activity Continued Date Reference NumVr Amount Posted Descriptlon 0"06 06/12 06/13 06116 06116 06/17 06/19 06/20 06/23 06/23 Withdrawals, Transfers and Account Fees in Funds Fee (card# Check UCard Purchase on nion 76 0405308 ChinoHillsHi7850515), lls CA Ref #24164073162220352242819 8662827387 Dnd World Cc ID:1103347739 Leticia Delgado ID# A01366 Ref:000012385916400 CheckCa Circle K 346115901 Dana rP Point CA0515), 6 Ref#24164073166220926628069 Check Card Purchase on 06115 (Card #287850515), Catholic Sin es Cam 949-3889b040 CA Ref #24717053167121673388183 Check Card Purchase on 06/16 (Card #287850515). _.._ e:..,.,�� Inn-91R-48 8 CA Trader Joe's # 11 Irvine CA Check Card Purchase on 06/19 (Card #287850515), Backpporch 800-272-6611 TX Ref #24692163170000066331284 Check Card Purchase on, 648939 635444 037683 32.00 15.14 199.00 20.15 35.00 19.00 19.10 8.95 19.31 19.60 i 06/23 I Purchase on 06/22 (Cara #eorouww), Wildcats Irvine CA $2,309.42 Total Withdrawals, Transfers and Account Fees ❑ Bank of America: In Balance � To assist you in reconciling your account, we have provided the following summary information. A reconciliation worksheet is printed on the reverse of this page. • Your ending balance from this statement................................................................................................................................. $661.05 • Subtract insufficient funds fees from your checkbook register.................................................................... ❑ ATM Information This period, you visited the following ATM locations: Bank of America's ATM Network • #120502 Newport Hills, Newport Beach, CA California Page 3 of 3 007I724.0O,T1B k • .r `�j.• i•Yrr r .. r r r Y 14 • .• ..� y,a•,r.y. •i�FW. • �Ysy^• 3ah �1'.i y fit. 8182912420 TO 919497218657 P.01/03 JUL 29 2003 16:37 FR HANK OF AMERICA u Your Bank of America checking Statement Nypceeas 1020 EO-3 LETICIA DELGADO 42 ➢ERKELEY IRYINE CA 92612-4614 k account balinoss. Our free Online banking service IAmerelows YOU to Enroll at WwWcbanKofamor1ca-com$- Statement Period: June 24 through July 24, 2003 Aeeount Number: 10204-05293 At Your Service Call: 949.837..5482 0nllne: www.bankofamerlca.com Written Inquiries Bank of America Newport Contor Branch PO Box 37176 San Franclsco, CA 94137-0001 Customer since 1998 Bonk of ur b usinossAand ic0 we enJOYservin9you. transTer Tula— ..............vvvxeaxxv......._____.__ uu...rcvwcc>vcx>e>vcvcv Summary of Your NYAcceas checking Account N Dinning Halenee on 06/24/D3 a661.05 Number of ATM withdrawals and transfers + 2,a71.71 Number of Purchaso transactions Total Deposits Number of 24 Nour, Customer Service Calls Total Checks, Withdrawals, - 3,117.51 Self -Service Transform, Account Foos Assisted 6415.45 Ending Balance ___»va..:............ 9 28 4 g �. a.o....r.r..._____ .rurruvaccavvx-==s-_>-_xx___ Important Information About Your Account In September wa will make changes to the information describing automated clearing heu sa transae ti ens postins to your account. These technical changes provide You with mere reforonce information in an easy-ta-road format. ma. u.o..vscv_x>cvcvc>c>— ---cv c_vv.............v ve vcc>cvccvccccccvc> v vcaau u.u..vvavvcr_v>ccvcacvxccv Hank of America New: Nara ChaHail at the man Francisco Museum of Modern Art Ju3Y 26-Nov 4, 20Vi ONLY U.S. VENUE! Hank of America is proud to sponsor the Ne rc ChI,e11 exhibition• vworkssit snever for the retrospective of this universally renowned artist including many for'o re seen in this country. For tic ka ts, visit ticketweb,com or call 866.468,3399, Nov, Online Banking lots you monitor your money in real time and view Dp•to-the-m3noto account activity. You can track transactions throughout the day to k f POM AT"deposits and more.oand withOnline rawal$Hanki npoat wvwabdnKofame r3 cat court deposits, loan paym ess Sign up for direct doPosit and Dot faster eccaos to Your Puy or any regularly recurring deposit, if You haven't Yet discovered direct deposit, you,ra missing out on one of tha most convenient ways to have access to Your m,may. There is no sign-up too and no monthly charoa. For more details, visit JUL 29 2003 16:38 FR BANK OF AMERICA 8182912420 TO'919497218657• P.02/03 ILETICIA DELGADO I....) statement Period: June 24 through July 24, 2003 Account Number: 10203-05299 Chocks Paid * Gap in check sequence Amount Number Amount Data Paid Number Date Paid k 226 20.00 a 844.74 06/24 07/02 a 2 200.00 Total of 3 Checks Paid D7/14 Account Activity Date Posted 06/3D 07/15 06/24 09/24 OL/24 06/27 04/27 06/27 06/27 06/30 06/30 04/30 06/30 06/30 06/30 07/01 07/02 07/03 07/03 07/03 07/07 07/07 Description Deposits and Credits payroll St Anne Schaal Ca I➢: 9111111301 Delgado, Leticia Lin I➢# 698000337000hn6 Ref:0000T601359700D payroll St Anne Schaa000049C. XD: 4D011111101 Delgado,Let ID#2000005lc is Lin Total Deposits and Credits Withdrawals. Transfor3 and Account Fees Chock Card Purchase on 06Card #CA7850515), 17th St Beauty Sup Cast( Rot OZ4224433175203200300352 Ch aConfirmation#564149278518 Ctr EastbluPf Banking enter #0002431CA Purchase on 06/24 (Card #257550515), T radar Joo's a 11 Irvine CA purchase on 04/27 (Card #28785a515), Trader Joo's # 11 Irvine CA Check Card Victoria'saSecret se On 00406 Newport 2Beach SCA) Ref #24792623177604040690165 Check Card urchaseNon 06/2e( SCar 11287850515), Arden CA Rof #24610433177004089282119 Cash withdrawal on 06/26, Bank of America ATM #110102 (Card #287a5D515) Purchase on 06129 (Card M207850515), Albortson's 16507 Irvine CA Purchase 0n 06/29 CCard #207850515), Mobil Oil Irvine CA Telephone Transfer to Checking 243IS-04669 CSR Chock Card Purchase on 06/27 (Card #287850515), Sears Auto Cntr 6851 Costa Mesa CA Rof #24610433179004053467975 Check Card Purchase on 06126 CCard #287850515), V generation Irvine CA Ref 024055233179200212047429 Chock Card Purchase on 06/27 CCard *287850515), Farovor 21 070 Irvine CA Rof #24493983179930000368910 Cash withdrawal on 07/01, Hank of America ATM 0110101 CCard 0207050515) Purchase on 07/02 (Card #287850510, Trader Joe's # 11 Irvine CA Chock Card Purchase on 07/01 CCard #207850515), USA Petroleum 044 IrV1no CA Rof 024418003183183170603008 Chock Card Purchase on 07/01 CCard 8287850515), USpS 0569390253 Irvine CA Ref 1124387753103001350590661 Chock Card Purchase on 07/02 CCard 428785D515), Newport Coast Pharmacy Newport Beach CA Ref N2449390310420648676a056 Check Nwieeallorio USA 000-411-8104ard Purchase or, 07/03 (Card #, CT7850515) Ref #24692163184000997439525 Chock Card Purchase on 07/02 CCard #207050515), Lawrence Y. La Md 949.215.9344 CA Ref #24071053184300178188667 01, 064.74 Reference Number Amount 4999.23 999.24 41.999.47 e7.54 25.00 663944 48.63 663960 13.50 21.01 21.54 OD3111 60.00 641378 16.57 265730 17.23 25.00 25.14 42.55 79. 72 005277 160.00 610736 20.72 19.69 20.00 20.00 1.00 10.00 Page 2 of 3 Continued on neXt p390 caiirornia psis .� ' .. p • .. s. • 29 2003 16:38 FR EONK OF WERICR ele2912420 TO 9194972le657 P.03/03 JUL Statement Period: June 24 through July 24, 2003 LETICIA DELGADO Account Number: 30203-05298 ___ eamla—CaaeeC =aas..vaaa.a va.vaaa-.sea.vea-aeca a evvvvaa_ as...vecaaavvea..maaacaeeevevc__ Account Activity Continued Reference Number Amount Date Ptod Description withdrawals, Transfers and Account Fans (Card #297850515), 10.53 07/07 Check C'erd Purchase on 07/05 Exxonmob1l34 01263110 Irvine CA Ref #2416405318737000a060943 648141 17.38 07/07 Purchase 40.00 TraderO J°e4s(#ard 11 Irvine CAS), 009728 07/07 Cash withdrawal on 07/04, America ATM #051705 (Card #287850515) Bank of T1r cash withdrawal from Chk SRga Banking Ctr South coast Center 50.00 07/08 CA Banki #0002443 CA Confirmation# 7691597667 19.12 07/11 Cnock Card Purchase an 07/09 CCard #207850515), EXxonmob3134 078SI355 Corona D CA Raf 424164053191378000067751 000271 20.00 07/11 Cash withdrawal on 07/11, - America ATM #244302 (Card 0207050515) 777431 4.96 07/14 Bank of Purchase , o/De 31.49 Thecafe Franc Irvine0CA5) 658635 07/14 on 07/14 (Card, s Marko Irvine0 CAS) 3.90 07/15 Check card Purchase on 07/13 CCard #287050515), coffee Bann-0106 Carona Del H CA Ref 02476197319527427101a354 19.00 07/16 Check Card on (Card 790`913-48987CA0515), Fitness/15 Fita24uHourse Rol #74692163196000505461163 DD5519 300.00 07/16 Cash withdrawal on 07116, Bank of America ATM a051703 (Card 0287850515) 19.57 07/18 Check Card ase on 6 0515) C, Shell Oiln27440033002NewPerta Reach Rof 624692163198000639932035 130.00 07112 Check Card Purchase on 07/16 CCard #287350515), , California Smile Da sign 949-955-3366 CA Raf #24897553198000L18B00024 8.95 07/21 Check chase an 07/19 rd #287850515), ' Da ckporcTX Raf 1l24692163200000755944096 641608 9.53 07/21 Pureh aTrader0 Joe9s(#ard 11 Irvine CA5)I 630457 13.23 07/21 Purchase on 07/19 CCard #2a76505I5), Sys Mothers Marko Irvine CA 007998 20.00 07/21 Cash withdrawal on 07/19, Bank of America ATM #2431D1 CCard 9287850515) 009272 200.00 07/21 Cash withdrawal on 07/18, Bank of America ATM #051702'(Card 0287050515) 001514 240.00 97/21 Cash withdrawal an 07/20, Bank of America ATM #120501 (Card #28785D515) 07/24 CA Tlr cash withdrawal from Chk 5298 Banking Ctr Eastbiuff Banking 100.00 Center #0002431 CA Confirmation# $091500435 007521 120.00 07/24 Cash wlthdrawal on 07/23, Bank of America ATM #622945 (Card #207850515) e2,052.55 Total Withdrawals, Transfers and Account Fees aaa_-svesauuvv.._-escamuuummm.aoaaa.c.w.....a.ay.a..aac.mam.a.......a.=.aamva..v.....co..aasaae_veeummmar_a Income Restricted Certification r A_ nt 1 //�n �_ Unit #_�-- �_ Initial Certification Re -certification Other Yes No tluest;lut, Uwe receive Family Support, Spousal Support, and/ any otht cash contributions of gifts, including rent or utility payments from ersons not liven with me. Uwe receive Veteran's Administration, Pension, Unemployme benefit, Disability benefit, AFDC, Lottery winnings, Inheritan or Annuities. Uwe receive income from Rental Pro e . Uwe receive benefits/income from Social Security to include SSA, SSI and/or periodic social security payments. The household receives unearned income for family members a e 17 or under. Uwe are entitled to receive child support payments. I/we am currently receiving child support payments. Uwe am/are currently making efforts to collect child support owed to me. d/we have other assets (example: 4111K,1RA, Revocable Trusts, Stocks, Bonds, Treasury Bills, Money Market accounts, r r r nfneoosits Whole Life insurance Real Estate) I/we have cash on hand. Student Status: oes the household consist of persons who are all full-time usehold in the next 12 months? you answered �s to either of the previous two questions are lu: ➢ Married and filing a joint tax return. Income 5-)8.(0G Under penalties of perjury, I certify that the information presented on this form is true and accurate to the best of my knowledge. The undersigned further understands that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information will ent. result in the denial of application or termination of the income restricted lease agreem Resident Signature Dffe n Signature of Owner/Agent Date *** REC 2003197 163046 H9110EEO F2GT SOCIAL SECURITY ADMINISTRATION 0 LETICIA DELGADO FOR INES GAMBOA 82 BERKELEY ST IRVINE CA 92612-4614 CIPQYAl ',QA1 (F-DQQ ) *** Date,: July 16, 2003 Claim Number: 602-80-3523AI Name: INES GAMBOA rou asked us for information from your record. The information that you requested is shown below. If you want anyone else to have this information„ you nay send them this letter. •1 Information About Supplemental Security Income Payments Beginning January 2003, the current Supplemental Security Income payment is ...............$ 578.66 This payment amount may change from month to month if income or living situation changes. Supplemental Security Income Payments are paid the month they are due. (For example, Supplemental Security Income Payments for March are paid in March.) Type of Supplemental Security Income Payment Information You are entitled,to monthly payments as an aged individual. i h IRVINE APARTMENT MANAGEMENT COMPANY BOND SUMMARY August 2003 NEWPORT NORTH OC85 IRVINE APARTMENT MANAGEMENT COMPANY BOND SUMMARY August 2003 NEWPORT NORTH 29. 1107 Aviles 1+1 1 4 08/23/01 35,554.52 884.25 08/04 30. 1108 Romero/Serrano 2+2 5 11/05/01 56,534.90 1026.7 5 11/03 31. 1118 Hardison 1+1 2 01/18/03 37,171.60 1160 01/04 32. 1128 DelFante 3+2 4 11/06/99 83,456.10 1512 11/03 33. 1142 Samakar 2+2 3 8/28/03 49,323.62 1271 8/04 34. 1144 Se eluband 1+1 1 11/16/00 14,022.00 1160 11/03 35. 1145 Vacant 1+1 36. 1154 Pilon 2+2 1 01/15/03 42,037.55 1361 01/04 37. 1159 Goddard 1+1 1 02/14/03 40,413.69 1210 02/04 38. 1183 Pottter 1+1 2 611196 52312.86 1210 06104 39. 1184 Olson 2+2 1 7/28/03 32800.58 1361 07/03 40. 1200 Wood 2+2 3 08/04/01 58,041.33 1361 08/04 41. 1203 Gallicano 2+2 1 11/07/01 37729.53 1280 11/03 42. 1206 Bottiaux 2+2 2 10/19/02 34927.08 1361 1 10/03 43. 1207 Robbs/Stotts 2+2 1 2 7/14/96 1 37,066.54 1271 5104 44. 1231 Mandelbaum 1+1 1 12/26/99 35,627.51 1210 12/03 45. 1330 Dail 2+2 2 616103 41992.34 1271 6104 46. 1408 Amor 2+2 4 08/15/02 50,471.19 1361 08/04 47. 1411 Loran er 2+2 1 02/22/02 52,208.34 1326 02/04 48. 1412 Fu'ioka 2+2 1 7/10/98 47,632.21 1361 7/04 49. 1418 Lee 1+1 2 7/12/02 40,277.28 1160 07/04 50. 1441 Gen 1+1 2 12/08/01 60,834.24 1210 12/03 51. 1444 Douglas 2+2 1 2/12/99 51388.75 1326 02/04 52. 1502 Smith 2+2 4 3/31/96 72908.89 1351 03/04 53. 1557 Ramirez 1+1 1 02/08/03 40,000.00 1210 02/04 54. 2116 Shimora/Celis 2+2 2 8/l/2003 30,753.27 1271 8/04 55. 2123 Ross 1+1 3 11/16/01 49,894.73 1210 11/03 56. 2134 Huish 2+2 3 9111199 22,574.20 1361 9/03 57. 2224 Aniozian 1+1 1 5/27/98 21,860.37 1160 5/04 58. 2225 Ziese 1+1 2 01/10/03 37,713.74 1210 01/04 59. 2226 Syrquin 2+2 1 1 12/17/96 21,458.48 1361 12/03 60. 2301 Aithen/Mchu h 2+2 2 05/10/01 1 39,661.38 1361 61/04 61. 2309 Harney 1+1 1 11/23/02 39418.03 1210 11/03 62. 2312 Del ado/Gamboa 2+2 2 7/31/03 41,581.92 1271 07/04 63. 2322 Marino 1+1 1 8/8/96 49,500.00 1 1115 1 8/04 64. 2402 Westbrook 2+2 2 12/21/02 28289.27 1361 12/03 65. 2423 Malkin 2+2 2 8/23/96 32,114.59 1280 8/04 66. 2426 McKee 2+2 2 6/4/02 56,736.00 1271 6104 67. 2507 Bora 2+2 3 01/31/03 49,572.00 1280 01/04 68. 2600 Hayden 3+2 3 8/1/03 49294,41 1413 8/04 69. 2612 Van Nieuwenhu se 2+2 3 08/08/02 44,067.90 1361 08/03 70. 2618 Lo ian 1+1 1 8/8/03 39,520.00 1130 8/04 71. 2628 Fa azfar 3+2 1 12/10/01 43,583.62 1512 12/03 72. 2633 Chun Kahn Chun 2+2 3 08/20/03 444281.57 1280 08/04 73. 2712 Lisotta 2+2 1 02/01/03 41,071.60 1361 02/04 74. 2719 Sutherland 1+1 1 6/30/03 36,731.36 1130 6104 75, 2720 Larson 1+1 1 ' 10/10/99 56,922.30 1160 10/03 IRVINE APARTMENT MANAGEMENT COMPANY BOND SUMMARY August 2003 NEWPORT NORTH VERY LOW (Phase hi - beginning 4/l/98) Apt. Address Resident Name Size # of I Occ. M/I Date M10 Date House Income Rent Recert Due 1. 106 Lausen 1+1 1 4/11/98 $30,630.15 $ 756 4/04 2. 122 Gaxiola/Mullinax 2+2 2 03/08/03 29500.00 $ 851 3/04 3. 126 Francis/Vidal 2+2 4 12/28/00 $49393.92 $ 851 12/03 4. 208 Tarta lini 1+1 2 04/01/01 $27,468.74 $ 756 04/04 5. 224 Cronin 1+1 1 3/l/03 $23,322 $ 756 03/04 6. 228 1 Jones 1 2+2 2 1 5/8/99 1 1 $25,656.08 1 $ 851 1 5/04 7. 243 Batts 1+1 1 5/l/99 $24,570.00 $ 756 5/04 8. 301 Francis 2+2 1 2 2/03/02 $22,503.20 $ 851 02/04 9. 318 Radford 1+1 1 7/8/99 $28,419.86 $ 756 7/04 10. 320 McGinley 1+1 1 4116199 $21,360.01 $ 756 4/04 11. 333 Steinman 1+1 1 2/10/03 $24,700.00 $ 756 2/04 12. 1180 Siroonian 1+1 1 4/7/02 $11196.00 $ 756 04/04 13. 1323 Buoncristian 1+1 3 11/10/01 $27684.77 $ 737 09/03 14. 1324 Hale 2+2 1 4/1/01 $33,843.96 $ 851 04/04 15. 1333 Stork 1+1 1 9/7/02 $23,068.00 $ 756 09103 16. 1419 Ray/Brown 1+1 2 5/11/03 28,132.00 $ 756 5/034 17. 1530 Siddi i 1+1 3 6111100 $38,900.04 $ 756 06104 18. 2128 Johnston 2+2 2 6/8/00 $31,673.20 $ 851 06104 19. 2140 Vise 2+2 1 02/01/02 $20,736.00 $ 851 1 02/04 20. 2210 Ferran 2+2 2 01/12/03 $26030.00 $ 851 01/04 21. 2300 Mohler 2+2 3 611199 $11748.00 $ 851 06104 22, 2408 Shoeibi/Motta hi 2+2 2 5/12/02 $16,128.00 $ 851 05104 23. 2425 Uchida 2+2 3 04/11/01 $37,372.40 $ 851 04/04 24. 2428 Winslett 2+2 1 03/17/00 $23616.00 $ 851 3/04 25. 2440 Afshar/Afshar 2+2 2 05/06/01 $22,205.16 $ 851 ' 05/04 26. 2450 Warfield 1+1 1 4/11/98 M $13,882.00 $ 756 4/04 27. 2519 Cotter 1+1 1 5/29/01 $25,635.36 $ 756 5/04 i 28. 2608 Vidal/Gaxiola 2+2 2 611199 $29,980.00 $ 851 06104 29. 2702 Delgado 2+2 4 3/1/02 $16224.00 $ 851 03/04 1998 Phase in-106-122-224-318-320-2450 1999 Phase in- 228-243-1180-2608-2300-126 2000Phase in-2428- 1333-2519-1530-2128 2001 Phase in - 333-208-1323-2425,1419,2140,2440,305 2002 Phase in - 2210,2408,2140,2702,1324 Total munber of apartments on this property: 570 % of property deemed Income Restricted (Low): 15.26% % of property deemed Income Restricted (Very Low): 4.74% TIP = Total Tenant Payment (Resident is on Certificate or Voucher) Total vacant as of 083103 - 23 9 3 New Certificates_ Recertification )UnitNumber 2433 INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: Tbis form is designated to assist you in computing Annual income in accordance with the method set forth in the Department of Housing and Urban Project ("HUD") Regulations (24 CPR 813). You should make certain that this form is at all times up to date with the HUD Regulations. All capitalized terms used herein shall have the meaning set forth in the Regulatory Agreement. CSCDA (Pool) - Newport North We the undersigned state that Uwe have read and answered fully, frankly and personally each of the following questions for all persons who are to occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit. 1 2. 3. 4. 5. Name of Members Relationship Social Security Place of Of the to Head of Household Household Age Number Employment CI.uixi r,) in �=d 22 555—$7^969F 1.lv -Iona 14r oral ✓lcovnmale 20_ j�>4-o7-29cia 1-14.Ao mvt d!e dllvn �(Zwviti Pmmmade 1 g 611— 32 —9619 Income Computation 6. The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children under 18 years) listed above for the 12-month pe •od beginning the earlier of the date that Uwe plan to move into a unit or sign a lease for a unit is S �9 r oSi .tCS Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real or personal property (without deducting expenditures for business expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets); (c) interest and dividends (including income from assets included below and other net income from real or personal property); (d) the full amount of periodic payments received from social security, amenities, insurance policies, retirement funds, pensions, disability or death benefits and other similar types of periodic receipts, including any lump sum payment for the delayed start of a periodic payment; (e) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (t) the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter and utilities; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not residing in the dwellings; (h) all regular pay, special pay and allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the household or spouse; and (i) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; (b) amounts which are specifically for or in reimbursement of medical expenses; (c) lump sum additions to family assets, such as inheritances, insurance payments (including payments under health and accident insurance and workers' compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational Institution, and amounts ._paid by�he.goxemment lg a veteran for in meeting the costs of tuition, fees, books and equipment. Any amounts of such scholarships or payments to veterans not used for the above purposes are io Fe incla33iu income; (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; M relocation payments under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970; (g) foster child care payments; (h) the value of coupon allotments under the Food Stamp Act of 1977; (i) ' payments to volunteers under the Domestic Volunteer Services Act of 1973; v 0) payments received under the Alaska Native Claims Settlement Act; (k) income derived from certain submarginal land of the United States that is held in trust for certain Indian tribes; (t) payments on allowances made under the Department of Health and Human Services' Low -Income Home Energy Assistance Program; (m) payments received from the Job Partnership Training Act; (n) income derived from the disposition of funds of the Grand River Band of Ottowa Indians; and (o) the first $2000 of per capita shares received fromjudgement funds awarded by the Indian Claims Commission of the Court of Claims or from held in trust for an Indian tribe by the Secretary of Interior. 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necessary items o rsonal property such as furniture and automobiles and interests in Indian trust land) Yca No; or (b) have they disposed of any assets (other than a oreclosure or bankruptcy sale) during the last two years at less than fair market value? Yes No ( c) If the answer to (a) or (b) above is Yes, does the combined total value of all such assets owned or disposed of by all such persons total more than $5,000? Yes ✓ No (d) If the answer to ( c) above is Yes, state: (1) the combined total value of all such assets: S (2) the amount of income expected to be derived from such assets in the 12-month period beginning on the date of initial occupancy in the unit that you propose to rent: $ (3) the amount of such income, if any, that was included in item 6 above: S S. (a) Will all the persons listed in column l above be or have been full-time student during five (5) calendar months of this calendar year at an etJucational institution (other than a correspondence school) with regular faculty and students? Yes ✓ No (b) Complete only If the answer to Question 8(a) is "Yes"), Is any such person (other than nonresident aliens) married and eligible to file a joint federal income tax returns? Yes No 9. This certificate is made with the knowledge that it will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and Uwe declare that all information set forth herein is true, correct and complete and based upon information I/we deem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. 10. I/We will assist the Owner in obtaining any information or documents required to verify the statements made herein, including either an income verification from my/our present employer(s) or copies of federal tax returns for the immediately preceding calendar year. 11. I/We acknowledge that all of the foregoing information is relevant to the status under federal income tax law of the interest on bonds issued to finance the of the apartment building for which application is being made. We consent to the disclosure of such information to the issuer of such bonds, the holders of such bonds, any trustee acting on their behalf and any authorized agent of the Treasury Department or Internal Revenue Service, I/We declare under penalty of perjury that the foregoing is true and correct. Executed this 2e*1 day of.... U 2063 (year) in the City of NgIMODA- i�' �1, California Appli— cn� ' / 'pp'lica i Applicant Applicant (Signature of all persons (except children under the age of 18 years) listed in number 2 above required) FOR COBflq, LION BY APARTYLWr OtiVPM ONLY: 1. Calculation of eligible income; a. isater amount entered for entire household in 6 above: $ b. (1) If the amount entered in 7(e)above is yes, enter the total amount entered in 7(d)(2), subtract frt '•u figure the amount entered in 7(dx3) and enter the rema� tinl�e (S ); (2) Multiply the amour v to . 6 the current passbook savings rate a '0 to determine what the total annual earnin /(d)(1) would be if invested in passbook savmR "• �), subtract from that figure the amount ante, 'n 7(a)(3) and enter the remaining balance ($ (3) Enter at right the greater of the amount calculated under �,//�A� (1) or (2) above: $ o. TOTAL EUMLE INCOME (line La plus line I b(3): $ k-�q 1 2. Toe smount entered in l.c: Qualifies the applicant(s) as a Moderate•Sncotne Tenant(s). — �-.- Qualifies the applicant(s) as a Lowerincome Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenaut(s). 3. Number of apartment unit assigned: 2633 Bed_roomsize: ZfiZ Rent:S L:23,0.00- 4. This apartment unit W- ras not) last occupied for a period of 31 or more consecutive days by persons whose eggregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartment unit qualified them as it Lower -Income Tenaut(s). 5. Method used to verify applicant(s) income: X Employer income verification. Copies of tax returns. Other( em�4aL k-Sl uli 5 ) MBA Date a.,+csn=+aow INCOME & ASSET CALCULATION WOPMHEET It I reatNamo FhtNams Kabgunft Sot I a2t9orw1h Ago sacbMwity# F/lIt"at YES or No 1 G44ut4Q% HOH PA 1-7.29-%% Zt 8 4698 2 114.A%Ar4G aN Kart w. - `63 - (-a 1 o 7D e 3 t41.1 L�rrr�t"n \. ult 32 !9 4. 6 B 7 B Mont. # Sawa Saga Bete S Av agars veto eAlunal Totai E2 WA 24 All 78 At M¢a t Yn . es X — PE Total Box A $ Il 9-1 1.0 SOCIAL SECURITY, PENSIONS, ETC. FOE BT MeiM. # Sowca BesaBeis E Avar Mora VarawAlmal Total 63 Wr 24 SUNIVA 26 BFWn a Ma t YA $ g$ TotalBoxB $ O PUBLIC ASSISTANCE Me 4 # Swroe SaasBata ' B AV agars AMan nimel Total 61 WA iA Sa a ?0 BAK ¢ Ma 1 Ye S $ $ m$ S =S Total Box C $ O Rv1PUTED INCOME FROM ASSETS Box G: $ 0 Effective Date: S 10 2 IfBoxBexceeds $5,000multiply BoxEbythe current Type ofPrognan-/1 95 passbook interest rate: x % Unitlio.: 2 's-$ UnitSizo:��_ If Box B does not exceed$5,000 enter-0. in Box No. ofpersone: ' INCOME CONTRIBUTED FROM ASSETS Box H: $ l 0. 