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C: <br />C <br />Exhibit 3.3 -- Sample Format for Computing Part 5 Annual Income <br />1. Name <br />2. Identification <br />ASSETS <br />Family <br />Member <br />Asset Description <br />Current Cash Value <br />of Assets <br />Actual Income from <br />Assets <br />3. Net Cash Value of Assets ........................ 3. <br />4. Total Actual Income from Assets ....................................................... <br />4. <br />5. If line 3 is greater than $5,000, multiply line by (Passbook Rate) <br />and enter results here; otherwise, leave blank. <br />5. <br />ANTICIPATED ANNUAL INCOME <br />Family <br />i Members <br />a. Wages/ <br />Salaries <br />b. Benefits/ <br />Pensions <br />c. Public <br />Assistance <br />d. Other <br />Income <br />e. Asset <br />Income <br />i <br />I <br />I <br />Enter the <br />greater of <br />4 or 5 <br />from above <br />in e. <br />Ilines <br />I I I I <br />1 6 Totals a. <br />b. I <br />C. I <br />d. <br />e. <br />Enter ;ctal of items from 6a. through 6e. This is Annual Income ................. <br />7. <br />T ecrnrncal Gwoe for Determining Income and Allowances for the HOME Program — 17 <br />