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Tenant's Name: <br />Address: <br />LAKESIDE CENTER INC. <br />ASSET CERTIFICATION <br />(FOR CASH VALUE) <br />Stater Zip Code:_ <br />Valueof House ..................................................... <br />Checking............................................................. ............................................ <br />Savings............................................................... <br />Cashon Hand ........................................................ <br />.Stocks and Bonds ................................................... <br />Time Certificates/CD's............................................. <br />Assets disposed of for less than Fair Market Value............ <br />Real Estate (other than home) .:................................... <br />Other Assets ....................... :.................................. <br />IItA's.................................................................. <br />. <br />Life Insurance (Whole Life Only) ..............:................. <br />E <br />TOTAL ASSETS ................................ $ <br />(line 14 of TC (FmHA 1944-8) <br />L 'hereby certify that I have listed all my assets as <br />required by community. <br />Signature of Applicant <br />Date <br />We are pledged to the letter and spirit of U.S. Policy -for achievement of equal housing opportunity <br />throughout the Nation. We encourage and support an afrmative advertising and marlwting program m <br />which there are no barriers to obtaining housing because of race, color, religion, sex, handicap6 familial <br />status or national origin. <br />NOTE: ALL SUPPORTING DOCUMENTATION IS ATTACHED TO THIS FORM! <br />DOC 210 <br />