6'1 MH: Max. Income Limit: _ Enter the greater of Box F or Box O AR:_ —� 1401/.Limit: TOTAL ANNUAL I & TOTAL ASSETS $ I o.'5 -7 = $ 4 `k p v %�i Certification Initial Certification Re -certification Other cash contributions benefit, Disability benefit, AFDC, Lottery or Annuides. - ,,,�_..«. ,,,,—._.._ eats. SSA, SSI and/or periodic social securitypa Ym The household receives unearned income for family members Uwe are enuucu,v ..�-••--------•• - Ilwe am currently receiving child support payments. it,, endare currently making efforts to collect child support Stacks, Bonds, Treasury Bills, Money Olt are If you answered yes to comer or uic p,=.•�� you: ➢ Married and filing a;joit tax return. Under penalties of perjury, I certify that the Information presented on this form is true and accurate --' - to the best of my knowledge. The undersigned further, understands that providing false represernihte denherein alrei ap lication or terminationtitutes an act of fraudOf the income restricted leasor e agreelete mentation will r Date R t ignature �q Date Signature of Owner/Agent Sep 03 03 C4150p KEIJFORT R 6407203600 pay IrtvuN AauRMENY MANAtl4'M�' COMPANY Rental APPllceti. end R¢elp( }t" Appfl tffm b~rg r� O�aale<OInP eIt IM1li(e(In N1e1N Ie IBC M1�in9'N/A'v'rnrt'xinwt tyjl�6�t llei tet� � Nlda1,'Iw 1M ...enepetnnt to yae In dal NEWPORT N 94972ossse P•i NIMNA��MPANY MVINOAPANTMENT Ipnd4lralh.f 4�n.ifN.•wr^^ri^wnrl•"Ah' hrMN © �'••Ix+Maw^ I�IIprIM WSF 6r•nl LJ �))MwwT r��,f��A.f.}q� "..kWh �^LWrf•n.-OfM• ' 1144r+JJi1, Al1.MMlM. Ia�l�{� A �•'L�JOP-•Iu.LM, wir.'s• I�.L �.Olh.r• aw.I.ILN4WAkNI L,L- L0JIMr �AlfarddwlG+IN Iaf.nl M.wdh' �rtmldlM�Yw tACApf.iMdml.r �fOPwW lJ . ��� •—l- Y.., i4 c PCI'l1I Irwln Ywr MW In the COn ...._ _ lroflfrf IS IHi -- gY•nher^wia.A^uww Consent to.VeriflctlNon Mf CredN end Oth6P 7nfw" Iwn- pe•didd•^^muM1M.wA1hnM...M^`Y""^•"_.. ..wu.l r•F.A WIAdwIMw.hw IM,wnvfpiMpa^wMwl[.sawmw. 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ANAwI•' A APf d Mtlntlpf menl C^MPonY 1.4µwm1 Cb,. IFICATION OF ZERO INCOME ,,,, (To be completed by adult household members only, if appropriate.) Household Name: pr+424jio rIAVVI __ Unit No. 263s - t Development Name: f\1 �f- tWe 01 City: •l 1. I hereby certify that I do not individually receive income from any of the following sources: a. Wages from employment (including commissions, tips, bonuses, fees, etc.); b. Income from operation of a business; C. Rental income from real or personal property, d. Interest or dividends from assets; e. Social Security payments, annuities, insurance policies, retirement funds, pensions, or death benefits; f. Unemployment or disability payments; g. Public assistance payments; h. Periodic allowances such as alimony, child support, or gifts received from persons not living in my household; i. Sales from self-employed resources (Avon, Mary Kay, Shaklee, etc.); j. Any other source not named above. 2. I currently have no income of any kind and there is no imminent change expected in my financial status or employment status during the next 12 months. 3. I will be using the following sources of funds to pay for rent and other necessities: M^MMc� Under penalty of perjury, I certify that the information presented in this certification is hue and accurate to the best of my knowledge. The undersigned further understand(s) that pmvidmg false representations herein constitutes an act of fraud. False, al misleading or incomplete information may result in the termination of a lease agreement. ,ofApplicanVf i.nt Printed Name of Applicant/Tenant Date Certification of Zero Income (September 2000) Income Re Restricted rt trt t d Certification Unit # _�— r' Initial Certification a Re -certification Other Yes Fuca l.lv+s Uwe receive Family Support, Spousal Support and/or any of cash contributions of gifts, including rent or utility payments from ersons not livin with me. 1/we receive Veteran's Administration, Pension, UgSeln 1 n / y benefit, Disabilitybenefit AFDC, Lottery nn or Annuities. Lwe receive income from Rental Pro e Uwe receive benefits/income from Soul ecutrto include SSA, SSI and/or periodic social security Payment- xThe household receives unearned income for family members aee I7 or under. p eats. Thve We entitled to receive child -- port payments. Uwe am currently receiving child support payments. I/we am/are currently making efforts to collect child support owed to me. Uwe have other assets (example: 401K, IRA, Revocable Trusts, Y Stocks, Bonds, Treasury Bills, Money Market accounts, c o nts, te) Oil are nouscLLUiu Ll1 If you answered ves to either of the previous two questtons are you: ➢ Married and filing a joint tax return. Z.C>0 Under penalties off perjury, The undersigned further 1underst ads that providing false on presented on this form is true and accurate re the best t. s g representaf s herein constitutes an act of fraud. False, misleading or incomplete information Will result in denial of appli n or terminat' f the income restricted lease agreement. Date Date Signature of Owner/Agent POOR." QUALITY R ORIGINAL (S) 11/06/2003 10:26 81B34104B PAGE 02 Nov 06 03 10:44a NF'JORT N 949• �15g6 flu( 18 03 01:55p Nt:'^rtRT N ,.., P. 94 ?01599 f ENIPL.O . lEYT !'ERLF'LC.ATLO:�•••' ". •:-cBt!: Date:_ VIR/03 a> • _ Bn. Im„a 6G4 .�L7 _a�taa �533 ,a-pll:ar:. rnp-: %:;-e Scsta: SteurnVt,:r•)e: � ; �.,�, I h� ai•. A :cn:e rdtsse ai .T.�p:c.r..er,: ulc-r..tt:an. •Ae-••crnr :x•e The ird!.••d_a! D3n'2: di•e: q a.Ct'e :! Jr :a: of iausira ptorarr. t/lx: eCuiret vePa.-t:os Of !,,^,;agile 7ht trfern•:on p:c s::e:�tui, :ena*n cmildea:!a::o rars3c!!or. of!ka: ss!e- eurp,•se ar..y: Ya r,^•o�;! r_ypoase is tn.et8 Dad g: ra•;•.•appre:rated• }ywpp.* 11114'h i4P&4"v4i3 z' m:larc ,w. zvj +QBM,-Is C1v A266 11trurn Form To: V ;Ire,; tva;es'Sit-y 5� �- e'-::eex'e cne• re:r }• Atrrageorrregarhouape:aeck•?Za-�a...�.. �t rit'M:a.: Rtrc S per'ttvr A. Shift sD!!fe:entia! Roar• S pe h,_: A, Ct}nni11i0-s• teausea, rips, mF.er: c rr'r:}eo::eS Y.r_r; List Dap aor:rpa ec enn,-c ;n :.-e er_lov-4 S r�:e ; f e^ay tri:h a ;he :aS Ti::c N'c— Last Dayc; E•rp*T.uni Dm%cckts feel: :•;;: ::hi rto:::iti}' }ear,T Ot;;Cr� > ormm.tr, a hours per veek: 0 ofshih d:ffe:enh_I hours pc. week: :Fot[i.• b>ueet}• semo-ncnthil' tronthly yearly oti:e: : I2 r!orms: jm.Gt(e�,e.. �•+7ZS �; Eficais=Doer /� 1!6e emp!opee': xnr@:1 rcreow a• s;rr,d:e, p!:enc ir.9•atc the !4'oii Cc:tad;s!: A o.:a: rcna:ks• ��! .e,LG.rw� La' �• Er. p:a; e•�5:n::a:e IFL./.S-q ! --PIAaAOA1 'eni:oa-s Yrfa•eJ .Xorne ��' IAt�tla:M! ,I'� _�"Z/L7,2�/ _YwrvsCa�..�•, � 3'd2'. `�M"'ra+!'Yc�t_i �+(• I rrt'r• f•� l••:1_l•r]n1� t]TO � 9.SC4•tsr ��'/ •� I I P 0 - /D3 �l 3��- �35�� 4 ks•�sai+(� AOL.� ��:'t • 1 Fo. 'r E m..• A0T6: Ser' en :nn; of Tl::c tf chGr p s CM: r,;'<ee h� eia•uol-,rcar.te to r.'akt .vi:Ii;!;,;u ru:events or::rere:r<icrm!::nt to any Ja-:!'TAW o: Agenq o: Ib LrNtet Saw at :e e•y rk:ur ui:hl'. 0 ,Wu &divwr / Emp!gm•r!nt 1'n• rrnna� (Se-tIlm-N::,;: 08/20/2003 14:17 818341834E PAGE 02 Newport North Apartments 2 Milano Dr. Newport Beach, CA 92660 (949) 720.8765 (949) 720-1598 FAX Verification of Family Support Address: Z eS s S*V mAA eo Newport Beach, CA 92660. 1, F,rYp y kANr&, am receiving a monthly family support payment in the amount of S,_ Lg from y, Ya oar &AIwA Social Security Number .ryes •sy - ?ag I hereby certify under penalty of perjury that the information provided above is true and complete. .r Signaturc of rccciver: �,s rsEc Signature of provider:/�'� G / State of Califo is County of O Signed before me this d day of 2003 , California, To certify which witness my hand and seal office. Notary Public in and for the said County and State My commission expires on: yYltir s, �,6 JAMIE J. Yt Commiwlon#19A2E22 L' Notary Public - Cellrolnld Los Angeles County My rZvm FgN=MsrS40 ,N VL 0. Asset Calculation Worksheet Name Account Type c6c t-1 n (+) q3q. 6 q divided by 2' (average account balance) ( x ) Interest rate: % z (_) Income from asset: $ Cl/ I) 13 Washington Mutual Bank,FA THE FEE FOR EACH OVERDRAWN TRANSACTION, WHETHER PAID OR RETURNED, IS *21.00. 01-X-83 BRYAN KAHNG 19350 BLYTHE ST RESEDA CA 91335-1617 K TO REACH CUSTOMER SERVICE, PLEASE CALL TELEPHONE BANKING AT 1-800.788-7000, 158,437 STATEMENT PERIOD: FROM 05-03-03 THRU 06-03-03 BE A CELEBRITY, EVERY DAY! SIGN UP FOR GOLD CHECKING AND GET OUR VISACR) GOLD CHECK CARD. GET FREE COOL PERSONAL CHECKS AND FEE -FREE TRAVELER'S CHECKS, ALL FOR A LOW MONTHLY FEE. SAVE UP TO SOX ON HOTELS, MOVIE TICKETS AND MORE. ASK US FOR DETAILS. FDIC INSURED. FREE CHECKING WASHINGTON MUTUAL BANK, FA FDIC INSURED BRYAN KAHNG ACCOUNT NUMBER: 394-283104-6 YOUR OVERDRAFT LIMIT, AS OF THE STATEMENT END DATE, WAS B 200.00. THIS MAY BE CHANGED AT ANY TIME WITHOUT NOTICE. OVERDRAFTS ARE SUBJECT TO A PER TRANSACTION CHARGE. 0 BEGINNING BALANCE TOTAL WITHDRAWALS TOTAL DEPOSITS ENDING BALANCE 939.69 98.76 .54 841.47 YTD INTEREST PAID .90 YTD INTEREST WITHHELD: .00 DATE WITHDRAWALS - DEPOSITS TRANSACTION DESCRIPTION 05/12 36.75 VISA -BORDERS BOOKS &MUSNORTHRIDGE CA 05/12 11.20 VISA -ISLANDS REST #006 IRVINE CA 05/16 20.00 ATM-NCHG SIA07650 BRIDGE & PEREIRA RD IRVINE 52 0516 05/19 20.00 ATM-NCHG SIB07002 19500 PLUMMER G1 NORTHRI➢GE 06 OS17 05/19 .26 PAYPAL VERIFYBANK XXXXXXXXXXX6785 05/19 .28 PAYPAL VERIFYBANK XXXXXXXXXXX6785 O5/27 10.81 VISA-SPORTMART &633 NORTHRIDGE CA PAGE 01 OF 01 w 13 Washington Mutual Bank,FA THE FEE FOR EACH OVERDRAWN TRANSACTION, WHETHER PAID OR RETURNED, IS 021.00. O1-X-83 BRYAN KAHNG 19350 BLYTHE ST RESEDA CA 91335-1617 TO REACH CUSTOMER SERVICE, PLEASE CALL TELEPHONE BANKING AT 1-800-788-7000. 156,546 STATEMENT PERIOD: FROM 04-03-03 THRU 05-02-03 D BE A CELEBRITY, EVERY DAY! SIGN UP FOR GOLD CHECKING AND GET OUR VISA(R) COLD CHECK CARD. GET FREE COOL PERSONAL CHECKS AND FEE -FREE TRAVELER'S CHECKS, ALL FOR A LOW MONTHLY FEE. SAVE UP TO SOX ON HOTELS, MOVIE TICKETS AND MORE, ASK US FOR DETAILS. FDIC INSURED. FREE CHECKING WASHINGTON MUTUAL BANK, FA FDIC INSURED BRYAN KAHNG ACCOUNT NUMBER: 394-283104.6 YOUR OVERDRAFT LIMIT, AS OF THE STATEMENT END DATE, WAS 4 200.00. THIS MAY BE CHANGED AT ANY TIME WITHOUT NOTICE. OVERDRAFTS ARE SUBJECT TO A PER TRANSACTION CHARGE. BEGINNING BALANCE TOTAL WITHDRAWALS TOTAL DEPOSITS ENDING BALANCE T 8.601 189.91 1r121.00 939.69 YTD INTEREST PAID : .00 YTD INTEREST WITHHELD, .00 DATE WITHDRAWALS DEPOSITS TRANSACTION DESCRIPTION 04/16 1,121.00 ATM-NCHG SIA07650 BRIDGE & PEREIRA RD IRVINE 92 0416 04/18 20.00 ATM-NCHG SlAD7650 BRIDGE & PEREIRA RD IRVINE 65 0418 04/18 1.43 VISA -GAP ONLINE 800-GAPSTYLE ON 04/21 21.12 VISA-UC IRVIHE-BOOKSTORIRVINE CA 04/23 40.00 ATM-NCHG SIA07650 BRIDGE & PEREIRA RD IRVINE 46 0423 04/23 6.44 VISA-AMAZON.COM ■PAYME800.201.7575 WA 04/23 9.24 VISA-AMAZON.COM *PAYME800-201.7575 WA 04/23 8.24 VISA-AMAZON.COM IPAYMEBGD-201-7575 WA 04/23 43.44 VISA-AMAZOH.COM XPAYME800-201.7575 WA 05/01 20.00 ATM-NCHG SIA07450 BRIDGE & PEREIRA RD IRVINE 41 0501 05/02 20.00 ATM-NCHG SIA07650 BRIDGE & PEREIRA RD IRVINE 92 0502 PAGE 01 OF 01 A P P e t R s t r Y F a 1 I! r e ,IRVINE'APAI�IENih1ANAG 6nJslhAHY Rental Application and Receipt for Application Screening Fee Please complete this farm in it's entirety, noting eN/A°or"none° where applicable. The Information you provide will be verified prior to IAMC's approval to rent an apartment to you in anapartment community owned by either ilia Irvine Company or IMne Apartment Community: Address: Print Applicant's full nome (Last,FlM, Middle Initial) 7r15r. Dateaf Birth Sodd5ecurityNumber Driver's License# 8F-Y Af < Y H sr3 Go -07-0 037"L2! Name of Co -Applicants (separate Appllcahan rei uired for each Ca -Applicant) (fiat. First. Middle InlN-1) , (art, First. Middle Inlild) (lust. First, Middle Initld) QHW4. 9FAf cps b v T ,FM, Middle Idtbl) Mst, Flat, Noun. DUMB (lent, Fast. Middle lnald) Applicant's Pmant Address City ZIP a-m Phone# /8)3 IS batee Prom EMN A dress: b f;lkd. 1'a at Le At e ❑ Rena ra Detached family home Attached family hams Mr Apartment Monthly Payment P �� To whom do You make le/mums? � k Present landlord's Name Addmu City ZIP Phone# AIPP ,1 34yrils W RESE Via•jW3,16- A/91 -?L 23 Immediate Prior Ad&ei, Of less thou l yr.at abaft) ❑ awn wmhy Payment: Bake Fa /.3 oL ate" FAPJCVIC1 LOW4 El Acn' $ azq. act T° 7/3fA Immediate Prior landlord's Name Addresa city IIP Phone PA KVBf)' (-a5 46ard8a ) vAre d -78 -720 be you awn a Pet) Yet © No Mmberaf Pefs: 0 Typo: N/4, Proposed acaupantI (last, First, Middle Initial) Woof Birth (Lest First, Middle Initial) Datc of Birth G)/ (Loft, Fbat,Mlde-inlflcl) DetooF Birth (Taft, Fbst, WdIe INtloQ Dateaf Birth GkuN n V 11/1I/xH (Loft, First, Itldiclnhkl) Bate of Birth (Tat, First, Mlddic Initial) Dateaf Birth Employer (If self-employed, name of business) Business Address Dncysding ZIP Code) A.M. DA4A1A1V Go, Phone# Type of Balms Position Came Supervisor Phone# ca Tnme GA57PMlA FFM/ LIAA YJ•709- 7 G"' 'M°' Ta P e; w r) •IP PReAto -!M l 73 Si tics ukW4 Pe 13 other Income Source Applicant must provide 2 pay stubs or arrant W2 farm. Contact Immediate Prior Employer Addms(Including ZIP Cod-) Phone# DomeM. Incme ,s � Frwn VI-4- Mo. To Checking: book and branch Dn-lude aty/State) Account# WASH" 7bA/ MILTIt 4 A/ary, n (D a CR 31 q [0 6 5avinuI bank and branch (Include City/State) Account# Have you aver filed bankruptcy) ❑Yes FK]No County and stash where filed Whutyear7 Ham you ever had any public recard suits, Part, Judgment- or repoS=IOM Yes ON, Whatyear7 Nave you ever: If yes, describe In detail: Been,cricted ofafelalyp❑Yes �No Bun evicted) ❑Yes ®Na Defaulted an a lease? ❑Yes ON. Neareafetwagenry.plemerohfy.. oecalame,addmsd.phalmamber) /IARD,A Acr ILA#NL M3r0 81-I'M Br /y)g') A23. 9favr Relatlamhip. 3y5i-F(L If applicable, parents' phase ambers: R)PP (WA16 WS, )3#9-7Lz3 AoaN4 !LA/ANlp-- fY/d )3#9-76z3 Faaw'sMmn f7aNweYNera 1 WAred WIN Praetd2 A TaaeiSlalJY .IRVIgB'A7?AR!'MEtiT,T.fiANPtiEME[1T,COMP'. How did you first libra of this oportmant mmmunityP 1:10C.Pegister ElDrlve By EJPental-Llving•cam mpeamalwsp Event Apartment&lde E]51gv 1:1Y/ebslta-0thrr" 1751 mum 0,I9, Apt. Magazine 0 Other TAC ammaity❑Raferml" �Newspapsr-0thv" ❑Penal Living(LAC Magcl LA Times ❑Rcbmtor Service FIMagaira-Other" ❑Far Rent Magesia ❑SD Union f JFW ❑Affordobk Hmaing E]L(L'Apt Isdo CMIAe M5DReadar rancard/Mallcr, ®Other -Not Urled"s - "PLEASEFILLIN. FitiEAm Rraran far relacelbn: Haw many whldcs do you own/drlw? Q Make Year License# Make Year Uanre# T— ote: Parking of recreational vehicles, boats or trv)lers is not permitted In the Community. aayau,Paveltenter's Insurance? ❑Yes ®No Consent to Verification of Credit and Other Difcrination: I am making this Application wluntarlly far the purpose of obtaining IAMC's approwl to rani an oparlment In the dpartmen cemmunity shorn above. I hereby outhorlse and mraeut to allow 3AMC,Ow ar, and their respective emplayw and agents(calledlvely, the RAMC Portiv'),W obtain and verfy the credit and other Information provided by me In this Application through credit reporting agencies, tenant screening service mmponles, banks (inebding electronic funde vm,1flcptlon), emplay. and other persons or entitles with Infonmot1arireletla9 to thip Applkalln, ' I mWwtand that If I lease this apartment, the IAMC Pares shall havea conNrming right to review my credit Information, payment history, asmrpacy history and other Information in this Application for purposes related to my Lease aLd/or-for account review or Improvement of applicatlonmethodi. I hereby release and hold harmless Tha Irvine Company, Irvine Apartment Cem,nualfles, LP.,Irvine Apm1mmtJMMaq !,t Company,andall of their respective officers, employees and agents, from any and all liability, Iagal proceedlrgs sailcasts, Inelodlig attorneyf far, artily auf of the vvHicatlan and/ar use of the Information <onfalad In this Appllmibn, Includiy the relmse of such Informvtion to othvpartly. I wormn that, W the best of my kmwledge, all of the Infarmatbh provided,, this Application Qa0uMV but cat limited to the ateM1ment of my flw,l.l condition) is ime, accurate, complete and correct as, of the dote of this Application. If any Information provided by me b determined to be fake, well false statement will be grounds for diupprowl of my Appllrnrion ar tarmlmtlon of my Leese with Owrer. I agree td ratify IAMC If say of the Information provided In this Application changes during the Application prows or during my tenancy. I also understand that IAMC will retain this Application,aI.rl with arty other Information provided by ma, whether or cat this Application Is approved. A nomisfundebleApplla5an Screening Fee of $30.00 (as ltembed below) Is required from etch Appgantfo process WlsAppllaSon ad W cheek am Informal" provided AsepartApplla0an to Rent Mud be signed by each Appiicmdwhowilloccupythe apsrlmeolbefonthkAppllcaganwN be eonadeMby WIC `%'^r� � ''•5, .• 713a/>5 Oats r DPllcant's xlgarirc RECEIPT FOR APPLICATION SCREENING FEE amount Is to be used to screen Applicant (vMh regards W credit hlstaryand other background Information. The amount charged esfollowr• Actual costa of credit report, unlawful detaioer(eviction) search, and/or other screening reports $9.95 Cost to obram, proms and verify screwing Inf.motlon(may lnduda staff'. time and other related costs) $20,05 Total fee charged (may not exceed $30 per Applicant) $3000 nt ne tharlaes verification of Information supplied by Applicant an this Application through credit reporting agencies, penonel reference and other Information sources. Data Applicant'uigaWre Irvine Apartment Management Company By: Rnised,07101 Paga2d2 µy LLnTtlUiMM1 09/11/03 Tnll 10:21 FAX 2132693327 10'd 10101 IPA ENTEPRICE INC b001 Sop OS 03 04:47p NEYPORT tt 9497201SOO p.3 ""— Veit#— Namm. — r INt1al Ctrtlnut[oa n "`— Reterd0mtlen Other 'Ihe household teceUK RdrAMd IacOme for Melly rmembm Thee em cm ftdy teneivw child e0ppoltpeye`"ts. Jlws em "' eolteodyote9log eflb0a to wlleo! childeoppmt 6 LlI�•> Masad tnd SlkseleIDttcttetutw •I _ Under peoaltles orperjuryr I certlq• that the lnrenuattea presented an thts rerm is ims and accurate m the best of MY Yn01Vled2,e. The undersiRaed further anderslAnds that prm�tdlete informdNon will repre"til 00 us berrla eohstllutrs en%ufMtanfrannn ud. Fatce, Inlsteedia; ar fneo p resYlt In the dug.,efDDDilnnnn er •er Ie• f�s�n�_rvnnde_- • t.b• �nt•nKnt TO'd -Izc 9<i2ET 01 4NVtJCine6rCi IJRId li.=.:20 MST—L0—TO E Earned Income Calculation Worksheet Name David cl,,,n Employer In - N - oy+ IQur(r r Most Recent Ending Pay Period Date 711? 103 7 YTD Income 2112y.49 divided by Start with hire date If at Job for less than a year (how often paid Calculated Annual Income Hire Date 1�03 Gross per Pay Period 79.39 (A 72, N (+) (_) 146.5 7 divided by (_) 73.2q (how often paid) (=) Calculated 31?0q.52 1 1 1 3, g 11,08 1, DAVID YOUNG 50421 067 W4 INFO FED-S/Ol CA•S/Ol ,. AV-0EPI Yt !i 's .r'.t,HECKO +xMENEI `+.Sm s• i;V C A ' V 1'AB Y -Y.F ../-:<'ilS9Y (:• •1 t Ari,,cinnnO _ nanlrcnna mnRPVnna a.dn PART 4.64 HOURS 1 611 32 2619 a, 'd N'1''Ftd+'EAN I : 'raA'r� 't`n>'O ^?•" • •• • ;`OECtJ07. ON9+" �Y' �4:•'�" l,, 'Ir 4' 'v�" .r,,v:,:rs ��9• pI,„y:v. rMEDICAR � EC., 1.08 •�i si12724 29.76 REG 67 8.50 8.75 74.38 2052.30 FED TAX .00 3.02 39.73 SHOE PURCH .00 Ip.- EX11RIm115(1119nt1 1M11•h•fl4T E::fREF--� �X.5"ES F'Gil TMI'IE FL'APCSE OF rtl ng Lt. 4 • CO3, Ix 1M14 p'-•rl/ I,rf..:rtdvenl: I .•ar u L•rAt end A 8110ca.. sPlll 'V mw.o hP„ZJ IYIiM NIIUI¢d ALtq)ppyP'YOP,NM1(gd3Ft O11NOAN'aM1lrruOKnitM1IlY 0ANL 1pd lOpcolFW4.3Nt VI•gy R: Lo-nSulrEittlne..nu+hay'A�'41r bP4atn0itienri•�o SWu•uad bider Pn(¢s le llfR mw M'r+FS'1 !n0 (OCbm¢r'! il„INpJGM1d Ol• m0e1 mK,.d:nt i SICLMnI4N C'I OI 0:5¢r Our 0asw'lm IN•t4.Q T rJ.R)S;rG•q o 41S? C eitotag Ck11YE, 9v'f•LCQR w tRV4�' , CALIFCRNIh 9261' •&�d7 9n0 v .� iv. • Pn NVn n .pp)t WAO E9'd'} ` 74.38 I 6.39 69+OFDO .00 61.99 74,38 .00 Em 2.052.30 .00 2.052.30 179.35 1 39.73 1.833.22 • DAVID YOUNG 50421 , 067 W4 INFO FED-S/01 CA-S/O1 ' fi 'td•.ISUsr;dCi: tilFS :eB YkrEi P .n j• „J..r.ti)I•;.iP.:•i lPgr h, <;"'I•i.:: !S:�Uea' PURCH I uu :billy:, clt C' -•J.; Newport North Apartments 2 Milano Dr. Newport Beach, CA 92660 (949) 720.8765 (949) 720-1598 FAX Verification of Family Support Address: S6 33 .$4N HAW Newport Beach, CA 92660. I, (� In N , am receiving a monthly f mily support payment in the amount of$ iSroU from i°bs ko�SocialSecurity Number 09(, QC• JaN6 9ooQ L{& I hereby certify under penalty of per'ury that the information provided above is true and complete. Signature of receiver: Signature of provider: State of California County of Signed before me this day of 20_ , California. To certify which witness my hand and seal office. Notary Public in and for the said County and State My commission expires on: VLOa. Asset Calculation Worksheet Name David C6 Account Type aw- C. �In ( + ) 79Z,U2 divided by z (average account balance) (x) Interest rate: % (=) Income from asset: $ 'e' M Washington Mutual Bank,FA THE FEE FOR EACH OVERDRAWN ITEM, WHITHER PAID OR RETURNED, IS 421.00. 5120000DO31955 17-X-83 DAVI➢ Y CHUN JUNG SOON LEE 17725 ORNA DR GRANADA HILLS CA 91344-1320 TO REACH CUSTOMER SERVICE, PLEASE CALL TELEPHONE BANKING AT 1.600.78B•7000. 227,978 STATEMENT PERIOD: FROM 07-26-02 THRU 08-26-02 0 GIVE THE GIFT THAT HAKES WISHES COME TRUE. AMERICAN EXPRESS(TM) GIFT CHEOUESI AVAILABLE IN FACE VALUES OF 425, 450 OR 4100. STOP BY ANY WASHINGTON MUTUAL FINANCIAL CENTER TODAY. FREE CHECKING WASHINGTON MUTUAL BANK, FA FDIC INSURED DAVID Y CHUN ACCOUNT NUMBER: 440-226880-2 JUNG SOON LEE OVERDRAFT LIMIT 100.00 ADAAFFT Tn A PER ITEM OVERDRAFT TRANSACTION CHARGE BEGINNING BALANCE TOTAL WITHDRAWALS TOTAL DEPOSITS ENDING BALANCE 200.00 199.53 IOO.DD I IOD.47 VTD INTEREST PAID 1 .00 TIT INTEREST WITHHELD, .00 DATE WITHDRAWALS DEPOSITS TRANSACTION DESCRIPTION 06/01 40.00 AIN-HCHG S1007002 19500 PLUMMER GI NORTHRIDGE 14 0801 Otl/OI 25.00 AUTOMATIC SAVINGS PLAN DEBIT 08/0, 24.84 VISA-B. DALTON 01521 NORTHRIDGE CA 08/06 15.56 POB MOWS MARKET 21900 BALBOA BLV➢ GRANADA HILLS 07 0608 08/08 20.00 ATH•NCHG SIAOSS79 11160 BALBOA BLVD, GRANADA HILLS 37 0808 08/22 60.00 ATM•HCHG SIAOB679 11160 BALBOA BLVD. GRANADA HILLS 07 0622 00/26 60.00 ATM •HCHG SICOBI19 17900 CHATSWORTH ST. GRANADA HILLS 24 0824 08126 40.00 ATM•RCHG SICO6119 17900 CHATSWORTH ST. GRANADA HILLS 26 0824 08/26 11.13 VISA-DENNY-S 07142 NORTHRIDGE CA DETAIL OF CHECKS PAID: CHECK _e DATE 6MnMHT CHECK DATE NIIMRFR PAID AMOUNT CHECK NUMBER DATE PAID AMOUNT 096 08/12 3.00 PAGE 01 (CONTINUED ON NEXT PAGE) Washington Mutual Bank,FA 81200000031955 17-X-86 DAVID Y CHUN JUNG SOON LEE 27725 ORNA DR GRANADA HILLS CA 91344.1320 227,979 STATEMENT PERIOD: FROM 07-26-02 THRU 08.26.02 7 GIVE THE GIFT THAT MAKES WISHES COME TRUE. AMERICAN EXPRESSCTMI GIFT CHEOUESI AVAILABLE IN FACE VALUES OF 125, 450 OR 4100. STOP BY ANY WASHINGTON MUTUAL FINANCIAL CENTER TODAY. STATEMENT SAVINGS WASHINGTON MUTUAL BANK, FA FDIC INSURED DAVID Y CHUN ACCOUNT NUMBER: 392.628897-4 JUNG SOON LEE BEGINNING BALANCE TOTAL WITHDRAWALS TOTAL DEPOSITS ENDING BALANCE 1,600.08 .00 125.92 1 1,626.00 INTEREST PAID, .92 ANNUAL PERCENTAGE YIELD EARNED , .IS % YTO INTEREST 1 NTEREST WITHHELD, .00 DATE WITHDRAWALS DEPOSITS TRANSACTION DESCRIPTION DL/OI 25.00 AUTOMATIC SAVINGS PLAN CREDIT 08/26 .92 INTEREST PAYMENT PAGE 02 OF 02 w Washington MJual STIEMENT OF ACCOUNT 81200000031955 140,979 17-X-83 DAVID Y CHUN _ JUNG SOON LEE 2633 SAN MARCO STATEMENT PERFROM 06-26-IODS NEWPORT BEACH CA 92660-3269 03 THRU 07-25-03 0 FREE CHECKING ICONTINUEO FROM PREVIOUS PACE) ACCOUNT NUMBER: 440-226880-2 TE WITHDRAWALS DEPOSITS TRANSACTION DESCRIPTION Z5 250.00 PAYPAL TRANSFER XXXXXX007 25 19.00 VISA -PACIFIC THEATRES CCULVER CITY CA SAIL OF CHECKS PAID: 1MBER PAID AMOUNT NUMBER PAID AMOUNT NUMBER PAID 106 07/09 408.30 210 07/24 30.86 N115 07/23 M109 07/09 98.32 N112 07/21 16.01 TE: N INDICATES CHECK OUT OF SEQUENCE STATEMENT SAVINGS WASHINGTON MUTUAL BANK: FA DAVID Y CHUN JUNG SOON LEE IEGINNING BALANCE 172.15 I ?REST EARNED: AMOUNT 20.00 FDIC INSURED ACCOUNT NUMBER: 392-628891-4 TOTAL WITHDRAWALS TOTAL DEPOSITS ENDING BALANCE 3D3.00 928.27 797.42 27 ANNUAL PERCENTAGE YIELD EARNED : .49 X YTD INTEREST PAID s 1.21 YTD INTEREST WITHHELD: .00 'E WITHDRAWALS DEPOSITS TRANSACTION DESCRIPTION SC 'AIL OF CHECKS PAID: 'AIL OF CHECKS PAID: (CONTINUED) E WITHDRAWALS DEPOSITS TRANSACTION DESCRIPTION 11 25.00 AUTOMATIC SAVINGS PLAN CREDIT IB 900.00 OLD TRANSFER FROM 4402265802 .4 50.00 OLD TRANSFER TO 4402268802 I1 50.00 OLD TRANSFER TO 4402268802 :1 100.00 OLB TRANSFER TO 4402265802 :3 100.00 OLB TRANSFER TO 4402268802 ;5 .27 INTEREST PAYMENT GAf.F D9 fr.nNTTN1IFD DN NFYT OArFI UP Washington ►.. tual STATEMENT OF ACCOUNT $1200000031955 17-X-86 DAVID Y CHUN JUNO SOON LEE 2633 SAN MARCO NEWPORT BEACH CA 92660-3269 240,980 STATEMENT PERIOD: FROM 06-26-03 THRU 07-2S-03 BE A CELEBRITY, EVERY DAY! SIGN UP FOR COLD CHECKING AND CET OUR VISACR3 COLD CHECK CARD. GET FREE COOL PERSONAL CHECKS AND FEE -FREE TRAVELER'S CHECKS, ALL FOR A LOW MONTHLY FEE. SAVE UP TO SO% ON HOTELS, MOVIE TICKETS AND MORE. ASK US FOR DETAILS. FDIC INSURED. STATEMENT SAVINGS IATE WITHDRAWALS 7/25 3.00 7/25 (CONTINUED FROM PREVIOUS PAGE) ACCOUNT NUMBERS 392-628597-4 DEPOSITS TRANSACTION DESCRIPTION SERVICE CHARGE 3.00 REFUND SERVICE CHARGE PAGF 03 OF O3 0 8 A P P I It t H 1 s t r Y E In p I 0 Y In t F a I P r n a 1�/A11(*y/11C� IRVINE AFARIMENPMANAGEMEPiTCQMPANY ' Rental Application and Receipt for Application Screening Fee please complete this form in it's entirety, noting'N/An or'none where applicable. The information you prai will be verified prior to IAMC's approval to rent an apartment to you in an apartment community owned by either The Irvine Company or Irvine Apartment eammumnee, c.r. r, — Community. Address: Print Appllcant's full nume(Wt, First, Middle Imiki) 7rJSr. Date of Birth 5a<lal SecuritytJumbm Driver's Qceue# CPiDlN p�ID , f u(>i�F2� tu'aI 2Giq Name ofCO-Applicants (Separate Application aired for each Co•Applicant) (Last. First, Middle lNtinq (Lue, First Middle Initbq (fast, First, Middle lnkld) t}(uNG ,bFr KaHlv�(IF-flr� (Let Fire. Middle lNtkl) (Imt First Middle Initial) (Wit, Fire, Middle INtlal) Applicant's Precut Address cry IIP awn Phone# t7Y !.