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LAKESIDE CENTER INC. <br />SELF-EMPLOYMENT VERIFICATION <br />Full Name of Applicant or Tenant <br />Present Address: <br />This certifies that I, received a total of $ <br />for the following work <br />I expect to earn $ for the coming twelve (12) months from <br />to for -the following work: <br />Signature of Applicant or Tenant <br />STATE OF X <br />COUNTY OF X <br />BEFORE ME, the.undersigned, a Notary Public in and for said County.and State, <br />on this day personally appeared known to me to be the person <br />whose name is subscribed to the foregoing instrument, and acknowledge to me that he <br />executed the same for the purpose and consideration therein expressed. <br />GIVEN UNDER MY HAND AND SEAL OF OFFICE, this the day of <br />,19 <br />(Seal) <br />Notary Public in and for <br />County, <br />We are pledged to the letter and spirit of U. S. Policy for Achievement of equal housing oppommity <br />throughout the Nation.' We encourage and support an affirmawn advertising and marketing program m <br />which there are no barriers to obtaining housing because of race, color, religion, sex, handicap; familial <br />status or national origia <br />DOC 204 <br />