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LAKESIDE CENTER INC. <br />FAIR MARKET VALUE STATEMENT <br />I certify that no member of my family has disposed of assets for less than fair market <br />value during the preceding 2 years. Yes or No (circle one) <br />Signature of Applicant <br />Date <br />If the above answer is "YES", Please answer the following questions: <br />Type of assets disposed of <br />Date disposed of <br />Amount received <br />Market Value *of Assets at the time of disposition <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 affirmative advertising and marketing program in <br />which there are no barriers to obtaining housing because of race, color, religion, sex, handicap, familial <br />status or national origin <br />DOC 212 <br />