(o.4L.,� Dieu From f>2 EM1tai Addxss: tixe CeAtJrr,n`r:P..I' ).rrVflr.V '(F':c( �-j pm Ctl!rt VsI iPR �• Dcmeudfamly lwme: ❑ Attacked family home U AparM1rcnt. ❑ Monthly Payment $ To wlmm do you maps pgments/ PrumiLandk,d's Name Address ary ZIP Phone immediate Prior Address (if Ins than 1 yr. atabove) ❑ own Monthly Payment. D w' Flom ❑ psnt i 1fi Immediate Prior LomBcrd's Name Address CM IIP Phone# Number of Pen: type: Proposed Nei (Wit, First, Middle Initial) Date of Birth (Last, First. Middle Initial) Dateof Birth LNgN N\ITj (Last, First Middle Initial) \1�21�Q4 Date of Birth (last First. Middle INtinl) Dam of Birth Y.A" L, I. —'At, / e•ltile•' (Last first, Mind Inlilan Date of Birth (Lost First Mlddle INtkd) auto at Birth tol.N(I ,titr. -I(19((; ( Employe, (If U-lfemplayd, xm0 of buslxss) Busirwss Address (inchdily ZIP Code) IN N CI_tY Y, I`?'Lr a Phone# Typeof Businus Position '� F I Dj SupwLsar Phox# Income ti.75/I-,r, 944-854• Rf •. n]n� r." LP.hpl c 6 Cr,M1C'a- Ma n t;ta ZI(, otherAmme Sourer AppBcanr mustprovide2 pry scabs or arrem WBfarm. Contact Immedlam Prior Employer Address (Including IIP Cod°) ph.. # 9-A LcP Won Flwa (� L' Irmm • e TO +(ILj (AMYUS OFC:'F %4•.t+� CA 11 C\2 Gii w (` M0' Checking: bank and branch(Indudeaty/State) Clr•nk1)t'il- � Account# ygb1244: rY _ \IDSrIrcSil: ta.,tuni. Savllgn honk and 6raneh(indude CiryySime) ,r t•, jar. Acmunt# :•ial';i.', Clpt,zzC4::. Hove you ever filed banlruld-P Ely- No County mW State where filed. What year] Have you ever had any public record suits, lieu, Judgments or repasembM rid( ❑ ye IJbI° What yeah Hies you over: If yes, dearlbe In detall! feloruy]❑yu Do Been convicted of o Bete evicted] Ely" MN. Defaulted an a lean] ❑ym DNo 'case of emergenry. Pc mtlfy G(Loral rams. addresI0 ?numb4rr) Relatloehl (i1g.E o-3S 4n'� SA'.r: f A,. t;f <tl L.v:tr'4 ,: Cir 'rr:'tl P' f : applicable, pvrcnti phone numbers. 1t Chun ante" Wee Mother's Nme ytaW111t. I lied#d 07MI Ronk- a�.A I - IRVINEAPARTMENT MANAGEMENT COMP,ANY Now did you first learn of this apartment community/ ❑o.C. Re,hrerDrive By E]PentabLlving am Promotlsn/Sp. Event ❑Apartment 6uide ElSlgns ElWebsite- Other " F153 Mercury Orig. Apt. Magazine ❑ other SAC community ❑Reform- ❑Nawspper•Othee Postal living(W Mago" nnvt ❑Relowror5mice ❑Magdtine- Other • For Rent Magoalae ❑SD Union [:]I* Affordoble Nausing ❑IAC Apt. Info Center ❑SD Reader [:]Posicard/tidier ottherr-Nat Listed• • PLEASE FILL IN: rr,�,p KCN/' Reaonferreloailon: Now mom/ vehicles de you awrddrim? 1 Make 4l Ut DP PC,C(, lP year (12 License# Make Year License# Note: Parking of recreational vehicles, boats or trailers is not permitted In the Community. Do you have Renter's Insurance] ❑Yes Ev Na Consent to Verification of Credit and Other Information: I. makIq this Application voluntarily for the purpose of obtaining IAMC's approval to rent an aWneut in the apartment community shown above. I hereby authoria and consent to alb.IAMC,Owner, and their r",atv. employes and agents(alleelWely, the'IAMC Pamirs•), to obtain and verify the credit and other Information provided by me In this Application through credit reporting agencies, teen screening service mmpaNes, bade(Including Iatanl. funds verification),employe+, and Other persons ar"tltles with Information misting to this Application I understand that If I base this apartment, the IAMC Parties shill haw a continuing right to review my ,s dlt Information, paymmrt history. occupancy history and other Inforaaticn in this Apphaticn for purposes related to my Last and/cur for account review or Improvement of appliance reathods. I hereby releaa and held harmless'rh. Irvine Carepany Irvine Apartment [.amenities, LP.,Irvina Apammrnt Management Company, and all of their rapcdI. officers, employees and agents, from my and all liability, legal praaedrgs and casts, Ialud,ngaNarneWfees, arislrg out of the verification..V., use of the Informatlon contained In this Application. Including the relwa of Such Informal'. to Other wt.. I warrant that, a the but of my hrowledge, all of the Information provided in this Appllatbn (Induding but not limited to the statement of my financial aiditlon) Is ale, accurate, complete and amen a of the date of this Application. If any Information presided by me ls determined to be false. Such false statement will be grounds far disapproval of my Appllaton or tamlnadl a of my base with Owner. I agree to notify IAMC If any of the Informatlan podded In this Appllatlan changes during tree Appllatlan processor during my tenancy. I also understand that IAMC will retain this Application, along with any other Information provided by me, whether or rot this Application ls approved A lwnmrun dable Application Screwing ree of $30.00 (as Itombsd below) la a)lulrad film each Applicant la proats this Appll colon and to check the Information provided. AseparsteAppliadan ISRenlmustbesigned by cash Apulcantwhowilloccupy the sparlibeforsthis AppllatlanwN be cansldwelby LAXC. Date Applicant's signature RECEIPT FOR APPLICATION SCREENING FEE bow amount Is to be used to screen Applicant with regards to credit hmary and other background Information. The amount charged niacdesfoibws. 1. Actual ash of credit report. unlawful detoinar(ainian)xo 6, an&., other screening reports $9.95 2. Con to obtain, process and verify scnealng Information (may include staff's time and other related ens) $20.05 3. Total fee charged(moy not umcc d$30 per Applicant) $3000 ant oulhoNra verification of Informatlon supplied by Applicant on this Appliatlon through credit reporting ;,moles, personal reference , and other Informatlon our.. bate By: Applicant's signature Irvine Apartment Management Company Renned.07/01 FeA2d1 IppaenrrMNOlau ��- New Certificates X / Recertif, - UmtNumber 1316 INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designated to assist you in computing Annual Income in accordance with the method set forth in the Department of Housing and Urban Project ("HUD") Regulations (24 CFR 813). You should make certain that this form is at all times up to date with the HUD Regulations. All capitalized terms used herein shall have the meaning set forth in the Regulatory Agreement. CSCDA (Poof) - Newport North I/We the undersigned state that 1/we have read and answered fully, frankly and personally each of the following questions for all persons who are to occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit. 1 Name of Members Of the Household 3. 4. Relationship to Head of Social Security Household Age Number 5. Place of Employment Ve,.aplri, rexml Penj 39 134- F�-99a6 rye cen F� r 0 orcryo ewk yo�drrt , C ice Sis4&- �_ 00.o-10-q 261 tVCN� 1 Income Computation 6. The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children under 18 years) listed above for the 12-month period beginning the earlier of the date that I/we plan to move into a unit or sign a lease for a unit is $ 1 10136$ . 47 Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real or personal property (without deducting expenditures for business expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets); (c) interest and dividends (including income from assets included below and other net income from real or personal property); (d) the full amount of periodic payments received from social security, annuities, insurance policies, retirement funds, pensions, disability or death benefits and other similar types of periodic receipts, including any lump sum payment for the delayed start of a periodic payment; (e) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (f) the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter and utilities; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not residing in the dwellings; (h) all regular pay, special pay and allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the household or spouse; and (i) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; (b) amounts which are specifically for or in reimbursement of medical expenses; (c) lump sum additions to family assets, such as inheritances, insurance payments (including payments under health and accident insurance and workers' compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational Institution, and amounts paid by the government to a veteran for use in meeting the costs of tuition, fees, books and equipment. Any amounts of such scholarships or payments to veterans not used for the above purposes are to be included in income; 7. 8. 9. 10. 11. • YJ - .•gnu v i (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (f) relocation payments under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970; (9) foster child care payments; (h) the value of coupon allotments under the Food Stamp Act of 1977; (i) payments to volunteers under the Domestic Volunteer Services Act of 1973; 0) payments received under the Alaska Native Claims Settlement Act; (k) income derived from certain submarginal land of the United States that is held in trust for certain Indian tribes; (1) payments on allowances made under the Department of Health and Human Services' Low -Income Home Energy Assistance Program; (m) payments received from the Job Partnership Training Act; (n) income derived from the disposition of funds of the Grand River Band of Ottowa Indians; and (o) the first $2000 of per capita shares received from judgement funds awarded by the Indian Claims Commission of the Court of Claims or from held in trust for an Indian tribe by the Secretary of Interior. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necessary items of personal property such as furniture and automobiles and interests in Indian trust land) _X Yes No; or (b) have they disposed of any assets (other than at a foreclosure orbankruptcy sale) during the last two years at less than fair market value? Yes x No ( c) If the answer to (a) or (b) above is Yes, does the combined total value of all such assets owned or disposed of by all such persons total more than $5,000? X_ Yes' No (d) If the answer to ( c) above is Yes, state: (1) the combined total value of all such assets: $ Bi 422. 68' (2) the amount of income expected to be derived from such assets in the 12-month period beginning on the date of initial occupancy in the unit that you propose to rent: S toy, 5 7 , and (3) the amount of such income, if any, that was included in item 6 above: $ b 8.S 7 (a) Will all the persons listed in column I above be or have been full-time student during five (5) calendar months of this calendar year at an educational institution (other than a correspondence school) with regular faculty and students? Yes X No (b) Complete only if the answer to Question 8(a) is "Yes"). Is any such person (other than nonresident aliens) married and eligible to file a joint federal income tax returns? Yes X No This certificate is made with the knowledge that it will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and Ilwe declare that all information set forth herein is true, correct and complete and based upon information I/we deem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. I/We will assist the Owner in obtaining any information or documents required to verify the statements made herein, including either an income verification from my/our present employer(s) or copies of federal tax returns for the immediately preceding calendar year. I/We acknowledge that all of the foregoing information is relevant to the status under federal income tax law of the interest on bonds issued to finance the t3$ of the apartment building for which application is being made. We consent to the disclosure of such information to the issuer of such bonds, the holders of such bonds, any trustee acting on their behalf and any authorized agent of the Treasury Department or Internal Revenue Service. I/We declare under penalty of perjury that the foregoing is true and correct. }h FOB COWLEnON BY APARTMENT OWNER ONLY: 1. Calculation of eligible income: a. Enter amount entered for entire household in 6 above: b. (1) If the amount entered in 7(o)above is yes, enter the total amount entered in 7(d)(2), subtract frorr `tt figure the amount entered in 7(dx3) and enter the rema' zing •a ($ ); (2) Multiply the amouL MA to' a the current passbook savings '13 to determine what the tote] annual eamiz . 1(d)(1) would be if invested in passbook savini ��, subtract from that figure the amount ente, 'n 7(tq(3) and enter the remaining balance ($ (3) Enter at right the greater of the amount -calculated under (1) or (2) above: c, TOTAL 131101331,8 INCOME (line l.a plus line I.b(3): 2. Tee amount entered in Le: Qualifies the applicant(s) as a Moderarm Income Tenant(s), X Qualifies the applicant(s) as a Lower-Inct= Tenant(s). Qualifies the applicant(s) as a Very -Low Income Tenant(s). $ N/A 3. Number of apartment unit assigned: 139 Bedroom size: 2 t z Rent: $ Z IJ. 00 — 4. This apartment unit (&vw not) last occupied for a period of 31 or more consecutive days by persons whose aggregate anticipated annual income as certified in the above manner upon their initial occupancy of the apartment unit qualified them as a Lower -Income Tenant(s). S. Method used to verity applicant(s) income: / V Employer 'income verification. INCOME,- (-At rf If a rinr.l tnrno, - Lnsl Nmno Flrat Na].._ elationship Sox ofBr Ago Sor101 Socudty ll ]dmlt PrNr Stb1 Hoff3y S 6 IM-0-9we YN0rNo 2 P Ur OM"7a-9267 a45 — 7 5 — e EMPLOYMENT Family Memb. iF Source Base Rale Avera e g Average Annual $ Hours 52 24 2G 12 1 Total WK SCMIMO UI•VJK MU YTt— '$1815q $ a -- .`In SOCIAL Total SECIIRITV_ PFNslnnls Frc 1OXA: y y Fie mFly—b. iA SourT�Base -Hours AverageAveralMemb. 52 24 zG 12 1 Total N% StMbMO UbVJK I.1 Yr. PUBLIC ASSIST/Nr:F Talal Dnx 0 $ Family Source Base Rate Average Memb. IA • $ Hours Average Annual 52 24 26 12 1 Total Wx bWl. 0 DI.M rd Vli — $ _$ $ =$ nr�ee u1nr. � 'total Dnx C� —$ Family Memb, 0 Source Base Rate $ Average Hours Average Annual 52 24 21; 12 - " 1 Total WK SEMI MO 01•VJK M YI! $ _$ "total Dnx D $ TOTAL ANNUAL GROSS INCOME A through D nnaannnl-anon st�yyL_�& HJ.JCIJ Member 9 Asset Description (savings, checking, stocks, bonds, etc) Imputed/ Current I or C Grosstfalr Mkt. Value , Cost to Got Cash NET Family Assols Value, Actual Inlmcsl Rate Aciuol Annual Income from Assets 17 d% �— --cl 7 _ L• 1= % °T $ Totals Box L•: 13oau F: -:� IMPUTED INCOME FROM ASSETS Box E exceeds $5,000 - multiply E by the current passbook interest rate: It Box E dons not oxcaad $5.000 War .0. In box G: Enter the greater of Box F or Box G in. ZI .X 2 -BOXG $ g•y7 INPUTED INCOME FROM ASSETS S Sj.hi BOX If: lain]1141 1 olelAQuel lucan, Family lnmma 11muAbnL• Effective Delo ? TypoorProgram%. Unl(No. rag Unit Sixa 2+2 No. al persons 9. hVl: V Max. Income Limit $. 4S,?lbao- AR: _ 140% Limit $ INCOME CONTRIBUTED rROM ASSETS TOTAL ANNUAL INCOME $=c tjA . old & TOTAL ASSETS $• log, 5 7= F Please camp1 lu IAMC's aP Cmnmunitics Comnmuily: Mot ApIlllranl C fdan" of C.-Al (Loaf, nit. MI (Lost• First, MI Appllwt's pre 3 & Detached Nonil Monthly Paymal Pvcnt Lwldbr Immcdlote N bt N` Imn odlale Prior rralwsorJ�dacup, VL i (last, tint. Mid (Wq. Flrsl, NO Employer (If self G Mori a Olhcr,IP n(m/' .i / Inm"dlale M•br Chuklrg. Lanka JJIGF� Savings book. Hava you ever ill CVunly and 5late iilA\UKVA1C2�: IRVING APARTMGNT MANAGEMENTCOMPANY How did you first learn of this apartment community! QO C. Register ❑Drive By ❑Rental-Llving,com Promotion/Sp Event Apartment Guide El Sig. 5611�IAC �Website- Other �SJ Mercury �OH9 Apt. Magazine Community ❑Referral' E1hAws11znathcr' ❑Rental Living(IAC MagoLA Tmas ❑Rclextor Service — I I Ag.c.-Other• For Rent Magazine ❑SD Union �FIMr I❑Affordable Housing IAC Apt. Info Center 1:1SD Reader ❑Past card/Moller ❑Other -Not Listed' ' PLEASEFILLIN• Reason (or relocation' How many vehldm do you avNdrive9 Make�j Af�WP year /9Lj? License# Make year dense ye Note: Parking of recreational vehicles, boats or trailers is not permitted in the Community. Do you have Renter.Insaroncep Elves Elmo f Consent to Verification of Credit and Other Information: I am making this Application vah.tariiy for the purpose of obtoinby IAMC's approval to rent on apartment in the apartment community shown .bale Ihercbyinthonze and cement 1. allow IAMC, Owner, and their respective employees and agents (collectively, the'fAMC Pmtic$"). to obtain and verify the credit and other information provided by me In this Application through credit rcparting agenda, tenant z,rcening service campanias, banks (including electronic funds verification). employers and other person or entities with information relating to this Application I understand that if I base this apartment, the IAMC Parties shall have a minutes right to rcvlew my credit Information, payment history, ocmpasry history and other Information In this Application for inaTosm related to my Lease and/or for accaunt review or Improvement of application methods. I hereby reicas. and hold harmloss the Irvine Company, Irvine Apartment Cam enalties, L.F. , Irvine Apartment Management Company, and all of their respective officers, employees and agents, from any and.11 liability, legal proceedings and casts, Imkn iwg attorwaW fees, arm, out of tla verification and/or use of the (Of ormafiaa contained m this Application, including the release of such Information to other p.rtiet I warrant that, to the best of my hmwled9e, all of the information pmvlded in this Application (Including but cat limited to the statement of my financial cond,tian) is we, accurate, complete and mrcect as of the date of this Application. If any Information provided by me Is determined to be false, such false statement will be grounds far disapproval of in, Application or termination of my Leine with Owner. I agree to ratify IAMC if any of the Information provided In this Application c angea during the Application process ar during my to.,. I atso understand that IAMC will retain this Application, along with nary other information provided by me, whether or cat this Application is opprowd Anon-refundableAppllmllonScreening Foci 00 (wilte tit ed below) Is required from each Applicants process011sApplledlanand tocheck Us Information provided A separate Application to Rant must Inidgned byoach Appa nlwho will oempyNespomanl befaroNb pplieallon will be canddarcdIAMC. � b 2 Data APPIImnt4 flgnaturc RECEIPT FOR APPLICATION SCREENING FEE m above amount m to be used to screen Applicant with regards to credit history and other background Informai The amount charged licensed as follows. Actml costs of credit report. unlawful detairer(evictwn) search, and/or other screening reports $995 Cost to obtain, proms and verify screaming hformotion(may include staff's time and other related men) $20.05 Total fee charged (may not exceed $30 per Applicant) $30,00 at authorizes verification of information supplied by Applicant oa this Application through credit rep.01, agencies, personl roferenca and other Informman sources. !//� "Z&Dote Appbcantl slgmfurc Wile Apartment Management Company 71Q Ili 3 By: line ed.oy/01 Pape 2 as ApprnknTont."Oh.., r Income Restricted Certification \Questionnaire \'ame: Unit- Initial Cerciticatien Re-ceri licadon Other Vac \n OuPctinn 1Ionthh-Income J. we receive Fa.—j!y Supcorr. Spousal Supper, and 'or any other cash ccarribunors of gifts. including rent or utility payments from cersons nor living With me. I, we receive Veteran's Acministration, Pension, Unemployment benefi:. Disabilirr benefit. AFDC. Lottery winnings, Inheritance, i Or Ancuitie5. I I we receive in -core from Rental Property. SSA, SSI and or periodic social security payxnews. �I The l:ous.'hold receives u"a-ned income for family members I ate' 17 or trod'.,. 1 ue are errided to receive child S;ipport payments. i ( IY I I v:e am ciiCen:1v receiving, child support payments. I I I I v.e ---.'are ci:r:ecay ma -!as effo-s to collect child support ov:e_ to me. I I ' i I I vre have ocher assets (example: 401K. IRA, Revocable Trusts, Sto:la. Bonds. Treasury' Bills, \loney Market accounts, Cenilicate of Deposits, V hole Lire insurance, Real Estate) I i., h_vz cash on hand Student Status: Does t'ne hous-hold consist of persons who are all fill -time smaen:s (exan:ole: Colleee U'nivers:ty, trade school, etc.)? Does your household anticipate becoming a fill -time stiidenr househild in the next 12 months? If }roc: answered yes to eifner of the previous two questions are yo;l: NIvri:d and fifia^ 2 joint tap rehim. Under penalties of perjurp.I certify that the information presented on this form is true and accilrate to the best of ni% knowledge. The undersigned further understands that providing false representations Iht refit constitutes 0 act of fraud. False. misleading or incomplete information gill res t n the den I licat' * terny nation of the income restricted lease agreement. Earned Income Calculation Worksheet Name Employer Most Recent Ending Pay Period Date 6/2a(03 YTD Income - 13, C t67. 36 divided by 13.3` o T Start with hire date if at job for less than a year (=) W.95 (how often paid) N 26 =) Calculated Annual Income 25', it .? Hire Date Gross per Pay Period �i�Og6.a2 (+) T ,12 6 . ?, 7-71 (_) 21Zl2.2a divided by I 2 (how often paid) M 26 (=) Calculated Annual Income ZQ 1750, . aG. 46K 20 0066 46K Earnh.;,a Statement A wl EYE CENTER OF ORANGE COUNTY ME 24022 CALLE DE LA PLATA 1 1 l��f STE # 305 Pay Period: 6/16/2003 to 6/29/2003 LAGUNA HILLS, CA 92653 Pay Date: 7/02/2003 Employee Number: 0066 Deparlrant Number: 20 Social Security Number: 13a - 68 - 9906 Marital Status: S I NGLE Number Of Allowances: 01 Hours and Earnings Description Hours Rate I This Period 1 Year -To -Dale REGLAR 58.57 14.0000 819.98, 11170.78 0/TIME 1.02 21.0000 21.421 382.97 VACTON 8.00 14.0000 112.001 749.00 SICK 7.00 14.0000 98.00 306;00 HOLDAY I 424.00 UNALOW I 34.61 FRINGI 34.62� 450.06 H1P Gross Pay Yoar To Dato $13,067.36 r CAROL R VERDON 938 BAYN/OOD DR NEWPORT BEACH, CA 92660 II87 16 I 1405. '284.60 CDCIT 25.48I A 1 $1,086,02 1 $234.51 1 $851.51 EYE CENTER OF ORANGE COUNTY ME 24022 CALLE DE LA PLATA STE R 305 Check Date: 7/02/2003 DEPOSIT •46K 20 0066 46K EYE CENTER O. jRANGE COUNTY ME 24022 CALLE DE LA PLATA STE # 305 LAGUNA HILLS, CA 92653 Employee Number. 0066 Cepartr?6t Number. .20 v Social Security Number 134-68-9906 Marital Status: SINGLE Number Gt Allowances: 01 Earn' - s Statement l�(�Y�t�( Pay Pencd: 6/02/2003 to 6/15/2003 lil Pay Date: 6/18/2003 CAROL R VERDON 938 BAYWOOD DR NEWPORT BEACH, CA 92660 ' Hours and Earnings Taxes and Deductions Description I Hours I Rate ' I This Pericc Year -To -Date Description This Period Year -I o-Date REGLAR 76.55 14.0000 1071.70 10350.80 FICA 86.16 951.00 0/TIME I .95 21.0000 19.95 361.55 FED WT 124.71 1289.70 VACTON 637.00 CA ST 27.90 259.12 SICK 208.00 CA DIS 10.13 111.88 HOLDAY 424.00 ONALOW 34.61 FRINGI 34.62 415.44 i i Pay Year To Date 1 Gross Pay This Period Total Deductions This Period Period r512,015.96 1 51,126.27 *248.90 f,,,,7ayThIs *877.37 `IE:u PI DDD.UuIE:rr :JJ7il°IIYILr((__hLO 1=5J _, hW=r L71. i!_311177e1= L_;_:..J J. LL I_.:.J °iE.1-1 Fi: Jid LA°:i:.:!( ri?TJ LlI *17_=F:.:fr:1'l: r EYE CENTER OF ORANGE COUNTY ME DEPOSIT 24022 CALLE DE LA PLATA STE # 305 check Date: 6l78/2003 LAGUNA HILLS, CA 92653 *877.37 DEPOSIT TO BANK# 122000496 CHK ACCT# 0691454284= _ Ny To Tn. 20 0066 46K = `AA� $877.37 order Of CAROL R VERDON = 938 BAYWOOD DR — --_-- NEWPORT BEACH, CA 92660 ****VOID********VOID**** vi , ,IVQUCHER ONLY - NON-NEGOTIABLE 1i LLL��� Jul 23 03 02:51p p.2 Jul 23 03 02:25p ME JRT M 949720 8 p.2 CNIPLOVNIENIT VERIFICAA ]OY TO 8E COMPLETED BY M2.NACEMENT aPfD EXECUTED B Y TES ANT THIS SECTION (Name S address of employer) Date:__. VOC62t K A 4Av — S 130 1 rove S-6eg l a $.,ile670 _MAEi 121 1 62-0. a — RE:,,_ -acial Se r MI r+r�nn c4-8 ,. 13rs Applicant7ensn[Name curity Number Unu-(i[assigned) I hereby authorize release of my employment mformxuoa. - Sign'. of Applicar"Tmam Data The individual named directly above is an apphcanVlenant of a housing program that requires verification of income The ,nib nation,provided will remain confidential to satisfaction of that stated purpose only. Your prompt response is crucial and greatly appreciated Project O„tRrManagemeni Agent .2 YY100Uv 0 fir. Return Form Tn: wewtoa'+ &Bac�' Gq 42660 THIS SECTION TO BE COMPLETED BY EMPLOYER awpbycc Nanic: `--�` t"'L Job Title. �A �n.I .✓7"y..o•oj[O`�" Presently Employed: Yes " Date First Employed 1�-�•oZ No! Last Day ofEmployment - urtc t N'ages/5alary: 5� .11r)T (circle one) hourly weekly bo-weekly semi-monthly . onihl -yearly other_ O Average S ofre5ular hours per week. 1 Z • Year-io-dale eurnings: g C n 0 through 001 .3 ovenimc Rate. S- N per hour Avcragc: ofovernme hours per week: f�. et hour Average E of shift differential hours Per week: (v (!4 Shill Differential Rate. 5�1� p g Commissions, bonuses, lips, other: $ 71L (circle one) hourly weekly bi-w•cek)y semi-monthly monthly ycatly other List any anticipated change in the employee's rate of pay within the nest 12 months:- ; E(fcaiye date• lithe employee's work is seasonal or sporadic, please indicate the layoffperiad(s).--- Additional remarks: Date SignatureEmdo)•ei's Pnmcd tome n Clarification Record Applicant/Resident Name: Cgra� Verd2/1 Date: Ql I0I03 ❑ Initial Certification Date of Expected Move -In: ❑ Re -certification Means of Clarification: Date of Clarification: Contact Name: summary of Explanation or Clarification Given: arp� G Effective date: ® Phone Conversation © Person -to -Person Conversation ❑ other: Employee Name: i .,�,-La _Title: (YLo�GuS Employee signature: . Y•' :r Asset Calculation Worksheet Name• Carol Verda� Account Type Ck er- ,>>. 6i 599 . 6 4 (+) (_) 10/857.75 divided by 2- (average account balance) +` •` .7 JAI c ly, ,Ili I OF AC( U N T 5 UNION BANK OF CALIFORNIA LAGUNA HILLS OFFICE 069 PO BOX 512380 LOS ANGELES CA 90051-0380 CY04 Z 0 A 0000 CAROL R VERDON 938 BAYWOOD DRIVE NEWPORT BEACH CA 92660 Page 1 of 2 Statement Number: 0691454284 5/7/03.6/5/03 TeleservicesO For 24-hour Automated Direct Service 800-238.4486 800-826-7345(TDD) Representatives are available from 6 am to 11 pm To open additional accounts, or apply for loans, call your banking office at 949-830-3200 Visit us of www.uboc.coni Thank you for banking with us since 2001 ■ News this good needs to be shared with everyonal Online Bill Pay with Bank@HomeO on the WEB is now Free'. Spend less time paying bills and have greater control over your finances. To get started, log on to UBOC.com/instant or contact an Online Banking Specialist at 800-796-5656, option 1. IBasic checking account holders: Restrictions may apply. For details, see the description of your account In our disclosure and agreement. Days in statement period: 30 L Balance on 5/7 $ 5,268.19 Additions 2,332.09 7 Su61raclions -2,010.72 Checks-1,059.89 Payments-218.88 ATM withdrawals-720.00 Other withdrawals -11 95 Balance on 6/5 $ 5,589.56 l Statement Average Ledger Balance $ 5,667.74 We waived your service charge this statement period. " Additions Dota Description Reference Amount 5/7 EYE CENTER OF OR PAYROLL PPD ."""""""""""446K 51068846 $ 410.29 5/15 OFFICE DEPOSIT 47312444 232.85 5/21 EYE CENTER OF OR PAYROLL PPD "* ...... *'646K 54301898 791.08 6/4 EYE CENTER OF OR PAYROLL PPD """""""""""8AM 51152756 897.87 Total $ 2,332.09 Checks Nwnber Dole Reference Amount Number Data Raference AmouN 0140 5/15 22431739 $ 114.U5 0743 6/2 2673i718$ A14.1i 0141 6/2 22218023 6.58 Total $ 1,059.89 0142 6/2 22405AOI 525.15 Acount Payments Dole Description code Reference Amount online and 5/21 DOEDTREAS 310 FEDPREAUTH PPD """""""""""0200 54286356 $ 218.88 electronic banking a • � l� k;, u; �� art, ' .. g,4' t . .f,r• i •% \a • ..1. , .. �I •• tlZ. r* Page 2 of 2 Statement Number: 0691454284 5/7/03.6/5/03 ATM withdrawals Dale Descr;ploonlLocation Reference Amount 5/12 UBOC HARBOR VIEW D/U NEWPORT BEACH CA 44210471 7131 1123 $ 60.00 5/13 UBOC LAGUNA HILLS W/ LAGUNA HILLS CA A4210471 71331101 60.00 5/19 UBOC HARBOR VIEW D/U NEWPORT BEACH CA 44210471 71381404 60.00 5/20 UBOC LAGUNA HILLS W/ LAGUNA HILLS CA 44210471 71AO0822 60.00 5/27 UBOC LAGUNA HILLS W/-,rLAGUNA HILLS CA 44210471 71471057 60.00 5/27 UBOC HARBOR VIEW D/U NEWPORT BEACH CA 44210471 71431858 300.00 5/30 UBOC LAGUNA HILLS W/ LAGUNA HILLS CA 44210471 71501058 60.00 6/2 UBOC LAGUNA HILLS W/ LAGUNA HILLS CA A4210471 71531136 60.00 Total $ 720.00 Other withdrawals Dale Desuiplion Reference Amount including fees and 5/20 DELUXE CHECK CHECK/ACC. PPD 53906218 $ 11.95 adjustments bTAT ElWr N7 Page Iof2 OF ACC U N T S Statement Number. 0691454284 UNION BANK OF CALIFORNIA 4/8/03 - 5/6/03 LAGUNA HILLS OFFICE 069 Teleservicas0 PO BOX 512380 LOS ANGELES CA 90051-0380 For 24-hour Automated Direct Service 600-238.4486 800.826.7345(IDDI Representatives are available from 6 am to I 1 pm 0 To open additional accounts, or apply for loans, call your CY04 Z O A 0230 banking office at 949-830L3200 CAROL R VERDON Visit us atwww,uboc.com 938 DAYWOOD DRIVE NEWPORT BEACH CA 92660 Thank you For banking with us since 2001 IN An easy number. A loll -free number. An anything your heart desires number. When life is calling for anew house, car or a great get away vacation, call 1-866-UB-LOANS for on equity, home or auto loan today. in statement period: 29 Balance on 4/8 $ 6,617.49 Additions 2,111.06 Subtractions -3,460.36 Checks-1,821.48 Payments-218.88 ATM withdrawals-1,395.00 Other withdrawals -25.00 Balance on 5/6 $ 5,268.19 Statement Average Ledger Balance $ 6,319.56 We waived your service charge this statement period. Additions Date Descri lion Reference Amount 4/9 EYE CENTER OF OR PAYROLL PPD 56965631 $ 843.72 4/23 EYE CENTER OF OR PAYROLL PPD 53176042 461.54 5/1 OFFICE DEPOSIT 4541130E 112.00 5/5 OFFICE DEPOSIT 47817486 693.80 Total $ 2,111.06 Checks Number Date Reference Amount Number Date Reference Amount 0135 4/16 18523986 $ 127.68 0138 5/5 23432525 $ 414.78 0136 4/22 14318663 250.00 0139 5/1 10510387 1,009.02 0137 4/30 14622333 20.00 Total . S 1,821.48 Account Payments Dale Description code Reforenco Amdua „ online and 4/21 DOEDTREAS 310 FEDPREAUTHPPD 52620979 $ 218.88 electronic banking ATM withdrawals Dote Descri tion/f000tion Reference Amounl 4/14 UBOC HARBOR VIEW D/U NEWPORT BEACH CA 44210471 71021009 $ 200.00 4/14 7-ELEVEN ELMWOOD, NY 44210471 71031624 101.50 4/15 CHASE HU'GTON NY A4210471 71041833 301.50 4/16 CITIBANK E NRTHPORT NY 44210471 71052214 61.50 4/17 FLEET BANK NORTHPORT NY A4210471 71071731 61.50 4/21 CHASE HOGTON NY 44210471 71082009 81.50 '^�•• �-mot,' • %'} - Page 2 of 2 Nlalul Statement Number. 0691454284 4/8103.5/6/03 ATM withdrawals Data DescripltonlLocclion Reference Amount continued 4/21 THE BANK O F NY HUNTINGTON NY A4210471 71100818 $ 81.50 4/22 FLEET BANK NORTHPORT NY 44210471 71121502 81.50 4/24 FLEET BANK GREENLAWN NY A4210471 71141126 81.50 4/25 CHASE EAST N-PORT, NY 44210471 71141928 81.50 4/28 FLEET BANK NORTHPORT NY 44210471 71160726 r 81.50 5/1 UBOC LAGUNA HILLS W/ LAGUNA HILLS CA 44210471 71210945 60.00 5/2 UBOC HARBOR VIEW D/U NEWPORT BEACH CA 44210471 71221455 60.00 5/6 UBOC LAGUNA HILLS W/ LAGUNA HILLS CA A4210471 71261056 60.00 Total $ 1,395.00 Other withdrawals Dole Desaiplion Rafaranca Amount including fees and 4/14 ATM NETWORK WITHDRAWAL FEE 65055665 $ 2.50 adjustments 4/15 ATM NETWORK WITHDRAWAL FEE 65044160 2.50 4/16 ATM NETWORK WITHDRAWAL FEE 65034512 2.50 4/17 ATM NETWORK WITHDRAWAL FEE 65034662 2.50 4/21 ATM NETWORK WITHDRAWAL FEE 65044253 2.50 4/21 ATM NETWORK WITHDRAWAL FEE 65044254 2.50 4/22 ATM NETWORK WITHDRAWAL FEE 65043926 2.50 4/24 ATM NETWORK WITHDRAWAL FEE 65034453 2.50 4/25 ATM NETWORK WITHDRAWAL FEE 65045079 2.50 4/28 ATM NETWORK WITHDRAWAL FEE" 65055705 2.50 Total $ 25.00 New Certificates Ix ./Recertification Unit Number l i 72 INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This form is designated to assist you in computing Annual income in accordance with the method set forth in the Department of Housing and Urban Project ("HUD") Regulations (24 CFR 813). You should make certain that this form is at all times up to date with the HUD Regulations. All capitalized terms used herein shall have the meaning set forth in the Regulatory Agreement. CSCDA (Pool) - Newport North UWe the undersigned state that Uwe have read and answered fully, frankly and personally each of the following questions for all persons who are to occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit. 1 2. 3. 4. 5. Name of Members Relationship Of the to Head of Social Security Place of Household Household Age Number Employment Income Computation 6. The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children under 18 years) listed above for the 12-month period beginning the earlier of the date that I/we plan to move into a unit or sign a lease for a unit is $ 323.6� Included in the total anticipated income listed above are: (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other compensation for personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real or personal property (without deducting expenditures for business expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets); (c) interest and dividends (including income from assets included below and other net income from real or personal property); (d) the full amount of periodic payments received from social security, annuities, insurance policies, retirement funds, pensions, disability or death benefits and other similar types of periodic receipts, including any lump sum payment for the delayed start of a periodic payment, (e) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (f) the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter and utilities; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not residing in the dwellings; (h) all regular pay, special pay and allowances of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the household or spouse; and (i) any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; (b) amounts which are specifically for or in reimbursement of medical expenses; (c) lump sum additions to family assets, such as inheritances, insurance payments (including payments under health and accident insurance and workers' compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational Institution, and amounts paid by the government to a veteran for use in meeting the costs of tuition, fees, books and equipment. Any amounts of such scholarships or payments to veterans not used for the above purposes are to be included in income; (a) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire; (I) relocation payments under Title II of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970; (g) foster child care payments; • (h) the value of coupon allotments under the Food Stamp Act of 1977; (i) payments to volunteers under the Domestic Volunteer S.9rvices Act of 1973; 0) payments received under the Alaska Native -Claims Settlement Act; (k) income derived from certain submarginal land of the United States that is held in trust for certain Indian tribes; (1) payments on allowances made under the Department of Health and Human Services' Low -Income Home Energy Assistance Program; (m) payments received from the Job Partnership Training Act; (n) income derived from the disposition of funds of the Grand River Band of Ottowa Indians; and (o) the first 52000 of per capita shares received fromjudgement funds awarded by the Indian Claims Commission of the Court of Claims or from held in trust for an Indian tribe by the Secretary of Interior. 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necessary items of personal property such as furniture and automobiles and interests in Indian trust land) _Yes No; or (b) have they disposed of any assets (other than at a foreclosure or bankruptcy sale) during the last two years at less than fair market value? Yes No ( c) If the answer to (a) or (b) above is Yes does the combined total value of all such assets owned or disposed of by all such persons total more than $5,000? Yes No (d) If the answer to ( c) above is Yes, state: (1) the combined total value of all such assets: S (2) the amount of income expected to be derived from such assets in the 12-month d beginning on the date of b initial occupancy in the unit that you propose to rent: S 145—,: 131. ? an " (3) the amount of such income, if any, that was included in item 6 above: S S. (a) Will all the persons listed in column I above be or have been full-time,student during five (5) calendar months of this calendar year at an educational institution (other than a correspondence school) with regular faculty and students? Yes _X _No (b) Complete only If the answer to Question 8(a) is f1Yes"). Is any such person (other than nonresident aliens) married and eligible to file a joint federal income tax returns? Yes X No ) 9. This certificate is made with the knowledge that it will be relied upon by the Owner to determine maximum income for eligibility to occupy the unit; and I/we declare that all information set forth herein is true, correct and complete and based upon information I/we deem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. -- ---- --- ---- -- 10. I/We will assist the Owner in obtaining any information or documents required to verify the statements made herein, including either an income verification from my/our present employer(s) or copies of federal tax returns for the immediately preceding calendar year. l 1. I/We acknowledge that all of the foregoing information is relevant to the status under federal income tax law of the interest on bonds issued to finance the 1142 of the apartment building for which application is being made. We consent to the disclosure of such information to the issuer of such bonds, the holders of such bonds, any trustee acting on their behalf and any authorized agent of the Treasury Department or Internal Revenue Service. 1/We declare under penalty of perjury that the foregoing is true and correct. Executed this � day of_ 20Q$_ (year) in the City of tl-1O.0 f+ &California lz�' 5 MoVlalaY Applicant ApplicanT (Signature of all persons (except children under the age of 18 years) listed in number 2 above required) FOR COMP MON BY APARTMENT OWNER ONLY: 1. Calculation of e4lble income: a. Enter amount entered for entire household in @ above: b. (1) If the amount entered in 7(c)above is yes, enter the total amount enured in 7(d)(2). subtract ftthr 'if figure the amount entered in 7(dx3) and enter the regg sin1'W ($ )S s g1323•42 I . t (2) Multiply the amom. 'et In I the cuuent passbook savings rate +� e O to determine what the total annual eatviq /(d)(1) would be if invested in pasabook aavin+ �), subtract from that figure the amount en te n 7(a)(3) and enter the remaining balance ($ 0) Enter at right the greater of tine amount calmilated under �,� (1) or (2) above: S iii���A o. TOTAL 1111010318 INCOME (line l.a plus line U(3): 2. The amount entered in l.c: QualMes the applicants) as a Moderate -Income Tenant(s). X Qualifies the applicant(s) as a Lowenrincome Tenant(s). Qualifies the applicaat(s) as a Vary -Low Income Tenants). 49 ,32 3.62- i I 3. Number of apartment Unit assigned: I I y 24 Be&rro= size: z I Rent: 1 4. This apartment unit (Was ),ot) last occupied for a period of 31 or more consecutive days by persons whose aggregate anticipated annual one as certified in the above manner upon their anal cecupancy of the spartmeue unit qualified them as a Lower -Income Tenaut(s). 5. Method used to verify applicants) income: _ Employer income verification. Copies of tax returns. Other Rho/63 h Date a• 0..^^ M INCOME & ASSET CALCULATION WORKSHEET I MEW SOCIAL SECURITY, PENSIONS, ETC. PUBLIC ASSISTANCE OTHBRINCOME to* AYCd # Sam eualata A A Inca A Almal Tad Wtaz u EnHN R11 tt A4 t Tr $ $ Totai Box D $ ._ TOTAL ANNUAL GROSS INCOME A Throw D $ a .v r G F�F;yZ 4 �/ � n .,iL': � � � N� i r; yGijr.,.�.7 rt +.Ig7 G t t= S-`—t r wir SYf➢tr�.. ^r x ��. � { a n ��_ •'+x.— n t1 .Y.. ��3y1'�ii �,�. au tS%(��,�i','�J rtrt '��� `"��.:,����t ,.:,C:at t -� aY R�eeC.� firy Illmb AnothscrtlIm # tlollC atad etcl 1C4smdl CIrCt BYaytelrAYlt ICrC Palle I LhrtmW[i�5 AYifan AssaleYaln ACd htawtBale anil Alnml IcmleOmAaeeta St. b-? .69 IS e S I 72 6 4 1 %$ e $ It IS arI $ I I % I S ar t 0 $ 0 S er =$ 16 D'm % S a' $ $ _ $ I % I $ $ $ _ $ I % $ $ IS _ $ % $ $ $ = S % $ Totals Box E: I $ 11,sga.0 7 1 Box F: IS v TomINETFamtly Tom]Actual Income Incomefmm Asset; IMPUTED INCOME FROM ASSETS Box $ It'54=1,0? Effective Date: YltaoB 03 If Box E exceeds $5,000 multiply Box E by the current Type of program %: LOty passbook interest rate: x 2 % Unit No.: II$2 Unit Size: V- Z If Box E does not exec It$5,000 enter-0-in Box No.ofpersons: a INCOME CONTRIBUTED FROM ASSETS $ox H: $ 23�. 4$ M : /� Max. income Lint 50,950.0a Enter the greater of Box F or Box G AR: 140%Limin TOTAL ANNUAL INCOME $ 4 6O111,A4 & TOTAL ASSETS $ Q . qSr = $_ 94 , 3 Z3,62 Income Restricted Certification Questionnaire Name: M is 61� A N Unit # _ ' r _ Initial Certification Re -certification Other Vaq Nn Ouestion Monthly Income V Uwe receive Family Support, Spousal Support, and/or any other di®cash contributions of gifts, including rent or utility payments from persons not living with me. Uwe receive Veteran's Administration, Pension, Unemployment benefit, Disability benefit, AFDC, Lottery winnings, Inheritance, " V or Annuities. i I/we receive income from Rental Property. Uwe receive benefits/income from Social Security to include / SSA, SSI and/or periodic social security payments. JItY! The household receives unearned income for family members age 17 or under. Uwe are entitled to receive child support payments. f 1)� Uwe am currently receiving child support payments. JV I/we amlare currently making efforts to collect child support owed to me. Uwe have other assets (example: 401K, IRA, Revocable Trusts, /J Stocks, Bonds, Treasury Bills, Money Market accounts, (/ Certificate of Deposits, Whole Life insurance, Real Estate I/we have cash on hand, Student Status: Does the household consist of persons who are all full-time f students (example: Colle ersity, trade school, etc.)? Does your household anticipate becoming a full-time student household in the next 12 months? If you answered }_es to either of the previous two questions are you: ➢ Married and filing a joint tax return. � Under penalties of perjury, I certify that the information presented on this form is true and accurate to tht:.b o my ledge. The undersigned further understands that providing false lip esentatio s j rei onstitutes an act of fraud. False, misleading or incomplete information will resuI 'rr'the denial of applicatio r termination of the income restricted lease agreement. Resident lure Date 91 is C,o Sisnature of Own r/Agent Date Rental Application and Receipt for Application Screening Fee Please complete this form In It's entirety, noting -WA- or -none where appBaable. The Informationyou provide will be verified prior to IAMC's approval to rent an aparhnentto you in anaportment mrlulmrity owned by either The Irvine company or Wre, Apartment Cummunitles, LP. (collectively, •Owner`). rwme(Ust, First, MiddleInifW) IrAr. seanfty Number Firx, Mlddk InlHal) (last. First, Middle Wild) (Lori, First, Mlddk Irdtkl) P 1 parr, Plat Middle InitioQ (fax, Fbst Middle INllaB (1M,Flrn Middle lnitk$ 1 e APPlimnt's Present Address Clty ZIP L1 Own Dakr e From EMd Address: n t Raw, To Detarlwd famlly home: Attahedfemllyhomer Apmnmrnm N Monthly Payment$ To whomda you make pryo nisi 1 s Present landlord's Nmrc Address city ZIP phone# t � Immedlate Prior Addrm Of less than I yr. at above) awn MonthF/Payment Do'ea Y ❑ Pram Immediate Prior landlord's Name Ad*= all, ZIP Phase# be you own a Pet) 11 Yea El No tdenbnof Peas: Type: D Proposed 0m first, Middle Imtlal) Dote of Birth (Iax,Fast Middle Idtid) bate of Birth Cn(last, e (last, Flat Mlddl tlal) Date of Oirth (Lox, First, MiddleInitkl) Data of BIM, P e n (last, PlM, Middle lnlild) Dols of BlMh (Lost Flex, Mlddln INfld) West Birth f IF s In ove of emergenry, plwe roHfy. (fowl mme, addevdphola tumberJ r a a If applimble, parents' phone wmberr. n ( ) a Father's" Mothcl,Js Redsed:07101 Peat d2 AppladanTaoeMOmt.w a I110%1NVAIC IRVINE APARTMENT MANAGEMENTCOMPANY Now did you first learn of Ihis apartment community? O.C. Register Drive By ❑RenfahLlving.com Apartment Culde 1:15190, Wabsite•Other• Orlg Apt. Magazine M Other ]AC Cii—ItY❑par" ' Rental Living(IAC M.90" Times ❑Rdomtor Sersdce For Rent Magazine EJ5D Union [—]Fly- IAC Apt Info Center E]So Amer Il Postcard/Moiler e PLEASEFILLIN Promotion/Sp. Event EISJ Mercury i�(uewsmpar•Olher^ LL❑JJMogaa.l. • Other ❑Affordable Housing ❑Olhm•• Not LUred Reason for ml...flow Haw many vehldes do you own/driveg Make Year License M Make year License ft Note: Parking of recreational vehicles, boats or trailers Is not permitted in the Community. Do you have Renter's losuromp yes Chb Consent to Verification of Credit and Other Information I am making this Applimllan voiunm,rIY for the purpose of obtaining IAMC's approval to sent an apartment in the apartment community shown above. I hereby vuthoriee and cammw to allow IAMC, Ownar,and their mspeclim employees and agents (collectively, the •IAMC Forties`), to obtain and verify the credit and alher hdorovi provided by me in this Applimllon through credit reporting agencies, tenant screening service companies, banks @nduding electronic, funds vedflcotlan), employers and other persaos or entitles with Information relating to this Application. I understand that If I leas. this apartment, the IAMC parties shell he.. cofined, right to review my credit Information; payment history. ocmpmry history and other information In this Application for purposes related to my tease and/or for account review or Improvement of applimtton methods. I hereby release and hold harmless ilia IMm Company, IMng Apertment Communities. LP..Irvim Apartment Management Company and all of their respective officers, employees and agents• from any and all liability, legal proceedngs and costs, bmkNlrg altar"' fees, arising out of the verification and/or use of the infarmsnon contained In this Application•Includhy the mime of such Information to other parties, s I warrant that, to the best of my knawtedgc, all of the Information provded (n this Appbmtian (imludy but nai Iimlfed to size statement of my financial condition) is true, accurate, complete and correct as of the thereof this Applimllan If any information prodded by me Is dclermined to be false, each false statement will be grounds for disapproval of my Application or termination of my Losses with INI ar. I agree to notify IAMC If any of the informal Ion provided in this Application changes during the Application process cur during my tenancy. I oba understand that IAMC will mWn this Application, along with any other Information provided by me, whether or rot this Application D approved. Ano miundable Appllcilien Wassing Fee of$30.90(as ltemlzed below) Is required from each Applicators process this Application and to chock the InformtdonproWdad Asepanr.Appllaadon to 11.0 must be signed by each Appllanlvsho wlp occupy 11mi., entbafem lhle Applimdon will ba conAderedbyNYC.— 8 iY0I Date AFplicnt's signature RECEIPT FOR APPLICATION SCREENIWG FEE la above amount is to be used to screen Applicant with regards to credit hisrery and other background information. The amount charged Itemized m folkws: 1. Actual costs of credit report, unlawful Warner(evletlon) search, and/or other screening reports $9.95 2. Cost to obtain,process and verify screening ln(orrimik-(mm/Include staff's time and other related costs) $20.05 3. Total (cc charged (may cot exceed $30 per Applicant) $30.00 ,pile.. authorizes verification of Information supplied by Applicant on this Application through credit reporting agencies, personal reference and other information sources. Applicant's signature l BY 6 /� 3bo�i Irvine Apartment Manage elf Company Radrad.0y/01 ,rl-'�.� paae2d2 /"y rdaa"ImTopaWam.vw M Earned Income Calculation Worksheet Employer Most Recent Ending Pay Period Date 7 12 6(0 3 YTD Income Z91Z46.23 divided by Start with hire date if at job for less than a (_) it 3 SS, 14 (how often paid) W 1 26 =) Calculated Annual Income Li9 I0a1-o Hire Date 200 2 Gross per Pay Period 5'G6 .sG (+) 1114Ll.S7 (+) I1-7II. LI3 divided by 1 ?2 (how often paid) M 2 (=) Calculated Annual Income 2 2t V4 9.7Z Macy's West, Inc 170 O'Farrell St. San Francisco, CA 94102 Pay Group: ZOl-Macy' - Hourly Advice #: 3787749 � Pay Begin Date: 07/2�,�1 Pay End Date: 07/2672�U3 Advice Date: 08/01/2003 IIIIIIIIIIIIIIIzIII DEPOSIT ADVIUL Marjan Samakar Employee IN 17127430 :;TAk:Oiaxa� :::::: 5:>:: ••••••'•:;5;;..: "''':::::':: Marital Status: Married Married 08/01/2003 17002 17002801ON 3787749 17127430 1407 Location: Macy's West - SoCoastPlaza RIF SSN: 569-79-3057 Allowances: 0 0 Addl. Pct.: Addl. Amt.: :::�>:: :•:.: •i N i; R 'N S<:{{{<•}: �>:•> •:•: i} •::•:•:•}:•}:•}:•:•i:<•,: �::•:>}:•ii: i:•i}::<•:<•:•}:•:•}}:•.•{t7{85:;:;:�:::::::::::::::::::::::::::::: _.Current - ------_---•YTO--_._. Description Rete Hours Earnings Hours Earnings Description Current YTD Commission 118.06 11,556.97 Fed Withholdng 35.20 3,469.75 Regular Earnings 13.000000 34.50 448.50 958.77 12,464.01 Commission - Better Items 0.00 2.00 Fed FICA - MRI 7.37 407.14 Fed OASDI/Dis 31.52 1,740.89 TIA Adjustment 0.00 3.00 39.00 Commission - Fabricoat 0.00 1,708.52 CA Withholdng 6.20 746.84 CA OASDI/Dis 4.58 252.71 Holiday Pay 0.00 30.00 596.60 HolidayWkd = Rate x 1.5 0.00 14.45 281.78 Instant Credit 0.00 189.00 Mon Prod Hours 0.00 16.00 208.00 Straight Overtime 0.00 13.10 170.30 Vacation Pay 0.00 ll2.50 2,239.05 Total: 34.50 566.56 7.82 29 66. 7 Total: 6,9433 . N . T R••S •D T N :• • N P•: "YTO . O.'.ri on urrent YTO. Description Current YTD Description current B1ueSbield CA PPO 51.76 207.04 United Way Flat Amount 1.00 17.00 Delta POS A Pre Tax 6.32 25.28 Macy's 401(k) Plan 28.33 1,472.75- Blue Shield CA PUS 0:00 1,051.65 Met PPO B 0.00 92.34 Total: Total: 1.00 17.001 Taxable <•'•:TOT'L'•:GRD68:L•:•:: •:•::•:•F'F31•T •Current: 'BLE:GROSS•'<:�<:•:•:<:+:•::•:•}:•}; :.; :70TAL':TA7(ES :{•ii:•}'TOTAL'•:OEIXUCTION&:•:•:•:•i::;;•�•;•NEF:AAY.•:• YTo: 29,266,23 26,606,17 6,617.33 21866.06 19,782.84 NET: PAY•fl[STRIBUTION'•:{ ; ;•:•: ;•: ;•:•; }::<; ;•}:• Advice #5191149 . Total: 394.28 Macy's West, 170 O'Farrel7 San Francisco, Deposit An To The Account(s) Macy's West, Inc 170 O'Farrell St. San Francisco, CA 94102 Pay Group: ZOI-Macy': k - Hourly Advice #,: 3758096 �.,.✓ Pay Begin Date: 07/ Pay End Date: 071IM3 Advice Date,: 07/18/2003 DEPOSIT ADVICE Marjan Samakar Employee ID: 17127430 TAS(:thA'7'A::,�>5:�:::•:::�:,RP''" .'• :+ ' '' Mar al 5 a us., Tied Married 07/18/2003 17002 170028Oi ON Location: Macy's West - SoCoastPlaza RIF - Allowances: 0 0 3758096 17127430 1407 Addl. Pct.: , SSA: 569-79-3057 Addl. Act.: ::::: :.:i•:. •: :•. _-Current -----• - ---- •VTO ----- Description Rate Hours Earnings Hours Earnings Description Current VTO Coneission 465.55 10,974.10 Fed Withholdng 120.92 i 3,268.24 Instant Credit 4.00 187.00 ,Fed FICA - MHI 16.08 382.09 Regular Earnings 13.000000 18.25 237.25 895.22 11,637.86 Fed OASDI/Dis 68.76 1,633.75 Vacation Pay 19.647757 22.50 442.07 112.50 2,239.05 CA Withholdng 29.96 704.43 Coesission - Better Items 0.00 2.00 CA OASDNis 9.98 237.16 Hon Prod Hours 0.00 8.D0 104.00 TIA Adjustment 0.00 3.00 39.00 Commission - Fabricoat 0.00 1,379.30 Holiday Pay 0.00 30.00 596.60 HolidayWkd = Rate x 1.5 0.00 14.45 281.78 Straight Overtime 0.00 13.10 170.30 Toni: 40.75 1.144.87 Total: 45. 0 6 225. ••YTD.• •YTD•• Description urrent Description Current Description current VTD• BlueShield CA PPO 33.44 103.52 United Way Flat Anount 1.00 15.00 Delta POS A Pre Tax 6.32 12.64 Macy's 401(k) Plan 57.44 1,380.54 Blue Shield CA POS 0.00 1,051.65 Met PPO B 0.00 92.34 Total: Total: Taxable •:<•:TOF L'•:GR068:{•:•:•}:•::•iFm•TAXABL•E:GRO55•:C•i:•:•};.}i:•};;.;•?;•i}:•;:;;:TOF'L':TAIfES•::•:•i};:TDFAL'•:DED.VCiIONS.•:•:•i:titi :{::i:•NET:AAY.v Current, 111M.YTD: 24,970.30, 6,225.67 2 655.69 18,542.63 NEF:•PAV•Il[STRIBIATIDN::•:•:•: }:•:{•::;:;•i:•:•i:;{{• Advice !800.97 Total: Macy's West, Inc 170 O'Farrell St. San Francisco, CA Deposit Amount: To The Account(s) Of: 94102 $800.97 MARJAN SAMAKAR 956 Stanford St Irvine, CA 92612 5 DATE: 07/18/2003 ADVICE NO. 3758096 :•PIRECi:•PkP.DSFT:AISTRIgt1Ta4N<•:; ::•>:•>:<•:•:<:•>:•>::•: Account Typo Account Number Deposit Amount Checking 294229090 $SOO.97 , Total: S800.97 DEPOSIT ADVICE ONLY -- NON NEGOTIABLE Account Type Asset Calculation Worksheet 1, qo I , 32 ( +) 1,244. o5" (_) 3,Ig5.37 (x) divided by I? -- I, J5--I;z.69 (average account balance) Interest rate: % le (_) Income from asset: $ 16� WESCOM Credit Union Account Number 294229 Statement Period 08-01-03 thru 08-31-03 1 Page 1 of 5 MARJAN SAMAKAR 956 STANFORD ST IRVINE CA 92612 ACCOUNTSUMMARY SAVINGS/ CHECKING ACCOUNTS BALANCE Savings (1) $1.00 Checking (1) $1,901.32 TOTAL BALANCES (2) $1,902.32 YTD DIVIDENDS EARNED TAXABLE DIVIDENDS EARNED $0.05 $0.05 ACCOUNTSUMMARY LOANS I BALANCE Vehicle (1) $17,691.30 Personal Line & Loans (1) $116.82 Credit Cards (1) $5,987.29 TOTAL BALANCES (3) $23,795.41 For questions contact us: Phone: 1-888.4-WESCOM (1-888.493-7266) Telier#Phone: 1-8774-TELLER (1-877-483-5537) e-Mail; mall@wescom.org Web Site: www.wescom.org P.O. Box 7058 Pasadena, CA 91109.7058 Protect your family with help from Wescom Financial Services Your family depends on you for all of the important things, especially financial security. And, with life insurance protection, you can ensure that your family will be taken care of after you've gone. Family Protection life insurance can save you up to 30% on premiums, with no medical examination required and convenient automatic monthly payments. Don't wait another day to take control of your family's future. For more information visit www.wescomfinancial.org. REGULAR SAVINGS oo Dividends Earned In 2003: $0.06 Beginning Balance + Deposits & Other Credits (0) - Withdrawals & Other Debits (0) $1.00 $0.00 $0.00 Trans Effective Date Date Transaction Description Amount Beginning Balance New Balance $1.00 New Balance 1.00 continued on page 2 EXPRESS CHECKING 69 Dividends Earned In 2003: $0.00 Beginning Balance + Deposits & Other Credits (6) - Checks Cleared (12) - Withdrawals & Other Debits (32) = New Balance $1,244.05 $4,434.16 $2,103.96 $1,672.93 $1,901.32 Trans Effective Date Date Transaction Description Amount New Balance Beginning Balance 1,244.05 08/01 Deposit ACH MACY'S WEST, INC 394.28 1,638.33 TYPE: PAYROLL DO 08/01 Check # 000253 -27.00 1,611.33 08/03 Withdrawal Debit Card -26.42 1,584.91 08/01 WHOLESOME CHOICE IRVINE CA 08/03 Withdrawal Debit Card -42.71 1,542.20 08/01 EXXONMOBIL59 07803877 IRVINE CA 08/04 Check # 000257 -550.00 992.20 08/04 Check # 000255 -215.00 777.20 08/04 Check # 000254 -18.87 758.33 08/04 Withdrawal Debit Card -20.00 738.33 08/01 DARTMOUTH COURT IRVINE CA 08/05 Deposit by Check 800.00 1,238.33 08/06 Withdrawal Debit Card -6.38 1,232.95 08/05 WHOLESOME CHOICE IRVINE CA 08/07 Check # 000258 -300.00 932.95 08/08 Deposit ACH MACY'S WEST, INC 680.68 1,613.63 TYPE: PAYROLL DO 08/08 Withdrawal Debit Card 08/06 USA PETROLEUM #044 IRVINE CA -16.66 1,596.97 08/08 Check # 000264 -500.00 1,096.97 08/11 Check # 000259 -200.00 896.97 08/11 Check # 000260 -30.00 866.97 08/11 Check # 000262 -15.43 851.54 08/11 Withdrawal Debit Card -35.44 816.10 08/10 WHOLESOME CHOICE IRVINE CA 08/12 Check # 000263 -200.00 616.10 08112 Check # 000265 -32.66 583.44 08112 Check # 000261 -15.00 568.44 08/12 Withdrawal Debit Card -42.71 525.73 08/10 EXXONMOBIL59 07803877IRVINE CA 08/13 Withdrawal Debit Card -2.46 523.27 08/12 WHOLESOME CHOICE IRVINE CA 08/13 Withdrawal Debit Card -15.14 508.13 08/12 WHOLESOME CHOICE IRVINE CA 08/14 Withdrawal Debit Card -11.50 496.63 08/12 RITE AID STORE 5766 IRVINE CA 08/14 Withdrawal Debit Card -19.62 477.01 08/13 WHOLESOME CHOICE IRVINE CA 08/15 Deposit ACH MACY'$ WEST, INC 498.96 975.97 TYPE: PAYROLL DO 08/15 Withdrawal Debit Card -4.62 971.35 08/13 BLOCKBUSTER VIDEO #06100 NEWPORT BEACH CA 08/15 Withdrawal Debit Card -10.19 961.16 08/13 ALBERTSON'S #6507 S9H IRVINE CA 08/15 Withdrawal Debit Card -11.01 950.15 08/13 USA PETROLEUM #044 IRVINE CA 08/15 Withdrawal Debit Card -19.00 931.15 08/13 USA PETROLEUM #044 IRVINE CA WESCOM M 294229 - MARJAN SAMAKAR Credit Union Page 2 of 5 EXPRESS CHECKING o9 (CONTINUED) Trans Effective Transaction Description Amount New Balance Date Date 08/18 Withdrawal Debit Card -19.84 911.31 08117 WHOLESOME CHOICE IRVINE CA 08/20 Withdrawal -500.00 411.31 08/20 Withdrawal Debit Card -106.50 304.81 08118 SOS - SANTA ANA 714-438.6500 CA 08/22 Deposit ACH MACY'S WEST, INC 1,366.33 1,671.14 TYPE: PAYROLL DD 08/22 Withdrawal Debit Card -65.32 1,605.82 08/20 UHAUUIRVINE B00270322IRVINE CA 08/24 Withdrawal Debit Card -9.97 1,595.85 08/22 RITE AID STORE 5766 IRVINE CA 08/24 Withdrawal Debit Card -27.61 1,568.24 08/22 WHOLESOME CHOICE IRVINE CA 08/25 Withdrawal Debit Card -15.16 1,553.08 08/24 WHOLESOME CHOICE IRVINE CA 08/25 Withdrawal Debit Card -30.60 1,522.48 08/24 WHOLESOME CHOICE IRVINE CA 08125 Withdrawal Transfer To Loan 04 -400.00 1,122.48 08/27 Withdrawal Debit Card -23.12 1,099.36 08/25 USA PETROLEUM #044 IRVINE CA 08128 Withdrawal Debit Card -19.09 1,080.27 08127 WHOLESOME CHOICE IRVINE CA 08/29 Deposit ACH MACY'S WEST, INC 993.91 , 2,074.18 TYPE: PAYROLL DO 08/29 Withdrawal CHECK ORDER FEE -12.00 2,062.18 08/29 Withdrawal Debit Card -30.76 2,031.42 08/28 DOLLAR STORE COSTA MESA CA 08/29 Withdrawal Debit Card -40.93 1,99OA9 08/27 EXXONMOBIL59 07803877IRVINE CA 08/29 Withdrawal Debit Card -56.73 1,933.76 08/27 RITE AID STORE 5766 IRVINE CA 08131 Withdrawal Debit Card -12.98 1,920.78 08/28-"-TRADER JOE'S'400001115 IRVINE'CA 08/31 Withdrawal Debit Card -19.46 1,901.32 08/29 SEE'S CANDY #147 COSTA MESA CA Summary of Cleared Checks Date Date Date Check# Cleared Amount Check# Cleared Amount Check# Cleared Amount 000253 08/01 27.00 000254 08/04 18.87 000255 08/04 215.00 000257` 08104 550.00 000258 08/07 300.00 000259 08/11 200.00 000260 08/11 30.00 000261 08112 15.00 000262 08/11 15.43 000263 08/12 200.00 000264 08/08 500.00 000265 08/12 32.66 `Asterisk next to number Indicates skip In number sequence. WESCOM 294229 - MARJAN SAMAKAR Page 3 of 5 Credit Union PERSONAL LINE OF CREDIT o3 Interest Paid In 2003: $242.87 Annual Percent Rate Daily Periodic Rate Balance Credit Limit Credit Available 10.900% .029863% $116.82 $3,500.00 $3,383.18 Trans Effective Finance Date Date Transaction Description Amount Fees Charge Principal Balance Beginning Balance 3,389.22 08/01 Loan Interest Rate change from 11.150% to 10.900% 08101 Index change from 4.250% to 4.000% 08/16 Payment by Check -3,300.00 0.00 27.60 -3,272.40 116.82 Closing Balance 116.82 A Payment of $10.00 is due on 09/20/2003. 2002 TOYOTA/RAV404 Interest Paid In 2003: $791.44 Annual Percent Rate Daily Periodic Rate 6.240% .017095% Trans Effective Finance Date Date Transaction Description Amount Fees Charge Principal Balance Beginning Balance 17,9M.93 08/25 Payment Transfer From Share 09 -400.00 0.00 95.37 -304.63 17,691.30 Closing Balance 17,691.30 A Payment of $392.52 is due on 09/25/2003. Credit Card Information as of 8/30/2003 Credit Credit Current Payment Card Type and Number Limit Available Balance Due Date PLATINUM VISA xxx xxx xxx 14,000.00 8,012.00 5,987.29 09/16/03 8377 WESCOM 294229 - MARJAN SAMAKAR CreditUnton Minimum Last Payment Last Payment Payment Amount Date ' 120.00 500.00 08/08/03 Page 4 of 5 PERIODIC STATEMENT DISCLOSURE FOR OPEN-END LOANS Periodic Rate: The Periodic Rate and ANNUAL PERCENTAGE RATE are subject to change on loans marked Equity Line of Credit, Express Equity Line or Share Line of Credit. Subject to the terms of the Note, you have the right to repay your Equity Line of Credit or Express Equity Line without prepayment charge. How You Determine The Balance On Which My FINANCE CHARGE is Computed: You will figure the FINANCE CHARGE an my account by applying the periodic rate to the unpaid balance of my account. To get the unpaid balance you will take the ending balance of my exeunt each day, after adding any new advances or purchases and subtracting any payments or credits. This gives you the unpaid balance. BILLING RIGHTS SUMMARY This notice contains Important Information about my rights and msponslbllities under the Fair Credit Billing Act. IN CASE OF ERRORS OR QUESTIONS ABOUT MY PERIODIC STATEMENT If I think my periodic statement Is wrong, or If I need more Infonnadon about an Item on my periodic statement, I must write to you on a separate sheet at Wescom Credit Union, Account Services, P.O. Box 7058, Pasadena, CA 91109.7058. 1 should write to you as soon as possible. You must hearfrom me no later than sixty (60) days after you sent me the FIRST periodic statement in which the error or problem appeared. I can telephone you, but doing so will not preserve my rights. In my letter, I should give you the following Information: (1) My name and account number. (2) The dollar amount of the suspected error. (3) Describe the error and explain, if I can, why I believe them Is an error, If I need more Information, describe the Item I am not sure about. I do not have to pay any amount In question while you are Investigating, but I am still obligated to pay the parts of my periodic statement that are not In question. While you Investigate my question, you cannot report me as delinquent or take any action to collect the amount I question. IN CASE OF ERRORS OR QUESTIONS ABOUT MY ELECTRONIC TRANSFERS I will write to you at Wescom Credit Union, Account Services, P.O. Box 7058, Pasadena, CA 91108-7058 or telephone you at 8881493-7266 as soon as I can, if I think my periodic statement or receipt is wrong or if I need more Information about a transfer on the periodic statement or receipt. You must hear from me no later than sixty(60) days after you sent me the FIRST periodic statement on which the error or problem appeared. 1 will: (1) Tell you my name and account number. (2) Decide the error or the transfer l am unsure about, and explain as Beady as I can why I believe there Is an error or why 1 need more information. (3) Tell you the dollar amount of the suspected error. You will Investigate my complaint and will correct any error promptly. If you take more than ten (10) business days to do this, you will re-cmdit my amount for the amount I think Is In error so that 1 will have the use of the money during the time it lakes you to complete your Investigation. Account Identifiers: When referring to your specific accounts, use the entire Amount Name alongwilhthe two -digit number shown after the Account Name. Using both the name and two -digit number will ensure accurate account information. WESCOM Credit Union WESCOM 294229 - MARJAN SAMAKAR Page 5 of 5 Credit Union WESCOM Credit Union Account Number 294229 1 Statement Period 07-01-03 thru 07-31-03 1_ Page 1 of 4 MARJAN SAMAKAR 956 STANFORD ST IRVINE CA 92612 ACCOUNT SUMMARY SAVINGS/ CHECKING ACCOUNTS BALANCE Savings (1) $1.00 Checking (1) $1,244.05 TOTAL BALANCES (2) $1,245.05 AVERAGE DAILY BALANCE $877.63 YTD DIVIDENDS EARNED $0.05 TAXABLE DIVIDENDS EARNED $0.05 ACCOUNTSUMMARY LOANS BALANCE Vehicle (1) $17,995.93 Personal Line & Loans (1) $3,389.22 Credit Cards (1) $12,396.42 TOTAL BALANCES (3) $33,781.57 For questions contact us: Phone: 1-888-4-WESCOM (1-888-493-7266) Teller#Phone: 1-877-4-TELLER (1-877-483.5537) e-Mail: mail@wescom.org Web Site: www.wescom.org P.O. Box 7058 Pasadena, CA 91109-7058 You could win lmillion points in the CU Rewards Sweepstakes! Charge what you need. Win what you want. Every time you use your Wescom Credit Card for purchases between August 1 and October 31, 2003 you'll have a chance to win up to 1 million CU Rewards Points, which can be used for a wide array of awards - from electronics to jewelry, airline tickets to cruises. Plus, you earn CU Rewards Points each time you make purchases with your Wescom Credit Card. Don't have a Wescom Credit Card? Click here to apply today. Fnr mnra tnfn"nfinn nn the N I Rpwnrds Swaanstakes. visit www.wescom.org. REGULAR SAVINGS oo Dividends Earned In 2003: $0.05 Beginning Balance + Deposits & Other Credits (0) - Withdrawals & Other Debits (0) = New Balance $1.00 $0.00 $0.00 $1.00 Trans Effective Date Date Transaction Description Amount New Balance Beginning Balance 1.00 continued on page 2 EXPRESS CHECKING o9 Dividends Earned In 2003: $0.00 Beginning Balance + Deposits & Other Credits (6) - Checks Cleared (10) - Withdrawals & Other Debits (28) = New Balance $285.00 $3,466.21 $1,502.53 $1,004.03 $1,244.05 Trans Effective Date Date Transaction Description Amount New Balance Beginning Balance 285.00 07/01 Check # 000242 -2.23 282.77 07/01 Withdrawal Adjustment Debit Card 16.11 298.88 06/29 BORDERS BOOKS &MUSIC#388 COSTA MESA CA 07/01 Withdrawal Debit Card -2.93 295.95 06/29 TRADER JOE'S #00001115 IRVINE CA 07/01 Withdrawal Debit Card -10.00 285.95 06/29 DARTMOUTH COURT IRVINE CA 07/01 Withdrawal Debit Card -16.11 269.84 66/29 BORDERS BOOKS &MUSIC#388 COSTA MESA CA 07/02 Deposit by Check 500.00 769.84 07/02 Withdrawal Debit Card -35.77 734.07 06/30 TRADER JOE'S #00001115 IRVINE CA 07/03 Deposit ACH MACY'S WEST, INC 54_ 2_ 11, 1,276.17 TYPE: PAYROLL DO 07/03 Check# 000244 -851.00 425.17 07/04 Withdrawal Debit Card -20.00 405.17 07/02 DARTMOUTH COURT IRVINE CA 07/07 Withdrawal Debit Card -3.22 401:95 07/04 ALBERTSON'S #6507 S9H IRVINE CA 07/08 Withdrawal Debit Card -45.09 356.86 07/06 EXXONMOBIL59 07803877 IRVINE CA 07/11 Deposit ACH MACY'$ WEST, INC 761.10 1,117.96 TYPE: PAYROLL DO 07/11 Check # 000245 -140.00 977:96 07/11 Withdrawal Debit Card -15.51 962.45 07109 99 RANCH MKT#9 SEK IRVINE CA 07/11 Withdrawal Debit Card -21.09 941:36 07109 USA PETROLEUM 044 IRVINE CA 07/14 Check # 000241 -15.00 926.36 07/14 Withdrawal Debit Card -6.73 919.63 07112 CHAMPAGNE FRENCH BAKERY COSTA MESA CA 07/15 Withdrawal Debit Card -1.89 917.74 07/13 EXXONMOBIL59 07803877IRVINE CA 07115 Withdrawal Debit Card -3.88 913.86 07/13 TRADER JOE'S #00001115 IRVINE CA 07/15 Withdrawal Debit Card -18.79 895.07 07/13 EXXONMOBIL59 07803877IRVINE CA 07/15 Withdrawal Debit Card -43.99 851.08 07/13 TRADER JOE'S #00001115 IRVINE CA 07/17 Withdrawal Debit Card -58.17 792.91 07/15 RITE AID STORE 5766 IRVINE CA 07/18 Deposit ACH MACY'S WEST, INC TYPE: PAYROLL DO 800.97 1,593.88 07/18 Check # 000243 -67.00 1,526.88 07/18 Check # 000249 -60.00 1,466.88 07/18 Withdrawal Debit Card -23.37 1,443.51 07116 CALIFORNIA PIZZA 036 IRVINE CA 07/20 Withdrawal Transfer To Loan 03 -100.00 1,343.51 07120 Withdrawal Debit Card -35.79 1,307.72 WESCOM kU 294229 - MARJAN SAMAKAR Credit Union Page 2 of 4 EXPRESS CHECKING 09 (CONTINUED) Trans Effective Transaction Description Amount New Balance Date Date 07/20 TENKO TERIYAKI HOUSE IRVINE CA 07/21 Check# 000247 -100.00 1,207.72 07/21 Check # 000246 -67.30 1,140.42 07121 Withdrawal Debit Card -43.90 1,096.52 07/19 EXXONMOBIL59 07803877 IRVINE CA 07/22 Check # 000252 100.00 996.52 /1NA A7 07/20 ALBERTSON'S #6507 S91-1 IRVINE CA 07/22 Withdrawal Debit Card -6.04 988.43 07/20 ALBERTSON'S #6507 S91-1 IRVINE CA 07/22 Withdrawal Debit Card -22.21 966.22 07/19 USA PETROLEUM 044 IRVINE CA 07/22 Withdrawal Debit Card -37.42 928.80 07/19 SUPER IRVINE INC IRVINE CA 07/25 Deposit ACH MACY'S WEST, INC 845.93 1,774.73 TYPE: PAYROLL DD 07/25 Check # 000250 -100.00 1,674.73 07/25 Withdrawal Debit Card -6.50 1,668.23 07/23 EDWARDS UNIV TOWN CTR 61RVINE CA 07/25 Withdrawal Debit Card 12.95 1,655.28 07/23 TRADER JOE'S #00001115 IRVINE CA 07/25 Withdrawal Transfer To Loan 04 -400.00 1,255.28 .,..,..., umkd..,•.,.,, nsku rt-A -4.50 1,250.78 07/26 CHAMPAGNE FRENCH BAKERY COSTA MESA CA 07/28 Withdrawal Debit Card -6.73 07/27 CHAMPAGNE FRENCH BAKERY COSTA MESA CA Summary of Cleared Checks Date Date Check # Cleared Amount Check # Cleared Amount 000241 07/14 15.00 000242 07/01 2.23 000244 07103 851.00 000245 07/11 140.00 000247 07/21 100.00 000249' 07/18 60.00 000252' 07/22 100.00 "Asterisk next to number indicates skip In number sequence. PERSONAL LINE OF CREDIT 03 Interest Paid In 2003: $215.27 Check # 000243 000246 000250 1,244.05 Date Cleared Amount 07/18 67.00 07/21 67.30 07/25 100.00 Annual Percent Rate Daily Periodic Rate Balance Credit Limit Credit Available 11.150% .030547% $3,389.22 $3,500.00 $110.78 Trans Effective Finance Date Date Transaction Description Amount Fees Charge Beginning Balance 07/20 Payment Transfer From Share 09-100.00 0.00 31.50 Closing Balance A Payment of $68.00 is due on 08/20/2003. WESCOM 294229 - MARJAN SAMAKAR Credit Union Principal Balance 3,45y.72 .68.50 3,389.22 3,389.22 Page 3 of 4 2002 TOYOTA/RAV4 04 Interest Paid In 2003: $696.07 Annual Percent Rate 6.240% Daily Periodic Rate .017095% Trans Effective Finance Date Date Transaction Description Amount Fees Charge Principal Balance Beginning Balance 18,308.29 07/25 Payment Transfer From Share 09 -400.00 0.00 87.64-312.36 17,995.93 Closing Balance 17,995.93 A Payment of $392.62 is due on 08/2512003. Credit Card Information as of 7/30/2003 Credit Credit Current Payment Minimum Last Payment Last Payment Card Type and Number Limit Available Balance Due Date Payment Amount Date PLATINUM VISA xxx xxx xxx 14,000.00 1,603.00 12,396.42 08/17/03 248.00 200.00 07/09/03 8377 PERIODIC STATEMENT DISCLOSURE FOR OPEN-END LOANS I do not have to pay any amount In question while you are Investigating, but I am still Periodic Rate: The Periodic Rate and ANNUAL PERCENTAGE RATE are subject to obligated to pay the parts of my periodic statement that are not In question. While you change on loans marked Equity Line of Credit, Express Equity Une or Share Une of Investigate my question, you cannot report me as delinquent or take any action to collect Credit. Subject to the terms of the Note, you have the right to repay your Equity Line of the amount I question. Credit or Express Equity Line without prepayment charge. How You Determine The Balance On Which My FINANCE CHARGE Is Computed: You will figure the FINANCE CHARGE on my account by applying the periodic rate to the unpaid balance or my account. To gel the unpaid balance you will take the ending balance of my account each day, after adding any new advances or purchases and subtracting any payments or credits. This gives you the unpaid balance. BILLING RIGHTS SUMMARY This notice contalns Important Information about my rights and responsiblli0es under the Fair Credit Billing AcL IN CASE OF ERRORS OR QUESTIONS ABOUT MY PERIODIC STATEMENT If I think my periodic statement Is wrong, or if I need more Information about an Item an my periodic statement, I must write to you on a separate sheet at Wescom Credit Union, Account Services, P.O. Box 7056. Pasadena, CA 91109.7058. 1 should write to you as soon as possible. You must hear from me no later than sixty (60) days after you sent me the FIRST periodic statement In which the emor or problem appeared. icantelephone you, but doing so will not preserve my rights. In my letter, I should give you the following Information: (1) My name and account number. (2) The dollar amount of the suspected error. (3) Describe the error and explain, if I can, why 1 believe there is an error, If I need more information, describe the Item I am not sure about. IN CASE OF ERRORS OR QUESTIONS ABOUT MY ELECTRONIC TRANSFERS i will write to you at Wescom Credit Union, Account Services, P.O. Box 7058, Pasadena, CA 91108.7058 or telephone you at 8881493.7266 as soon as I can, If I think my periodic statement or receipt Is wrong or If I need more Information about a transfer on the periodic statement or recelpt. You must hear from me no later men sixty(60) days after you sent me the FIRST periodic statement on which the error or problem appeared. I will: (1) Teti you my name and account number. (2) Decide the emoror the transfer l am unsure about, and explain as dearly as 1 can why I believe mere is an error or why I need more Information. (3) Tell you the dollar amount or the suspected error. You will Investigate my complaint and will correct any error promptly. If you take more than ten (10) business days to do this, you will re-credlt my account for the amount I think Is in error so that I will have the use of the money during the time it takes you to complete your Investigation. Account Identifiers: When referring to your specific accounts, use the entire Account Name along with the two -digit numbershown after the Account Name. Usingboththe name and twodlgil number will ensure accurate account Information. WESCOM Credit Union WESCOM 294229 - MARJAN SAMAKAR Page 4 of 4 Credit Union ,%,✓ - l../ Asset Calculation Worksheet Name 1%InY�aj'1 Samn.lcc� Account Type 9 U I01G25.35- (_) 10,025% 3$ divided by (average account balance) ( x ) Interest rate: % fy (_) Income from asset: $ Sd eommo m m o Tti c m� 0 0 N O m m L 0 m Y B N c e L m L m Ta mf6 TC C� No a m a m m a 6 M M Y r O LL m Cam' C 0 O .. •.L 'L yam.. m ^ Y• — Y n 'tip, +i T Y''O � V d m tlO QO dV ' YJ m'F m O d Y L c e uce a >y ,r" .19i�.°'ta,o nm ua YYUM Om Hm A � i.c Cm p9d tl C M Y M W 0 W U O'M-+1 1 A: CALL' m Q i 9 N L mk Z Z •I O•r1 U O 4J M Y m C 'pN U d Y I. I �• • Y V• 0 � , i�1 m 6 6 hci O f i m O O O O N O e O m m �•� §•}� n N 99 O O O O O O O W y G3.V0 �y n m P m �m a m CmO N O O W 1�M�A H H MC� N ,O m m O .99 O N O O O m m of II�/1 e a g n u o w w o 0 m O O O O m O O O N m O c N m O O O O O 99 O N m m O Q. _ w u dr n m m m m ' 9 a 0 w w p l9 `W H � LL w J N C,L; m m 0 0 0 0 m 0 0 0 n n i b p N m O O O O N O O O m m M m U Y eW O b m 0 m 0 A ~A � � QyrW L f .'l LL g N N H LT�yyy y O 4iK� C C M J "ia° 13 m mwo /f•1 L Y�� C O � N W K IL IL O N OW b IL y H Y aJ W moo oh0. a m m Li O O O O O O O m m N K Ham! iq an d N m m N m N > C � C Q tup,L li e W ap K 3 ZN y Y �56�Y ,5` m m e O O O m O O O m m Y M �- •�y�- 5� P O O O O O N .99 9 m, no �1 �[.M1OUei 9 d O O n P r n O O 9 m �7 �VVV�µ^^^ LL C Y! M M Y Y M N ( 4J� LL H m W c O M N m0 p�l yPy'] ig g 7@ yHj w h C V O O ?{{ C L •J-' O N Q N m U m Y} A l2{. ? Y O m y V w O Q O % Y jF C C q O O m CL Yq m Y +i w d N m N Y L f A L Y w A V d Y O O m L m d A C q C d Y C> O% F• T d p '4• f O C O q O L W ��'�L C +1 m C> T Y w +'1 Q m r•1 m 6 A L m O m C C N Y rl Q L m m n a m A c m a w m w c c mt o 0 4tirCE O tl O M> +1 O tl O Y y mQ UO J LL 2 m 5 f ' �lRtiQt�SY,aRY�1F#k7' Rental Application and Receipt for Application screening Fee toflows ZAM -3 OPPethisfranin it's eMamtirety, you ating N/A"or"en°ne" where t CommunitypowlIcObic The information you provide will be wlfltd ned by cithw rha 1,ine Company or Urine Apartment priorto IAMC'a approval to root an apartmdnt to you In an aporlm Communities, LP. (collecNvely, — - - f lurch �� ociol seduity NonW+' Applicant'n full name (latt, Fhat, Mlddlelnitid) Jrlsr, 0 ���_ a 3-7 0 r G of Ca•Aaalica:ds (4parate Appilmtbn rtT[rcd for each Co. APP11.. i) ct?"O? U own Sl �� rl Y1- p� m I fomlP/home: Attached family home: AporlmenY• Payment $ To whom do you make P"ftbP yWlord's None Address oy ZIP M Pro, Address M lw Mwn l Yr. at olwre) ❑ �n (Monthly Po Do You awn a Pet? O Proposed Ocaponl � (IM,F4st Middh I w FlM, Mlddh t E e P a Y m t F n a n e araY 5 N.-n AAA.... C" IIP r�IImo�(i I I Yd I"1 No••.' slumber of Pab: P In omnof femeracnry. Plw--W ("l name."ress B Pho. C If applimbk, parents'phone wmbutl n s FathdsHune I P *a 07101 Pw d2 Typr. Phone# r-e Phone # AWadc ROPsnmlotw Now did you font lean of this apartment commuNty? F104, Register ElDriveBy ❑Rental-Llving.com �Promo11oN5p. Event ❑Apartment Guide ❑Signs Owebslte-Other" ❑57 Mercury 0,19• Apt. Magazine ❑ Other IAC Cammanny❑Refarrd" nNeeryepwrvwhm- • Rental Llving(UC Ma9OLA Tina ❑Relomtar Swim ❑Magmina- Other " ❑For Rent Mogaslne ❑SD Union ❑Flyer ❑Affordable Housing ❑IACApt.Iido Center ❑SD RIader ❑Pastmrd/Mclkr ❑Other-Notlho d- e PLEASE Fa1.IN• rN,at,'.f r relomtiom vehicles do you awNdt•IwP Make Yea Uanre# Make •Year Limase# Parking of recreational vehicles, boats or trailers is not permitted In the Community. e Ranieri Iasuranmp ❑Ya []NO Consent to Verification of Credit and Other Information: I me making this AppllmUnn voluntarily for the purpose of obtaining IAMC s approval to yenta apartment In the apartment mmmunlry shown @bore I hereby amhorlu aM masad to dbwIAMC, awrer.and flak ropeclM empbysu andagmb (mlleatiwy, this RAMC Parties'), to obtain and vrrlfy the acdlt and other ofarmatlon provided by Na In this Appllmtlon through oedlt rwportbg agenc4a, tenant sawaningswou mmpanles, banks 0ncludal, ekwoonle funds vrrlflaanon)• employers and other persons or entities with oformation relating to this Appliudbn. I umkWdnd that If I lease this epartmmt, the IAMC Parties shill how a m:dlmbg right to reNaw my orcdo Infomanon, payment history, oaapnry history and other Information In this Appllcatbn far purpmv rebfed to my Lease and/or for account review or Improvement of appllmtbn methods. I hereby release and hold harmless Tha Irvine Company, TM. AWnwat Communities, LP., Irvin Apartment Moragement Company, and all of their respectirc officers, •mplayevand agents, from aayord an liability, logo[ promrdhgs end costs, I.WIN wourreys' fW, aHhg out of the wrlflcotlon and/or uoa of this Information contained In this Application, Including the release of Hoch Information to other parties. I warrant that, to the bat of my knowledge, all of the information provided In this Application (including but not limited to the statement of my flnandal mhdltt.h) Is true, accurate, complete and correct a of the dateaf this Appllmtiom If any infornotlen providedby me b determiud to be robe, cosh false statement will be grounds for dlsopprowl of my Appllmtlon or termination of my Lease with Oww,, I agree to ratify IAMC If any of the Information provldcd in this Application changes during the Appllmtlon pro. m, durkg myunanry, I also undo oat d that IAMC will retain this Application, along with any other Information p avldcd by me, whither or not this Applicatlan Is apprarcd. conBdendby W(C. Date RECEIPT FOR APPLICATION SCREENING FEE :bore amount isN 6e used to screen Appllmnt whh rcgadf to acdlf history and olha backgrauM bfarmaNam Theamountdmrged Wood as follows: 1. Achad mars of credit report, unlawful deteirar(eAmfloa)seaoh, and/or other scnrnhg mports $9.95 2. Cast to obtain, process and wiry screWng Information &W Include _staff*$ time and other rebied mob) $2005 3. Totvl fee ehar9ed (may rat rxreed $30 per ppllmnf) 430.00 ant oufharlus verifleation of [at., tbnryp APPllmrdon this Appllmtlonthrough rre it\reporHn9 agmc4s, persoml ufrrenm s and other Information mureas. / Date / \ Apjillmnt'ssignature By: Date Irvine Apartment Management Company Pe11ad.07/01 P(p2tle AppEaawRtlW0:01A, ...,r w." Income Restricted Certification Questionnaire :!-,- 11 , Initial Certification Re -certification Other VPc Nn Question Monthly Income I/we receive Family Support, Spousal Support, and/or any other .410 cash contributions of gifts, including rent or utility payments from persons not living with me. Uwe receive Veteran's Administration, Pension, Unemployment benefit, Disability benefit, AFDC, Lottery winnings, Inheritance, or Annuities. I/we receive income from Rental Property. Uwe receive benefits/income from Social Security to include SSA, SSI and/or periodic social security payments. The household receives unearned income for family members age 17 or under. Uwe are entitled to receive child support payments. / Uwe am currently receiving child support payments. Uwe am/are currently making efforts to collect child support owed to me. Uwe have other assets (example: 401K, IRA, Revocable Trusts, Stocks, Bonds, Treasury Bills, Money Market accounts, Certificate of Deposits, Whole Life insurance, Real Estate) I/we have cash on hand. Student Status: Does the household consist of persons who are all full-time students (example: College[University, trade school, etc.)? WDoes 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: ➢ Married and filing a joint tax return. Under penalties of perjury, I certify that the information presented on this form is true and accurate to est of my cwledge. The undersigned further understands that providing false epres ions here n constitutes an act of fraud. False, misleading or incomplete information will res i in the d 'al o application or termination of the income restricted lease agreement. 1 L� Residotrt Sigrmtttre —" Date Si�-ture of OwnerfAgent Date _08/21/03-_18:10 FAX 6120791610.,ltlnko's Stadium Village CERTIFICATION OF ZERO INCOME " (To be completed by adul household members Only, if appropriate.) Household Name:- MAlrN �'4m4haE Lkw ' Jail No. Development Name: �12N11Qd"1' (VrH City; (Jew'a ri' 1. 1 hereby certify that I do not individually receive income from any of the following sources: a. Wages from employment (including commissions, lips, bonuses, fees, etc.); b. Income from operation of a business; C. Rental income from real or personal property; d. Interest or dividends from assets; e. Social Security payments, annuities, insurance policies, retirement funds, pensions, or death benefits; f. Unemployment or disability payments; g. Public assistance payments; h. Periodic allowances such as alimony, child support, or gifts received from persons not living In my household; 1. Sales from self-employed resources (Avon, Mary Kay, Shaklee, etc.); j. Any other source not named above, 2. I currently have no income of any kind and there is no imminent change expected in my financial status or employment status during the next 12 months, 3. 1 will be using the following sourcoa of funds to pay for rent and other necessities: /f2 �rGh � v✓t%�Ccvr� Under penalty of perjury, I certify that the information presented in this certification is true and accurate to the best of my knowledge. The undersigned further understand(s) that providing false representations herein eonstitutaa an act of fraud. False, misleading or incomplete infomsltion may result in the ternriruiden of a lease agreement - se, . .-4, $-Zj— a 3 Ccnification of Zero Income (5eplamber 2000) To'd Vz:91 £OOi: IZ 6nH 986£-£IS-VTL:xed N9ISM 2InINI S,A:)UW P004� IRVINE APARTMENTMANAGEMCNITCOMPANY Rental Application and Receipt for Application Screening Fee Please complete this form in it's entirety, noting "NA" or "none where applicable. The information you provide will be verified prior to IAMC's approval to rent an apartment to you in an apartment community owned by either The Irvino Company or Irwne Apartment Communities, L.P. (collectively, "Ownar"). Community: Np+ MoriAA Address: KY IIYZ COrCLtCn Pr. Print Applimnt's full mma(Last. First, Middle Inlllan JrJSr. Dole of Birlh Saciol5cmdry Wmber DriverrvIyys Llmv�c/N A nnmam waPPurants {sepamm nppn[afmn re Ircdtaradsh Co-Appllcmt) / / �•/ (Lmt. First, MlddleInitkn (Lief, First, Middle Initial) (last. First. Middle Initial) P P 1 (Last, Finl, Middle Inihol) i (Lear, Fief, Middle InitW) (Lief, First. Middle Initial) nApplimnt's Pre�s�mtpAdJrcsry aly ZIP Ow„ Phone - Dales b 7t'raNTf/RO, �, / F. -Nail Address h t Penf: Te Ocfaalud family home: litte Iwatfamlhyli,ou Apartment. H Monthly PaYn:anl5 To whom de, you make payments] + Present seMlors's Nome Address aty ZIP Phone rP t a Tmmedbte Prior Address of less than 1 yr, at above) Own P Manthiy Payment. y "F— ❑ Reny S Immedlad Prior Landlord's Name Address City ZIP 0. you awnaPef) ❑ Yet Q4 No Nonberof Petia Type• O Pmposcd Ocmpont u (Wt.Fkst, Middle v a n (last, First. Middle t s Relatiovhlp If applimble, parents' phone mmbers. ( ) ( ) Falhri sNme Mofhdatem rgpraz a5-'L AniaalmTaMYPIOLiu 1-0 i�a�' :IHsG�iSAP How did you first learn of this apartment community? O.C. Register Drive By ❑kut6Llvin9.mm ❑promotlontsp. Event Ape Mant Wide 1:1519" ❑wehtlte•othv" ❑WM.." �Orlg Apt. Magaxlne Other 1AC Cammw.My❑RAfmtd• ❑NewspaperOfte Rental LIAng(IAC Ma90lA Tines ❑Rcomtor Service E]Ma9a2lne-Other' ❑Far Rant Megetlne ❑SD union Flyer M95Q11. Housing ❑IACApt.Ido Cana ❑SDReoder ❑Postwd/Mdler MOther -Door Listed' ' PLEASE FILLIN• Reason for reioaotl-N How man/ vehleles do you ow/Mvq G_ Make Year License# Mahe Year Llcmds# Note: Parking of recreational vehicles, boats or trailers is not permitted in the CommunitY. be you have Rental, 21 --? ❑Yes W Consent to verification of Credit and Other Information: . I om making this Appllmtlan voluntarily for the pure se of obtaining IAMC's approval to rent an aParment In the aPartmad eammunity shown above. I l"b/authorin and eantou to allow 3AMC, owner, and their reepedlm,mpbyses and agents (mlleetivvF/, the `UMC ParOes`).to Obtain and verify the rredr end other idomntlon prWded by me In this APPlica0ma through eedit reporting age alas. Lamm eernning service campanles, bank, (ineluding eieehanle funds mrificatba, employers andotha permns or saute, with Idanmtion relating to this Application. I understand that If I lease this apartment, the IAMC parties Shan ham a mMlmiy right to review my aredu Idormatbn, payment hlsmry. occupancy history and other Information In this Application for purposes related to my Lease and/or for account review or Improvement of application methods. I hereby release and hold harmless The lrvlre Compaq, Irvine Apartment Cammunitles, LF., Irvine Apartment Mamga n rat Company, and all of their respeetim oHlern, employee, and agents, from or,/ end all liability, legal proceedings and costs, Wading d"arrcys' fw, m•lsle, out of the verificatlan and/or osa of the infarmatlen mrdalned In this Application, including the release of such Information te other parties. I warrant that, to the beer of my bwwudge, all of the Information provided In this Application Rnck ding but not limited to the statement of my Planned condition) Is tore, ocmrom, complete and arteet as of the date of Zhu Applleation. If any information provided by me Is demrmined to be false, such false statement will be grounds far duapproml of my Appllcation or teredretion of my Lease Win Owner. I agree te ratify UMC If any of the information provided le thls Application charges during the Applidation pm,,,s or during my tenancy. I also understand that ,AMC will retain this Application, along with airy other Information ProNded by me, whether or net this Appllmtlon b oPP."a AnamtemndablsAPPnCclon gcn,ning Fee 0410.00 (enemi,ulbdow)amqukMhow "an Appnuntlopmaen this Ap*Aon Mal to ch iCkthe InmmsllonpmMded. AseperiaAPPllnnantoRentmustbosignedbyssehApPlkffiwhawaoCCUPythsePalmmtberm B"SApPnngontdn as censidaedbyuna Date Applicant's slgromre ecr,CTPr FOR APPLICATION SCREENING FEE above amount b to be used to screen Applicant with regard, to cedit history and other background Informatiom The Maud charged Actual costs of credit report. un-101 detalrcr(evlctbn)swdl. and/or other saeelea top" $9.95 Cast "obtain, process and verify sareeNng ldotmatbn(may lealude daff's time and 'that related cost,) 520.00 Total fee chorged.(My not exceed $ao pan Applicant) $30.00 orises Wiflcatlon of lnformatian supplied by Applicant on this Application through credit reporting a disc. personal reference Date Company Pags2d2 A TsRe m rat RaNsed. oy/a] 1-40/ r Income Restricted Certification Questionnaire I Name: �l���ri� t1_-,-�—�� i � � �� � Unit # 1 X - Initial Certification Re -certification Other Yes No Question Monthly Income we receive Family Support, Spousal Support, and/or any other cash contributions of gifts, including rent or utility payments from persons not living with me. I/we receive Veteran's Administration, Pension, Unemployment enefrt, Disability benefit, AFDC, Lottery winnings, Inheritance, or Annuities. I/we receive income from Rental Pro erty. 1/>ve receive benefits/income from Social Security to include SA, SSI and/or periodic social,security payments. The household receives unearned income for family members age 17 or under. Uwe are entitled to receive child support payments. I/we am currently receiving child support payments. Uwe am/are currently making efforts to collect child support owed to me. I/we have other assets (example: 401K, IRA, Revocable Trusts, Stocks, Bonds, Treasury Bills, Money Market accounts, ertifrcate of Deposits, Whole Life insurance, Real Estate Uwe have cash on hand. S dent Status: Does the household consist of persons who are all full-time students (example: College/University, trade school, etc.)? oes your household anticipate becoming a full-time student household in the next 12 months9 you answered Les to either of the previous two questions are you: ➢ Married and filing a joint tax retum. Under penalties of perjury, I certify that the information presented on this form is true and accurate to the best of my knowledge. The undersigned further understands that providing false representations herein constitutes an act of fraud, False, misleading or incomplete information will result in he denialrof ap lication or termination of the inco a restricted lease agreement. Resident Signature Date Signature of Owner/Agent Date c&,r�ICATION OF ZERO INCOME,.../ (To be completed by adult household members only, if appropriate.) Household Name: MU' 1a`1�'P- S'IAn4 0; K1 n Unit No. iI `4 -Z_ Development Name: i kLv por&r NA-D O-T— i /i �t WArcN 1— �NnLs,City: (�L t u>�n(� I hereby certify that I do not individually receive income from any of the following sources: a. Wages from employment (including commissions, tips, bonuses, fees, etc.); b. Income from operation of a business; C. Rental income from real or personal property, d. Interest or dividends from assets; e. Social Security payments, annuities, insurance policies, retirement funds, pensions, or death benefits; f. Unemployment or disability payments; g. Public assistance payments; h. Periodic allowances such as alimony, child support, or gifts received from persons not living in my household; i. Sales from self-employed resources (Avon, Mary Kay, Shaklee, etc.); j, Any other source not named above. 2. I currently have no income of any kind and there is no imminent change expected in my financial status or employment status during the next 12 months. 3. I will be using the following sources of funds to pay for rent and other necessities: M0.Y�M cvri0.�/n/ Under penalty of perjury, I certify that the information presented in this certification is true and accurate to the best of my knowledge. The upoersigned further understand(s) that providing false representations herein constitutes an act of fraud. False, misleadine or inco lete information may result in the termination of a lease agreement. >nn Il �YJa-TGt? Sla-l� ialu�.rz /L3�o3 Signature of plicant/Tenant a--- Printed Name of Applicant/Tenant Date Certification of Zero Income (September 2000) New Certificates X /Recerti8ctawn�.-- Unit Number 260ci INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT OWNER: This farm is designated to assist you in computing Annual Income in accordance withthemethod set forth to in the Department the HUDRegulations.Housing Urban capitalized terms) Reghelrein shall have the 3meaning set forth )- you should in the Regulatory ke certain that tAgree is at all times up v CSCIDA (pool)- Newport North I/We the undersigned state that Ihve have read and answered fully, frankly and personally each of the following questions for all persons who are to occupy the unit being applied for in the above apartment project. Listed below are the names of all persons who intend to reside in the unit. I Z, 3. 4. Name of Members Relationship social Security Place of Of the to Head of Number Employment Household Household Age 39 $%D 5s- 54 12tra Inc 39 1Vrti� r j+, vvvti 5� Co s5t n,s— 15 06-50-4018 Income Computation h this 6 years) listedeabove for the 2 month period beginning hd income, calculated in accordance e earlier paragraph the date that I/we plan sto move into children unit or sign a lease for a unit is S� I �? '(� .�i�l�i . Included in the total an4ct dted tncom iste above are: (a) all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other compensation for m personal services, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real or personal property (without deducting expenditures for business expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets); (c) interest and dividends (including income from assets included below and other net income from real or personal property); etirement (d) the ful amount of periodic funds, pensions, disability or death benefits and other ents received from osimilar typcial es of periodic receipts, includinganylump sum payment for the delayed start of a periodic payment; (e) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (f) the maximum amount of public assistance available to the above persons other than the amount o any assistance specifically designated for shelter and utilities; pp (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not residing in the dwellings; (h) all regular pay, special pay and all of a member of the Armed Forces (whether or not living in the dwelling) who is the head of the household or spouse; and (i) any earned income tax credit to the extent that it exceeds income tax liability. Excluded front such anticipated income are: (a) casual, sporadic or irregular gifts; payments under (b) amounts which are specifically for or in reimbursement of medical expenses; (c) lump suns additions to family assets, such as inheritances, insurance pay eatnd s (inclment for personal or health and accident insurance and workers' compensation), P gains property losses; (d) amounts of educational scholarships paid directly to the student or the educational Institution, and amounts ment. Any paid bythe government to a veteran for payments to veterans not used fortheabove purposes a ethe costs of tuion, fees, books dto bat eluded in amounts of such scholarships or income; (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile Ere; (f) relocation payments under Title iI of the Uniform Relocation Assistance and Real Property Acquisition Policies Act of 1970; (g) foster child care payments; (h) the value of coupon allotments under the Food Stamp Act of 1977; (i) payments to volunteers under the Domestic Volunteer Services Act of 1973; (j) payments received under the Alaska Native Claims Settlement Act; (k) income derived from certain submarginal land of the United States that is held in trust for certain Indian tribes; (1) payments on allowances made under the Department of Health and Human Services' Low -Income Home Energy Assistance Program; ( payments received from the Job Partnership Training Act; m) (n) f funds of the Grand River Band of Ottowa Indians; and income derived from the disposition oarded by the Inian ta shares received ftomjudgement funds aw (o) the firstComm sS2000 sion the Courtper of �rof Claims or from held in trust for an Indan tribe by he Secre ary orf Interior. 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necessary items of personal property such as furniture and automobiles and interests in Indian trust Ind) k Yes No; or have they disposed of any assets (other thann�at aif�ooreclosure or bankruptcy sale) during the last two years at ass (b) than fair market value? Yes ( c) If the answer to (a) or _(b)above is Yes, does the combined totaal value of all such assets owned or disposed of by a ll such persons total more than 55,000? Yes (d) If the answer to (c) above is Yes, state: (1) the combined total value of all such assets: S (2) the amount of income expected to be derived from such assets in the 12-montanderiod beginning on the date of initial occupancy in the unit that you propose to rent: S _. (3) the amount of such income, if any, that was included in item 6 above: S S. this calelndar year at an ed l all the persons scat nal institution (other than in column I above be or a correspondence school) e been full-time student with regularing r faculty and students? Yes at (b) Com late oniv itthe answer to Question 8(a) is "Yes"), Is any such person (other than nonresident aliens) married and eligible to file a Joint federal income tax returns? Yesne maximum income o -determi 9, eligibility toaoccupy he unit; te is made with tand U ehe lde�lare that all e that it linfobe rrmat oelied n set forth heon by the rein isttr e, correct and complete and for based upon information Uwe deem reliable and that the statement of total anticipated income contained in paragraph 6 is reasonable and based upon such investigation as the undersigned deemed necessary. ocuments 10 iI/e will assistncluding eitherran inncomee verification from my/ourrpresentemployer(s) orequired piesvof fedeerify ral stax ements made herein, he Ownr in obtaining annformaion orreturns for the immediately preceding calendar year. IL . I/We acknowledge that all of the foregoing information is relevant he apartment a the siatus t build de f federal income anon is being tax law of the interest on bonds issued to finance the , 6 O�_ P made. We consent to the disclosure of such information to the issuer of such bonds, the holders of such bonds, any trustee acting on their behalf and any authorized agent of the Treasury Department or Internal Revenue Service. I/We declare under penalty of perjury that the foregoing is true and correct. 2003 (year) in the City of k �alifomia Applicant Applicant (Signature of all persons texcep ider the age of 18 years) listed in number 2 above required) FOR COi1MZnON 13'Y A3.'ARTY MNT OWMR ONLY: 1. Calculation of ellgibl6 Income: a. ;ester amount entered for entire household in 6 above: b. (1) If the amount entered in 7 entered in 7(d)(2), subtract 7(dx3) and enter the re is yes, eater the total amount t figure the amount entered in hh;a, ($ )9 (2) Multiply the amour. �t to current passbcoY savings rate +� fn determine what the total annual earn lift) d)(i) would be if invested in passbook savzaE "• subtract from that figure the amount ente, 7(a)(3) and enter the remaining balance ($ (3) Enter at right the greater of the amount calculated under (1) or (2) above: e, TOTAL El.%G BLB INCOME (line l.a plus line I,.b(3): 2. The amount entered in Le: Quallfles the applicant(s) as a Moderate4ncotne Tenant(s). �^ Qualifies the applicants) as a Lower -Income Tenant(s). Qualifies the applicant(s) as a Very -Law Income Vnaot(s). 3. Number of apartment unit assigned: ion Bedroom size: 3 4 ?-//a Rent: $ iL? A. This apartment unit (was not) last occupied for a period of 31 or more consecutive days by persons whose aggregate anticipated annual Income as certified in the above manner upon their initial Qc=anq of tite apartment unit qualified them as a Lower -Income Teaant(s). S. Method used to verify applicants) income: Employer income verification. Copies of = returns. )( Other ( Ian jcyte e IG Sa u10 ) Manag Date ex Income Restricted Certification Name: Initia: Certification Re -certification Other Unit # Yes No Question Lwe receive Family Support, Spousal Support, and/or any oth, cash contributions of gifts, including rent or utility payments from ersons not Iivin with me. Uwe receive Veteran's Administration, Pension, Unemployme benefit, Disability benefit, AFDC, Lottery winnings, Inheritan or Annuities. Uwe receive income from Rental Pro e Uwe receive benefitstincome from Social Security to include p SSA, SSI and/or periodic social security payments. XThe household receives unearned income for family members a e 17 or under. Uwe are entitled to receive child support payments. I/we am currently receiving child support payments. I/we am/are currently making efforts to collect child support / owed to me. I/we have other assets (example: 401K, IRA. Revocable Trus J� Stocks, Bonds, Treasury Bills, Money Market accounts, on Does the household consist of persons who are an run-nmc students (example College/Universitytrade school, etc.)? Does your household anhcinate becoming a full-hme student household in the next 12 months? If you answered Yes, to either of the previous two questions are you: ➢ Married and filing a joint tax return. Under penalties of perjury, I certify that the information presented on this form is true and accurate to the best of y knowledge. The ndersigned further understands that providing false represees ns herein cotrstitu s arr act of fraud. False, misleading or incomplete information will result i e de ial of appli on or t nation of the income restricted lease agreement,661 Dat �1261Ca Signature of Owner/Agent Date HIIA\I�Y/IIC IRVINE APARTMIENT MANAGEMENTCOMPANY' Rental Application and Receipt for Application 5creening Fee Please complete this form in It's entirety, noting'N/Am or'none' where applicable. The Information you provide will be verified prior to IAMC's approval to rent an apartment to you In on apartment community owned by either The Irvine Campany or Irvine Apartment Communities, L.P. (collectively, °Owner'i) Community: Address: Firm Apphcaue fullwme(Los, First, Middle Inillal) JrJSr. D.I.of Blrih Sonal Semmlty Numbv Drivv's Llmnso# G= —a. Name of Apphcanit(Seperute APPhcahonee aired far each Ca-Apphronl) A (Lmt, First, Middle Inalal) (Lon, 1, First, Middle Inillal) (Last• First, Middle Im lbl) P P. t Itcut r1rn. Middle lnOW) W.M.t,Mlddle Inillal) (Last, First, Middle Initial) I '1 a Appllcanl's Present AddrlIea'r,,`— City 2IP //,'� IEl n phone 't _ talcs: a rjI I& Icy DfCtf()J �M-1TAt1 VCLLS Rem• ✓con Aadrctt To e n Ddadxd family lwma At Inched (amlyname: Aprimenn •V,r� H Manlld pamcnl qL,y To whom do make 1 y y i � yo poyments) iPreterit Lendlords Nome t Addvs Cl ly ^ Phom 11 IILh•wri r Immedla rAddrm (If less lhmnl yr. at above) Own Monfhfy Payment: Did..From y Rant $ 1 To i Immediate Peter Landlord's Nome Address city ZIP Phone# ElOo yea ownarel7 Yes bA No Nunber of Petc Type: 0 Pra asrit Ocmpanls(Last, First, Mlddlejnitnl) Data of DGlh (tacit, First, Middle Initial) Dale at 1141111 acut,rast,MIN.Inninly Data of Birth (Lmt, First, Middle Initial) Dmcaf Dlrtll P n (last. rkst. Middle Initial) Doleaf Birth (Last, FlraL Middle Ininco Data of Blrlh e s E Emplryee(it s=lf•.mplafed,nameaf buamss) Susinesir Address(Including MP Code) on ir r1i �oxy-t1a7 Plane to Typr of Du ne PAW." I Dater. T I r Photo (p� Income o ILI'Id�S L- rczan C ou'1Ctet— Ta 11m KC^6 1 MMPD Ma. Y Olheriiiroaia source Applicant muY Provide 2 pay stubs or=rent We farm. Contact at e on Immedwle Prior Employer Address (Indudy ZIP Code) Phone# MI Inrome From f To Me CheaMing banks ntl branch(Inrtude Clly/stale) Account 5avings: bank and branch (include Chy/51a1c) Account It f 1 n Have you ever filed bnnkrupiry] ❑Yes No o County and 51.1. where filed. hot yea] n a He.ym aver had am'Publiererord nits• Iimw,judgments orrepossessbns) Yes No WhatywA 0 I Have you ever: If yes, describe In dealt. Been camlacd of o felony2mYes p� No/ Deenencted) Five, Defoulledonaleasea Y .,. In one of emerganry, plans. notify: (Local come• address d phone number) r Relationship. f a if appllmbic, porcmi plow numbcn: n ( ) a Folber'skNne Mn@er's Nave t RcOud 07mi Paw1d2 reywaviioRawugly IRVINE APARTMENT MANAGEMENT COMPANY Have did you first learn of this apartment community] oaRegion, Drive By Rental•Llving cam ❑ ❑Apartment 6ulde ❑Signs ❑ebsllcM•01f r' Ong opt. Magazine01hm'IACCammm1lY❑Referral• �g.., ❑ Relocator Service FV Rental Living CIAO Mog�Ln Tines UAL ❑Ryor ❑Far Rent Magazine �SO Union �IAC Apr.Info Center ❑so Reader Fposlcard/Haller �promotian/Sp, Fvent ❑57 Mercury vt• LAINmspper•Olbcr' magaslae•Olher El Affordoble Noising �Olhcr•biil haled' ¢ • PLEASE FILL IN: —_ relocation' chicks do you own/drive) Make�Ye.r License It IAokc_—_ year License Parkin of recreational vehicles, boats or trailers Is not permitted In the Yen he« Renter's Insure...) Consent to Verification of Credit and Other Information: I an, m ddl, this Application voluntarily for the piTnse of obletaimg IAMC'z approval to ,at fin opertment In the aimrinmm mmmanity siwwo above. Iherelrywthon«and consent to allow IAMC,Owner• and their resMetive airplay... and agenes(callecti ^IC1 I,. RAMP Pnrlies'1, 1. obtain and verify the cede and other informatlan Provided by in. s and olherlcation pmonf ors enitllies wtith i.fermatlaa raining Iorting Inown llhis Appl coil.^ce campmes, banks CMNding electronic fundz venFlcarlon), page cal fibui I undcnland that if I l«m lh6 aportmetip the TAMC Parties shall havemm�tlmdr9 right torMew mY credit lnfnrmallon. Mym ry. o,mrynnry history and other Iaformatkn in this Application for pulps,, related to my Leaze and/ar for accaim «new or imprvwmvnt of application methods. train doll of I hereby rcle.n. end hold harmless The Irvin Campmry. Irvi« AMmment Commsmmee ings Irvine Aprlowal «IrvIDi M.',,.y,- fee" msug am at the their«speetive offlinrl,emPlnYces and age.".Irammry und.11liability. legalproceedingso casts, gn verification and/or use of the Information contained in this Appllmtl.n. Including the release of cacti In(ormnllnn I. other p e 11.1 I warrant that. to the best of my knowledge, all of the Internet len provided In this Appiicatbn (Including Mgt not limited m the smle,neni of my (inenebl«ndition)mtree,a,ale, oomplate and correct osol lbedots o(Ihis Application Tl arty inlarmmwn rev., try me lsn notify to be false, such felt. 0.1weant will be groups far diuPprowl of my Application or termined.. of my Lease with Onwarur T alsecunld.ntand slat IAMCIfany of the mforave"w" prodded In this Application dmmgeo during the Appboatlan precut ar dwlM any ry IAtAC will retain this Appllcatbn, along with any olho• Infewlethen provided by me, whelher or net Oils Apairobon is approved Anon•refundable Appllezllan ScleenlnB Fao of$3g.ee(esnamlud below) isrequlmd Inlmmcjon prodded. AsepaatoAppllealion t0nentmuethes1gled by each Applies consldmedbYWNt. A n_ l— Dale RECEIPT FOR APPLICATION SCREENING FEE amount Is 1. be used to screen Applicant with «gcrJs to credit history and other background InternalTim nmaunl charged as follows Rg g5 Asrual msts.f credit rcpart,unkiwful delainer(eWdwn)"^rndude,toff', tlmaandnlheeports atedcasts) ¢¢F200R Cast so obtain, Pra«v and verify screening [,formal].. (may y10 00 Total fee charged (may net exceed $30 Per Applicanl) rsalel reference authorites verification of Information mpplmd by Applixnt an this Application Ihneugh credit reposing og<nsin, pe it other information saurcas. / ) ^ I 0 r, onto Data Rcdsed.07101 BY: Applicant's Irvine Apartment Management Company paI'alnanti.Nmnt s, Earned. Income Calculation Worksheet Name Employer IR c -, inr Most Recent Ending Pay Period Date Hire Date 5 /2s/o E:2000 -�j YTD Income 21,7a8' goo divided by 11 Start with hire date if at job for less than a year (how often paid) (X) 26 Calculated Annual Income 41q l2$2.4s I/ Gross per Pay Period I � 0aG 6.6G N E: divided by (how often paid) M I:= (_) Calculated Annual Income 4161R-73.16 'tarnln0�,,iazemenL +,o JUN-25-2003 15t37 u�p ;��.r�„°;afiA2if�;•fr•f Yr.;�s�Ywsal� t.:tv a BUCA, INC. 7300 NICOLLET MALL #3043 MINNEAPOLIS, MN 55403 Taxable Morfto) Status. Single Exemplinne/Allotvances: .. Federal' 10 State: 10 ' Social Security Numbar; 570-55.3543 , Earnings ' rate hours • • ihjs'period, ' Regular 1788.47 80r00 Ltd 13.00 Sw , Bonus Discretion. Bns y' •PBr'4Atit"�ye�y{'uva 1011i7 ei�T.l'A%^' olrP{�^ 'DeductionspeducGong'—8tattlto�'' Federal Income Tax .55.67 • Social Security Tax' -106.75 Medicare'• Tax ^24: CA Stale' Income Taut ' ' •46•144 CA SUIISDI Tau 15.60. Other Checking 1,454v16 Dental Ins • "7.00' Ltd _yr }9••' ; Medical .Ins 76; • j 3•.66 S(d • Stock Purchase . ilelt.;13i4Yri�.'>st�_ "1:•a;"�'•fY1�G + Excludad'from federal taxBtilb.witgl Your federal Jaxabla'WOOOP'this periq $1,721.66,.• ; ' D' •�';1(RFSTINA trt..rlH.r�o,..•', 21 I • ' ��3� '�P� t• Period Endinb:' ' 05/25/2003 Pay Date: OQ2912009 . KRISTINA M. HAYDEN 15112 1/4 DICKENS SHERMAN OAKS,CA 91403 edr'todate' Other B'epeflts;Bit', :,•1,:; ; 'thls Period=;.," total, to;ilate, 15,0�6.22 Infomiatiori• - 80o•,00 . ' Total; Hours ••• .. ;1 ,633•.4b• ' ,1.67.00' •, 1 '• 1,2 .19 ' •297.29. , 641.78 ' 184.53.. 137:00 65.39 .. . ''1,15e.00 .. � �• •f•• 696.99' 4. ,are, ; Xyr,ft..; ,,, .5 ',;':!1 ' a � . •. • .• • r • .. '1 OI<DINX.IR 1: ,•5}, r;•!j: •^r`t'•i(•�1 !jrr�tiii� � �TE '•1;; .y 10 JUN-25-2003 15:38 GtltIIIIll J. _� 0tGLG•IOWN R% Olow SUCA INC. 1300 NIGOLLET MALL #8043 MINNEAPOLIS, MN 59403 Taxabla Marital 3181US: 309re ExemPtlen81AJlowantxe: Fedaral: 10 State: f0 Period Endingr 05/11/2003 Pay Date; 05/16122003 KRISTINA M'. HAYDEN 15112 1/4 DICKENS SHERMAN OAKStCA 91403 Social Security Number 670-65-3643 . ' '••, rot. ts4urs th{erAorlod :ear, lo;date o• :: OltlAY. t�eb�flta 3nd'. ,`!'ihi�"'riaa::' total'to'date, Eernin a 1nYhS nsaUbn" 7Q0.00. Regular ,3'Te6.47 B0.'OA' 5114' 1• :7:otal;;CioFifs , , Lid Std Bonus ','t8'7.�OD ':'i;,•• . Discretion. Bns ear=-� - ,m r• .. ;,,' .�. •Stat. .. { .:•7,'97,.87.: ;;;::, .. , Deductions 4toSb.27' Federal income Tax Social Security Tax Nledidare lax • • :'!' ' ' -CA Slate Income'Tax . CA St11/Sbi Tax' 45.1,81 7¢6!72:.:' (;.......'... • • .... •O her . ,. .. , , ;,.: ,.:.: •;.,. , �� ,• r.:. Ctlacking 1 , 429: J6 • t. :!::' ioo* • k30�:00•:' Dental Ins ;13 :. ":•• ,::':' .. 5fr. O. i . , 'Ltd. .. 8.1)ll'i:' ......... •• ... ' 'Medical Ins. ' 2T3.f10' :r ;;; ;•.1 iti;.64,: •, .t::,."; !•Af:.. ,•n:'�., Sid �i� '99G:rgYr, ...:'"'..:..:. :.... :' '&t0,ck Purchase', '• ' ..:"•••.`::•':... .'�::.. /�i:;.;'•�,i:;::;1,,:.' i;::' ' � . •, ..m� W.ro•�$''S,'j„", i3dxr..'e:'j7"i'i!'1f"�SR�°`6rn :; t,; .=i',.' �,; i;�. I'•'%' :' ':j'::' � ... . � ., �. `esthi8;:�aiid •:aYe::+'��':':I:i. :i,!�:i� '�i;:":::,:::i:' :i:::. •, Your lederal•taxabta Wa8 r P. '.S1 . •��, .1, ':1:• ' I. •'�+ ,: rta;;:, '..lira., ,.,: • .,u... •• .. 1ntn:bam , t ht,il•a}' Y t: •' Q, ld y ,'!,• t� r,t �Ilf ,r��'!i�'l0'71r Z .r3�ft • I+i.•� r� �-�'%=`f F!{,i�� , t�,�'AI'` •rtg nfsn i.n 1 ^��..fffa+" ' ''�j �satit '?�lif�f"•r"�i� tl,ir. Yjtt r. 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MAW KRISTINA M HAYDEN' 15112 1/4 DICKENS SHERMAN OAKS CA 91493 y' M VV VH�J J6 f9920f�F,1.CUI8)28f•18f0 '• SEE INSERT FOR IMPORTANT INFOgMAT�1 �N ekab. 95@FAXt8l8)23)711.7123 RMAROINGYOURRIOMTODI9.- -BIWNO ERRORS AND IMMUlAT10N E !11RORS. ,,dHgi CA 913670 FAxl8181346.7I91 AM MEMBER N0, ENDING GATE, BRANCH PAGE, 05-31-03 1• 2 GA91'4030000 8152 P 0903819212 . i �.i:l.i{. t5'F 1: •e Qiitry ✓i J,% ��i�� 1t,�='1;:�'i:1 W t.j :�: :,p•:.'1 r. 1 \.�1t0�i'»f•fi..',�k r I�J;� '•"W1 }� v+,��f�!(j it9'"•k 'Ilya i.. �.•'�, t :l `.. �r 1\t 1•s ��, *E"ij5 \'ytt�I�a�,f>i.�r�•7 Il„�4'•t'.•4;. �5 ttl�` xp II'; 1�', 5 � .?d -3\(I p { r n,9i h: tYl d���1\7•+ atr1l.� �ji';j I:. �S :N4„SlrySt?,��isiu:�:3.�,•"�If; 1r�4vr�'.Iri;,=1 r'pyyy�.Ai�\ i. '�'''4{�^`4.15 �'��'� �,�!��'qY SF t'l;�f[ oe •• .. 4Y<t5^�lilweY.d�ipai �SiYIY�_]'.i:•t..•.:re.1N5,.IaY�$ti:�•�.1 3a�.tl. aY�tIYY;:s�.nat• Lii`if:.'��.''., 35 35 •i97,4:30 ', 967•.10 t ai. 1" • JUN-26-2003 16:55 _� y �- � • _ OF ACCOUNTS P.U. Box2f1019, GIW 9r17R1U+9 SEE INSERT PU RI0Hq AM INFORMSILLING ATION Grmdoregrunch.310A mdo3lnn, Ghndalc LA CA9WO. FAXO143•d4.7 qEG DING RRORSVD ORRIGHT7 ONE ERRORS. ��• gyt, yag:ygwicl,•=fly14A,WdNf Nl,, ooe+tb,Qo, CAA7Ug•FAX(d83)731.7333 ERRORS AND REGUTATIONEERgORS. tyur VdR3graxh:71SS1 Unwed Saul, tvoodWMNgtx LA•91ib7 • FN((813) 346•3293 (JW)3!(•FPLU•Mw,'•fl+mCwB EMEMIDER NO. ENDING DATE BRANCH PAGE 9212 04-30-03 1 1y ' CAB14030000 7862 P ,t is •,':t:l I,t•.":.,, t•ihti4o'r tiderlW 19 it'•i)UD �•• KRISTINA M WAYDEN iszits_iRLal7ltajdiriilntir6ever@9Q:d?71N k'latlAe, �StY 15112 1/4 DICKENS `;'? iay4h"s istiare} aciririliili'tis?SZb4i11,ihe,`,�eoQh ;fepS`s:.'• SHERMAN OAKS CA 91403 t`: ':: 9 t• :,+ i :+` li,;,:i:; ilia " il', ii•'s:ttig ri't{'; ,t.rts'•• ;:',: „� ..: :SI)i.CP,:): i;,., +.lst7 „•,. : 1ft: :Y�i. •. i::• ,j,', 's!' `; t•;:Al.., ,'•`�•, �::i lt�t`;Ii:flS,.. i•.:. i.. ___ I{FIi; Yilllt, 6)q: ti,�i.'Fttl H :1i,S:'I::li It U ::ij .t• f( `�•. i-�J. , BALANCE TRANSACTION DESCRIPTION AMOUNT DATE „ „ f i, ff ,•, •s t�,1,tuifbi��ti<b'c'-�bru„t•,?MA4• fp�c .i:•:,ii;: :iA�C�1�•i•, r: iz i', i i 11i1K1� 1 11 " 1!%�t iArtB�,itl ?i l'S:' i APtTI`OT'?IRfiNSEER'. t•:,\:j2+atP.i}q�1{4't��tEtCl2AptII .t08. `lf Il:I4�ltiit::1`aIt1B0/tl•''tt lir fr tl.', i TRANS. .. ;i�y:: iS P�i Wit�P,4'dtTfCt"ARC:'497i2�b`iy2�'� ,Wde,:'i 1 (a ! ;i,::i�4$.Oa r,•'•, �•,i : 8 4P7, 2R03 `` .000,• ApIt28iiFFt�lt�lTFi i ' ''•'P�shA5'•4btitc+ci •�' $iaRC1i !Ftl0 j16Et : sYlt 'S i i ,.a'r•':' S.0 r: ,i'+`:siF:L'Er,' { [i,ll'C�h �er;ti'}tl�<:2j. ;I, i t� , ct''.1t!i 3t001 :i,;; :•s. 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SHERMAN OAKS; .tA ' • 0` ` l ; ; ApRUdr,N1TNDRAGAL i', .i, : >1.. q t••!i' '• ,30:00�.,1,.,{, ';! ;':3i�d39.20 APR03. • SNf�?lE: OjtAFT' A02; '' TRd40 0 06t Q> i i ,.,. i , ; i , .: ,64.A9= : , , r , i 9G9,'•36 . CEl;• Q4ai43�'+.'I,:i?t,lil7,,,, ;:800.36 ApQg, $N19iE;ORAFT., '.940; ; TRa, :.•i,uit, rf , .�; f. 7fi669. SH9.d0; 76 83' APRO7' TRANSEkR 3 Fistal Connect xd�7e+trAd>tS bpi F04'l 1`{��ta;i 96r ; 1 P' APRQT.' pF1'QAfETRI %dNE;' CAPITAL :QN:4+t1•is1 'i""" 767.24 %PR07 MERLi{ATir SAL•PS'DRAFT'. ' `' IiF,t :At:.t.• R}4V�L!OAIiSi,EA;Ob 05- 3 i•': 24I64073Q96299614331UZB6yy4M :,.'ri .... ..0P 12.31- !::s764.03. IWRUB ' NERCI(ANL SALES: URAF F . '. L y ; i, : fi I ; .. i " s r?iiir•; .: OhKti.NA Q4-06: 3'' t P46104330970720Q112�t51,�e494!T�t''1¢ �:t;;• .•`1? !'` 46.46- 70d:47 APRU9! kRCHANT• SALES' DRAFT :?:, t t " IJER. v-oi#D�# to 3b isllEgxAPKs'cn;'pq-'. • 244927.9309B,4O900,1�P �3 i;;t. ! ii't E00.99- A92A8 IEKPIt�BJdId� ! `' AP.RlII EFT :ypFp y� tt:!:•; ;;+ •,•r ittkjrX t?iT �,'., 'is''�u itiza ;;111��;ji .'. ,tt ".,: 15:00- APRlU, SNARE•:DRAFT. * . •:";,, 1 s , •,t?t•4 : •" i.:i:':tt:14� :i!ii 28.85- 464,13 APRl1,MEItCNANT SALES DRAFT x%2S¢1 '!�¢ t - f''„ i; ' �402. s,1Dop1n2agg s8s r�#t�k a dJas '3 x1 ir�Rk� • °A, i' rye 09- 3 ' APRl1, MJ�ai NT.SRKES'ORAFT .;'.!1't) tl't!3(fh!' iii t vAion Intist '• •+``'' 'in _-.1'. R39. }SHED; CA Od-09,- 3 911. E h8442f931004040o090U'i'!RrgYl�!" 9i' : i' 125'.ti0- 3 /AlPPgx3Pl liLTjIDfWWRL :'I'j5 'i A�.39 . , , . . ,i :•ireii; " ::A264,ti= :-0i162..6 AQ 11SMAE.ORAFT 405' 265 1�690REAFT494; TRAF439' : • : i t:,. ItdS (�413 :I4d4:Q60328 3704'CANUERGA•BLVO.; i •E it-tn :?tA; , ',, : A. ARR14?YEXCWWI SAWS VZAFT , i'!,I�i�i•,�DIO.CITY. :CA,04-13 3 ,:++ I : itlt::ii:• 2A�LAG5131D42b741E656487' G O TtiU ' VALU�t. ' • .:, ; =13 tlO ! r • t a s • I ? 37...65. t : } W28350giiD� t..gt16•. S 533;00- R16,DRAfit ,NULVASiI .:i: iBACE#;r: • PAYQDL•L•i ?1Gd�� 12 0$: %r'ir.t,r' ? "j:j.4?9:72 APA171iEF?.AGN: .. - .i@UfAiTNG.: 4' .. :{;:+ ' BI1CA :IIfC. Pd1YROLC '% •16284, ` , • . • : - i.I s'�29:9�i,'', APR7;7;EfTgCl1:•: ''I'ii' y26.72 APAVI SM4lEi0RAFT• ::49A :': TRACH#;?,, ,itt D41PBTRA :,, 0 z MAW. 4ATEtBEPOSLT FEE s ,10� i i'' EFjEci6#:,906:.:S; 833•.DO: :? :!•;ii:{i"iii ?:•,!,25 35: l r' !'9U1'. 7 Ad�i' �ItiklpRAHAI.. . ) I)'''I•t: " it :;,,. : ; ,j� .f;:is 1 ..,. "• POS+0417' 7428V pIlOQ4B .11i88�.''}1ABNOLiA; BLVD! *! ; , EiEv* ON4$; CA' ,' • :'-..• ; ; ; : _ ' • ' ki99:37= :i� U 7 554• �. i12;00 SNARE GRAFT= 4Q7 . rTiSCFl ; ,59.1t+¢t+AS414�': 280;00% .'1'•`Fisba'IJ44naeci;Tfer••• •r19':•200313t '•..'' ;''• .. :,•, JUN-26-2003 16:56 nv ypx ulwn —..w... aenadrA�ca�os rA �eoo)1.fF� �»wJum[Va KRISTINA N NAYDEN ' 15112 1/4 DICKENS ' SNENNAN:DAKS CA 91403 DATE 0 ndR3B19212 I'04-3D-03 R___ ,—; G VbUR•RIG}iT To DISPUTE B6.LINU ERRoRs AND•REGuunoy?GRS PAGE 2 CA9I4o30000 3863 P Resident Name: Apartment Newport North 2 Milano Newport Beach, Ca 92660 Phone: (949) 720-8765 Fax: (949) 720-1598 Verification of No Child Support hereby certify that I do not I hereby certify under penalty of perjury under the laws of the State of California that the information provided above is true and complete. signature n 4 H tt 0 r y F a I IRVINC APARMENTMANAGEMENTCOMPANY Rental Application and Receipt for Application Screening Fee Plans. can ,let. nus to, ,I is It's nin,'/, noting "N/A" or "nal on where applicable. The information you provide will be verified prior to IAMC's nlryrowil to real an aparlmmB1 la you in an apartment calnmumty owned by either The Irvine Company or Trine Apartment emlmmn ,." e r ".. ••,^.•n -I . cninninty; + FY Address: Prim Appllnml's fullemim(L.I. w.l. Middle1 11.11 JNSr, Daleof Birth m 5oeldsarlly Mailer Drover's Liccue# Name of Lb•AI•Pb.unla (Scpome Apld. W ww rc� ub cd far cacti Ca•Applimnt) (Last, First, Middle Tmlld) (Last, First. MldJIc lNtbl) (Lust) 11 'e.•b\m•Wild) 44 DyQv (Ws• First. h9ddl. rallel) (Lusl.11.•.I Wile INIIeQ (ter. First. Middle Initial) e m,e0 ApPlnn :' nxmnl Address Clly ZIP El Own Phone - —rhau5MO q01 b•MN Address. From �n T. neat E—it Real: Bandied lmndy lame. Alm.hodfa,Nlylwme AAparnnenL MoulRly Pny,nnfC� _ To wham do you make poymenl:p Present l mmla is Name A Jrcsf CITY ZIP q' ki Phone # Qj d`J r lea a 1p� U� s xel �y �f -b InnncJFile h br Ad•h es (If lus 1111111 yr. of uUove) ❑ awn Monthly Payment Doter. From Rent: $ IT. LnuaJlnle l,h.a ,r5nn;'• Nw,a Address City ZIP Phone Do ym ownn PW El Yes ❑ No tf, iifPets TYPc1, bulc of Birth (Lut. First, Middle TNllel)Mld,He lnlllnnDataaf I(L7111 Bm111 (Wtt,Flnt, MiddleINliatn<I,Middlelnillan Oaleof Birth (Lul, First, Mldiln Ldtlal) Dalcaf Birth I niplo)er (if set) nnpbyed,,ana of huabmse) Betimes Address (Bwlulny W Cad.) None PUom ll type of Buomt's Position Bole Svpmvisor Phola# — Iwme _ --- cram T. Mo. Unim,Inanm Souree Applicant must pxwde 2 Pay stubs or rumen WZform. Contact Imrv•d,,;1•,mr Emplo}rr Addr:ss(ludnding ZIP Cade) I J•ii.g bn,Amilbroii<i to Iludelil//51u1e, Phone# Deter From income Mo. To A ... unt# „ugs: Dunk and U-nid.(Nullul (Ily/Slut Account ll V ^ , I ear, filed hauls. ,' Y) Yes Mild ,.-1".]5D,a where I. _ WFatyean p•. ..o-lm,l airy lad: .ant 011. lmny ludBunilsorrepossusiou) Li Yu 1—jNo What ycoe7 — I I, ynn ever m 11 yes, deso a in MM: _ Pn•u,uwi.eduto felony)❑Yes Dlq-, Been evldad) DYas FFr��r�Me Befuuhed ennlarsc) ❑Yr•Na P _ A • in "do of cnmrgcnc•/, plea e 11 illy (Wes rt s 0 If op11itt e. pments' Iwne lumbar a-i� � ( is Fallnl'sl jurc ( A,icd WNt INAMNiigNARO: VANE APARTMENT MANAGE NTCOMPANY Hew did y.. Drsl kern of Ihis nparlment mmmenalty) Ralaldicons ❑promnllon/sp. Evens �OLRegister ❑ving Drive By Apartment Guide Sigm ❑Y/ebsite•011e" ❑SY Meregy ❑ Ofig Apt. Magozina ❑OtheeiACCemmunly❑Referrcl• ` i—Lu omspnper•011,ce L_t ❑Rental Living (IAC Mago �TAOS ❑R<Iaaior ScMm Magazine •Other for Rent Magazine EISD Vnion nFlycr Affordable Housing TACApLIn(o Center n5D Reader ❑Paatcnrd/Moiler ❑other •pbt Listed• • PLEA5EFILL IN:� forreloatkns L()o(^I rN vchkla Jo yen awNdrlvei Make Year t('C) License Year— rv,1)n% _ Liccrtsa 7s of recreational vehicles bo./ts or trailers is not permitted in the Imtma.Lep Consent to verification of Credit and Other Informatian: t am nuking this Application voluntarily for the purpose of calcining tAMCb appmval to rent an apartment in lite apartment KAMCPrtI shown h Flo above I harcbynutlerize and consent .albw IAMC.Owneo and their respealve employees and agents(collativtly, obmm and verify the aedli and otter information provld d by me m this Appllcatlan Ihrcu9h credit rcim"'ol-9antleg. loran' screening service. .bt.,. and banal (Including dnd oche funds verlflwtlan), employers and other persons or entitles with Information reluting to tills' hpf ocollon. it to r0cw TAMC occupnncy history and. liar lnfarmeli n In thls Appli<nfanlfor purposes related to my Llease and/or lfar accolunt revlewior ovemenrof oppllmllan methods. _ in. Company. and oil of I la3M rcby release and hold harmless vu r,hu,Company.m Apartment CO-lealsprocledlgs and cast,, altonyftfee,. a rising cut of t he cox rcspecliveof flcOrs, mnplareas and agento. from may and all lmbgily. 9 P eC vrlflc. inn and/ar use of the mformaton aOtomed in this AppOa ton. Inebding ll:e release of such Information to other parties.. I wm•rcgl that. 1. the bat of my kmxled9e, all of the information provided in Me Application (Including but rot limited to the statement of my m- if any Ild.ramothm, tobecfalbe, condition) false se"Amapxlll be ground, far duapp.-I of my Application orterminationof my Loose withpOxrcrd I agree 'aarotifymy Md 'AMC If -I-( the 1.1... minn imoliinthis olpperatttion Chanas ddd dtth me.lication arrastbs Apple nob approve.d1. oIindrstod that [AAtr-11 olou, l has Aimlica Ilan. alongn wy A non•nfundabla App Infe mslnil provhdcd. coluldcrctl yIAMC. n Ole RECEIPT FOR APPLICATION SCREENING FEE Teat from ,a.bova amount is I. be used to screen Applicant Win regards to credit history and other background In(ormatic , The amount charged Ita lzad a$ falkus. $9.95 1, AAml .,Is o(crcdlt report, unlow(ul detalncr (evictkn)search. and/or other sveenllg reports §2! 0.02 2. Cast to obloa, Fracas' and vrifyscracmig lnfarmolian(may Include stairs time and other related costs) §30.00 3. Total Ice charged (may not eeceed $30 per Applicant) African' autharieer verlllmtlan of Information suppbed b/ APPllm It an this Application 1 ducks and alter Informallan sources. It Oahe C. Irvin A admer 1 � BY: Date / lMp2w2 MMsad OlAu J' agencies, personal reference company yy,rxmnmtanragrotr, INCOME f ,SSET CALCULATION WOR' -IEET Last Name Flrat Nor..- Relationship Sax Dale of Birth Aga Social Socarity 0 Frr Slmtmrt I i HOH VIIL .3(4 YES or NO r.1a 2 F ? 63 q0 56- ut) a a �' 6 !S 615-�'o-ga7g fvo A 5 6 � 7 B r INCOME Family Memb, yA Source ' Base Rate $ Average Hours Average Annual 52 24 2a 12 1 Total WK SEMI -MO el•WK MO YR A $ \ '$ $ =$ Total Sox A: $ — SOCIALSECURITY Family Memb. rA PENSIONS ETC. Source i Base Rate Average Average Annual $ Hours 52 24 20 12 1 Total W SLMWO UI WK tA0 YIi $ W $ III LE..D C$ $ $ Total $ UOLIU ASSiS IANuE Family Memb. It ' Source Base Rate $ Average Hours Average Annual 52 24 20 12 1 Total WK :iCMI•MU abl•A( rdU Ylt - Tofai...- OTHERINCOME Family Memb, yd Source Base Rate $ Average Hours Average Annual 52 24 2a 12 1 Total INK SEMi•MO al-M 61 Ylt $ '$ $ _$ Total Dox D: $ TOTAL ANNUAL GROSS INCOME Athrough D >->>>>nan>>>-> ASSETS Member R Asset Description (savings, Chocking, stocks. bonds, etc.) Imputed/ Current IorC GrosstFair Mkt. Value. Cost to Get Cash NET Family Assals Value Actual Interest Rile Actual Annual Income front Assets 5- --`T y OFF Y Totals Box E: S Box F: $ 1 Family lncolno hmnAeeeL• .V IMPUTED INCOME FROM ASSETS II I Fffeclive Dale Aii!UA4 Box E exceeds $5,000-multiply TypoofProgmin% t w E by the current passbook interest rate: X % Unll No. 2400 Unilsize�_ If Box E does not exceed$5,o0e No. of Persons onlar-a- In box G: BOX G: 5 I^ INPUTED INCOME Mil: t,[_Max. Income Limit $ 30,2.Sd, FROM ASSETS AR: 140%Limit; Fs- rr•s Enter ilia gloater at Box F or Box G in: BOX K: INCOME CONTRIBUTED FROM ASSETS TOTAL ANNUAL INCOME$ 4412E2.4 & TOTALASSETS$ f1.9- =$__ �� r�LZL_ _� Income Restricted Certification Questionnaire G� Unit #-202-- Name: �. J Initial Certification Re -certification Other es No due"" U Uwe receive Family Support, Spousal Support, and/or any other cash contributions of gifts, including rent or utility payments "we TCCe1Ve Veteran's AQrriun-1--, , .- ----- . - benefit, Disability benefit, AFDC, Lottery winnings, Inheritan or Annuities. Lwe receive income from Rental Property, I/we receive benefits/income from Social Security to include SSA, SSI and/or periodic social security payments. x The household receives unearned income for family members aue 17 or under, Lwe are entitled to receive child support payments. / I/we am currently receiving child support payments. V Uwe am/are currently making efforts to collect child support Uwe have other assets (example: 4uin, inn, ......- Stocks, Bonds, Treasury Bills, Money Market accounts, have cash on Lent Status: are If you answered yes to either of the previous two questions are you: i^ Married and filing a joint tax return. the information presented on this form is true and accurate Under penalties of perjury, I certify that to the best of my knowledge. The undersigned further understands that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information will resul i -the deni I f applicltion or termination of the income restricted leasagreement. C— Date d Resident Signature Signature of Owner/Agent Date C: rIFICATION OF ZERO INCOME Household Developme (To be completed by adult household members only, if appropriate.)%� ,t No. 0 — . f� City: I hereby certify that I do not individually receive income from any of the following sources: a. Wages from employment (including commissions, tips, bonuses, fees, etc.); b, Income from operation of a business; C. Rental income from real or personal property; d. Interest or dividends from assets; insurance policies, retirement funds, pensions, or death e. Social Security payments, annuities, benefits; f. Unemployment or disability payments; g. Public assistance payments; h, Periodic allowances such as alimony, child support, or gifts received from persons not living in my household; i. Sales from self-employed resources (Avon, Mary Kay, Shaklee, etc.); J. An`y other source -not named above. currently ei nexnd t 12 dere is no imminent change expected in my financial statusmployment status during I will be using the following sources of funds to pay for rent and other necessities: Under penalty of perjury, I certify that the information presented in this certification is true and accurate to the best of my knowledge. The undersigned further understand(s) that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information may result in the termination of a lease agreement. e Signature o pelican Want Printed Name of A p Icatit/Tenant Certification of Zero Income (September 2000) New Ceniricates y. /Rec. -at;on Unit\umber INCOME COMPUTATION AND CERTIFICATION NOTE TO APARTMENT 0\l•?IER: This form is designated to assist you in computing Annual Income in accordance with the method set forth in the Department of Housing and urban Project ('•HUD") Regulations (24 CFR 313). You should make certain that this form is at all times up to date with the HUD Regulations. All capitalized terms used herein shall have the meaning set forth in the Regulatory Agreement. CSCDA (Pool) -• Newport North 1/We the undersigned state that [/we have read and answered fully, frankly and personally each of the toIIowing questions for all persons who are to occupy the unit being applied for to the above apartment project. Listed below are the names of all persons who intend to reside in the unit. 6. ?• 1 4. Name of Members Relationship Of the to Head of Social Security Place Employmentace f ceoor Household Household Age Number Qer•u l Lb4lct✓1 fleg/J— 3 7 6s8-8,7-8845 Fo-�rt2rs Insrtrrnca Income Computation The total anticipated income, calculated in accordance with this paragraph 6, of all persons (except children under 18 years) listed above for the 12-month period beginning the earlier of the date that IAw plan to move into a unit or sign a lease for a unit is Sw 520 00 -- Included in the total anticipated income listed above are: __(a)_all wages and salaries, overtime pay, commissions, fees, tips and bonuses and other compensation for personal service's, before payroll deductions; (b) the net income from the operation of a business or profession or from the rental of real or personal property (without deducting expenditures for business expansion or amortization of capital indebtedness or any allowances for depreciation of capital assets); (c) interest and dividends (including income from assets included below and other net income from real or personal property); (d) the•full amount of periodic payments received from social security, annuities, insurance policies, retirement funds, pensions, disability or death benefits and other similar types of periodic receipts, including any lump sum payment for the delayed start of a periodic payment; (e) payments in lieu of earnings, such as unemployment and disability compensation, workers' compensation and severance pay; (f) the maximum amount of public assistance available to the above persons other than the amount of any assistance specifically designated for shelter and utilities; (g) periodic and determinable allowances, such as alimony and child support payments and regular contributions and gifts received from persons not residing in the dwellings; (h) all regular pay, special pay, and allowances of a member of the Armcd Forces (whether or not living in the dwelling) who is the head of the household or spouse; and W any earned income tax credit to the extent that it exceeds income tax liability. Excluded from such anticipated income are: (a) casual, sporadic or irregular gifts; (b) amounts which are specifically for or in reimbursement ofntedical expenses; (C) lump sum additions to family assets, such as inheritances, insurance payments (including payments under health and accident insurance and workers' compensation), capital gains and settlement for personal or property losses; (d) amounts of educational scholarships paid directly to the student or the educational Institution, and amounts paid by the government to a veteran for use in meeting the costs of tuition, fees, books and equipment. Any amounts orsuch scholarships or payments to veterans not used for the above purposes are to be included in income; (e) hazardous duty pay to a household member in the Armed Forces who is away from home and exposed to hostile fire: (f) relocation payments under Tide 11 of the Uniform Relocation Assistance and Real Prooerty Acquisition Policies Act of 1970; I,) foster child care payments: (h) the %clue of coupon allotments under the Food Stamp Ac. of 197 7: M payments to volumeers under the Domestic Volunteer Services Act of 1973; i U) payments received under the Alaska Native Claims Settlement Act; (k) ir_ome derived from certain submarginal land of the United States that is held in trust for certain Indian tribes: (q payments or allowances made under the Department of He and Human Services' Low -Income Home Energy Assistance Program; (m) payments received from the Job Partnership Training Act; (n) income derived from the disposition of funds of the Grand River Band of Ottowa Indians; and (o) the first 52000 of per capita shares received fromjudgement funds awarded by the Indian Claims Commission of the Court of Claims or from held in trust for an Indian tribe by the Secretary of Interior. 7. Do the persons whose income or contributions are included in item 6 above: (a) have savings, stocks, bonds, equity in real property or other form of capital investment (excluding the values of necessary items of personal property such as furniture and automobiles and interests in Indian trust land) _ Yes _NNo; or (b) have they disposed of any assets (other than at a foreclosure or bankruptcy sale) during the last two years at less than fair market value? Yes _ eY No ( c) If the answer to (a) or (b) above is Yes, does the combined total value of all such assets owned or disposed of by all such persons total more than 55,000? Yes X No (d) If the answer to ( c) above is Yes, state: (1) the combined total value of all such assets: S (2) the amount of income expected to be derived from such assets in the 12-month anderiod beginning on the date of initial occupancy in the unit that you propose to rent: S F (3) the amount of such income, if any, that was included in item 6 above: S S. (a) Will all the persons listed in column I above be or have been full-time student during five (5) calendar months of this calendar year at an educational institution (other than a correspondence school) with regular faculty and students? Yes _�No (b) Complete only if the answer to Question S(a) is "Yes"). Is any such person (other than nonresident aliens) married and eligible to file a joint federal income tax returns? Yes X — No 9, This certificate is made with the knowledge that it will be relied upon by the Owner to determine maximum income for ) t eligibility to occupy the unit; and Uwe declare that all information set forth herein is true, correct and complete and based upon information Vwe deem reliable and that the statement of total anticipated income contained in paragraph 6 -- -fs reasornasble and based upon such investigation as -the undersigned deemed necessary. --- - -- 10. I/We will assist the Owner in obtaining any information or documents required to verify the statements made herein, including either an income verification from my/our present employer(s) or copies of federal tax returns for the immediately preceding calendar year. 11, I/We acknowledge that all of the foregoing information is relevant to the status under federal income tax law of the interest on bonds issued to finance the 9619 . of the apartment building for which application is being made. Wc,consent to the disclosure of such information to the issuer of such bonds, the holders of such bonds, any trustee acting on their behalf and any authorized agent of the Treasury Department or Internal Revenue Service. I; We declare under penalty of perjury that the foregoing is true and correct. Executed this h day ofyL.s� _. J 701(year) in the City of. California ­42� Applicant Applicant Applicant Applicant (Signature of all persons (except children under the age of IS years) listed in number 2 above required) FOR COhL°I MON BY APAR'TAMIN'T OWNER ONLY: 1. Calculation of eligible income: a. E=r amount entered for entire household in 6 above: b, (1) U the atnaunt entered in 7(e)a ente:ed in 7(d)(2), srbhx frot 7(dx3) and enter the renew tins (2) Multiply the amaru •t to savings rate ^> > annual eantiA passbook sav' _ the amount is yes, enter the total amount figure the amount entered in &:e ($ )S the current passbook O to determine what the total /(d)(1) would be if invested in __), subtract from that figure enter the remaining balance ($ (3) Eater at right the greater of the amount calculated under (1) or (2) above: C. TOT9.L El10TBLE INCOME (line l.a plus line l.b(3): 2. The amount entered in l.c: Qualifies the anplicant(s) as a Moderate -Income Tenaat(s). x Qualifies the applicant(s) as a Lower heame Tenant(s). Qualifies the applicants) as a Very -Low Income Tenaat(s). 3. Number of apartment unit assigned: 6 I Bedroom size: 1+-- Rent: $ 1130 A. This apartrn Pt unit as not) last occupied for a period of 31 or more consecutive days by persons whose aggregate adliannu pated aal income as certified in the above manner W= their initial occupancy of the apartment unit qualified them as a Lower -Income Tenant(s). 5, Methed used to verify applicant(s) income: Euq:loyer income vez*ication. Coo es of = returns. Other ( !? /1 /0 '3 Date Mamgex a�uc+w+eerau 1Rvlrie€pPThiar>AGdrtEeiEeA(t{p�N fr Rental Application and Receipt far Application Screening Fee pleode Complete 11 'NM' where InforNtlo" you ovide ill warified to IAMC'sapprmol to rentis form (n It,s on apartment you n anoting /Aeapartment caremuNtyPowreA byelh"Th D, Company orwLvina Apartment Communities, I.P. (collectively, °Owner%. print ApplimM's full name Met, FM, Middle trim) 00r/IN C Hgp— faG Nome of Ca4pplicaa(S.Parcte A APPIImHan ire (Last, First, Middle initial) Ma P P I (last, First. Middle Initial) (� 1 a APPIImn's Preset" Address City ZIP Sr15n bateaf Birth social security Number 'or wrh Lo-ApPlimrt) First, Middle INtW) IM*t. Fkst.M Own Beni: * DeNrhed fanny home: Aft.. Wfamity hams AYasan L� FI Mor1hly Pey"m$ % To whom do you mate ls'"M i . present Landlord's Name Address city ZIP tru re. a Immcdla ePrior Add W( ex than l yr.atebasw) Monthly Paymo h. r y Reny. $ Immedlax prior Laedlord's Nome Address city ZIP n .,.. u,. Numba of Petfl _ F a a I F r 0 n Phone # Type Pcopaxd Ocmpants(Wt, First, Middle INtlal) Date of BlMh MM, First, Mldtlle InllW) Date of BIMh (Wt, FlM, Mlddia Inhlo7 Date of Birth Ms1,FDx,Mlddie INiW) Date of Birth (last. Fret, MiddleINflaq Dateaf Birth (Iast,Flrct,MlddIs1rifWI) Dire of Birth EmPisfe"Of xlFunPloynd, come of Wsltiw)Bus ",•e Address (Including ZIPCods) r Phone#Type of Business Position DNea Su r�Ixr �J Phone income Otherme source Applicant most provide B peysNW ar asrrcnt W2 form. Contact Immndlyte Prior Employ5r Address (Including MP Coda) l Phox1 �j r.� Datee I 0/ ome Income To ! o -ra sa c�O��p 2 Ma. cTY.-L?fo i Checking: ban and branch (Include Clty/state) Account# p d / snAogz bank and branch (I de City/state) Aemunt # �-f Naveyou ew filed bm:k-Ptry) I Xl yes '•yam• 7 l C - Whatyru) CC Caunty and shot. whoa feed: El14 . you ever Fad any public record sults, Item, ludgmsmsor rcposseubM yn ah" Wheyear) Have you ever: If yes, describe In detoll: Been convlMed of a felotry)❑yes Na Beon evIded) yes �N-o Oefoult.donalees.) Ely-W—w Inmseefemergemy.pieascnotifY•Mml come, adhessaphore uomber)(p 7.Cj7-'5(003 Relationship: If applicable, parents' Ph6k tomhrrr• ( ) FoMv's Wane AbIHe'allon /VP4maml I adsad.0)1)1 kUrIOIa1.A .J How did you first learn of this apartment wmmedty? By ❑Rental-Llvirgcom �primotlon/Sp. Event QO.C. Pegiver Drive ❑5190 ❑Websne•Other " ❑SJ Atarmry ❑Apartment Wide ❑Newrygw,.Other• Magazine ❑OIWr IACConmvmltY � ❑0r19.Api. Tl Living (L1C Mag1❑S aesD ❑ ❑Rekmiar 5ervica ❑Mogaalne• Other e Housllg For Pme Vnlon ❑ Mo9mleeother• �Rental Affordabk ❑FtN' Wt Usfed' ❑ SD ❑IAC Apt.Trda fiatw Radar ❑Pastmrd/Moilr � pI.EASE FILI.IN'-- Roman far nbcatom How man vahlel"d you own/drrve] �s^�t2 Llunse# Year "T Y��e� Uae me tf ake� • Make twilers is not pepn3hted in the Corot Mr+'I Porkittto of t'ecreatlonal vehicle, boots or Do you have panels smurrcee L. Other T tformcMan: Consent to Verifiention of Credit and tw.par n,e,1, the eam <mnti m+yrtioxn I am makingtho Appltmtlon valunartly forth. purpoesofobtad IAMCCepec PMwdta p nec,%and agents (mllecths�the-IAMC PoatI 9 1w s,m,haw. I hereby authorlsc and otown, to,low TAMC, Owner, obtain and vwify the credit and other Infowmtbn provided ..players ye In s ands otheron porousor entifcs with igh credit nformation relating to thin hprpllica loa mmpanles, banks Pocbdig el. manic funds varifimtbn), P he I undwsmnd that if I Iwo thk opea'tn 'the IAMCPMIcrfidlh°ve amne" NI a and/or for account review or lmpwvw of occupancy hkforyc'pd other Informooan In this Application far purpmee related to my Iran application methods. of I hwebyrclwe an3A} hold harmless haTH' 'ro earned all liability, legal pMwcdlrgsmdApartmeat U. ic°sts, feuding aat Apartment n�a� act, WISIM outlef the their Mpealveof[Icws, employees o9m verification and/orasc of the irdormotion coldalrcd in thk APPllmtkn, Includllg the rciwc of such Irtformaflon to otWWI.. I wcrir`mt that, h t}e best of my kmwkdge, di of the Information pmV&d In this Application Bwk"Iml bur rot limited to the emtenwrdof my ll,3111014 if any Information Provided by M financial condition) b true, acmrote, complete and correct m of the Ate Ilmflon arof this ptermlreflon of my LLeaw wlih Owner. I agree to notify ud fa Mfalse, each false aMemmd will be grounds for of of m/ pp a Burl telianry. Ialso understand that IAMCHanof the!Ildormanan provided in this Application changes during the ApplkSfkn process r during my her Information pmvldcd by me, xhetm, or not this Application Is appmered. IAMC will MUM this Application, along with any at Rear Is 111 and to check Atmndefundahlo4pllagon SetnninggFFaeat $311.0 ad �kaaM 1 I"AmowwmocacupyNaspailmenlLefa iltid,Appeal wMbe e InformaBenprovid4 AaepxskAPP conoldersdolA11C1 Q%% O z Appli,&'s Signature /I — ,.to V RECEIPT FOR APPLICATION SCREENING FEE rth.a belax,a APPtoRwt waporimcntfromamount kto be used m screen ApPllmnt with rc9°°o tocredit Warr and other background Information. The amount charged m folbwr. $9.95 Acnml u#sofdreport. unkwfol des°Irer(evbtbn)har screening rcponf f20.05 Cost to abtaln,procas rd verlfyscr'eemng leformatlan(mn includestaff•,time andathe, related costs) a!$30.0! Total fee charged(aay not anceed $ao per ApPllmnt) gcal refercnca .. .,.__,__.._..m,,alavaf Informotlan supPged b/ ApPli°°°ton thh APPllmtionthraugh credit rcpoging awa-paea, and other biferm4l eourcas fsh-2,a6 Date Irvine AP d Management Company gy: pa,,2dt p�emrwamrota, Pedsan O710h Income Restricted Certification Name: G %12 f'U Loa � 0. Unit # initial Certification Re -certification Other Income Yes No vuesuuu Uwe receive Family Support, Spousal Support, and/or any of Xcash contributions of gifts, including rent or utility payments f,, nnrcnnc not livine With me. Uwe receive Veteran's Aotmmsaanon, rcnsauu, �_• Y•w•••- `/ benefit, Disability benefit, AFDC, Lottery winnings, Inheritan 7� or Annuities. Uwe receive income from Rental Pro erty. I/we receive benefits/income from Social Security to include SSA, SSI and/or periodic social security payments. The household receives unearned income for family members ge 17 or under. Ware entitled to receive child support payments. XI/we am currently receiving child support payments. Itwe am/are currently making efforts to collect child support IN X Itwe have other assets (e: Stocks, Bonds, Treasury Certificate of Deposits, I/we have cash on hand. Student Status: Money Market accounts, Life insurance, Real Este persons who are all full-t Does your household anticipate becoming a tuu-nme smaeni ' household in the next 12 months? If you answered yes to either of the previous two questions are r( you: V� ➢ Married and filing a joint tax return. Under penalties of perjury, I certify that the information presented on this form is true and accurate to the best of my knowledge. The undersigned further understands that providing false representations herein constitutes an act of fraud. False, misleading or incomplete information will result' denial o plication or termination of the income restricted lease agreement. 0 Resi ent Signature Date S 12.10 3 Signature of owner/Agent Date FROM :Davidson Insurance FAX NO, :818 700 9318 . 03 2003 01:55PM P4 ,:t isy: FRIEL INS. AGENCY; IFriel insurance Agency July 25, 2003 Cheryl L.ogian 18841 Kingsbury St., #28 Granada Hills, CA 91344 Re: Customer Service Position Dear Cheryl, 949 252 1552; Jul .29.W- 0:08AM; F•c.:' ~20051 S.W. Birch,'i•di '4.• Newport Beach, CA'; 949 / 292-9083 FAX 282.1552 1 He. # OA22338 5t.•�U j t ,1uCP� We are pleased to welcome you to our agencyl You have been chosen over a number of applicants and we believe that your experience and expertise with Farmers personal lines will be a tremendous asset, As we discussed, you hour plus a allowance and any other lfuturel be abenefits will be avai aid at a rate of $1,00 blerto you as per our employee manual. We look forward to working with you! Sincerely, Kim Jaco b Friel insurance Agency 0 Auto • Fire 9 Life • Commercial INCOME r 3SET CALCULATION WOR: EET 1 Last Noma First Nar,. r Relationship HOH Sax Dale of Birth $I O Apo 32 Social Security It 5-KI Fir Student YES or NO 2 5 4 5 5 7 B INCOME EMPLOYMENT Family Memb.# Source 'WK Base Rate $ Average Hours Average Annual 52 24 26 12 1 Total SEMI -MO I ul•vm I me Y2 1' $ IQ k =s3q 52noo $ — =a $ -- _$ Total Box A. L pa - SOCIAL SECURITY, PENSIONS, ETC. Family Memb. # Source Base Rate $ Average Hours Average Annual 52 24 20 12 1 Total WK SFMI•MO el•WK MO YR $ =W $ C$ Total Box D: $ PUBLIC ASSISTANCE Family Memb. // • Source Base Rate $ Average, Hours Average Annual 62 24 20 12 1 Total JEMIM0 al•WK Me Ylt ' Total Box C:. 5 OTHERINCOME Family Memb. /f, Source Base Rate $ Average Hours Average Annual 52 24 20 12 1 Total WK SEMI•M 01•WK Me YR $ =a $ =a Total BOX D: S ^ TOTAL ANNUAL GROSS INCOME A through D »»»»>>>> ASSETS Member 0 Asset Description (savings, checking, stocks, bonds, ale.) Imputed/ Current IorC Gross/Fair Mkt. Value . Cost to Gel Cosh NET Famlly Assets Value Actual Interest Rain Actual Annual Income front Assets 112010.72 - 121103Z ee r � Totals Box E: :� IMPUTED INCOME FROM ASSETS Box E c rcecds $5,0o0-multiply E by the currant passbook Interest rate: If Box E does not exceed $5,000 enter-0- In box G: Enter the greater of Box F or Box G in: ON . x ie .BOX,: S or INPUTED INCOME FROMASSETS $ y BOX H: a,m ncl ,o,., 111.10Wmu FarNly klmalo Thin AeacL• Effective Dal o qunUc� Typo of Prngmm%_ LC4!1 Unit No. AXIS* UnitSko 1-FT No. of Persons I Mfl: v Mex.IncomeDmil$A155'D-D�- AR: 140% Umit$ Asset Calculation Worksheet Name InPr� l c�cy] Account Type 1, 21$. o-7 363. 3Z 1 (_) 21 5 sl . 43 divided by 2 (_) lIzgO.72 (average account balance) ( x ) Interest rate: % 0� (_) Income from asset: $ _iJ 0 Washington Mutual STATEM T OF ACCOUNT THE FEE FOR EACH OVERDRAWN TRANSACTION, WHETHER PAID OR RETURNED, IS $21.00. 03-E-83 CHERYL D LOGIAN 16841 KINGSBURY ST APT 26 GRANADA HILLS CA 91344-6439 TO REACH CUSTOMER SERVICE, PLEASE CALL TELEPHONE BANKING AT 1-800-788-7000. 137,014 STATEMENT PERIOD: FROM 06-06-03 THRU 07-07-03 BE ) GOLD CELEBRITY, EVERY DAY! SIGN CHECKS AND UFEE FREEP FOR LTRAVELERt'S CHECKS. ALL FOR G AND GEOUAARCHECK LOW MONTHLY FEE. SAVE UP TO 50Z ON HOTELS, MOVIE TICKETS AND MORE. ASK US FOR DETAILS. FDIC INSURED. FREE CHECKING WASHINGTON MUTUAL BANK, FA FDIC INSURED CHERYL D LOGIAN ACCOUNT NUMBER: 871-414965-1 YOUR OVERDRAFT LIMIT, AS OF THE STATEMENT END DATE, WAS S 1,000.00. THIS MAY BE CHANGED AT ANY TIME WITHOUT NOTICE. OVERDRAFTS ARE SUBJECT TO A PER TPAW'UrTTON CHARGE. 13 BEGINNING BALANCE TOTAL WITHDRAWALS TOTAL DEPOSITS ENDING BALANCE 1,363.36 2,286.97 21141.68 2,218.07 YTD INTEREST PAID .00 YTD INTEREST WITHHELD: .00 DATE WITHDRAWALS DEPOSITS TRANSACTION DESCRIPTION - 06/06 27.35 VISA-WHITEWATER PHOTOS 590-622-3456 CA 06/09 21.71 VISA-CHILI'S GRILL OOOONORTHRIDGE CA 06/10 10.34 VISA-WOODRANCH BBQ & GRNORTHRIDGE CA 06/10 14.88 VISA-OGGI'S PIZZA & BRE661-2527883 CA 06/11 44.35 VISA -FASHION TIME MISSION HILLSCA 06/13 902.76 CUSTOMER DEPOSIT STO 2526NORTHAL PORTER RANCH 22 0614 06/16 06/16 26.06 18.19 VPas ISA-FOREVER-MART D6/16 33.96 VISA -OLIVE GARDEN OOOICHATSWORTH CA 06/16 19.95 VISA-GRC*WNSR PILTES 2 800-747-3503 CA ST GRENADA HILLS 88 0617 06/17 23.00 POS RALPHS 16940 DEVONSHIRE 06/17 32.45 VISA -BORDERS BOOKS &MUSNORTHRIDGE CA SAN FERNANDO MISGRANADA HILLS 80 0619 06/19 49.41 POS TARGET 0287 17055 ATM-NCHG SIB07195 11160 BALBOA BLVD. GRANADA HILLS 30 0622 06/29 20.00 POS VONS STO 10321 SEPULVEDA MISSION HILLS 14 0623 06/23 06/23 17.23 35.42 VISA-WOODRANCH BBQ & GRVALENCIA CA GRANADA HILLS 77 0625 06/25 8.09 POS RALPHS 10823 ZELZAH AVE 06/25 16.04 VISA-MARIAS ITALIAN KITNORTHRIDGE CA 06/26 35.72 VISA -OLIVE GARDEN OOOICHATSWORTH CA 06/27 49.28 VISA -VICTORIA SECRET 800-888-1500 OH NWC OF RESEDA & DEVONSNORTHRIDGE 18 0628 06/30 35.39 POS WALGREEN COM POS WAL-MART 925 19821 RINALDI STREET PORTER RANCH 93 0628 06/30 06/30 18.40 4.30 VISA-HOLLYWOOD VIDEO NORTHRIDGE CA 07/01 11238.92 CUSTOMER DEPOSIT 07/01 25.60 VISA-CALIFORNIA PIZZA ISANTA MONICA CA 07/01 18.39 VISA -PINK ICE SANTA MONICA CA 07/02 17.00 VISA -NEW STYLE NAILS NORTHRIDGE CA 25450 THE OLD ROAD VALENCIA 45 0703 07/03 35.00 POS WAL-MART #22 POS WAL-MART STO 2526 WAL-SAMS PORTER RANCH 22 0705 07/07 11.05 POS VONS STO 16830 SAN FERNANDO MISGRANADA HILLS 91 0705 07/07 13.84 PAGE 01 (CONTINUED ON NEXT PAGE) N Washington MutuaF STATEM' T OF ACCOUNT v CHERYL D LOGIAN 16841 KINGSBURY ST APT 26 GRANADA HILLS CA 91344-6439 FREE CHECKING )ATE WITHDRAWALS DEPOSITS )7/07 16.23 )7/07 26.30 )ETAIL OF CHECKS PAID: CHECK DATE NUMBER PAID AMOUNT 1078 06/10 802.00 1079 06/06 100.00 *1081 06/16 50.00 1082 06/09 50.00 1083 06/18 80.00 NOTE: * INDICATES CHECK OUT OF SEQUENCE 03-E-83 137,015 STATEMENT PERIOD: FROM 06-06-03 THRU 07-07-03 (CONTINUED FROM PREVIOUS PAGE) ACCOUNT NUMBER: 871-414965-1 TRANSACTION DESCRIPTION VISA -CHARLOTTE RUSSE #3NORTHRIDGE CA VISA -FASHION 21 #12 GRANADA HILLSCA CHECK NUMBER DATE PAID AMOUNT 1084 06/17 37.57 1085 06/23 126.00 1086 06/20 30.00 1087 06/20 14.98 1068 06/25 93.45 13 CHECK DATE NUMBER PAID AMOUNT 1089 06/27 48.04 1090 07/03 60.00 1091 07/01 70.00 PAGE 02 OF 02 FROM :Davidson Insurance FAX N0. :618 700 9318 . 03 2003 01:55PM P2 0 Washington Mutual THE FEE FOR EACH OVERORANN TRANSACTION, HHETHER PAID OR RETURNED, IS 42100. 03-E-83 CHERYL D LOOIAN 16841 KINGSBURY ST APT 26 GRANADA HILLS CA 91344-6439 STATEMENT OF ACCOUNT TO REACH CUSTOMER SERVICE, PLEASE CALL TELEPHONE BANKING AT 1-800-788-70D0, 135,236 STATEMENT PERIODS FROM 05-07-03 THRU 06-03-03 14 BE A CELEBRITY, EVERY BAYT SIGN UP FOR GOLD CHECKING AND GET OUR VISA(R) GOLD CHECK CARO.- l - GET FREE CODL PERSONAL CHECKS AND FEE -FREE TRAVELER'S CHECKS, ALL FOR A LON MONTHLY FEE. SAVE UP TO BOX ON HOTELS, MOVIE TICKETS AND MORE. ASK ITS FOR DETAILS. FDIC INSUREO, FRER CHECKING WASHINGTON MUTUAL BANKP FA FDIC INSURED CHERYL D LOGIAN ACCOUNT NUMBER: 871-414968-1 YOUR OVERDRAFT LIMIT, AS OF THE STATEMENT END PATE, WAS S 1,000,00, THIS MAY BE CHANGED AT ANY TIME. NITROUT NOTICE. OVERDRAFTS ARE SUBJECT TO A PER TRANSACTION CHARGE. 3E6INNING BALANCE TOTAL WITHDRAWALS TOTAL DEPOSITS ENDING BALANCE • 1039.71 r 1,362.35 2r385.00 4#363.36 VTO INTEREST PAID .00 YTO INTEREST WITHHELD, .00 DATE WITHDRAWALS DEPOSITS TRANSACTION DESCRIPTION 05/07 90.00 ATM-NCHG S1808066 18661 DEVONSHIRE STREF.NORTHRIDGE 66 0607 05/07 B." PCs NALGREEN CON NMC OF RESEDA A DEVONSHORTHRIDGE 60 0507 03/09 4D.00 ATM-NCHG S1008066 19601 DEVONSHIRE STREENORTHRIDCE 34 OB09 05/09 7,44 VISA-QUINZO'S SUB 0451 GRANADA HILLGCA 0511Z......-, - . .... 100.00 ' • •CUSTOMER 9IPOSIT—" _..... _..... ....... _..... .. • -' - - ....._..... .. r 05/12 29.93 VISA-Khl'$ CAFE 420 CHATSHORTH CA 05/29 9.72 VISA-MARIAS ITALIAN KITMORTHRIDGE CA 05/18 786. 79 CUSTOMER DEPOSIT ' 05/16 37,25 VISA-GRC*MNSR PILTES 1 800-747-3503 CA 0S/19 41.19 POs RALPHS 36940 DEVONSHIRE $T GRENADA HILLS 91 0517 O3/19 3.39 FOG VOWS S 10321 SEPULVEDA MISSION HILLS 38 0518 05/19 16.89 POS VONs S 26830 SAN FERNANDO MISGRANADA HILLS 77 0519 05/20 100.00 CUSTOMER DEPOSIT OS/2D 350.00 CUSTOMER DEPOSIT ' 06/90 17.00 VISA -NEW STYLE NAILS NORTHRIDOE CA 03/97 16.32 POS TARGET 0636 9770 NORTH NEMPORT RIGSPOKANE 37 0525 05/27 20.38 PDS VOtS S 16830 SAN FERNANDO MISORANADA•HILLS 99 0527 05/29 822.22 CUSTOMER DEPOSIT 05/30 7.57 VISA-CLOTHESTIME 964K RESEDA CA 26/02 29.32 Pas VOWS S 16530 SAN FERNANDO MISSRANADA HILLS 07 0601 06/04 26.09 VISA -CLAIM JUMPER 0I3 NORTHRIDGE CA 06/04 47.95 VISA -FASHION 21 $12 GRANADA RILLSCA 06/05 8.27 POS VOWS STO 16830 SAN FERNANDO MISGRANAOA HILLS 06 0605 06/05 26.00 CUSTOMER DEPOSIT PAGE 01 (CONTINUED ON NEXT PAGE) FROM :Davidson Insurance FAX NO. :818 700 9319 w Washington Mutual 03-E-83 CHERYL D LOGIAN 16842 KINGSBURY ST APT 26 GRANADA HILLS CA 01344-6439 03 2003 01:55PM P3 STATEMENT OF ACCOUNT 135,237 STATEMENT PERIOD: FROM 05-07-03 THRU 06-05-03 14 FREE CHECKING (CONTINUED FROM PREVIOUS PAGE) ACCOUNT NUMBER! 871-414965-1 DETAIL OF CHECKS PAID: CHECK DATE CHECK DATE CHECK DATE NUMBER PAID AMOUNT NUMBER PAID AMOUNT NUMBER PAID AMOUNT 1064 05/07 795.00 2070 05/19 46.73 HIS 05/22 20.06 M10fi6 05/08 10100 3071 05/20 48.04 1076 05/27 120.01 1067 OB/14 42.43 1072 05/21 200.00 1077 05/19 22.05 106A 05/22 75,00 1073 05/22 70.00 *1080 06/05 30,00 2069 05193 226.00 2074 05/22 6.48 a0iE1 M INOICATES CHECK OUT OF SEQUENCE PAGE 02 OF 02 Clarification Record Date: 9 03 Applicant/Resident Name:: . 5d Initial Certification Date of Expected Move -In: 9/6 03 ❑ Re -certification Effective date: Means of Clarification: ® Phone Conversation ❑ Person -to -Person Conversation ❑ Other: Date of Clarification: --ff-Lk Contact Name: Company/Organization: Summary of Clarification Explanation or Clarification Given: fYls Ki,n Tkak Title: A=j" ie�+ YYk�cCly Employee Name: i:"ruc�� �,r��� Date: 't?`/6T Employee Signature: